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SOCIALGERONTOLOGYA MULTIDISCIPLINARY PERSPECTIVE

Nancy R, HooymanUniversity of Washington

H. Asuman KiyakUniversity of Washington

Boston New York San FranciscoMexico City Montreal Toronto London Madrid Munich Paris

Hong Kong Singapore Tokyo Cape Town Sydney

i CONTENTS

Preface xix

p a r t o n eThe Field of Social Gerontology

c h a p t e r 1 The Growth of Social Gerontology

The Field of Gerontology 3Social Gerontology 5What Is Aging? 5

The Older Population Is Diverse 6An Active Aging Framework 7A Person-Environment Perspective on Social Gerontology 8

Environmental Press 8 • Environmental Interventions 10

Organization of the Text 10Why Study Aging? 11Growth of the Older Population 12

Changes in Life Expectancy 13 • Maximum Life Span 14

The Oldest-Old 16Ages 85 and Older 16 • Centenarians 18 • Population Pyramids 20

Dependency Ratios 22Population Trends 23

Ethnic Minorities 23 • Geographic Distribution 24 • Educationaland Economic Status 26

Worldwide Trends 27Impact of Demographic Trends in the United States 31Longevity in Health or Disease? 31

vii

CONTENTS

How Aging and Older Adults Are Studied 32Development of the Field 32 • Historical Forces of the Late Nineteenth andEarly Twentieth Centuries 33

Formal Development of the Field 33Major Research Centers Founded 34

Research Methods 34The Age/Period/Cohort Problem 35 • Cross-Sectional Studies 35• Longitudinal Studies: Design and Limitations 36 • SequentialDesigns 37 • Problems with Representative Samples of OlderPersons in Research 39

Summary and Implications for the Future 40Glossary 41Resources 42References 42

c h a p t e r L Historical and Cross-Cultural Issuesin Aging 45

Old Age Historically 46Old Age in Ancient Cultures 46 • Old Age in Greek andRoman Cultures 47 • Old Age in Medieval Europe 48• Old Age in Colonial America 48

The Effects of Modernization 49Alternatives to Modernization Theory 51 • Ideal of Equality versus Statusof Age in America 52 • Other Perspectives on Historical Change 53

A Cross-Cultural View of Old Age in Contemporary Societies 55Importance of Social Position and the Control of Property 56• Knowledge as a Source of Power 57

Effects of Culture and Modernization: The Case of Japan 59Summary and Implications for the Future 60Glossary 61References 61

p a r t t W OThe Biological and Physiological Context of Social Aging 65

c h a p t e r J The Social Consequences of Physical Aging 68

Biological Theories of Aging 69

Can Aging Be Reversed or Delayed? 72

CONTENTS - IX

Growth Hormones 72 • Caloric Restriction 73• Antiaging Compounds 74

Research on Physiological Changes with Age 74Aging in Body Composition 75 • Changes in Organ Systems 77• Changes in Sleep Patterns with Aging 87

Changes in Sensory Functions 88Changes in Vision 90 • Assisting Adaptation and Quality of Life throughEnvironmental Modifications 95 • Changes in Hearing 96 • Changesin Taste and Smell 100

Implications for the Future 101Summary 101Glossary 103Resources 104References 104

c h a p t e r 4 Managing Chronic Diseases and PromotingWell-Being in Old Age 109

Defining Health 109Quality of Life in Health and Illness 111Chronic and Acute Diseases 113

Interactive Effects 116 • Causes of Death in Later Years 116

Common Chronic Conditions 119Heart Disease and the Cardiovascular System 119 • Strokes andOther Cerebrovascular Problems 121 • Cancer 122 • Arthritis 123• Osteoporosis 125 • Chronic Obstructive Pulmonary Disease orRespiratory Problems 130 • Diabetes 130 • Problems with the Kidneysand Urinary Tract 131 • Problems with the Intestinal System 133• Oral Diseases 134 • HIV/AIDS in the Older Population 135• Accidents among Older People 136 • Older Drivers 137

