From these roots: The role of historically Black colleges and universities in preparing the nation’s gerontologists for an aging society

ABSTRACT

The aging of the United States population is creating an increased need for social workers and other helping professionals with training in gerontology. Recent estimates indicate that less than 3% of MSW students are enrolled in an aging concentration, as compared to 19% enrolled in children/youth concentrations. In addition, the phenomenon of a diverse baby boomer generation joining the ranks of persons age 65 and older has created a plethora of scholarship and curriculum development aimed at readying the aging network for the unprecedented growth of older persons. Social work can make unique professional contributions to the field of gerontology and older persons. This study asserts, however, that social work is not adequately prepared to practice in an increasingly diverse aging society. The social work profession has articulated commitments to acknowledging and affirming how diversity and culture shape the human experience and to developing social workers who can competently engage in research-informed practice and practice-informed research. However, there remains a need in social work education for more widespread use of culturally relevant pedagogies that can help achieve these goals. Informed by both the Afrocentric and Black perspectives, this study presents a content analysis of the curricula infused at two historically Black universities. The nature and extent of the contributions of historically Black universities to social work education is the focus of this article. The scope of this investigation also includes the identification of prominent Black social work educators and discusses the implications of these perspectives for more culturally informed gerontology curricula that promote culturally competent gerontological social workers.     

Chapter 6. Issues in Caregiving

SUMMARY

Some 10 to 29% of persons over 65 in the United States are sufficently physically, cognitively, or emotionally impaired to need some level of caregiving from their informal and formal support systems. Unfortunately, there are still some older persons who need care, but care is either not provided, inadequate, or involves some form of mistreatment. This chapter discusses the difficulties of maltreatment and substance abuse.     

Planning for Aging in Place: Incorporating the Voice of Elders to Promote Quality of Life

Abstract

Aging in place offers emotional and physical benefits; however, challenges associated with advanced age may make aging in place difficult. As communities across the country prepare for forecasted increases in the proportion of older residents, it is important to understand barriers that may prevent aging in place. Perceived barriers voiced by residents of a suburban county who completed an Aging in Place Needs Assessment Survey were categorized into four themes: need to downsize/home modification; need for assistance; family desire to reciprocate care; and isolation. A fifth group with no intent to relocate, but with concerns about having to, was also identified. Included among this group were persons with mental health or developmental disorders, such as anxiety and autism spectrum disorder. Results were examined through a person-centered lens to illustrate that aging in place may be the desired option even among residents who indicate that it is not. It is important that aging-in-place initiatives preserve identity by fostering a sense of autonomy, control, and well-being in older residents.     

Understanding Older Americans' Attitudes,Knowledge, and Fears About Vision Loss and Aging

ABSTRACT

The purpose of the present study was to identify factors associated with attitudes, knowledge, and fear of age-related vision impairment in a representative sample of US adults age 55 and older. Data were obtained from a national telephone survey. Attitudes toward vision impairment and aging were positive, but fears were extensive and knowledge was lacking. Higher socioeconomic status and experience with nonrelated persons who were visually impaired predicted better attitudes and greater knowledge. Being a women and having experience with persons who were visually impaired predicted lower fear. Findings emphasize the importance of accurate knowledge and training about visual impairment for practitioners working with this population.     

Gay Men

Summary

This report presents the findings from four ethnographic studies of older gay men (Brown, 1997; Brown, Sarosy, Cook & Quarto, 1997; Cook, 1991; Quarto, 1996; Sarosy, 1996). There were 69 total participants who ranged in age from 36 to 79 years; most were from 50 to 65 years of age. The purpose of these studies was to examine how older gay men have adjusted, psychologically and socially, to their sexual orientation and aging process. Participants reported that they spend 50% time or more with gay friends within their own age cohorts. Many reported being involved with the gay community in some capacity, while about 15% had no involvement with the gay community. Most participants were in regular contact with their families. Most stated that their families were aware of their sexual orientation. Most of the participants reported experiencing discrimination due to sexual orientation, and one third had experienced discrimination within the gay community based on age or ethnicity. With regard to sex life, the studies found an overall lowered frequency of sexual activity. Participants felt that HIV/AIDS has had a devastating impact on older gay men, interrupting the normal aging process for those who have contracted it and prematurely aging those who care for them. The studies' findings identified the qualities of healthy adaptation to aging for older gay males: having satisfying relationship, self-acceptance as one ages, good health, an active life with a variety of interests, and financial security.     

