ARTIFACT 1: PUBLIC POLICY IN AGING - GERO 6500
REAUTHORIZE THE OLDER AMERICANS ACT
Summary
Enacted in 1965 along with Medicare and Medicaid, the Older Americans Act (OAA) has been the primary vehicle for services and funding in every state that support the dignity and welfare of individuals age 60 and older. These services include programs that protect vulnerable seniors, such as the long-term care ombudsman program, nutritional programs, home-and-community based services, as well as health promotion and disease prevention activities for seniors.
Reauthorizing the Older Americans Act allows Congress to update and improve upon the law's vital programs and services. The OAA is required to be reauthorized every four years in order to provide Congress this opportunity.
The Older Americans Act expired in 2011, as Congress failed to act on this requirement. and since then legislation to continue this valuable service to our age 60-and-better Americans has stalled in House Subcommittees and Senate brinksmanship. With every day that passes the future of critical programs that serve seniors is more uncertain. Congress must restart the reauthorization process in 2015.
What is the Older Americans Act?
This legislation reauthorizes the Older Americans Act of 1965, a federal law with longstanding bipartisan support. The law provides for the organization and delivery of social and nutrition services to older Americans and their caregivers.
The federal Older Americans Act (and its reauthorization) would provide nearly $2 billion a year to support important services for senior citizens including support for family caregivers, community based programs, and particularly for long-term care services for Veterans.
A study commissioned by the US Department of Veterans Affairs concluded that between 2007 and 2017 the number of oldest veterans (aged 85+) will double, and Veterans Health Administration (VHA) enrolled veterans aged 85 and older will increase sevenfold, resulting in a 20-25% increase in use for both home- and community-based services. (Kinosian,Stallard and Wieland, 2007)
Further, the face of the American workforce is changing as people work longer in life. People are healthier, on average, at every age (Freedman,Martin, and Schoeni, 2002). Jobs are trending toward service occupations and away from a more physically demanding manufacturing sector (Lacey and Wright, 2009). And with more older women in the labor, hence more couples working, should they chose to retire together a delayed retirement may be in store for husbands. (Quinn, 2010)
Long-term care consumers benefit greatly from provisions included in the Older Americans Act. This law assists Long-Term Care consumers by:
While both the House and Senate introduced bills in both 2013 and 2014 to address funding continuance of the OAA, House Bill HR4122 was sent back to the Subcommittee on Higher Education and Workforce Training, led by Chairwoman Virginia Foxx (R-NC), and couched within the House Education and the Workforce Committee chaired by John Kline (R-MN), where it languished and stalled.
Language that will “hold harmless” funding to states, holding levels to within 99% of the previous year’s budget in most states, seems to have been the roadblock in both 2013 and 2014.
President Obama
President Barack Obama addresses OAA funded programs in the White House FY2016 budget. The Budget makes significant investments that support these priority goals, specifically in the areas of long-term services and supports, retirement security, healthy aging, and reducing elder abuse and neglect. For instance (White House Budget Fact Sheet FY2016);
The 114th Congress began well. The Senate Health, Education, Labor and Pensions Committee took up a 3-year reauthorization of the Older Americans Act (OAA) as one of its first markups of the 114th Congress, with Chairman Alexander (R-TN) enlisted the support of Ranking Member Murray (D-WA) and Sens. Burr (R-NC) and Sanders (I-VT). The Older Americans Act Reauthorization of 2015 was introduced to the Senate floor in January 2015. No action has been taken since.
The bill, S. 192, reflects a number of NCOA’s OAA reauthorization priorities, including provisions that:
We support the bill's stronger elder justice and legal services provisions, needed clarity for caregiver support and Aging & Disability Resource Centers, and new opportunities for intergenerational shared sites. The bill also retains current language that does not place any limits on how much OAA appropriations can grow.
The legislation takes the same modest approach to OAA changes as with the 2013 bipartisan bill by scaling back language that appeared in earlier reauthorization measures.
For example, rather than authorizing a new stand-alone demonstration program to identify model senior center modernization approaches and provide training and technical assistance to help other centers adopt them, the bill simply gives the Assistant Secretary for Aging the authority to accomplish this with existing resources.