Falls and Their Prevention 139Use of Physician Services by Older People 140

Use of Other Health Services 140

Health Promotion with Older People 142Improving the Success of Health Promotion Programs 144 • TheRelationship of Health Practices to Health Outcomes 145 • Exerciseas Part of Health Promotion 146 • Health Promotion Guidelines 149• Oral Health Promotion 150 • Limitations of Health Promotion 151

Implications for the Future 152Summary 153Glossary 154References 155

CONTENTS

p a r t t h r e eThe Psychological Context of Social Aging 161

c h a p t e r J Cognitive Changes with Aging 164

Intelligence and Aging 165Problems in the Measurement of Cognitive Function 168 • LongitudinalStudies of Intelligence 168

Factors That May Influence Intelligence in Adulthood 170The Process of Learning and Memory 172The Information Processing Model 175Factors That Affect Learning in Old Age 176

The Importance of Attention 176 • Practical Implications of AttentionChanges with Aging 177 • Environmental Factors 178

Age-Related Changes in Memory 180Tip-of-the-Tongue States 182

Improving Cognitive Abilities in Old Age 182Cognitive Retraining 182 • Memory Mediators 183

Wisdom and Creativity 186Implications for the Future 187Summary 188Glossary 189References 190

c h a p t e r b Personality and Mental Healthin Old Age 194

Defining Personality 194Stage Theories of Personality 195

Erikson's Psychosocial Model 195 • Jung's Psychoanalytic Perspective 197• Empirical Testing of These Perspectives 197 • The Kansas City Studies198 • Dialectical Models of Adult Personality 199

Trait Theories of Personality 200Emotional Expression and Regulation 202

Self-Concept and Self-Esteem 202

Stress, Coping, and Adaptation 204

CONTENTS

Some Useful Definitions 204 • Aging and Life Events 205• What Determines Stress Responses in Old Age? 206• Adaptation in the Later Years 207

Successful Aging 209A Critique of the Successful Aging Paradigm 212

Psychological Disorders among Older Persons 213Depression 214 • Suicide among Older People 219 • Dementia 220• Delirium 222 • Alzheimer's Disease 223 • Characteristics ofAlzheimer's Disease 226 • Behavioral Therapies and EnvironmentalInterventions 229 • Parkinson's Disease 232 • Alcoholism 232• Drug Abuse 234 • Paranoid Disorders and Schizophrenia 234• Anxiety 235

Older Adults Who Are Chronically Mentally 111 236Psychotherapy with Older Persons 236 Use of MentalHealth Services 238

Implications for the Future 239Summary 240Glossary 243Resources 244References 244

c h a p t e r / Love, Intimacy, and Sexualityin Old Age 252

Attitudes and Beliefs about Sexuality in Later Life 253Myths and Reality about Physiological Changes and Frequency

of Sexual Activity 254Women and Age-Related Physiological Changes 257Men and Age-Related Physiological Changes 261Chronic Illness and Sexual Activity 263Gay and Lesbian Partners in Old Age 267Psychosocial Factors and Late-Life Affection, Love, and Intimacy 270Facilitating Older Adults' Sexual Functioning 273Implications for the Future 274Summary 275Glossary 276References 276

CONTENTS

p a r t f o u rThe Social Context of Aging 279

c h a p t e r O Social Theories of Aging 283

The Importance of Social Theories of Aging 283Social Gerontological Theory before 1961: Role and Activity 284

Role Theory 284 • Activity Theory 286

The First Transformation of Theory 287

Disengagement Theory 287 • Continuity Theory 288

Alternative Theoretical Perspectives 289Symbolic Inter actionism and Subculture of Aging 290• Age Stratification Theory 291 • Social Exchange Theory 293• Political Economy of Aging 294 • Life Course Perspective 294• Life Course Capital 295

Recent Developments in Social Gerontological Theory:The Second Transformation 295Social Phenomenologists and Social Constructionists 295 • Critical Theoryand Feminist Perspectives 297

Summary and Implications for the Future 300Glossary 301References 302

c h a p t e r ) The Importance of Social Supports: Family,Friends, Neighbors, and Communities 305

The Nature and Function of Informal Supports 306The Impact of Social Supports on Well-Being 306

