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Copyright, ii
Preface, xvii
Acknowledgments, xxi
About the Authors, xxiii
Part one. The Field of Social Gerontology, 1
Chapter 1. The Growth of Social Gerontology, 3
The Field of Gerontology, 3
Social Gerontology, 5
What Is Aging?, 5
The Older Population Is Diverse, 6
An Active Aging Framework, 7
A Person–Environment Perspective on Social Gerontology, 8
Environmental Press, 9
Environmental Interventions, 10
Organization of the Text, 11
Why Study Aging?, 12
Growth of the Older Population, 13
Changes in Life Expectancy, 13
Maximum Life Span, 15
The Oldest-Old, 16
Ages 85 and Older, 16
Centenarians, 18
Population Pyramids, 20
Support Ratios, 21
Population Trends, 24
Ethnic Minorities, 24
Geographic Distribution, 25
Educational and Economic Status, 26
Impact of Demographic Trends, 27
Longevity in Health or Disease?, 28
How Aging and Older Adults Are Studied, 29
Development of the Field, 29
Historical Forces of the Late Nineteenth and Early Twentieth Centuries, 30
Formal Development of the Field, 30
Major Research Centers Founded, 31
Research Methods, 32
The Age/Period/Cohort Problem, 32
Cross-Sectional Studies, 33
Longitudinal Studies: Design and Limitations, 33
Sequential Designs, 35
Problems with Representative Samples of Older Persons in Research, 36
Summary and Implications for the Future, 37
Glossary, 38
Resources, 39
References, 39
Chapter 2. Aging in Other Countries and across Cultures in the United States, 43
Worldwide Trends, 43
Demographic Changes, 44
Economic Implications for Industrialized Countries, 48
The Impact of Modernization on Older Adults’ Roles in Traditional Societies, 50
Resources Held by Older Adults, 50
Modernization Theory, 51
Impact of Modernization on Filial Piety, 53
Overcoming the Impact of Modernization on Intergenerational Relations, 54
A Cross-Cultural View of Elders’ Roles in Contemporary Societies, 56
Immigrants from Traditional Cultures to the United States, 58
Living Arrangements of Older Immigrants, 60
Financial Dilemmas Facing Immigrant Elders, 61
Summary and Implications for the Future, 62
Glossary, 63
References, 63
Part two. The Biological and Physiological Context of Social Aging, 67
Chapter 3. The Social Consequences of Physical Aging, 70
Biological Theories of Aging, 71
Can Aging Be Reversed or Delayed?, 74
Growth Hormones, 74
Caloric Restriction, 75
Anti-Aging Compounds, 76
Research on Physiological Changes with Age, 77
Aging in Body Composition, 77
Changes in Organ Systems, 81
Changes in Sleep Patterns with Aging, 90
Changes in Sensory Functions, 92
Changes in Vision, 93
Assisting Adaptation and Active Aging through Environmental Modifications, 99
Changes in Hearing, 99
Changes in Taste and Smell, 104
Implications for the Future, 106
Summary, 106
Glossary, 108
Resources, 109
References, 109
Chapter 4. Managing Chronic Diseases and Promoting Well-Being in Old Age, 114
Defining Health, 114
Quality of Life in Health and Illness, 116
Chronic and Acute Diseases, 118
Interactive Effects, 121
Causes of Death in Later Years, 122
Common Chronic Conditions, 124
Heart Disease and the Cardiovascular System, 124
Strokes and Other Cerebrovascular Problems, 127
Cancer, 128
Arthritis, 129
Osteoporosis, 131
Chronic Obstructive Pulmonary Disease or Respiratory Problems, 136
Diabetes, 136
Problems with the Kidneys and Urinary Tract, 138
Problems with the Intestinal System, 140
Oral Diseases, 141
HIV/AIDS in the Older Population, 141
Accidents among Older People, 144
Older Drivers, 144
Falls and Their Prevention, 146
Use of Physician Services by Older People, 147
Use of Other Health Services, 148
Health Promotion with Older People, 150
The Relationship of Health Practices to Health Outcomes, 152
Exercise as Part of Health Promotion, 154
Improving the Effectiveness of Health Promotion Programs, 157
Limitations of Health Promotion, 158
Implications for the Future, 159
Summary, 161
Glossary, 162
References, 163
Part three. The Psychological Context of Social Aging, 171
Chapter 5. Cognitive Changes with Aging, 174
Intelligence and Aging, 175
Problems in the Measurement of Cognitive Function, 177
