Exam 2 Flashcards
Why use social theories?
- Help us understand and explain changes in social relationships and systems that occur in late adulthood
- Provide basis for examining primary dimensions of age
- Serve as guide for further inquiry and suggest possible practice and policy interventions
The importance of social theory
- Many people make positive or negative assumptions on basis of chronological age
- Some stereotypes may be result of unconscious theorizing about the meaning of growing older
- Theory development is systematic attempt to explain why and how age-associated change or events occur
Theory building
Cumulative development of explaining and understanding observations and findings
Theory building represents what?
the core of the foundation of scientific inquiry and knowledge
Theory building understands what?
Understand phenomena in a manner that is reliable and valid across observations
Theories are never proven or disproven, they are what?
strengthened or weakened
Social theories are less well developed compared to what?
biological frameworks
Social theories are gathered through what kind of research?
qualitative and quantitative
Social theories lead to accumulation of knowledge and point to unanswered questions that may require what?
further research
Biological theories are useful in what?
guiding people’s health behaviors and lifestyle choices, as well as designing health services and policies…however they do not encompass all the reasons that people age and behave the way they do
Early social gerontology theories attempted to solve problems facing older people rather than what
explain social phenomena
There has been a shift from a focus on the objective and measurable problems of old age to more attention to the what
interactive process that affects aging, subjective meaning, and personal experiences.
Social Gerontology Theories before 1961
role theory
activity theory
disengagement theory
continuity theory
Social Gerontology Theories before 1961 emphasized what
the consequences of role loss with age and how and individuals personal characteristics affected adjustments to these changes
People have self-concept and self-worth based on what
the roles we identify
Roles can be associated with ages and stages in life
ages and stages in life
Role theory
a. We all play a variety of social roles across a lifespan
b. Each role is typically associated with a certain age or stage of life
c. Losing any of these roles can affect our well-being and opportunities to enjoy active aging
How well individuals adjust to aging depends on what
how they accept their “typical” role changes that occur during later years
Chronological age – often used to sort
range of norms, expectations and roles
Age norms
assumptions we all make about age-related capacities and limitations – beliefs that a person of a given age can and ought to do certain things
Ages alters not only the roles anticipated of people, but what else?
the manner in which they are expected to play them
how may role losses impact someone?
may erode a person’s sense of identity and self-esteem
The activity theory tries to answer what question
how individuals adjust to age-related changes such as retirement, chronic illness, and role loss
The activity theory defines aging as what
a social problem that can be addressed by trying to retain the status, roles, and behaviors similar to those of earlier life stages
- remain active!
The activity theory Replace past role with what
age-appropriate productive roles
The more active the older person, they are more likely to experience what?
greater their life satisfaction, self-concept and adjustment
Senior centers and community dining centers were often designed as ways to develop what for the older residents?
new roles, activities, and social integration
The activity theory is consistent with what?
the value placed by society on paid work, individual responsibility, and productivity
- Loss of these is viewed as evidence of decline
What does the activity theory NOT take into account?
personality, social class, gender, race and lifestyle
- not all older adults seek or benefit from activity
What theory challenges the activity theory?
Disengagement theory (1961)
how does the disengagement theory view aging
as a time of withdrawal or separation from past roles and activities (maybe to transfer roles to younger generations)
What theory supports the idea that societies need orderly ways to transfer power from older to younger generations, and to prepare for disruption entailed by the death of oldest members
disengagement theory
How do social systems deals with the problem of aging?
by institutionalizing mechanisms of disengagement or separation from society
- Retirement, withdrawal from paid occupational roles
Older adults are presumed to benefit from
more passive roles, less frequent social interaction, and a focus on their inner lives
Disengagement is viewed as
inevitable and adaptive
What are challenges posed by the disengagement theory
a. Allows older people to maintain a sense of self-worth while adjusting to the loss of prior roles by withdrawing from social responsibilities
b. Challenges the assumptions that older people must be actively engaged in order to be well adjusted (Instead, views old age as a separate and distinct period of life, not an extension of middle age)
c. Cannot be assumed that older peoples withdrawal is necessarily good for society
d. Fails to account for variability in individual preferences, personality, culture, and opportunities within aging population
Why is the disengagement theory discounted by many gerontologist?
growing emphasis on active aging
What theory challenges both activity and disengagement theory?
continuity theory
Continuity theory focuses on what?
how individuals adapt to aging
- says that individuals tend to maintain a consistent pattern of behavior as they age
- Become more of what we already were when younger
The continuity theory says that older adults substitute similar types of roles for what
lost ones and keep typical ways of adapting to the environment
The continuity theory states that people do not change dramatically as they age and their personalities remain similar throughout their adults lives UNLESS
unless faces with major illness or highly disruptive life events
According to the continuity theory, when do older adults tend to be most satisfied?
if their current activities or lifestyles are consistent with their lifetime experiences
According to the continuity theory, what happens to personality as you age?
Central personality characteristics become more pronounced and core values more salient with age
For ex. People who have been more passive or withdrawn are unlikely to become socially active or volunteer upon retirement
The continuity theory overlooks what?
the role of external social, economic, historical and political factors that influence the aging processes
For ex: losing a job and home because of recession may have more impact on how one experiences aging than does ones personality and earlier life patterns
The continuity theory looks at individuals, does not account for what
biological and psychological changes that occur over time
What are some new Social Theoretical Perspectives
- Age Stratification Theory
- Social Exchange theory
- Political Economy Theory of Aging
- Social Construction
Age Stratification Theory
Examines how cohort and historical time periods affect aging
Just as societies are stratified in terms of social class, gender and race, every society divides people into categories or strata according to age
–> “young”, “middle-aged”, “young-old”, and “oldest-old”
A persons experiences with aging, including their roles and life satisfaction, vary with what?