Changing Family Structure 307The Growth of the Multigenerational Family 308 • DefiningMultigenerational Families 309 • Cultural Variations in MultigenerationalFamilies 310

Older Partners 312Marital Satisfaction 313 • Divorce in Old Age 314• Lesbian and Gay Partners 315

Sibling Relationships 318Never-Married Older People 319Childless Older Adults 319Other Kin 320Intergenerational Relationships: Adult Children 320

Patterns of Intergenerational Assistance 321

CONTENTS

Grandparenthood and Great-Grandparenthood 322Grandparents as Custodial Caregivers of Grandchildren 325 • Great-Grandparents 329 • The Effects of Divorce on Grandparenthood 330

Friends and Neighbors as Social Supports 331Interventions to Strengthen or Build Social Supports 333Intergenerational Programming 335Relationships with Pets 336Implications for the Future 336Summary 337Glossary 338Resources 339References 339

c h a p t e r L\J Opportunities and Stressof Informal Caregiving 349

Costs and Benefits of Informal Care 351For Society 351 • For Informal Caregivers 351

Caregiver Gains 353Who Are Informal Caregivers? 354The Gendered Nature of Family Care 354Spouses/Partners as Caregivers 356Adult Children/Grandchildren as Caregivers 357Family Caregivers of Color 359Caregiving for Relatives with Dementia 360Elder Mistreatment 361Legislation to Support Family Caregivers 366Use of Services 367Supportive Services for Older Adults 368Supportive Services for Family Caregivers 368

Service Utilization 368 • Support Groups for Caregivers 369• Psychoeducational Groups 369 • Respite Care 369 • ElectronicSupports 370 • Future Service Directions 370

Institutionalization 371Underpaid Family Caregivers: Direct Care Workers 372Implications for the Future 372Summary 373Glossary 374Resources 374References 374

y j y CONTENTS

c h a p t e r 1 1 Living Arrangements andSocial Interactions 383

Person-Environment Theories of Aging 384P-E Congruence Models in Gerontology 384

Geographic Distribution of the Older Population 385Relocation 386The Impact of the Neighborhood 389Victimization and Fear of Crime 389Housing Patterns of Older People 391

Independent Housing 391 • Planned Housing 394 • CongregateHousing 395 • Continuous Care Retirement Communities 396

Long-Term Care 397Nursing Homes 397 • Newer Options for Long-Term Care 402• Assisted Living: A Growing Trend in Long-Term Care 403• Private Homes That Provide Long-Term Care 404

Services to Aid Older People in the Community 406Home Care 406 • Adult Day Care and Adult Day Health Care 408

Technology to Help Aging in Place 408Housing Policy and Government Programs 412SRO Housing 414The Problems of Homelessness 414Implications for the Future 415Summary 416Glossary 418Resources 419References 420

c h a p t e r 1 2 Productive Aging: Paid and Nonpaid Rolesand Activities 424

What Do We Mean by Productive Aging? Definitions and Critique 424Retirement 427

The Timing of Retirement 428 • Satisfaction with Retirement 430• The Importance of Planning 433

Employment Status 434Challenges Faced by Older Workers 436 • More Older People SeekEmployment 437 • Barriers to Employment 438 • Creating NewEmployment Opportunities 439

CONTENTS .XV

Economic Status: Sources of Income in Retirement 440Social Security 441 • Asset Income 442 • Pensions 443• Earnings 444

Poverty among Old and Young 445Poverty Differentials over Time 445 • Poverty Differentialsby Gender 447 • Poverty Differentials by Race 447 • PovertyDifferentials by Age and Living Status 448 • Public Assistance 448

Patterns and Functions of Nonpaid Roles and Activities 449Leisure 449 • Membership in Voluntary Associations 451 • VolunteerWork 452 • Educational Programs 455 • Religious Participation,Religiosity, and Spirituality 456 • Benefits of Religious Participation andReligiosity 458 • The Value of Spirtual Well-Being 460 • PoliticalParticipation 462 • Voting Behavior 462 • Senior Power 463