Longitudinal Studies of Intelligence, 178
Factors That May Influence Intelligence in Adulthood, 179
The Process of Learning and Memory, 182
The Information Processing Model, 184
The Importance of Learning and Memory in Everyday Life, 186
Executive Function in Older Adults, 186
Factors That Affect Learning in Old Age, 187
The Importance of Attention, 187
Practical Implications of Attention Changes with Aging, 187
Environmental and Personal Factors, 188
Age-Related Changes in Memory, 191
Tip-of-the-Tongue States, 192
Improving Cognitive Abilities in Old Age, 193
Cognitive Retraining, 193
Memory Mediators, 195
Wisdom and Creativity, 197
Implications for the Future, 199
Summary, 200
Glossary, 201
References, 202
Chapter 6. Personality and Mental Health in Old Age, 208
Defining Personality, 208
Stage Theories of Personality, 209
Jung’s Psychoanalytic Perspective, 209
Erikson’s Psychosocial Model, 210
Empirical Testing of These Perspectives, 212
Dialectical Models of Adult Personality, 213
Trait Theories of Personality, 214
Emotional Expression and Regulation, 215
Self-Concept and Self-Esteem, 216
Stress, Coping, and Adaptation, 218
Some Useful Definitions, 218
Aging and Life Events, 219
What Determines Stress Responses in Old Age?, 220
Adaptation in the Later Years, 221
Successful Aging, 223
A Critique of the Successful Aging Paradigm, 225
Psychological Disorders among Older Persons, 227
Depression, 228
Suicide among Older People, 234
Dementia, 235
Delirium, 237
Alzheimer’s Disease, 238
Characteristics of Alzheimer’s Disease, 241
Behavioral Treatment and Environmental Interventions, 245
Parkinson’s Disease, 247
Alcoholism, 248
Drug Abuse, 249
Paranoid Disorders and Schizophrenia, 250
Anxiety, 251
Older Adults Who Are Chronically Mentally Ill, 252
Psychotherapy with Older Persons, 252
Use of Mental Health Services, 253
Implications for the Future, 255
Summary, 256
Glossary, 259
Resources, 260
References, 260
Chapter 7. Love, Intimacy, and Sexuality in Old Age, 271
Attitudes and Beliefs about Sexuality in Later Life, 272
Myths and Reality about Physiological Changes and Frequency of Sexual Activity, 273
Women and Age-Related Physiological Changes, 277
Men and Age-Related Physiological Changes, 280
Chronic Diseases and Sexuality, 283
Gay, Lesbian, Bisexual, and Transgender (GLBT) Partners in Old Age, 288
Psychosocial Factors and Late-Life Affection, Love, and Intimacy, 290
Facilitating Older Adults’ Sexual Functioning, 294
Implications for the Future, 295
Summary, 296
Glossary, 296
References, 297
Part four. The Social Context of Aging, 301
Chapter 8. Social Theories of Aging, 305
The Importance of Social Theories of Aging, 305
Social Gerontological Theory before 1961: Role and Activity, 306
Role Theory, 307
Activity Theory, 309
The First Transformation of Theory, 310
Disengagement Theory, 310
Gerotranscendence Theory, 311
Continuity Theory, 312
Alternative Theoretical Perspectives, 312
Symbolic Interactionism and Subculture of Aging, 313
Age Stratification Theory, 314
Social Exchange Theory, 316
Political Economy of Aging, 317
Life Course Perspective, 319
Life Course Social Capital, 320
Recent Developments in Social Gerontological Theory: The Second Transformation, 320
Social Phenomenology and Social Constructionism, 320
Critical Theory and Feminist Perspectives, 322
Postmodern Constructions of Aging, 325
The “Foucault Effect” on Gerontological Theory, 326
Summary and Implications for the Future, 327
Glossary, 328
References, 329
Chapter 9. The Importance of Social Supports: Family, Friends, Neighbors, and Communities, 333
The Nature and Function of Informal Supports, 334
The Impact of Informal Networks and Social Supports on Well-Being, 335
Changing Family Structure, 336
The Growth of the Multigenerational Family, 337
Defining Multigenerational Families, 338
Cultural Variations in Multigenerational Families, 340
Older Partners, 341
Marital Satisfaction, 343
Divorce in Old Age, 344
Gay, Lesbian, Bisexual, and Transgender (GLBT) Partners, 345
Sibling Relationships, 348
Never-Married Older People, 349
Childless Older Adults, 350
Other Kin, 350