give an example of this, and state what theory this relates to
varies with their position in age structure
For ex: a young old adult who is still employed exhibits different behaviors and attitudes as a result of their position in age structure
( Age Stratification Theory )
According to the Age Stratification Theory, a persons life stage and historical context (WWII, Great Depression, etc) explain what
differences in how people behave, think, and contribute to society
What theory does this explain: Great Depression cohort are more fragile and value self-sufficiency
Age Stratification Theory
Because of relationships to historical events, how do people in the old-age stratum experience aging process compared to older persons in the past
they experience aging processes differently
Why will baby boomers alter the age stratification system
given their large size, higher education and income levels, greater diversity, and redefined lifestyles
Give examples of how do baby boomers who are retiring today differ as a whole from the cohort that retired in the 1950s
Believe they should have lifestyle options
Reject notions of “seniors,” dependence, disability and frailty
More emphasis on remaining independent and productive
Technology savvy
View retirement and leisure more positively
Physically active and healthier
Live long enough to be great-grandparents
More planful and proactive about dying process
What happens as each successive cohort moves through the age strata?
they alter conditions so that later groups never encounter the world in the exactly the same way, and age differently
Social exchange theory
Draws upon an economic model of the cost-benefits of social participation to answer why social interaction and activity decreases with age often
Withdrawal and social isolation result from what? what theory does this relate to?
Results from unequal exchange process of “investments and reut unequal exchange
Social exchange
If an older person perceives the contributions are no longer valued by other, what happens?
they begin to withdraw from participating in social activities
Adaptive behavior
adjust to new less active role rather than actively seeking to influence their environment
Older adults generally seek to maintain _____. Explain
reciprocity
Offer resources to younger generations as long as possible, allowing them to exert some power in relationships – often a source of satisfaction
The Social Exchange Theory states that because of changes in roles, illness, or relocation, elders may have fewer economic or material resources to exchange, which can lead to what
their status may decline
- Not inevitable since they offer many nonmaterial assets (wisdom, love, respect, time)
Political Economy Theory of Aging views social class as
the primary determinant of older people’s position and life satisfaction
Inequality has increased, particularly among what age group
older adults
Groups in power trying to sustain their own interests by maintaining class inequalities ….what theory?
Political Economy Theory of Aging
“the rich get richer and the poor get poorer”
Political Economy Theory of Aging
What shapes the experience of aging and age inequalities in society
Socioeconomic and political constraints
inequalities are a result of what?
age, social class, race, ethnicity, gender, sexual orientation, and functional ability
Cumulative disadvantages
structural disparities experienced by people earlier in life are intensified in old age
Structural factors are institutionalized and reinforced by what
public policy
major problems faced by older adults are what
social constructed
- could be changes through political action and policy if those with power were willing to allocate more resources to their solution
Social Construction: Aging is defined as
a problem more by culture and society than by biology and bodily changes
Negative ways in which age is socially constructed has consequences of what
social policy, employer practices, public perception of elders, and how they are treated
Medicaid is disproportionately allocated toward nursing home care than toward home care and support…what theory
Social construction
General public tends to think of old age as
a homogenous physical condition, overlooking tremendous diversity that exists
*No one refers to childhood or adolescence solely as a physical condition *
We need to deconstruct the concept old and focus on
eliminating structural barriers
Social construction gives greater recognition to what
the importance of our interpersonal interactions in shaping the aging experience
What are Recent Developments in social Gerontological Theory:
- social phenomenology
2. Feminist gerontology
social phenomenology
a. more qualitative
b. Focuses less on understanding the meanings that people give to the social lives in the context of everyday living rather than on the explanation of the “facts” of aging
Theories that issues with the presumed “facts of aging,” and question the nature of age, how it is described, and whose interests are served by thinking of aging in particular ways… what theory does this describe
social phenomenology
social phenomenology aims to reveal..?
what role human awareness plays in the production of social action, social situations, and social worlds.
phenomenology is the believe that what?
that society is a human construction
social phenomenology attempts to discern
subjective meaning and data (through observation)
- information that cannot be uncovered by predefined measurement scales or survey questions
What is critical in understanding older adults and the aging process
The assumptions and interpretations of the purposed facts
Feminist gerontology
Feminists theorists have added a gender dimension to the political economy and life course perspectives regarding how institutionalized mechanisms disadvantage women across the life course
Gender-based inequalities and oppression of women across the life course differentially structure men and women’s experiences of aging
How does Feminist Gerontology contend hat current theories of aging are insufficient?
because they do not include gender relations as central to the aging experience
Feminist Gerontology limits what?
Limits labor market opportunities
Those living alone are more likely to be what
poor - they are more likely to live in poverty
What are the differences of older people living alone from 1900 to 2015?
6% in 1900
29% in 2015
what is the percentages of men and women over 65 years that are living alone?
37% of women over 65, 19% of men over 65; increases with age
What is the difference between living alone vs being alone (lonely)?
Many people who live alone have an actual social life
Describe the AARP survey about people who are 45 years of age.
found that 35% of people 45 and older were chronically lonely
Social isolation is a risk factor for what?
death
social isolation may exceed other risk factors, such as?
obesity and physical inactivity
Social factors affect a persons what
physical and mental health
How does a persons health affect relationships
Poor health may hinder people from initiating or sustaining social contracts/relationships
What may affect type and extent of informal social support needed?
Gender, race, and social class
Compare the older years of women compared to men
Women outlive men, more likely to be widowed, divorced, living alone
Women have strong and more supportive friends
Describe the prevalence of non-traditional families
becoming more prevalent
What are some reasons that nontraditional families will increase?
due to legalized same-sex marriages and civil unions
How are families defined (more recently)
family often defined by interactional quality; not blood ties
More couple ____ and _____
cohabitating and choosing not to have children
is there an increase or decrease in the % of children in the total population
decrease
more __________ are raising children
unmarried couples, gay/lesbian
more _______ are raising children without a partner to help raise them
single women
more _______ are working outside the home
mothers of young children
more _____ marriages
interracial
_____ families are increasing
multigenerational
What ethnicity is common for having multigenerational households?