Also, instead of making “economic security” a goal of the OAA, the language clarifies that the Administration's duties include supporting research and implementation of programs that address the economic needs of older adults and creating and disseminating materials related to the economic welfare of seniors.
There are two changes from the 2013-2014 bill in S. 192 that are worth noting:
The current Title III formula makes allocations to states based on the size of their senior population. However, there is a “hold harmless” clause that ensures that no state receives less than its allocation in 2006.
S. 192 includes new hold harmless language, which states that for each of the next three years that OAA is authorized and the formula is adjusted to reflect changes in states’ senior populations, every state is guaranteed to receive at least 99% of its Title III allocation from the previous year.
The committee makes clear in its summary of the bill that the intent is to protect states from losing more than 1% in each of the next three years, with no further adjustments until the OAA is reauthorized again. Also, small states known as “minimum states,” which receive a guaranteed baseline amount, would not see any changes.
But as deliberations on the hold harmless clause stalled reauthorization, it became clear that Senators needed to craft a compromise to help legislation advance.
Call to Action
Congress is about to agree to a bipartisan budget for 2015 that could again reduce federal spending for many critical senior services.
With the clock still ticking, programs will have to meet growing demand for community and home-based services and the same budgets they’ve had for the past several years have diminished or been frozen (NCOA, 2015).
Lawmakers often say they want to make it easier for seniors and younger people with disabilities to live at home. It takes a substantial infrastructure of housing, transportation, meals, health, and information services to make that possible.
By and large, the fiscal plan should increase funding from the low levels driven by recent across-the-board sequester spending cuts.
This bill reauthorizes programs through 2018 and includes provisions that aim to protect vulnerable elders by strengthening the Long-Term Care Ombudsman program and existing elder abuse screening and prevention efforts.
The bill also promotes the delivery of evidence-based programs, such as falls prevention and chronic disease self-management programs. The reauthorization streamlines federal level administration of programs, promotes the efficient and effective use of transportation services, and improves coordination between programs at the federal, state, and local levels.
Here are a few examples of what the senior services budget will look like, based on the 2014 committee work and the Older Americans Act Reauthorization of 2015 (courtesy of the National Council on Aging):
Urge Congress to Support the Older Americans Act
Chairman Alexander has chosen to make OAA reauthorization a top priority this year, the 50th anniversary of the Act. He is doing so in a bipartisan manner that remains true to the history of this important legislation.
Our goal is for the legislation to move quickly through the Senate, and for the House to then take up and pass an identical bill.
The Senate has started quickly with a January markup, but we need the full Senate and House to keep the momentum going.
Also, funding for OAA programs has not kept pace with the increasing numbers, need, and diversity of the senior population, and it is still threatened by automatic cuts imposed by sequestration.
Please help us urge Congress to reauthorize the Older Americans Act and invest in its programs.
Call your Senators and Representative. Urge them to action.
Send your Senators and Representatives an email urging prompt passage of a reauthorization of the Older Americans Act.
Copy these bullet points into your correspondence.
Sources
Aging Program Funding Table, FY2013-FY2016proj., National Council on Aging (NCOA)
Certner, D., Tell Congress Not to Leave Seniors Stranded, AARP, http://blog.aarp.org [February 12, 2015]
Congressional Budget Office, Review of S.192, www.cbo.gov/publication/49942 [April 10, 2015]
Freedman, V.A., Martin, L.G., and Schoen, R.F. 2002, “Recent Trends in Disability and Functioning Among Older Adults in the United States; A Systematic Review” The Journal of the American Medical Association.
Kinosian, B., Stallard, E., and Wieland, D. 2007, “Projected Use of Long-Term-Care Services by Enrolled Veterans,” The Journal of the Gerontological Society of America
Lacey, T.A., and Wright, B. 2009, “Occupational Employment Projections to 2018,” Monthly Labor Review.
Quinn, J.F. 2010, “Work, Retirement, and the Encore Career, American Society on Aging,” Generations; The Journal of the American Society on Aging.