Intergenerational Relationships: Adult Children, 351
Patterns of Intergenerational Assistance, 352
Grandparenthood and Great-Grandparenthood, 352
Grandparents as Primary Caregivers of Grandchildren, 356
Great-Grandparents, 361
The Effects of Divorce and Changing Marital Patterns on Grandparenthood, 361
Friends and Neighbors as Social Supports, 363
Interventions to Strengthen or Build Social Supports, 365
Intergenerational Programming, 367
Relationships with Pets, 369
Implications for the Future, 370
Summary, 371
Glossary, 372
Resources, 372
References, 373
Chapter 10. Opportunities and Challenges of Informal Caregiving, 385
Who Are Informal Caregivers?, 386
Costs and Benefits of Informal Care, 387
For Society, 387
For Informal Caregivers, 388
Caregiver Gains, 390
The Gendered Nature of Family Care, 392
Spouses/Partners as Caregivers, 394
Adult Children/Grandchildren as Caregivers, 396
Family Caregivers of Color, 397
Caregiving for Relatives with Dementia, 399
Legislation to Support Family Caregivers, 401
Use of Services, 402
Supportive Services for Family Caregivers, 403
Caregiver Assessment, 403
Service Utilization, 403
Support Groups, 404
Psychoeducational Groups and Skills Training, 405
Individual and Family Counseling, 405
Respite Care, 405
Electronic Supports, 406
Future Service Directions, 406
Elder Mistreatment, 407
Assessment, Interventions, and Reporting, 412
Placement in Long-Term Care Facilities, 414
Underpaid Caregivers: Direct Care Workers, 415
Implications for the Future, 416
Summary, 418
Glossary, 418
Resources, 419
References, 419
Chapter 11. Living Arrangements and Social Interactions, 429
Person–Environment Theories of Aging, 430
P–E Congruence Models in Gerontology, 430
Geographic Distribution of the Older Population, 431
The Aging Experience in Rural, Urban, and Suburban Areas, 431
Elder-Friendly/Livable Communities, 433
Relocation, 433
The Impact of the Neighborhood, 437
Victimization and Fear of Crime, 437
Housing Patterns of Older People, 440
Independent Housing, 440
Planned Housing, 442
Continuous Care Retirement Communities, 443
Long-Term Care, 444
Nursing Homes, 444
Culture Change in Nursing Homes, 447
Newer Options for Long-Term Care, 449
Assisted Living, 449
Private Homes That Provide Long-Term Care, 452
Services to Assist Aging in Place, 453
Home Care, 453
Adult Day Care and Adult Day Health Care, 455
Technology to Help Aging in Place, 455
Housing Policy and Government Programs, 459
SRO Housing, 461
The Problems of Homelessness, 461
Aging in Place among Older Prisoners, 463
Implications for the Future, 464
Summary, 465
Glossary, 467
Resources, 468
References, 468
Chapter 12. Productive Aging: Paid and Nonpaid Roles and Activities, 474
What Do We Mean by Productive Aging? Definitions and Critique, 474
Retirement, 477
The Timing of Retirement, 478
Satisfaction with Retirement, 482
The Importance of Planning, 485
Employment Status, 486
More Older People Seek Employment, 487
Barriers to Employment, 489
Creating New Employment Opportunities, 490
Economic Status: Sources of Income in Retirement, 491
Social Security, 492
Asset Income, 494
Pensions, 494
Earnings, 496
Poverty among Old and Young, 497
Poverty Differentials over Time, 497
Poverty Differentials by Gender, 499
Poverty Differentials by Ethnic Minority Status, 499
Poverty Differentials by Age and Living Status, 500
Public Assistance, 500
Patterns and Functions of Nonpaid Roles and Activities, 501
Leisure, 501
Religious Participation, Religiosity, and Spirituality, 503
Benefits of Religious Participation and Religiosity, 505
The Value of Spiritual Well-Being, 507
Civic Engagement, 509
Membership in Voluntary Associations, 511
Volunteer Work and Organizations, 513
Educational Programs, 517
Political Participation, 518
Voting Behavior, 519
Senior Power, 520
Implications for the Future, 525
Summary, 528
Glossary, 529
Resources, 530
References, 530
Chapter 13. Death, Dying, Bereavement, and Widowhood, 539
The Changing Context of Dying, 540
Attitudes toward Death, 540
Variation by Age and Gender, 541
The Dying Process, 543
End-of-Life Care, 544
Hospice Care, 548
The Right to Die or Hastened Death, 554
