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A U.S. organization of people 50 and older that advocates for the elderly. It was originally called the American Association of Retired Persons, but now only the initials AARP are used, since members need not be retired.

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AARP:

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Typically identified as five tasks of self-care that are important to independent living: eating, bathing, toileting, dressing, and transferring from a bed to a chair. The inability to perform any of these tasks is a sign of frailty.

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activities of daily life (ADLs):

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The view that elderly people want and need to remain active in a variety of social spheres—with relatives, friends, and community groups—and become withdrawn only unwillingly, as a result of ageism.

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activity theory

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Remaining in the same home and community in later life, adjusting but not leaving when health fades.

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age in place:

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A living arrangement for elderly people that combines privacy and independence with medical supervision.

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assisted living:

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The urge to accumulate and hold on to familiar objects and possessions, sometimes to the point of their becoming health and/or safety hazards. This impulse tends to increase with age.

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compulsive hoarding:

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The view that aging makes a person's social sphere increasingly narrow, resulting in role relinquishment, withdrawal, and passivity

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disengagement theory:

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The obligation of adult children to care for their aging parents.

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filial responsibility:

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People older than 65, and often older than 85, who are physically infirm, very ill, or cognitively disabled

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frail elderly:

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Actions (e.g., budgeting and preparing food) that are important to independent living and that require some intellectual competence and forethought. The ability to perform these tasks may be even more critical to self-sufficiency than ADL ability.

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instrumental activities of daily life (IADLs):

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he final stage of Erik Erikson's developmental sequence, in which older adults seek to integrate their unique experiences with their vision of community.

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integrity versus despair:

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A neighborhood or apartment complex whose population is mostly retired people who moved to the location as younger adults and never left.

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naturally occurring retirement community (NORC):

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The tendency for elderly people to perceive, prefer, and remember positive images and experiences more than negative ones.

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positivity effect:

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Theories of late adulthood that emphasize the core self, or the search to maintain one's integrity and identity.

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self theories:

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Theories that emphasize that social forces, particularly those related to a person's social stratum or social category, limit individual choices and affect a person's ability to function in late adulthood because past stratification continues to limit life in various ways

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stratification theories:

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Designing physical space and common tools that are suitable for people of all ages and all levels of ability.

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universal design:

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B. 21; 13

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In 2007, ______ percent of the men and ____ percent of the women aged 65 to 74 in the United States were still in the workforce.

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B. people have not planned how to spend their retirement time.

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A major problem with retirement is that:

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D. more; earlier

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Research shows that cohorts born in the 1950s and 1960s endorsed _______ responsibility toward older generations than _________ cohorts did.

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A. maintain reliable social relationships, even if they are few.

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An important task for successful aging requires that people:

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B. shopping for groceries

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Of the following, which is not considered an activity of daily life (ADL)?

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B. how to disagree.

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In general, older couples have learned:

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C. late-life depression

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A study by Brasson et al (2012) indicated that the brains, bodies, and behaviors of adults diagnosed with _____ were more like those of younger adults; they did not age in the appropriate way.

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C. keeping a budget

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In the U.S., which of the following activities is one of the IADLs?

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Monika is most likely the caregiver because she has the training and personality to do the job better than others in the family.

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Monika lives next door to her childhood home and has become the caregiver for her mother, a frail elderly woman with dementia and other physical weaknesses. Which of the following is NOT likely true of this case?

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B. IADLs require some intellectual competence.

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The difference between ADLs and IADLs is that:

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C. Annette, who lives with her husband of 40 years

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Who is most likely to be the healthiest and happiest at age 70?

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A. a unionized mechanic at a local factory.

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. All of the following workers are quite likely to remain in the paid labor force after age 60 EXCEPT:

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C. compulsive hoarding.

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Martha has accumulated such large piles of old papers and magazines that she can no longer use her table or desk, and she has held on to so much old furniture and clothing that many rooms in her home cannot be entered. In her attempts to hang on to various material items from her life, Martha developed:

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A. fewer

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In the United States, the trend has been toward _____ nursing home residents

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C. The definition of what constitutes abuse is not clearly defined.

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What is one of the reasons that elder abuse sometimes difficult to identify?

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B. correlates with believing that life is meaningful.

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In older adults, a positive world view:

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C. to identify with a political party.

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With regard to elections and public policy debates, the elderly tend

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A. people from each generation.

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Multi-generational families appear to be most beneficial for:

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A. feminist

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Which theory focuses on the gender divisions promoted by society?