White House, The President’s 2016 Budget, www.whitehouse.gov/budget_2016 [April 9, 2015]
Summary
Enacted in 1965 along with Medicare and Medicaid, the Older Americans Act (OAA) has been the primary vehicle for services and funding in every state that support the dignity and welfare of individuals age 60 and older. These services include programs that protect vulnerable seniors, such as the long-term care ombudsman program, nutritional programs, home-and-community based services, as well as health promotion and disease prevention activities for seniors.
Reauthorizing the Older Americans Act allows Congress to update and improve upon the law's vital programs and services. The OAA is required to be reauthorized every four years in order to provide Congress this opportunity.
The Older Americans Act expired in 2011, as Congress failed to act on this requirement. and since then legislation to continue this valuable service to our age 60-and-better Americans has stalled in House Subcommittees and Senate brinksmanship. With every day that passes the future of critical programs that serve seniors is more uncertain. Congress must restart the reauthorization process in 2015.
What is the Older Americans Act?
This legislation reauthorizes the Older Americans Act of 1965, a federal law with longstanding bipartisan support. The law provides for the organization and delivery of social and nutrition services to older Americans and their caregivers.
The federal Older Americans Act (and its reauthorization) would provide nearly $2 billion a year to support important services for senior citizens including support for family caregivers, community based programs, and particularly for long-term care services for Veterans.
A study commissioned by the US Department of Veterans Affairs concluded that between 2007 and 2017 the number of oldest veterans (aged 85+) will double, and Veterans Health Administration (VHA) enrolled veterans aged 85 and older will increase sevenfold, resulting in a 20-25% increase in use for both home- and community-based services. (Kinosian,Stallard and Wieland, 2007)
Further, the face of the American workforce is changing as people work longer in life. People are healthier, on average, at every age (Freedman,Martin, and Schoeni, 2002). Jobs are trending toward service occupations and away from a more physically demanding manufacturing sector (Lacey and Wright, 2009). And with more older women in the labor, hence more couples working, should they chose to retire together a delayed retirement may be in store for husbands. (Quinn, 2010)
Long-term care consumers benefit greatly from provisions included in the Older Americans Act. This law assists Long-Term Care consumers by:
- Combating Elder Abuse: The OAA combats the prevalence of elder abuse by providing states with grants to conduct elder justice activities (such as strengthening civil and criminal enforcement in court cases impacting older individuals and the creation of State Working Groups to enhance the coordination of federal, state, and local entities on elder abuse issues), administering elder abuse prevention programs, and funding the National Center on Elder Abuse.
- Supporting Family Caregivers: The OAA provides funding for the National Family Caregiver Support Program and the Native American Caregiver Support Program. These programs assist individuals that serve as unpaid caregivers for persons sixty or older and also grandparents that serve as primary caregivers for grandchildren or other related children living in the grandparent's home
- Helping to Promote Home and Community-Based Long-Term Care Services for Older Americans to Prevent or Delay the Need for Institutional Care: The OAA funds a range of home and community-based services for older Americans, including assisted transport services, home-delivered nutrition services, homemaker and chore services and transportation.
- Protecting Elderly Long-Term care Consumers: The OAA requires each state to have a long-term care ombudsman program, advocates for residents of long-term care facilities. They work to resolve problems of individual residents and to bring about improvement in resident care and quality of life at the facility, local, state and national levels.
- Helping to Educate Older Americans on Their Long-Term Care Options and Benefits: The OAA provides formula funding to states and Area Agencies on Aging (AAAs) for the purpose of providing information and assistance on long-term care options to older adults and caregivers. The law also authorizes Benefits Counseling programs in each state that assist older individuals, their family members and/or caregivers in applying for benefits and services, understanding their rights, exercising choice and maintaining their rights in solving disputes.
- Providing Access to Legal Services: The OAA helps provide legal services for the elderly through grants designed to help states integrate low cost service mechanisms, such as senior legal helplines, into state legal service systems. The law also provides funding to Area Agencies on Aging for the purpose of providing legal services to the elderly.