African Americans, Latinos, and Asian families
In 2014, ____ of households encompass 3 or more generations
19%
What are skipped-generation households
Intergenerational, grandparent/grandchild households
Parent is not present in household
Explain house skipped-generational households are increasing
7% of children raised by grandparents in 2010
Why the increase in multigenerational households?
- longer life expectancies
- rising increase of immigrants in the US
What is a primary factor for the increase in multigenerational households?
economic/financial factors
- high employment, rising home foreclosure, lack of affording housing options
- families are coming together to share space rather than spend money separately
Formal Supports (caregivers)
Professional services that are paid for (insurance, private pay, etc.) or are funded by local, state and federal government
- Formal supports are very expensive
Examples of formal supports
Doctors, nurses, social workers, physical therapists, OT, NA, homemakers, ETC.
Homemakers do what
clean, make food, relationship
informal support (caregiver)
members of a person’s social network who provide informational, emotional, or instrumental assistance
Examples of informal support
Family members, friends, neighbors, community volunteers, acquaintances, pets
Friendly visits, transportation/ride, shopping and errands, caregiving, companionship
where does the bulk of the care come from in the US
informal supports
What is the most important source of informal support for older adults
family
___ of older men live in a family setting, compared to __ of women
70%; 40%
Who is more likely to live with children, sibling, or other relatives
Widowed women
Why do adult children move back into home?
Typically for financial reasons and to provide assistance and support to older parents
What race is more likely to live with a family member other than a spouse
AA, Asian Americans, and Latina elders
IADLs
instrumental activities of daily living
grocery shopping, laundry, cleaning, meal prep, yard care, medication management
ADLs:
Activities of Daily living
dressing, eating, grooming, walking, toileting, bathing
Increasing age increases the likelihood that older adults will what?
will need assistance from an informal caregiver
Support and assistance provided by non-paid supports –> this is example of what
informal caregiving
Care needs vary how?
from person to person
How many adults in the US are providing care to someone who is ill, disabled, or older?
43.5 mil
Caregiving averages
24 hours/week; 13 days a month on IADLs; 6 days on ADLs
How many are providing the care for someone 50+
34.2 mil
how many are providing care to someone with dementia
15.7 mil
___ of caregivers are female
66%
___ of caregivers are 18-49; __ are 65+
48%; 34%
how many care for 2+ people
34%
how much care for parents? inlaws?
42%; 7%
how much care for a friend, neighbor or other non-relative?
15%
how many care for grandparent?
7%
Annual economic value for informal caregiving in 2015 was estimated to be
470$ billion
- to put in perspective, Walmart has annual revenue of 422$ bil
Value of informal caregiving for 65+ is
234$ mil
- More than what is spent by medicare, medicaid, and private insurance for institutional and home/community based services
Informal caregivers constitute a large and overlooked component of what
American economy, Heath-care system, and long-term services/supports
Without informal caregivers, what could collapse - explain
formal healthcare and long-term services/support systems
- Government funding/programs already being cut
- High pressure to quickly discharge patients from hospital and prevent re-hospitalizations
Cost of informal caregiving: Primary Stressors
hardships and problems anchored directly in caregiving
Cost of informal caregiving: secondary stressors
occur when primary stressors spill over into other aspects of caregivers life (job, friendships, etc.)
- Role strains, adjustment difficulties, financial losses
caregiver burden
physical, emotional, and financial costs associated with care
objective burden
daily physical tasks; time and finances devoted to care
Driving to appointments, managing medications and symptoms, handling legal, employment, financial aspects
subjective burden
caregivers emotional or feelings; how they perceive burden of care
- Grief, anger, guilt, worry, loneliness, sadness
Caregivers experience stress/burdens in three primary areas, what are they?
- Poor physical and mental health outcomes
a. Weakened immune system; hypertension; anxiety; depression; sleep disorders - Financial
a. Direct costs for medical care, equipment, hired help, lost income due to absence from work or quitting job - Emotional
c. Subjective burdens; loneliness; isolation; anxiousness; feeling overwhelmed; feeling fearful; and submerged in the care role
factors influencing level of caregiver stress?
- Nature of relationship between the caregiver and recipient
- Living with the care recipient
- Limited financial resources
- Timing in a caregivers life course (multiple demands/responsibilities)
- Gender (females have higher levels of depression/anxiety)
- Race and ethnicity (religion and spirituality may help some cope with stress)
- Social support networks
- Degree of reciprocity between caregiver and care recipient (can buffer stress)
Benefits of informal caregiving
- Confidence building
- Self-affirmation
- Pride
- Relief
- Greater closeness with care recipient
- Opportunities to improve relationships
- Find personal meaning; giving back
- Build resiliency
Elder abuse/mistreatment is not solely due to
caregiver stress
Elder abuse/mistreatment is most often connected to what?
- Caregivers own emotional or behavioral problems
- Mental or physical health problems
- Alcohol or drug dependence
- Resentment
- Isolation
- Poor coping mechanisms
- Lack of experience/education
- Power inequities (financial dependence between caregiver and care recipient)
Elder abuse/mistreatment
Any knowing, willful, or negligent act by a caregiver or other person that harms or causes risk of harm to a vulnerable, dependent adult
Elder abuse/mistreatment can occur in any style, such as
home, assisted living, nursing home, etc
types of abuse/mistreatment
- Physical
- Sexual abuse/exploitation
- Financial abuse/exploitation
- Emotional/psychological abuse
- Neglect/abandonment (either self-imposed or by another person)
Neglect
caregiver fails to meet the needs of a person
–. Withhold nourishment, medications, medical care, hygiene, etc.