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B. disengagement

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The most controversial version of social stratification theory is _____, in part because it can be used to justify ageism and social isolation.

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B. a naturally occurring retirement community.

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When many adults who moved into a neighborhood decades earlier never leave the area, the result is

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. independent living and aging in place.

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. Assisted living can be thought of as a combination of:

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A. both men and women

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Typically, who does more housework after retirement than before?

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A. late adulthood.

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According to Erikson, integrity versus despair is the focus of:

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they focus on individuals' perceptions of themselves and their ability to meet challenges to their identity

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Some theories of late adulthood have been called self theories

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they describe the ways in which societies place people on a particular life path.

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stratification theories

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emphasize "the ways people negotiate challenges to the self"Such negotiation is particularly crucial when older adults are confronted with multiple challenges like illness, retirement, and the death of loved ones.

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Self theories

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each person ultimately depends on himself or herself

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A central idea of self theories is that

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...

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Studies of personality over the life span confirm the continuity of self

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The most comprehensive self theory came from Erik Erikson.

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INTEGRITY

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integrity versus despair

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His eighth and final stage of development is called

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such self-glorifying distortions are far better than losing hope, "feeling that the time is now short, too short for the attempt to start another life" (p. 269). As with every crisis described by Erikson, tension occurs between the two opposing aspects of development. Past crises, particularly Erikson's fifth crisis of identity versus role confusion, reappear when the usual pillars of the self-concept (such as employment or good looks) crumble. One 70-year-old said, "I know who I've been, but who am I now?" (quoted in J. Kroger, 2007, p. 201).

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As Erikson (1963) explains it,

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That integration of death and the self is an important accomplishment of this stage

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This tension helps advance the person toward a more complete self-concept. In this last stage,

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The life review (explained in Chapter 14) and the acceptance of death (to be explained in the Epilogue) are crucial aspects of the integrity envisioned by Erikson

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...

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even as they acknowledge the physical changes of their bodies

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Most older people consider their personalities and attitudes quite stable over their life span,

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They may become depressed if they think their culture is not appreciated.

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The importance of self-validation is particularly apparent among older immigrants

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selective optimization with compensation This is central to self theories. For some people, simply maintaining identity correlates with well-being

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some people cope successfully with the changes of late adulthood through

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javascript:top.Define('positivityeffect')

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One strategy for selective optimization is known as the

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...

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Elderly people are more likely to perceive, prefer, and remember positive images and experiences than negative ones

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Unpleasant experiences are reinterpreted as inconsequentia

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Compensation occurs via selective recall:

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older people tend to be more patriotic and devout than younger ones

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This may explain why, in every nation and religion,

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...

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Stratification begins in childhood

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including income and health.

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Age affects a person's life in many ways,

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That harms both generations because it limits social experiences: Younger as well as older people have a narrower perspective on life if they interact only with people their own age.

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...

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is disengagement theory

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The most controversial version of age-stratification theory

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chosen by both older and younger generations.

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According to this theory, disengagement is a mutual process,

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ageism and social isolation

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Disengagement theory provoked a storm of protest because people feared it justified

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activity theory

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Some developed an opposing theory, called

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This is true at younger ages as well, although some studies find that activity is particularly likely to correlate with high functioning at older ages (

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Later research has found that elders who are more active are also happier and intellectually more alert as well as less depressed.

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nce generally the happier and healthier elders are quite active—continuing as worker, wife, husband, mother, father, neighbor—it could be argued that disengagement itself is the result of past stratification

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Since those who are sick and poorly educated are most likely to disengage,

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find new roles and activities to participate in

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Many retirees disengage from work but

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...

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The positivity effect, just described, may mean that an older person disengages from emotional events that cause anger, regret, and sadness, while actively enjoying other experiences

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Such stratification, when combined with ageism, makes people expect older women to be either warm and compliant (grandmotherly, providing kindness and cookies) or cold and ugly (hags or crones) (

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Feminist theory draws attention to stratification that puts males and females on separate tracks through life

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Women quit their jobs, whereas men worked longer.

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Both sexes provided care if their spouse became needy, but they did so in opposite ways:

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By contrast, employed husbands whose wife needed care retired only half as often as other men (

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To be specific, employed women whose husbands needed care were five times more likely to retire than were other employed women.

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Their caregiving response leads to poverty and loneliness.

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In this situation, past stratification disadvantages the older women:

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(5 percent versus 2 percent)

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Men living alone are more likely than women to have a sudden health crisis and are more likely to be the victim of a violent crime

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"weathering," an increased allostatic load that shortens life

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The stress of past discrimination is thought to catch up to African Americans, causing

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racial stratification prevented many African Americans from buying homes.