Health Status and Health Care Services Among Older Persons in India

Summary

India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.     

Health Care Rationing Affecting Older Persons

Abstract

Health care resources are finite and, therefore, need to be rationed among potential users. Over the past decade and a half in the United States, a variety of explicit, official rationing schemes have been proposed, including some in which chronological age would play a significant role. For ethical and political reasons, it is very unlikely that any age-based rationing schemes will be adopted explicitly and officially. However, various de facto forms of health care rationing are occurring at present. This article outlines the implications of payer behavior, physician practice patterns, the development of evidence-based clinical practice parameters or guidelines, and reliance on consumer choice of health plans as unofficial and generally unacknowledged mechanisms of health care rationing that may exert an important impact on the accessibility of health services for older persons.     

Preventing Economic Hardship Among Chinese Elderly in Hong Kong

Abstract

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.     

Serving our (in)visible elders: The impact of a LGBTQ+ aging presentation on a rural college campus

ABSTRACT

As the number of individuals 65 and older continues to grow, so too does the richness and complexity of their identity. Specifically, the culture of aging within the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community has received little attention in the literature. In order to best serve this population, human service professionals must understand the reality of aging within diverse communities. This article explores the impact of an invited campus speaker focused on LGBTQ+ aging on a rural college campus. Results indicate a general increase in overall knowledge and appreciation for issues directly impacting the aging LGBTQ+ community. Recommendations for practice, grounded in a social justice framework, are shared.     

Demography of Indian Aging, 2001-2051

Summary

India is the second largest country in the world, with 72 million elderly persons above 60 years of age as of 2001, compared to China's 127 million. One of the objectives of this paper is to assess the emerging scenario of elderly for the first half of the 21st century. According to projections, the elderly in the age group 60 and above is expected to increase from 71 million in 2001 to 179 million in 2031, and further to 301 million in 2051; in the case of those 70 years and older, they are projected to increase from 27 million in 2001 to 132 million in 2051. Among the elderly persons 80 and above, they are likely to improve their numbers from 5.4 million in 2021 to 32.0 million in 2051. The increasing number and proportion of elderly will have a direct impact on the demand for health services and pension and social security payments. Mobilizing resources for geriatric care and providing sufficient maintenance for the elderly will emerge as a major responsibility for heath-care providers and pension economists.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Gay,Lesbian, Bisexual,and Transgender (GLBT) Elders

Abstract

Current gay, lesbian, bisexual, and transgender (GLBT) individuals age 65 years and older grew up before the Gay Rights movement. They have learned over many years to hide their identities in order to avoid discrimination and ridicule. Unfortunately, this secrecy has led to the near invisibility of the elder GLBT population and to poor health and service access. This paper reviews what we know about GLBT elders, describes some of the unique strengths they bring to the aging process, and outlines some of the challenges they face. Micro, mezzo, and macro practice implications are suggested.     

“I feel like her daughter not her mother”: Ethnographic trans-cultural perspective of the experiences of aging for a group of Southeast Asian refugees in the United States

ObjectiveThis study seeks to understand trans-cultural aging and stressors for aging refugees. It describes the experiences of Cambodian refugee women as they age in the United States.MethodExperiences of 16 Cambodian refugee women (ages 44–60), participants of a Cambodian community health center support group, were examined over a year.ResultsAnalysis revealed complex experiences of aging in the U.S. including these: (a) loss of role as respected elder, (b) fear of living separate from children, (c) feeling devalued by children, and (d) feeling self-blame for intergenerational cultural gap. The women described years of employment interrupted by the exacerbation of post-traumatic symptoms later in life preventing further employment.DiscussionAn ethnographic trans-cultural perspective of the experiences of aging for Southeast Asian refugees. Aging refugees face stressors even 20–30 years after resettlement. Findings show decrease in functioning as survivors of torture age. Recommendations for social service programs and providers are made.     

