Developmental Psychology- Chapter 15

AARP:

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.

activities of daily life (ADLs):

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.

activity theory

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want and need to remain active in a variety of social spheres—with relatives, friends, and community groups—and become withdrawn only unwillingly, as a result of ageism.

age in place:

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

assisted living:

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

compulsive hoarding:

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.

disengagement theory:

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

filial responsibility:

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

frail elderly:

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

instrumental activities of daily life (IADLs):

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.

integrity versus despair:

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

naturally occurring retirement community (NORC):

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

positivity effect:

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

self theories:

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

stratification theories:

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

universal design:

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

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

B. 21; 13

A major problem with retirement is that:

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

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

D. more; earlier

An important task for successful aging requires that people:

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

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

B. shopping for groceries

In general, older couples have learned:

B. how to disagree.

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.

C. late-life depression

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

C. keeping a budget

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?

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

The difference between ADLs and IADLs is that:

B. IADLs require some intellectual competence.

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

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

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

A. a unionized mechanic at a local factory.

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:

C. compulsive hoarding.

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

A. fewer

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

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

In older adults, a positive world view:

B. correlates with believing that life is meaningful.

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

C. to identify with a political party.

Multi-generational families appear to be most beneficial for:

A. people from each generation.

Which theory focuses on the gender divisions promoted by society?

A. feminist

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

B. disengagement

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

B. a naturally occurring retirement community.

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

. independent living and aging in place.

Typically, who does more housework after retirement than before?

A. both men and women

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

A. late adulthood.

Some theories of late adulthood have been called self theories

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

stratification theories

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

Self theories

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.

A central idea of self theories is that

each person ultimately depends on himself or herself

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

…

INTEGRITY

The most comprehensive self theory came from Erik Erikson.

His eighth and final stage of development is called

integrity versus despair

As Erikson (1963) explains it,

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).

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

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

…

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

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

even as they acknowledge the physical changes of their bodies

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

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

some people cope successfully with the changes of late adulthood through

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

One strategy for selective optimization is known as the

javascript:top.Define(‘positivityeffect’)

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

…

Compensation occurs via selective recall:

Unpleasant experiences are reinterpreted as inconsequentia

This may explain why, in every nation and religion,

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

Stratification begins in childhood

…

Age affects a person’s life in many ways,

including income and health.

…

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.

The most controversial version of age-stratification theory

is disengagement theory

According to this theory, disengagement is a mutual process,

chosen by both older and younger generations.

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

ageism and social isolation

Some developed an opposing theory, called

activity theory

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

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 (

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

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

Many retirees disengage from work but

find new roles and activities to participate in

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

…

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

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) (

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

Women quit their jobs, whereas men worked longer.

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

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

In this situation, past stratification disadvantages the older women:

Their caregiving response leads to poverty and loneliness.

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

(5 percent versus 2 percent)

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

"weathering," an increased allostatic load that shortens life

Age and gender disparities may be magnified by ethnicity

racial stratification prevented many African Americans from buying homes.

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

have far more impairments than European Americans

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

…

Repeated stresses cause hypertension and obesity,

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

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),

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

Stratification may also explain developmental changes in

self-esteem

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

…

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

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

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

…

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

One explanation for this race crossover is selective survival

…

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

STRATIFICATION BY SES

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

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

…

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

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).

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

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

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.

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

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.

…

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

…

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

Many elders are reluctant to give that up

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

Many older adults who have pensions work part time

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

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

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

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

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

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

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

…

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

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

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

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

Volunteering offers some of the benefits of paid employment

(generativity, social connections, less depression).

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

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

Beyond that, volunteering reduces the odds of death.

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

Culture or national policy affects volunteering:

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

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

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

Why aren’t the elderly volunteering ?

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

Social culture

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

Organizations

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).

The elderly themselves

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

The science.

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.

every survey finds that most of the elderly give

money and time to help other people.

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

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

both men and women do more housework and meal preparation

after retirement

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

…

Gardening is popular

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

…

These correlate with less dementia and longer life

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

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

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.

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

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

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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

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.

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

This may be part of a universal developmental process.

Maslow reassessed his final level, self-actualization

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

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

This benefits their development.

Religious practices of all kinds

(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).

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.

…

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

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

about 2 percent volunteer in political campaigns

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

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

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

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).

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

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

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.

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

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

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,

…

The largest organized interest group in the world,

AARP

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

…

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

"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.

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

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

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

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

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.

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

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

…

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

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

Spouses buffer each other against the problems of old age

thus extending life

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

…

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

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

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

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

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

…

n general, older couples have learned how to disagree.

hey consider their conflicts to be discussions, not fights.

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

…

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

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

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.

…

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

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

For most older couples,

sexual interaction remains important

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

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

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

…

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

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

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

…

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

…

family members tend to support one another.

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

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

sometimes increasing when money is less needed

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

reduce the sense of filial responsibility

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

than did earlier cohorts

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

…

In the United States, every generation values independence.

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.

…

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)"

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

…

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

especially when either generation becomes dependent on the other

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

…

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

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

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

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.

Members of each generation tend to overestimate how much they contribute

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

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

…

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

…

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

…

In developed nations, grandparents fill one of four roles:

Remote grandparent Companionate grandparents Involved grandparents Surrogate parents

Remote grandparents

(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.

Companionate grandparents

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

Involved grandparents

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

Surrogate parents

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

Currently, in developed nations, most grandparents are

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

They provide babysitting and financial help but not advice or discipline

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

Such generative distance is not possible for grandparents who become surrogates

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

Social workers often seek

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.

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

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

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

…

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

depression, and marital problems than do other elders

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

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

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

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)

In most conditions, grandparenting benefits all three generations.

…

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

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

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

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

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

…

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.

…

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

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

Thomas Sander and Robert Putnam (2010),

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"

Gladwell (2010)

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?

Sander and Putnam (2010)

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.

Two other social scientists conclude:

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

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

…

according to insurance standards and medical professionals,

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

activities of daily life (ADLs)

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

instrumental activities of daily life (IADLs),

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.

It is more difficult to list IADLs because they vary from

culture to culture.

In developed nations, IADLs may include evaluating

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

In rural areas of other nations

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

Everywhere, the inability to perform IADLs makes people frail,

even if they can perform all five ADLs.

Between 1984 and 2004,

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

WHOSE RESPONSIBILITY?

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

PREVENTING FRAILTY

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

To prevent frailty

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

the elder, the family, and the community

could prevent or at least postpone frailty

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

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

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

…

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

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

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.

…

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

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

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

…

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

…

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

than for cultural ones

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—

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

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

…

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

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.

Caregiver exhaustion and elder abuse are preventable

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

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

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

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

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).

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

…

When caregiving results in resentment and social isolation,

the risk of depression, poor health, and abuse escalates

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

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

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

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

Political and legal definitions and remedies are not clear-cut

…

A major problem is awareness:

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.

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

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

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

but neither of these conditions proves abuse

Fortunately, outright abuse is now rare in nursing homes.

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

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

…

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

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

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

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

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

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

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

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

Another trend is toward smaller nursing homes with more individualized care

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

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

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

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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Most elder-care arrangements that include special services—

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

assisted living,

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

An assisted-living residence typically provides a

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

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

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

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

…

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

but many such places are unlicensed

Another form is sometimes called

village care.

village care

"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

…

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

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

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.

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

(Golant, 2011).

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

"final failing.

…

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

…

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