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Age and gender disparities may be magnified by ethnicity

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have far more impairments than European Americans

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Health disparities also accumulate, such that the elderly of an ethnic minority, especially if they are low SES and immigrant,

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...

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suggests multiple intervention points at which disparities can be reduced," beginning before birth

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s well as the other 8 to 14 indicators of allostatic load, to take a great toll each yea

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Repeated stresses cause hypertension and obesity,

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the Black person will still die two years earlier, on average, at age 82, not 84 (

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This may be the reason that if two Americans—one White, one Black—reach age 65 and are no longer at risk for the main causes of premature death for African Americans (low birthweight and violence),

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self-esteem

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Stratification may also explain developmental changes in

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...

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the oldest-old of all backgrounds have lower self-esteem than they did earlier in life, with a steeper drop that starts earlier (around age 65, not 85) for African Americans

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disappears at about age 80 and then reverses by age 100.

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Curiously, although the ethnic disparity in survival and self-esteem is evident for the young-old,

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...

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The average Black centenarian lives seven months longer than does the average non-Black one

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One explanation for this race crossover is selective survival

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Elderly Hispanics also seem to have a longevity advantage over elderly non-Hispanics in the United States

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other interpretations are possible. Perhaps ethnic inequality diminishes because very old age is a powerful "leveler," overwhelming ethnic and gender stratification

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...

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the pivotal influence on the well-being of the elderly may be financial,

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STRATIFICATION BY SES

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...

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Income correlates with those three but is not caused by them (

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hose who are born into low-SES families risk late-life diabetes, disability, and death. Obviously, poverty among elders should be alleviated, but mitigating poverty early in life may be critical for well-being in late adulthood (Herd et al., 2011).

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The problem may begin even before birth, since epigenetic factors—themselves affected by maternal health—shape the genetic expression

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One is medical care. Medicare pays for many medical expenses, but there are significant gaps

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Two aspects of current conditions in the United States make low income particularly difficult for the old

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The second problem is that inflation makes retirement income worth less than half of what it did when that money was first set aside. Those middle-aged adults who have adequate savings for retirement are in the minority: Those who are best prepared are already wealthy, another example of SES stratification

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part D of the plan, which is designed to cover medications, indicates that if costs exceed $2,830 in a year (as happened to 27 percent of enrollees in 2007), recipients must pay about $4,000 themselves until drug benefits begin again.

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...

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Every nation has had unexpectedly large increases in the number of older adults, and every nation is cutting government assistance to the poor. The resulting dilemma is more poor elders than before. Some nations have found better solutions than others, but nations can learn from one another.

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...

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In fact, most college students consider the elderly to be relatively passive and inactive, with plenty of time on their hands

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Many elders are reluctant to give that up

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"a growing body of research that points to the positive physical and psychological impacts, for women as well as men, of employment"

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Many older adults who have pensions work part time

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Participation in the labor force after age 60 is higher among nonunionized low-wage workers

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Older workers are also more likely to become self-employed, with small businesses or consulting work

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ome employers offer phased retirement (called "bridge work").

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Not necessarily, although some people thought so, warning about "the presumed traumatic aspects of retirement"

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Are all older adults healthier and happier when they are employed?

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(except in special occupations, such as that of jet pilot).

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Accordingly, in the 1980s, U.S. legislators outlawed mandatory retirement

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...

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when older workers in the United States were no longer required to quit at 65, the average age of retirement decreased.

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Only when retirement is precipitated by poor health or fading competence does it correlate with illness

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Retirement is as likely to improve health as it is to precipitate a decline.

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many elders find that their Social Security checks do not cover expenses

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A major problem since 2000 is that private pensions (possessed by about three-fourths of U.S. households) are tied not only to past work history but also to the stock market

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(generativity, social connections, less depression).

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Volunteering offers some of the benefits of paid employment

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Those who volunteered earlier in adulthood are more likely to continue volunteering in old age, becoming "mentors, guides, and repositories of experience" for younger people

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Longitudinal as well as cross-sectional research find a strong link between health and volunteering

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those who volunteer have about half the death rate of those who do not

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Beyond that, volunteering reduces the odds of death.

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A major reason why volunteering is beneficial to the volunteer is that it fosters social connections, which themselves can lead to more volunteering

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Culture or national policy affects volunteering:

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Second, less than one-third of all adults of any age volunteer.