Passive Euthanasia (Voluntary Elective Death), 556
Active Euthanasia, 558
Legal Options Regarding End-of-Life Care, 562
Bereavement, Grief, and Mourning Rituals, 569
Bereavement and the Grief Process, 569
Process of Mourning, 571
Widowhood, 573
Gender Differences in Widowhood, 576
The Death of Siblings and Friends, 579
Implications for the Future, 579
Summary, 581
Glossary, 582
Resources, 583
References, 583
Chapter 14. The Resilience of Elders of Color, 590
Defining Ethnicity and Culture, 591
Defining Minority and People of Color, 593
The Dramatic Growth of Populations of Color, 593
Research History, 596
Ethnic Minorities in Gerontology, 598
Older African Americans, 599
Economic Status, 599
Health, 600
Social Supports and Living Situations, 603
Older Latinos, 606
Economic Status, 607
Health, 608
Social Supports and Living Situations, 610
Older American Indians, 611
Economic Status, 612
Health, 613
Social Supports and Living Situations, 616
Older Asian/Pacific Islanders, 617
Economic Status, 619
Health, 620
Social Supports and Living Situations, 624
Implications for Services, 625
Implications for the Future, 628
Summary, 629
Glossary, 630
Resources, 630
References, 630
Chapter 15. The Resilience of Older Women, 639
Rationale for a Focus on Older Women’s Needs, 640
Older Women’s Economic Status, 642
Social Security and Gender Inequities, 644
Inequities for Women under Proposals to Privatize Social Security, 646
Proposals to Reduce Gender Inequities in Social Security, 647
Private Pensions and Gender Inequities, 649
Older Women’s Health Status, 651
Health Insurance and Gender Inequities, 651
Higher Incidence of Chronic Health Problems, 653
Osteoporosis, 655
Menopause, 656
Older Women’s Social Status, 657
Widowhood, 658
Limited Opportunities to Remarry, 659
Informal Networks and Social Support, 660
Implications for the Future, 663
Summary, 665
Glossary, 665
Resources, 666
References, 666
Part five. The Societal Context of Aging, 671
Chapter 16. Social Policies to Address Social Problems, 674
Variations among Policies and Programs, 676
Factors Affecting the Development of Public Policies, 678
Values Affecting Social Policy, 679
Economic Context, 680
The Development of Public Policies for Older People, 681
1930 to 1950, 681
Program Expansion in the 1960s and 1970s, 683
Program Reductions in the 1980s and 1990s, 684
The Politics of Diversity and Deficit Spending in the 1990s, 685
Era of the Market and Personal Responsibility, 686
Income Security Programs: Social Security and Supplemental Security Income, 687
Social Security, 687
The Future of Social Security, 690
Supplemental Security Income (SSI), 695
Private Pensions and Income Tax Provisions, 696
Private Pensions, 696
Income Tax Provisions, 697
Social Services, 697
Policy Dilemmas, 700
Age-Based versus Needs-Based Programs, 700
The Politics of Productivity versus the Politics of Entitlement, 701
Intergenerational Inequity Framework, 702
Critique of the Intergenerational Inequity Framework, 703
The Interdependence of Generations Framework, 704
Who Is Responsible?, 706
Reductions in Government Support, 707
Implications for the Future, 708
Summary, 709
Glossary, 710
Resources, 711
References, 711
Chapter 17. Health and Long-Term Care Policy and Programs, 716
Health and Long-Term Care Expenditures, 718
Factors Underlying Growing Costs, 719
Medicare, 721
Medicare-Funded Home Health Care, 723
Efforts to Reduce Medicare Costs, 726
The New Medicare, 729
Medicare Reform and Prescription Drug Coverage, 730
Medicaid, 735
Medicaid-Funded Nursing Home Care, 737
Medicaid-Funded Home Health Care, 738
Eligibility for Medicaid Home Health Care and Waiver Programs, 739
Medicaid Spend-Down, 741
Private Supplemental and Long-Term Care Insurance, 742
Resultant Inequities, 745
Health and Long-Term Care Reforms, 745
Health Maintenance Organizations (HMOs), 746
Social Health Maintenance Organizations (SHMOs) and Other Innovative Programs, 748
Implications for the Future, 751
Summary, 752
Glossary, 753
Resources, 754
References, 754
Photo Credits, 760
Index, 761

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