- Not always intentional
Self neglect
older adult engages in behavior (or lack of behavior) that threatens safety; fail to meet their own needs
Inability to perform essential self-care activities (medical care, meals, administer medications)
Financial abuse and exploitation
improper use of an elder’s funds, property, or assets
- Door to door scans
- Professional swindles by insurance or investment agents
- Caregiver, relative, acquaintance abuse
How does Iowa go about elder abuse/mistreatment
each state has its own procedures for identifying and/or reporting abuse
Per Iowa Dept of Human Services: Dependent Adult
“A person eighteen years of age or older who is unable to protect the persons own interests or unable to adequately perform or obtain services necessary to meet essential human needs, as a result of a physical or mental condition which requires assistance from another, or as defined by departmental rule”
Per Iowa Dept of Human Services: Caretaker
“A related or non-related person who has the responsibility for the protection, care, or custody of a dependent adult as a result of assuming the responsibility voluntarily, by contract, through employment, or by order of the court”
Currently, what must be evident for a state to investigate for elder abuse/mistreatment?
must be evidence that dependent adult is unable to protect themselves from abuse (dementia, cognitive deficits, severe mental health issues, etc)
“Dependent Adult Abuse”: physical injury
Physical injury: to, or to which is at variance with the history given of the injury, or unreasonable confinement, unreasonable punishment, or assault of a dependent adult.
“Dependent Adult Abuse”: The commission of a sexual offense
The commission of a sexual offense: under Iowa code 709 or section 726.2 with or against a dependent adult
“Dependent Adult Abuse”: exploitation
Exploitation of a dependent adult which means taking unfair advantage of a dependent adult or the adults physical or financial resources for one’s own personal or pecuniary profit, without the informed consent of the dependent adult, including theft, by the use of undue influence, harassment, duress, deception, false representation, or false pretensions
“Dependent Adult Abuse”: The deprivation of the minimum food shelter, clothing, supervision, physical or mental healthcare or other care
The deprivation of the minimum food shelter, clothing, supervision, physical or mental healthcare or other care necessary to maintain a dependent adults life or health as a result of the acts or omissions of the dependent adult.
“Dependent Adult Abuse”: Sexual exploitation
Sexual exploitation of a dependent adult who is a resident of a healthcare facility, as defined in section 135C.1, by a caretaker providing services to or employed by the health care facility, whether within the healthcare facility or at a location outside of the healthcare facility
Mandatory Reporting per Iowa Law:
social workers, police officers, psychologists, homemaker/home health aides, health practitioners (physicians, nurses, dentists, chiropractor, optometrist, EMS, etc.); staff of community mental health center, staff of supported community living service, sheltered workshop, or work activity center; outreach employees
Must report suspected abuse or neglect to who?
DHS (or DIA is in a care center, assisted living, ETC.)
What are we doing to stop elder abuse?
- FMLA (family medical leave act) and other dependent care workplace policies
- Respite care
- Caregiver support groups
- Educational/skills training events directed to caregivers
- Adult day services
- In-home services and supports (medicaid elderly waiver services, CDAC)
- Care centers; assisted living options
Elder abuse prevention and intervention
Partnership with DHS, law enforcement, attorneys, health and human service providers and others
Economic status often influences what?
how we feel about ourselves
- specifically our income and job
Old age is profoundly influenced by economic status and social status –> what are some examples of the difference status’s
wealthy vs. poor
employed vs. retired
private pensions vs minimum amount of SS
financial resources do not guarantee what?
quality of life and satisfaction
What do financial resources effect
physical and mental health
what is a relatively recent phenomenon in western society
retirement
prior to the industrial revolution, how long did people work?
until they died
What did retirement develop with?
industrialization, surplus labor, and a rising standard of living
When did SS come about and what was the purpose
1935; established the right to financial protection in old age
- based on economic contributions to society
- supports people of all ages who are unable to work due to illness/disability
- created new jobs for younger people by “removing” adults 65+ from the workforce
What prolongs the amount of time people rely on SS and other retirement benefits?
earlier retirement and longer life expectancies
- more pressure on SS systems
What inadvertently limits job and retraining options
the perception that people are “old” at age 65; people are seen as physically of cognitively incapable of employment or other activities
do most people do extensive planning for long phase of their retirement?
no
how do most adults derive most of their identity
from their job - many enjoy their jobs and get satisfaction from working
Why do some adults prefer to keep working past retirement?
to feel productive and give them sense of meaning and purpose
baby boomers assumed they would enter old age with what
adequate economic resources
Many baby boomers are better off financially/economically, resulting from
- Deferred marriage
- Reduced and later childbearing
- Higher education attainment
- Longer work hours
- Women increased labor force participation
- Acquired most real estate and invested in the stock market
- Multiple jobs/careers
- Switching jobs voluntarily and involuntarily
- Reinventing themselves in middle age
The future of many baby boomers if significantly impacted by what
recent global economic downturn and US recession
Why are baby boomers more negatively impacted by recession then prior cohorts
- Borrowed more and saved less than their parents
- Hold fewer assets
- Real estate values plummeted
- Private investments, esp. Individual retirement accounts or IRAs, decimated by economic downturn
what percent of boomers reported significant losses in their retirement funds after what year
60%; 2006
many baby boomers remain employed out of urgency and solely for what reason
financial
a large amount of young adults and middle aged adults report having how many savings
no or little savings
describe the retirement trend prior to 1986
Retirement age at 65 was mandatory for most jobs
- majority of people retired sooner –> 60-64
average age of retirement in 2013 was ____, up from ____ two decades ago
61, 57
what does the average American plan to retire at in 2019
66 or 67
Other factors determine when most workers leave labor force
health, social relationships, economic status, extent of financial preparation, and geographical location
Retirement goals change over the year, describe this and explain why is it the way it is
generous early retirement incentives to new incentives to delay retirement
- This is because we do not have the same retirement funds set up through corporations, the private retirement plans that were available to a lot of people are not the same, and the SS programming is under so much more pressure with all the people coming into the program
Why do older adults feel obligated to work longer?