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First, contrary to what most people imagine, older, retired people are less likely to volunteer than are middle-aged, employed people; three-fourths of people older than 65 do no volunteer wor

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Social culture. Organizations. The elderly themselves. The science.

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Why aren't the elderly volunteering ?

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Ageism may discourage meaningful volunteering. Many volunteer opportunities are geared toward the young, who are attracted to intense, short-term experiences. Two weeks of building a house during spring break or two years teaching with the Peace Corps in a developing nation are not designed for older volunteers

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Social culture

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Institutions lack recruitment, training, and implementation strategies for attracting older volunteers. For instance, although most primary school students would benefit from a personal mentor, schools have discouraging barriers (e.g., health exams, lengthy background checks, long flights of stairs).

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Organizations

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Almost half of the elderly volunteers do so within their own religious organizations. Only 1 in 12 older volunteers work with youth, compared with about 1 in 3 younger adult volunteers

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The elderly themselves

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he problem may lie not with the people but with the definitions used in the research. Surveys of volunteer work ignore daily caregiving and informal helping. Babysitting, caring for an ill relative, shopping for an infirm neighbor—are not counted. If they were, the rates of volunteering would be much higher, for the elderly overall and for minority elders in particular.

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The science.

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money and time to help other people.

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every survey finds that most of the elderly give

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96 percent of the women and 92 percent of the men provided help to someone else, not including their spouse

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A study of elders who had graduated from Wisconsin high schools in 1957 found that

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after retirement

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both men and women do more housework and meal preparation

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...

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Both sexes also do yard work, redecorate, build shelves, rearrange furniture.

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More than half the elderly in the United States cultivate plants each year

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Gardening is popular

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These correlate with less dementia and longer life

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...

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If they must move, most want to remain in their familiar neighborhood, perhaps in a smaller apartment with an elevator, but not in a different city or state

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That is the preference of most baby boomers as well: 83 percent of those aged 55 to 64 prefer to stay in their own homes when they retire

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One result is that houses are being built or remodeled to suit people who have problems with mobility or vision

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Florida has the highest proportion of people over age 65, but the next three states highest in that proportion—Maine, West Virginia, and Pennsylvania—are not places where older people move to, but places where they have always lived.

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javascript:top.Define('universaldesign')

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About 4,000 consultants are now certified by the National Association of Homebuilders to advise about

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If a low-income elder lives in a high-crime neighborhood (and many do), not only must the residence be made accommodating, but the neighborhood must be fixed as well, with a protective social network.

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NORCs can be granted public money to replace after-school karate with senior centers, or piano teachers with visiting nurses, if that is what the community needs

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This may be part of a universal developmental process.

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Older adults attend fewer religious services than do the middle-aged, but faith and praying increase with age.

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He suggested a sixth, more spiritual level, which he called self-transcendence

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Maslow reassessed his final level, self-actualization

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This benefits their development.

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The elderly are more likely than younger adults to believe in God and an afterlife

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(1) Religious prohibitions encourage health (e.g., less drug use); (2) joining a faith community increases social relationships; and (3) beliefs give meaning to life and death, thus reducing stress (Atchley, 2009).

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Religious practices of all kinds

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...

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Religious identity and religious institutions are especially important for older members of minority groups, many of whom feel a stronger commitment to their religious heritage than to their national or cultural background.

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In the United States, suicide after age 65 among elderly European American men occurs 50 times more often than among African American women

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Religious faith may explain an oddity in mortality statistics, specifically in suicide data

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In 2011, about 7 percent of U.S. residents older than 65 gave time for any political, civic, international, or professional group

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about 2 percent volunteer in political campaigns

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By other measures, however, the elderly are more politically active than people of any other age.

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gerontologists have been strongly attracted to the idea that active engagement in society is related to well-being in later life"

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Over the past 20 years in off-year (nonpresidential) U.S. elections,

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an average of 60 percent of those over age 65 voted, compared with 16 percent of those aged 18 to 20 (U.S. Bureau of the Census, 2011b).

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hows, the percent of adults who are registered to vote increases with age, with the eldest having the highest rates, despite some fluctuations over time.

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This difference seems to be more a result of age than of cohort

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the Pew Research Center for the People and the Press periodically asks U.S. residents questions on current events, and the elderly always best the young

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the elderly are more likely than younger adults to keep up with the news.

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...

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In 2011, elders (65 and older) beat the youngest (aged 18 to 30) by a ratio of about 3-to-2 in knowing the political party of Nancy Pelosi, John Boehner, Franklin Roosevelt, and Abraham Lincoln (Pew Research Center,

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AARP

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The largest organized interest group in the world,

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...