Realities and Hopes for Older Gay Males

Abstract

Data about gay men in the Midwest over the age of 50 are extracted from a larger study of gay men and lesbian women. Information is sought regarding the role of sexual orientation, social networks, and social programs and activities in personal assessments of both the aging process and life satisfaction. The sample was divided into two groups: men 60 years of age and older, and men between the ages of 50 and 60. Differences were found between these subgroups, especially regarding acceptance of the aging process; yet these men were more similar than different in most aspects of life. Participation in gay community activities, social and religious, was found to be important for the quality of life of these men. Those integrated into the community, formally and informally, were also more likely to believe that their sexual orientation had helped their aging process.     

Speaker abstracts

Purpose: There is no consensus on possible benefits and risks of testosterone supplementation. Here we review various controlled studies of testosterone supplementation in aging males.

Methods: We performed a PubMed search using the terms “testosterone/therapeutic use” with the limits “>65 years of age”, “randomized controlled clinical trials”, and “male gender”, starting in 1999.

Results: Forty-three articles have been published since 1999. Some of these studies also included patients in middle-age or younger. Findings reported in these articles were not entirely consistent. After weighting studies by the number of patients, hints are found that testosterone supplementation increases bone mass, lean body mass, muscle mass and hematopoiesis, and improves sexual functioning and perhaps mood, but does not affect serum lipids, cardiovascular parameters, prostate-specific antigen level, or cognition. Considering studies including only men older than 65 years, and in which testosterone supplements were compared with placebo treatment, slightly different results are obtained. In these patient groups, testosterone does not improve sexual function or mood.

Conclusion: The overall benefit of testosterone supplementation for the aging male remains unclear. Any supplementation in men with age-normal testosterone levels only on grounds of subjective symptoms is not advisable.     

Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.     

Successful Aging in the Middle-Aged Gay Man

Abstract

Successful aging into middle age is impeded by internalized ageism in the gay man. Developmental theory inadequately details the tasks at this stage. Lesbian and gay human developmental theory is now being conceptualized to encompass the entire lifespan. This article identifies and elaborates specific developmental tasks for the middle-aged gay man based on psychotherapy clients who successfully aged into midlife. Focusing on the elimination of internalized ageism and the development of a positive attitude towards aging, the author provides a human developmental model for successful aging at midlife.     

Motivational Style,Length of Residence,Voluntariness, and Gender as Influences on Adjustment to Long Term Care

Abstract

Seventy-five institutionalized older adults (Mage = 79.08, SD=9.73, 25 males, 50 females) varying by length of residence, gender, and motivational style (self determined vs. motivational) were queried to explore the impact of these variables on indicators of adjustment, i.e., health, life satisfaction, desired and expected control, self-esteem, ADLs, and positive/negative affect. MANCOVAs (controlling for social desirability) indicated self-determined motivational style to positively impact adjustment, as well as to interact (p <.05) with gender in this respect. Length of residence and gender each impacted ADLs, and motivational style also affected both desired/expected control and self-esteem, where those with higher self determined motivational styles had expectations for and desirability of control. Voluntariness of the decision to move generally positively impacted adjustment, but its impact was moderated by motivational style. Thus, persons who vary along motivational style, gender, voluntariness, and length of residence are likely to function in distinct ways in adjusting to being institutionalized.     

Implementation Issues for Consumer-Directed Programs

Summary

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs “closer to the people.” Consumer-direction goes even further by placing resources directly in the hands of consumers.

Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective “dialogue” that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

A Review and Reformulation of Adoptive Relationships from an Attachment Perspective

ABSTRACT

From an attachment perspective, the formation and maintenance of adoptive relationships involve many atypical events and circumstances for both adoptive parents and adopted persons. The present analysis reviews the existing theoretical and empirical literature on several of these issues and examines the utility of conceptualizing them from an attachment perspective, focusing in particular on Bartholomew's (1990) categorical model of attachment styles. Inferences regarding the impact of attachment status (both for those who adopt and for those who have been adopted) on interpersonal and family functioning are formulated and critical areas in need of further research are outlined.