a. Recession (2008) and reduced income and savings
b. Increased life expectancy and living up to 1/3 of life on a fixed income,
c. Decline in availability of private pensions
d. Escalating Medicare premiums and health care costs
e. Long-term care costs as they care for aging parents
Changing perspectives of work and retirement: societal perspective
changing values about “appropriate age” for education, employment, retirement, and leisure require re-examination of employment policies and norms
- “rewiring” rather than retiring
- more middle-aged and older persons enter or reenter collage, take courses, move into new careers, or begin graduate/professional degrees
Changing perspectives of work and retirement: other countries
Other countries are fostering new models of work and retirement
Changing perspectives of work and retirement: some Scandinavian countries
year-long sabbaticals every 10 years to re-evaluate careers or take break
Changing perspectives of work and retirement: Japan and European countries
“gliding out” plan of phased retirement in Japan and some European countries
–> Permits a gradual shift in a par time schedule and for older workers to train younger ones
Changing perspectives of work and retirement: how can jobs be reconstructed
allowing longer vacations, shorts workdays, and more opportunities for community involvement during preretirement working years
Encore Careers Movement
spawned nonprofit groups and programs that aim to help older workers find public service jobs that benefit society
describe the rate of older unemployed adults
Number of older adults employed has increased steadily
___ of 55+ were employed in 2013
Expected to hit ___ by 2019
20%; 40%
Those 65+ and employed has increase at least ___ since 1977
10%
The increase in number of women 65+ employed since 2000 was nearly ___ as much as for men
twice
Labor force participation is greatest among who
those 65-69 and those who have highest levels of education
More employed older adults are more likely to be employed ________________________.
full-time, though they prefer to have part-time flexible work
Like all age groups, unemployment rate for 55+ is at ___ levels; ~___, highest since 1948
high; ~8%
Describe the unemployment rate for older adults
unemployment rate has doubled since 2007
what makes it hard for older workers to get hired
ageism
Younger applications are often more desirable due to:
- Their willingness to work for less
- Their more “relevant” skill set
- Being considered more trainable
Barriers to unemployment
- Lack of job-hunting and technological skills
- Lack of confidence
- Businesses less likely to modify work environments, allow part-time work, or provide job retraining for older workers
- Age-based employment discrimination
- Negative stereotypes about aging and productivity
Age Discrimination in Employment Act (ADEA)
reduced blatant forms of age discrimination and eliminated mandatory retirement for most occupations
Since businesses are less likely to modify work environments, allow part-time work, or provide job retraining for older workers, what is the focus on?
efficiency and reducing costs, not accommodating older workers needs
Income sources for older adults
a. social security
b. assets
c. pensions
d. public assistance
Income sources for older adults: social security
Provides a foundation of retirement protection for Americans
What was SS intended to be
to be a supplement to other pensions and individuals savings
Eligibility for SS
determined by what you have paid into the Social Security system through payroll taxes as an employee
Social Security accounts for ___ of aggregate income for older population
33%
___ of beneficiaries depend on SS for ___ or more of their income
~25%; 90%
___ of older adults would be poor without SS
35%
42.5 mil retired people received SS in 2017, how much money?
60$ bil
Average retirement benefits are ___/year or ___/month; maximum in 2013 was ___/year
$16,848; $1404; $30,000
who is most likely to rely solely on SS as their only source of income
Women, elders of color and oldest-old
- they also tend to receive less than the average monthly SS benefit
income sources for older adults: assets
Interest-bearing saving and checking accounts that typically generate low earnings
- investments
- home equity
- personal property
What is arguable the most important asset?
home equity –> “financial safety belt” if not longer paying a mortgage (or owe more than what its worth)
Compared to current elder cohort, boomers are less likely to have ____ and more likely to have ____.
paid off mortgages; refinanced
Many older adults report what for asset income?
no asset income
Who is more likely to report no asset income?
women, oldest-old, and persons of color
60% of workers report that they have saved less than _____ for retirement
$25,000
Income sources for older adults: pensions
- Tied to a specific job and administered by an employer, union, or private insurance company
- Generally based on earnings/combination of earnings and years of services
- Intended to supplement social security income
what percent of employees receive pensions
~28%
what are the 2 types of pensions?
- Defined benefit pension plan:
a. employees pension payment is calculated according to length of service and earnings history
- Fixed/specified amount of guaranteed by the employer/company as a lifetime
- annuity
- IPERS - Defined contribution plan:
a. specifies how much money will go into a pension plan; employers, employees, or both contribute to plan
- 401K
Income sources for older adults: public assistance
Supplemental Security Income (SSI)
Supplemental Security Income (SSI)
income supplement program for elders, visually impaired, and disabled living on little or no income/resources
SSI does not require what
history of covered employment contributions
–> instead, must meet income and resource eligibility requirements
Maximum monthly SSI benefits (2018): eligible individual / couple
Eligible individual = 750$/mo
Eligible couple = $1125/mo
can supplement income through SS?
yes as long as they meet eligibility
SSI recipients may qualify for
food stamps and medicaid
why do many people not apply or participate in public assistance programs?
difficult and time consuming application processes
Many states have reduced SSI, as well as?
food assistance, and Medicaid benefits
who may be denied public assistance programs
immigrants
Summarize the gist of SSI
SSI helps get one to the lowest standard of living
Social class in old age is largely influenced by what
larger economy, past and current employment patterns, and resulting retirement income and benefits
Social class shapes what
shapes what is possible in old age and how to spend ones time in work or retirement
Social class is related to what
every measure of health, illness and disability
social class affects access to what?
medical and dental care, out-of-pocket health care costs, living situations, and social networks, transportation, and opportunities to experience productive activities
Income we have across the life course profoundly affects what
our choices in old age
Older adults are benefited from policies designed to give a minimum standard of income and health care such as…?
Social security and Medicare
older adults are more likely to own what
their own homes and have other assets like savings and retirement
Describe older adults net worth compared to those younger then 35
net worth tends to be greater than for those under 35
networth
all sources of income/assets
- However, those assets do not necessarily translate to liquid or disposable income, or money they can spend
Overall, proportion of poor adults is ___ than children and people aged 18-64
lower
Percent of poor elders ___ in past decade for the first time since the 1950s
increased
percent of poor elders may continue to increase, why?
if SS benefits don’t include costs of living increases
Around ___ of adults 65+ currently live at or below federal poverty level
9%
what was the federal poverty level in 2018?