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About 8 percent of AARP's budget goes to research and action regarding politics

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"the third rail" of domestic politics, named for the high-voltage electrical rail that delivers power to trains and could electrocute a person who touches it.

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AARP's political influence is thought to be one reason that the U.S. Social Security program is called "

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An estimated 60,000 people canceled their AARP membership because the organization supported President Obama's health care reform, while 10 times that number joined—not necessarily in support of health care, but because they thought they wanted to be part of AARP

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However, members of this age group do not necessarily vote their own economic interests.

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Generally, the political opinions of the elderly reflect national trends and their own personal history more than their chronological age

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The elderly typically are divided on most issues, including global warming, military conflicts, and public education.

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In 2012, again the elderly voted Republican (56 percent) but were outvoted by those under age 40, who voted for Obama (60 percent).

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Even on health care, although most realize the need for reform, in 2008 they were the only age group to vote for the Republican candidate for president.

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...

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Elders are also are more likely to identify with a political party—in the current cohort, usually Republican.

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Given that ageism zigzags from hostile to benign—and is often based on beliefs that are far from reality—it is not surprising that "older persons [are] attacked as too powerful and, at the same time, as a burdensome responsibility

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n fact, some suggest that the idea of "gray power" is a myth, promulgated to reduce support among young adults for programs that benefit the old

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thus extending life

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Spouses buffer each other against the problems of old age

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...

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Married older adults are healthier, wealthier, and happier than unmarried people their age.

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One older partner who is healthy and happy improves the other's well-being

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longitudinal research finds that spouses continue to affect each other, even in late adulthood:

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although some argue that income and personality are the reasons, not marital status

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Elderly divorced people are lower in health and happiness than are those who are still married,

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...

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About one in every six long-term marriages is not satisfying, in which case the relationship increases neither health nor happiness

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hey consider their conflicts to be discussions, not fights.

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n general, older couples have learned how to disagree.

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...

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In one U.S. study of long-lasting marriages, 86 percent of the partners surveyed thought their relationship was about equal in give-and-take

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when older husbands and wives share the same close friends, they are more likely to help each other if special needs arise

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One crucial factor is that, over the years, some couples improve their parental alliance,

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...

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A couple can achieve selective optimization with compensation: The one who is bedbound but alert can keep track of what the mobile but confused one is supposed to do, for instance.

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By that measure, sexual activity decreases with each decade (Lindau & Gavrilova, 2010). Remember, however, that diversity is common among older adults: Some are no longer interested in sexual intimacy whereas others enjoy frequent sexual interaction, hugging and caressing as well as, for some, having intercourse

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Besides caregiving, sexual intimacy is another major aspect of long-lasting marriages

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sexual interaction remains important

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For most older couples,

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especially those who are divorced or widowed—live apart from their sexual partner, not only because they want to age in place but also because they want independent relationships with their own children or parents

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. Although LAT is often associated with young or gay adults, many elders—

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...

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By contrast, some families currently span five generations, consisting of elders and their children, grandchildren, great-grandchildren, and great-great-grandchildren.

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representing multiple generations but with only a few members in eachbecoming more common

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Since the average couple now has fewer children, the beanpole family

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...

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Intergenerational relationships are becoming more important as many grandparents have only one or two grandchildren.

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...

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Although elderly people's relationships with members of younger generations are usually positive, they can also include tension and conflict.

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familism prompts siblings, cousins, and even more distant relatives to care for one another as adulthood unfolds.

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family members tend to support one another.

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sometimes increasing when money is less needed

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Emotional support and help with managing life may be more crucial and complex than financial assistance,

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reduce the sense of filial responsibility

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A longitudinal study of attitudes found no evidence that recent changes in family structure (including divorce)

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than did earlier cohorts

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In fact, younger cohorts (born in the 1950s and 1960s) endorsed more responsibility toward older generations

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...

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Likewise, almost all elders believe the older generation should help the younger ones, although specifics vary by culture

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That is why, after midlife and especially after the death of their own parents, members of the older generation are less likely to say that children should provide substantial care for their parents and more likely to strive to be helpful to their children.

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In the United States, every generation values independence.

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as adults become more likely to receive than to give intergenerational care, "reappraisals are likely the result of altruism (growing relevance as a potential receiver) or role loss (growing irrelevance as a provider)"

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...

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...