Implications for the Future 468Summary 471Glossary 472Resources 473References 473

c h a p t e r 1 3 Death, Dying, Bereavementand Widowhood 480

The Changing Context of Dying 481Attitudes toward Death 481 • Variation by Age and Gender 482

The Dying Process 484End-of-Life Care 485

Hospice Care 489

The Right to Die or Hastened Death 493Passive Euthanasia (Voluntary Elective Death) 494• Active Euthanasia 496

Legal Options Regarding End-of-Life Care 500Bereavement, Grief, and Mourning Rituals 507

The Grief Process 507

Process of Mourning 509Widowhood 511

Gender Differences in Widowhood 513

Implications for the Future 516Summary 518Glossary 518Resources 520References 520

XVI CONTENTS

c h a p t e r 1 4 The Resilience of Elders of Color 525

Defining Ethnicity and Culture 526Defining Minority and People of Color 527

Research History 529Ethnic Minorities in Gerontology 531

Older African Americans 532Economic Status 533 • Health 534 • Social Supportsand Living Situations 536

Older Latinos 538Economic Status 540 • Health 540 • Social Supportsand Living Situations 542

Older American Indians 543Economic Status 544 • Health 544 • Social Supportsand Living Situations 547

Older Asian/Pacific Islanders 548Economic Status 549 • Health 551 • Social Supportsand Living Situations 553

Implications for Services 554Implications for the Future 557Summary 558Glossary 558Resources 559References 559

15c h a p t e r 1 3 The Resilience of Older Women 564

Rationale for a Focus on Older Women's Needs 564Older Women's Economic Status 566

Older Women's Health Status 572Health Insurance and Gender Inequities 572 • Higher Incidence of ChronicHealth Problems 573 • Osteoporosis 575 • Menopause 576

Older Women's Social Status 578Widowhood 579 • Limited Opportunities to Remarry 579• Sources of Support 580

Implications for the Future 581Summary 583Glossary 583Resources 584References 584

CONTENTS

p a r t f i v eThe Societal Context of Aging 587

c h a p t e r 1 6 Social Policies to AddressSocial Problems 590

Variations among Policies and Programs 592Factors Affecting the Development of Public Policies 594

Values Affecting Social Policy 594 • Economic Context 595The Development of Public Policies for Older People 596

1930 to 1950 596 • Program Expansion in the 1960s and 1970s 597• Program Reductions in the 1980s and 1990s 599 • The Politics ofDiversity and Deficit Spending in the 1990s 600 • Era of Market andPersonal Responsibility 601 • Social Security and SSI 601

Income Security Programs: Social Security and SupplementalSecurity Income 601Social Security 601 • The Future of Social Security 604• Supplemental Security Income 60S

Private Pensions and Income Tax Provisions 609Private Pensions 609 • Income Tax Provisions 610

Social Services 610Policy Dilemmas 612

Age-Based versus Needs-Based Programs 612 • The Politicsof Productivity versus the Politics of Entitlement 613• Inter generational Inequity framework 614 • Critique of theInter generational Inequity Framework 614 • The Interdependenceof Generations Framework 615

Who Is Responsible? 618Reductions in Government Support 618

Implications for the Future 619Summary 620Glossary 621Resources 622References 622

c h a p t e r 1 / Health and Long-Term Care Policyand Programs 626

Health and Long-Term Care Expenditures 628Factors Underlying Growing Costs 629

XV111 CONTENTS

Medicare 631Home Health Care under Medicare 632 • Efforts to ReduceMedicare Costs 635 • The New Medicare 638 • Medicare Reformand Prescription Drug Coverage 639

Medicaid 642Medicaid-Funded Nursing Home Care 644 • Medicaid-Funded HomeHealth Care 645 • Eligibility for Medicaid Home Health Care 645• Medicaid Spend-Down 647

Social Services Block Grants and the Older Americans Act (OAA) 648Private Long-Term Care Insurance 648

Resultant Inequities 650

Health and Long-Term Care Reforms 651Health Maintenance Organizations (HMOs) 652 • Social HealthMaintenance Organizations (SHMOs) and Other Model InnovativePrograms 653

Implications for the Future 657Summary 658Glossary 659

Resources 659References 659

Index 666