$12,140 for one person; $16,460 for two people
what % of elders are considered “economically insecure”?
36%
- Living at or below 250% of poverty level; at risk for being poor
- A crisis or price spike could push them into poverty
Statistics for poor elders do not include who? what does this mean?
hidden poor; those living with relative or in long term care facilities
older adults are at _____ and _____ than those 18-64
marginal levels of income and greater risk of poverty
factors that increase the risk for economic insecurity in old age
- female
- over age 85
- living along
- LGBT
- AA, Latino, American Indian or Alaskan Native
- living in south
- housing costs exceeds 30% of income
cumulative disadvantage
argues that inequality is a cumulative process over the life course
- Inequalities experienced in old age are piled onto disparities faced as early as childhood; intensifies gap between rich and poor
- Inequalities typically become worse and are hard to reverse
___ of elders experience food insecurity
8%
food insecurity
Households that do not have enough food for every person to live an active, healthy life
Elders often forced to choose between paying for what
medications, healthcare, and putting food on table
People struggling to eat are almost 3 times more likely to what
skip pills, delay refilling prescriptions, or stop taking meds entirely
Older adults who face hunger are more likely to report what?
poor health, vitamin deficiencies, hospitalizations, and limitations in ADLs
What are the 2 primary insurance policies?
medicaid
medicare
medicaid
- state and federal funded program
- income and specific eligibility based
- Managed Care Organization (MCO)
- different for each state
how many medicaid programs in iowa?
26
medicare
- federally funded program
- age based eligibility
What are the 4 parts of medicare?
Part A: hospital care (not LTC)
Part B: doctors, medical tests, procedures, etc (anything you have had done to you; monthly premium)
Part C: Medicare advantage –> administered by private insurance companies
Part D: Prescription drug coverage; monthly premium
explain how medicare is not a comprehensive health insurance plan
there are “gaps” in coverage
ex. medicare does not cover LTC
Social security
A benefit available to individuals who are retired or disabled –> 3 main programs of the SS administration that can be accessed
Describe how social security has to do with retirement
- SS based on retirement age
- -> Begins at age 62
- ->Full at 66
- ->Based on your ss credits
- ->Spousal programs
SSI - Supplemental Security Income
Program that is strictly needs based according to income and assets
- disability or age controlled
- solely based on need
What is SSI (Supplemental Security Income) funded by
general fund taxes
Why is SSI (Supplemental Security Income) called a “means tested” program?
it has nothing to do with work history but strictly involved in financial needs
what do you need to meet the requirements for SSI (Supplemental Security Income)
you must have less than 2000$ in assets (3000$ for couple)
people who receive SSI (Supplemental Security Income) benefits are receiving what?
receiving enough money to bring them up to poverty level
SSDI (Social Security Disability Insurance)
- payment based on work history
- spousal and developmental support
- under age 65
how is SSDI (Social Security Disability Insurance) funded
through payroll taxes
SSDI (Social Security Disability Insurance) candidate requirements
must be younger than 65 and have earned a certain number of work credits (the amount of time they spend in the workforce directly impacts the money they receive and the eligibility for the program)
what happens when you have received SSDI (Social Security Disability Insurance) for 2 years
you become eligible for Medicare
A disabled person spouse, children, or dependents are able to receive partial depend benefits called…?
auxiliary benefits —> only ppl 18+ are able to receive the actual benefit
Supplemental Nutrition Assistance Program (SNAP)
- “food stamps”
- Food assistance program that provides and electronic benefit transfer (EBT) card that can be used to buy food at supermarkets, grocery stores, farmers markets, CVS
- Must meet requirements
- Children are still eligible is their parents are not citizens
what do policies typically result from?
legislation –> then translate into regulations, programs and services that determine how funds are allocated among different groups
– >Who should receive what benefits, from which sources, and on what basis
What shapes policy
Values, beliefs, and ideology
What are two contrasting core values reflected in many debates
- Individual welfare is essentially a person’s responsibility within a free-market economy unrestrained by government control
- -> Individualism, self-determination, personal choice and privacy - Individual welfare is the responsibility of both the individual and the larger community
- -> Government intervention (like Medicaid) is required to protect its citizens and to compensate for free market’s failure to distribute resources equitably
From the 1930s to the 1980s, public perception of older people was what?
more “deserving” than other age groups converged to create the universal categories of Social Security, Older Americans Act, and Medicare
means-tested policies determine what?
if a person is “deserving” of services reflect societies bias toward productivity and economic self-sufficiency
- Argue that state/local governments, private sector and individuals are responsible for own well-being
- Encompass self-help, family caregiving, private retirement investments, faith-based organizations, and volunteerism
Over the past 5 decades, programs for older adults shifted from government ensuring adequacy and protection to what?
cutting budgets, reducing government size, and increasing revenues
Our society has emphasis on individual responsibility with government playing what kind of role?
a residual or “backup” role
–> Government only intervenes when economy, family, or individual fail to provide for themselves or relatives
Western european countries have health and welfare policies representing a collective national responsibility that all citizens are entitled to have basic needs met by government –> what are some examples of this policies
Cradle to grave policies
Free healthcare for all
an ongoing debate is whether services should be delivered on the basis of ___ or ___.
age or need
What are the arguments for the entitlement programs based on age
- Efficient way to set a minimum floor of protection and transfer resources to older population
- Less stigmatizing
Critics of age-based programs argue what?
- No longer economically feasible; too many people
- Some people are relatively healthy and have enough income/resources to pay for services
- Reinforce the perception of “the old” as a problem
- Eligibility should be selectively determined on basis of income and functional ability to provide safety net for most vulnerable elders
Intergeneration inequity perspective
Emerged when fiscally conservative groups claimed that older citizens are “greedy geezers,” thriving at expense of younger age groups, and selfishly concerned only about retirement benefits.