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Asian daughters-in-law seem to experience similar frustrations and joys in caregiving as European American daughters do

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especially when either generation becomes dependent on the other

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By contrast, a poor relationship makes life worse for everyone. Ironically, conflict is more likely in emotionally close relationships than in distant ones

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...

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It is a mistake to think of the strength of the relationship as merely the middle generation paying back the older one for past sacrifices when they were children or young adults

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Instead, family norms—either for intergenerational support or for independence—seem to predict how family members interact in late adulthood

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Although sons seem more supportive of elderly parents if the parents took care of the sons' children, this is not true for daughters.

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Assistance arises both from need and from the ability to provide. Frequency of contact is related to geographical proximity, not affection. Love is influenced by the interaction remembered from childhood. Sons feel stronger obligation; daughters feel stronger affection.

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Extensive research has found that relationships between parents and adult children are affected by many factors:

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financial assistance and emotional support flow more often from the older generation down instead of from the younger generation up, although much depends on who needs what

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Members of each generation tend to overestimate how much they contribute

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...

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Only when elders become frail (discussed later) are they more likely to receive family assistance than to give it.

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...

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Most (85 percent) of those U.S. elders currently older than 65 are grandparents.

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...

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As with parents and children, the relationship between grandparents and grandchildren depends partly on the age of the grandchildren.

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Remote grandparent Companionate grandparents Involved grandparents Surrogate parents

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In developed nations, grandparents fill one of four roles:

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(sometimes called distant grandparents) are emotionally distant from their grandchildren. They are esteemed elders who are honored, respected, and obeyed, expecting to get help whenever they need it.

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Remote grandparents

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(sometimes called "fun-loving" grandparents) entertain and "spoil" their grandchildren—especially in ways, or for reasons, that the parents would not.

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Companionate grandparents

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are active in the day-to-day lives of their grandchildren. They live near them and see them daily.

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Involved grandparents

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raise their grandchildren, usually because the parents are unable or unwilling to do so.

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Surrogate parents

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companionate, partly because all three generations expect them to be beloved older companions rather than authority figures.

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Currently, in developed nations, most grandparents are

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If grandparents become too involved and intrusive, parents tend to be forgiving but not appreciative

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They provide babysitting and financial help but not advice or discipline

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when the biological parents are incapable of parenting; what results is a family structure called skipped generation because the middle generation is absent.

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Such generative distance is not possible for grandparents who become surrogates

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grandparents for kinship foster care, which works for the children as well or better than foster care by strangers, but it may be difficult for the older generation for many reasons.

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Social workers often seek

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another is that difficult grandchildren (such as drug-affected infants and rebellious school-age boys) are more likely to live with grandparents;

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One reason is that both old and young are sad about the missing middle generation

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...

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a third is that surrogate grandparents tend to be the most vulnerable elders, almost always grandmothers not grandfathers, already affected by past poverty.

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depression, and marital problems than do other elders

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in North America and Europe, grandparents who are totally responsible for their grandchildren experience more illness,

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United States who have not graduated from high school has actually decreased since 1990

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hildren of skipped-generation families are less likely to graduate from high school than are children from the same SES and ethnic groups who grow up in other family structures

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International college students, despite being thousands of miles away from their grandparents, often express warmth, respect, and affection for at least one of them (usually their maternal grandmother) back home (A. C. Taylor et al., 2005)

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Most grandparents enjoy their role, gain generativity from it, and are appreciated by younger family members

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...

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In most conditions, grandparenting benefits all three generations.

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Each younger generation has more people who never married: 5 percent for those aged 65 to 74, 8 percent for those 55 to 64, and 12 percent for those 45 to 54

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In 2010, 96 percent of people older than 75 in the United States had been married, making this oldest generation the most married cohort in history

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Some of them have partners, of the same sex or other sex, and are cohabiting or LAT, seemingly just as happy as traditionally married people

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Members of the current oldest generation who never married are usually quite content, not lonely

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...

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A study of 85 single elders found that their level of well-being was similar to that of people in long-term equitable marriages, and they were happier than either recent widows or the married adults in unequal marriages

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...

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All the research finds that older adults need at least one close companion. For many (especially husbands), their intimate friend is also a spouse; for others, the friend is another relative; for still others, it is an unrelated member of their social convoy.