- contend that SS is jeopardizing future generations and lowering responsibility for own retirements
Interdependence of generations framework
- Argues that younger and older generations support each other across the life course
- Address income inequalities among older adults
- Recognizes that many age-based programs often benefit younger generations
Facts about age-based policies
a. Age-based policies are often at center of various proposals to reduce government spending
b. Federal expenditures for older adults are growing as life expectancy and older population increases
Spending for SS, Medicare and Medicaid is estimated to outpace economic growth by___ times by 2030
2-3x
- not only drivers of growing deficit
- tax cuts
- Escalating defense spending and healthcare costs
Current reserves in Social Security Trust Fund help pay for what?
other federal expenditures as government borrow from these to cover other expenses
Since 2001, funding for defense has grown much faster than average growth rate for what?
Social Security, Medicare, and Medicaid combined
Age-based entitlement programs
most adults are automatically entitled to receive benefits based on their age, not on financial or health needs
- SS and Medicare
- Based on lifetime contributions into these public insurance/pension systems
Universal and categorical benefits
available as a social right to all persons belonging to a designated category
- Including age-based programs
- Older Americans Act
Need based or means-tested programs
decide eligibility by financial need
- Medicaid, Elderly Waiver, Supplemental Security Income (SSI), food assistance
Age-based policy approaches evolved in a very different historical period - explain how it was different
- Life expectancy was shorter
- Chronic diseases relatively rare
Poverty of elders higher than older age groups - Federal deficits less concerning
- Lower percentage of older adults in US (5% of population)
First Policies to Benefit Older Americans: 1930s-1950s –> what was the primary cause for increased government responsibility for older adults
economic factors
First Policies to Benefit Older Americans (1930s-1950s) was fueled by what
great depression
when was SS implemented
1935; it was assumed to cost less than reliance on local poorhouses
by encouraging retirement, SS was a strategy to reduce what?
unemployment, and create job for the young
First Policies to Benefit Older Americans (1930s-1950s) –> what did no one predict
Nobody predicted medical advances, longer life expectancies, and fewer young people paying into SS system
Expansion of programs in the 1960s and 1970s:
- Periods of economic growth can also be conductive to new policies
- Time of economic progress and increased social consciousness about needs of vulnerable populations
- Medicare, Medicaid, and Older Americans Act passed what
1960s and 1970s
Expansion of programs in the 1960s and 1970s: “graying” of the federal budget
- Creation of a wide array of major federal programs and interest groups
- directed toward older persons
Cost Efficiency and Program Reduction (1980s and 1990s) –> what are different factors that influenced policies
- A growing federal deficit and pressures to reduce government costs
- An anti-tax mentality
- Increasing concern about younger groups economic well-being
Cost Efficiency and Program Reduction (1980s and 1990s): what happened to public support for universal age-based benefits
began to deteriorate
Cost Efficiency and Program Reduction (1980s and 1990s) –> explain how economic diversity among the older population occurred
- Generous private pension and personal savings increased
- Became more apparent that chronological age is not accurate marker of financial status or functional ability
- Old age no longer considered sufficient ground for public benefits
Cost Efficiency and Program Reduction (1980s and 1990s) –> major societal shift in attitudes toward older population resulted in cuts across what?
the political spectrum
- Social security, medicare, and medicaid were drastically curtailed
- Belief increased that older adults should finance their own retirements
reduced government spending: Market and personal responsibility (since 2000)
Age-based entitlement programs were further challenged by Republican administration and Republican majority in Congress
- cost and intergenerational inequity issues that surfaced in 1980s are still salient
reduced government spending: Market and personal responsibility (since 2000) –> with democratic administration and congress in 2008, value stance was to what?
increase policy and supports for vulnerable populations of all ages
- was found difficult to act on values due to recession, record high number of unemployment and deficit, and Republican congressional victories in 2010
Factors influencing where elders live
- health status
- functional ability
- geographic location
- activity interests
- finances/income
- families/support
what percent of older Americans live in urban and suburban areas
80%
What percent of older Americans live in rural areas with fewer than 2500 residents
5%
- Often have lower income and poorer health
- More limitations in mobility and activity
- Lower availability of services, healthcare and transportation
- More interactions with friends and neighbors; robust informal support systems
Graying of the suburbs
significant proportion of people who moved into suburban developments in 1960s and 1970s remained there after retirement; fewer young people/families moving into these areas
- -> Designed around automobile
- -> Lower density of housing, greater distance to services, fewer mass transit options
Urban elders
- More public transportation
- Sidewalks conductive to walking
- Better and closer access to social and health services
- Higher risk and fear of victimization and crime
age with lowest victimization of crime
65+
generally, relocation is in response to major changes in lives such as what
Retirement, poor health, loss of partner
Existing home environment no longer fits their needs or is unsafe
Often time relocation is met with resistance
what percent of those 65+ live in traditional housing
90%
Over 23 million elder households
–> __ are homeowners and __ are renters
80%;20%
- Single-family homes, condominiums, mobile homes, cohousing/cooperatives, and apartments
Aging in place
The desire and ability to live in the home of your choice independently and safely for as long as possible
aging in place is associated with what
better health, life satisfaction and self-esteem - “home is where the heart is”
Age-friendly/Livable Communities
- Strategy that supports “livable” or “lifelong” communities
- Recognizes importance of physical design, environment, and accessibility as well as transportation, recreational activities, civic engagement, and social engagement
home and community based services
Help older adults age in place in the least restrictive environment possible
How have home and community based services evolved
evolved from emphasis on institutional care to home/community-based care
home and community based services include
- Adult day services
- Home delivered meals
- Respite care
- Home repair and modifications
- Homemaker services to assist with IADLs
- Personal care/aides to help with ADLs
- Chore services to assist with home/yard maintenance (lawn mowing, snow removal)
- Caregiver reimbursements
- Assistive devices
- Transportation
- Case management
- Various funding streams and eligibility criteria
home healthcare
home care services have increased dramatically as Medicare/insurance companies seeks to reduce hospital and nursing home costs
__ of older adults go online (~__ in 2012)
67%; ~50%
__ own computer/tablet
32%
__ have smartphones
42% –> Older smartphone owners are more likely to make 75K more
why will usage of information and community technologies continue to increase?