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. A study of widows found that those who fared best increased their contact with close friends after the death of their spouse

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Quality (not quantity) of friendship is crucial, especially among the oldest-old

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fear that social networking will weaken social involvement. They hope that "technological innovators may yet master the elusive social alchemy that will enable online behavior to produce real and enduring civic effects"

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Thomas Sander and Robert Putnam (2010),

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reported that the thousands of people who declared their support on Facebook for a group dedicated to ending the violence in Darfur gave an average of only 9 cents each to that cause. Might declaring support online make people less likely to donate, rally, write letters, or do anything else constructive?

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Gladwell (2010)

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note that "posts on Twitter (known as 'tweets') convey people's meal and sock choices, instant movie reactions, rush-hour rants, and occasionally even their profound reflections.

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Sander and Putnam (2010)

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"Changing social connectivity is, after all, neither a dystopian loss nor a utopian gain but an intricate, multifaceted, fundamental social transformation"

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Two other social scientists conclude:

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...

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one-third will be frail for at least a year before they die.

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is the inability to perform the tasks of self-care to maintain independence.

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according to insurance standards and medical professionals,

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eating, bathing, toileting, dressing, and moving (transferring) from a bed to a chair.

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activities of daily life (ADLs)

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which require intellectual competence and forethought. Indeed, problems with IADLs often precede problems with ADLs since planning and problem solving help frail elders maintain self-care.

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instrumental activities of daily life (IADLs),

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culture to culture.

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It is more difficult to list IADLs because they vary from

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nutrition, preparing income tax forms, using modern appliances, and keeping appointments

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In developed nations, IADLs may include evaluating

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feeding the chickens, cultivating the garden, mending clothes, getting water from the well, and making dinner might be considered IADLs.

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In rural areas of other nations

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even if they can perform all five ADLs.

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Everywhere, the inability to perform IADLs makes people frail,

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people older than 65 in the United States were less likely to be disabled in one of the five ADLs, and markedly less likely (by 42 percent) to have difficulty with IADLs

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Between 1984 and 2004,

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ne solution to this inequity is more government aid; another is to prevent frailty from beginning. Governments, families, and aging individuals sometimes blame one another for frailty

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WHOSE RESPONSIBILITY?

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Fear of falling might make the person walk rarely, preferring to stay in bed

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PREVENTING FRAILTY

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the person could exercise daily, first in bed, then lying on the floor, then with machines to increase strength and daily excursions

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To prevent frailty

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could prevent or at least postpone frailty

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the elder, the family, and the community

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s well as with all other kinds of physical and mental impairment, delay, moderation, and sometimes prevention are possible.

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ith many types of dementia, which causes severe IADL disability,

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...

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The caregiver of a married frail elderly person is usually the spouse,

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Less often, sons and daughters-in-law or adult grandchildren provide care

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If an impaired person in the United States has no partner, usually siblings or adult daughters become caregivers.

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...

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It is not true that professional caregivers are a substitute for family care; instead they are part of a team that is necessary when family members are overwhelmed.

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The stress is manifest in various illnesses, in part because the immune system weakens

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Even with professional help, family caregivers experience substantial stress; without help, they experience less health and more depression.

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...

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Some caregivers feel they are repaying past caregiving, and sometimes everyone, including the care receiver, expresses appreciation

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...

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In fact, a longitudinal study found that when caregivers feel increasingly supported by family, with practical help as well as emotional encouragement, they experience less stress over time, even though the frail person's needs increase

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than for cultural ones

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The designated caregiver of a frail elderly person is chosen less for practical reasons

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and they often have had no prior caregiving experience of that kind

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Currently in the United States, the spouse is the usual caregiver—two-thirds of the time it's the wife, one-third of the time, the husband—

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...

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one study found that caregiving African Americans are less depressed than caregivers of other ethnicities

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If one adult child is the primary caregiver, other siblings feel both relief and jealousy. The caregiver wants sibling help, but the siblings resent being told what to do. Care receivers and caregivers disagree about schedules, menus, doctor visits, and so on. Resentments on both sides disrupt mutual affection and appreciation. Public agencies rarely provide services unless a crisis arises.

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Even in ideal circumstances with cultural and community support, family caregiving in the United States often results in many problems:

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However, in many nations, public policy and cultural values result in "a system that places inappropriate burdens of elder care upon the family"

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Caregiver exhaustion and elder abuse are preventable

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and some families feel shame if they place an elderly relative in an institution.

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that elderly people often regard living in a nursing home as a fate worse than death

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Spouses in particular need some relief from full responsibility, including more free time (via professional providers or family members who take over on a regular basis) and better medical attention (usually with visiting nurses who provide medical and psychological care for both caregiver and care receiver).

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concerned about the well-being of people of all ages, advocate more help for families caring for frail elders at home

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...

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Elderly people are far more likely to age in place than was true 20 years ago, and help is more available

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the risk of depression, poor health, and abuse escalates

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When caregiving results in resentment and social isolation,

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f the care receiver is frail and demanding, and if care location is an isolated place where visitors are few and far between.

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Abuse is likely if the caregiver suffers from emotional problems or substance abuse

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Often elder abuse is financial more than physical, yet bankers, lawyers, and investment advisors are not trained to recognize it nor obligated to respond (

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Most social workers and medical professionals are alert to the possibility of elder abuse and are suspicious if an elder is unexpectedly quiet, or losing weight, or injured

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...

answer

Political and legal definitions and remedies are not clear-cut

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Professionals and relatives alike hesitate to criticize a family caregiver who is spending the Social Security check, disrespecting the elder, or simply not responding as quickly and carefully as the elder wishes.

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A major problem is awareness:

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Because elders who are mistreated by family members are ashamed to admit it, the actual rate is probably close to that one-fourth.

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Researchers find that about 5 percent of elders say they are abused and that up to one-fourth of all elders are vulnerable but do not report abuse

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but neither of these conditions proves abuse

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It is known that elders who are mistreated are more likely to be depressed and ill,

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. Laws forbid the use of physical restraints except temporarily in specific, extraordinary circumstances.

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Fortunately, outright abuse is now rare in nursing homes.

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...

answer

In the United States, nursing homes are frequently visited by government inspectors to "stop dreadful things from happening"

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continuity of care is crucial: An institution with a high rate of staff turnover is to be avoided.

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Among the signs of a humane setting are provisions for independence, individual choice, and privacy.

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Currently, however, most front-line workers have little training, low pay, and many patients—and almost half leave each year

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he training and the workload of the staff, especially of the aides who provide the most frequent and most personal care, are crucial:

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In Alaska, it costs $177,755 a year for a room shared with one other person; in Louisiana, it's only $50,370 (John Hancock Life & Health Insurance Company, 2011). Most people think that Medicare, Medicaid, or long-term insurance covers the entire cost—another misconception (Feng e

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he average annual nursing home cost in the United States in 2011 was $85,775 for a private room.

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(currently about 1.5 million people nationwide), and those few are usually over 80 years old, frail and confused, with several medical problems

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In the United States, the trend over the past 20 years has been toward fewer nursing-home residents

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nurses and aides work more closely together, especially in homes designated as Eden Alternative or Green

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Another trend is toward smaller nursing homes with more individualized care

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half of them will need nursing-home care at some point, usually for less than a month as they recuperate from hospitalization.

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90 percent of elders are independent and community dwelling at any given moment,

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...

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Some need such care for more than a year, and only a few will need it for 10 years or more (Stone, 2006).

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which could be home care, aging in place, and NORCs—are less costly and more individualized than nursing homes.

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Most elder-care arrangements that include special services—

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privacy and independence of home life with some of the medical supervision of a nursing home

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assisted living,

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private room or apartment for each person, allowing pets and furnishings just as in a traditional home

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An assisted-living residence typically provides a

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Services might include one communal meal per day, special bus trips and activities, and optional arrangements for household cleaning and minor repairs.

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Usually, medical assistance is readily available—from daily supervision of pill taking to emergency help, with a doctor and ambulance provided when necessary.

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...

answer

Assisted-living facilities range from group homes for three or four elderly people to large apartment or townhouse developments for hundreds of residents

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but many such places are unlicensed

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Almost every state, province, or nation has its own standards for assisted-living facilities,

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village care.

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Another form is sometimes called

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"It takes a whole village to raise a child." The idea is that if elderly people who live near one another all pool their resources, they can stay in their homes but also have special assistance when they need it

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village care

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Such communities require that the elderly contribute financially and that they be relatively competent, so village care is not suited for everyone. However, for some it is ideal

answer

...

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Elders need to live in settings that allow them to be at their best, safe and respected, in control of as much of their own lives as possible.

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the emphasis in living arrangements is on selective optimization with compensation.

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(Golant, 2011).

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"There is no one-size-fits-all set of optimum residential activities, experiences, and situations"

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"final failing.

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this nursing home encouraged independence and did not assume that decline is always a sign of

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Professional help, in assisted-living facilities or nursing homes, can be beneficial or dehumanizing.

answer

...

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The frail elderly are unable to perform activities of daily life (ADLs) such as feeding, dressing, and bathing themselves.

answer

...

Developmental Psychology: Chapter 15 – Flashcards

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