many boomers used ICTs in workplace
Ownership and usage of information and community technologies drops off considerably among what age
older-old (75+)
More places offering classes/trainings to computer w internet such as…
Library, community centers, senior centers, AARP, other nonprofit organizations
More older adults live in a home with internet access –> __ have high speed internet at home (__ in 2013)
51%; 47%
Assistive technologies
products, devices, or equipment that people with physical or mental limitations use to perform functions that might otherwise be difficult or impossible
- Walkers, WC, BR equipment, transfer equipment
- LifeAlert, Lifeline
- Hearing and visual aids, medication reminders
Telehealth
health information is transmitted electronically from the patients home to physicians office or ambulatory care setting (health clinic, specialist’s office, etc.); can also be transmitted to family members for surveillance
- Can increase compliance with meds/recommendation
- Improve patient’s perceived control or self-efficacy over their health
- Reduced hospitalizations and ER visits
what group is at the forefront of using telehealth
VA –> More than 35,000 veterans enrolled in telehealth
Patients with chronic diseases monitor and transmit vital signs via phone line to secure central site, which is reviewed by clinics
Gerontechnology
recent field of research and practice aimed at using technology to improve older adults’ autonomy (and likelihood of aging in place)
- -> Portable keypads or remote controls for operating thermostats, windows and their coverings
- -> Systems that make a room light up through sensors in the floor can help prevent falls
Robotics
being developed and used to help elders perform routine housework and personal services; and provide companionship
Smart homes
residences equipped with technology that connects all the devices and appliances in a home to communicate the residents
- -> Residents can use their voice, a remote control, or a computer to command their home network to open doors, light a path, turn on exterior lights, regulate room temp.,
- ->Can help monitor elders with care needs and reduce caregiver burden by allowing technology to help with some aspects of personal care and support
MedReady
automatically dispenses medications up to 4 times a day; is med is not taken within a certain amount of time then data/call center notifies family, contracts person, etc.
- Some are locked and set up by a nurse
- Automated system to call person after the scheduled med time and ask if the pill has been taken; if no response or older person does not recall taking meds, then phone alerts are sent to family member or other contact person
- Software to call and remind them when it is time to take meds
- Some devices/technology covered by insurance/Medicare/Medicaid
What are some examples of medical alert systems
Necklace or bracelet that can help elders who have fallen or have another emergency
Connects to emergency personnel or a designated individual is pushed
Some detects falls and alert people without being pushed
Government-subsidized housing for low-income elders AND age segregated housing such as assisted living is often geared to who?
middle and upper-income older adults
Active adult or lifestyle communities
offer wide range of activities and programming
Service-enriched housing
packages housing and care; different levels or care on-site; easy access to services and assistance
Continuing Care Retirement Communities (CCRC)
broadcast type of service-enriched housing recognizing that residents may need increasing levels of care over time
Continuing Care Retirement Communities (CCRC) –> Multilevel of care
offers range of housing, social, and health services on same campus
—> Independent apartments, assisted living, skilled nursing care, intermediate nursing care
—> remain in same CCRC but move into various levels of care as needed
—> expensive
Continuing Care Retirement Communities (CCRC) –> Assisted Living Facilities (ALF)
housing option for people not needing 24 hour medical care but needing some assistance
—> Private apartments with supportive services
—> Provided at least one meal a day, basic health care, minor ADL and IADL assistance, 24 hour security
how are Assisted Living Facilities funded?
Some accept Medicaid (usually through elderly waiver) funding but costs can still be prohibitive
what are the types of nursing facility care?
- Skilled care (SNF)
- Intermediate Care (ICF)
- Custodial Care (RCF)
Skilled Care (SNF)
Continuous “around-the-clock” care designed to treat a medical condition.
This care is ordered by a physician and performed by skilled medical personnel, such as RN or professional therapists. A treatment plan is established
Intermediate Care (ICF)
intermittent nursing and rehabilitative care provided by RN, licensed practical nurses, and nurse’s aides under the supervision of a physician
Custodial care (RCF)
care designed to assist with one’s activities of daily living. It can be provided by someone without professional medical skills but is supervised by a physician.
How is nursing home care paid for?
generally paid through Medicare, private pay, long-term care insurance or Medicaid
- Long-Term Care Insurance
- Private Pay - average $5,833 per month
- Medicaid - income/asset restrictions
Medicare pays for up to ____ days in a skilled nursing facility with caveats
100
Private Pay averages how much money for nursing homes per month?
Private Pay - average $5,833 per month
loss = deprivation which means
we no longer have something
unresolved grief
earlier generations told to “be strong” and not express painful thoughts/feelings
Anticipatory grief
grief reaction that occurs before and impending loss
Ex. Impending death of a loved one due to illness
Start imagining life without that person/thing
Disenfranchised grief
a loss that is not opening acknowledged by others, publicly mourned or socially supported
instrumental grief
grief experienced in more physical/cognitive/behavioral ways; more thinking and action than feeling; focus on doing and actively responding to grief
intuitive grief
grief experienced in waves of emotion; grief expression mirrors inner feelings and emotions; more feeling and thinking/action
3 stages of life review
Introspection
Self-reflection
Reminiscence
What percent of wives outlive husbands?
85%
what percent of both women and men over 65 are widowed?
40% women and 13% men
what percent of both women and men over 85 are widowed?
73% women and 36% men
elder of color are ___ higher proportion of widowhood than white peers
2x
most adults do not lose a sibling to death till about what age?
70
Kubler Ross Stages of grief
sock or denial anger bargaining depression acceptance/hope
5 wishes
type of living will/AD; designed to encourage conversations about broader questions related to health care decisions and preferences; meets legal requirements for AD in 42 states
honoring your wishes
initiated by Iowa City Hospice; 11 page healthcare directive
Includes Health Care POA, religious preferences, healthcare wishes/desires, CPR/DNR preferences, life support preferences, organ/body donation preferences, etc.