While both the House and Senate introduced bills in both 2013 and 2014 to address funding continuance of the OAA, House Bill HR4122 was sent back to the Subcommittee on Higher Education and Workforce Training, led by Chairwoman Virginia Foxx (R-NC), and couched within the House Education and the Workforce Committee chaired by John Kline (R-MN), where it languished and stalled.
Language that will “hold harmless” funding to states, holding levels to within 99% of the previous year’s budget in most states, seems to have been the roadblock in both 2013 and 2014.
President Obama
President Barack Obama addresses OAA funded programs in the White House FY2016 budget. The Budget makes significant investments that support these priority goals, specifically in the areas of long-term services and supports, retirement security, healthy aging, and reducing elder abuse and neglect. For instance (White House Budget Fact Sheet FY2016);
- White House Conference on Aging. “This year marks the 50th anniversary of Medicare, Medicaid, and the Older Americans Act, as well as the 80th anniversary of Social Security”, says President Barack Obama, addressing the funding of seniors programs in the White House’s Proposed Budget for the coming fiscal year.
“In 2015, the Administration will host the sixth White House Conference on Aging to recognize the importance of these and other key programs for older Americans, as well as to look ahead on how to improve and advance the quality of life for older Americans in the next decade.” - Supporting Family Caregivers. The Budget provides $15 million for a new Family Support Initiative focused on ensuring the optimal deployment of public and private resources at the State and community level to assist family members supporting older adults and/or people with disabilities across the lifespan.
In addition, the Budget includes nearly $50 million in new resources for existing aging programs that provide critical help and supports to older Americans and their caregivers, such as respite and transportation assistance. - Nutrition Assistance for Older Americans. The Budget provides $875 million for Nutrition Services programs, a $60 million increase over the 2015 enacted level, allowing States to provide 208 million meals to over 2 million older Americans nation-wide, helping to halt the decline in service levels for the first time since 2010.
The increase will also allow for new, evidence-based innovations to help ensure that funding for Nutrition Services programs is spent as efficiently as possible to maximize the impact of these funds. - Improving SNAP Access for Elderly Individuals. The Budget includes a proposal to allow states to streamline application and recertification processes to improve SNAP access for the elderly.
- Protecting Worker Pensions. The Pension Benefit Guaranty Corporation (PBGC) acts as a backstop to protect pension payments for workers whose companies have failed. PBGC receives no taxpayer funds and its premiums are currently much lower than what a private financial institution would charge for insuring the same risk. Despite the enactment last year of reforms in its multiemployer program, PBGC has a substantial deficit, with liabilities far exceeding its assets, and is projected to be insolvent within a decade. The Budget proposes to give the PBGC Board the authority to adjust premiums and directs PBGC to take into account the risks that different sponsors pose to their retirees and to PBGC. This reform will both encourage companies to fully fund their pension benefits and ensure that the PBGC's single- and multi-employer pension insurance programs remain financially sound. The $19 billion in additional revenue would be split between the two programs in accordance with the size of their projected deficits.
- Expanding the EITC for Older Workers. The EITC is among the Nation's most effective tools for reducing poverty and promoting employment. But because the EITC available to workers without children and non-custodial parents is small, they miss out on the anti-poverty and employment effects of the EITC. The Budget would double the "childless worker" EITC and make the credit available to workers with earnings up to about 150 percent of the poverty line. This would help many older workers, including those who had children but those children are now adults. The proposal would also harmonize the maximum age at which older workers are eligible for the EITC for childless adults with the Social Security full retirement age, which is increasing in stages over the coming years and will reach 67 in 2022. The proposal would directly reduce poverty and hardship for millions of low-income older workers struggling to make ends meet.
- Expanding National Service Opportunities to Harness the Experience of Seniors. Every day older Americans are making a positive impact in their communities, using the skills they have developed over a lifetime. The Budget expands opportunities for seniors to serve their communities through the Corporation for National and Community Service. The Budget maintains funding for Senior Corps, whose volunteers engage in activities like mentoring at-risk youth and helping other seniors with daily tasks so that they can stay in their own homes rather than entering costly congregate care. The Budget provides an opportunity for successful Senior Corps programs to grow through AmeriCorps which is providing over 4,000 more positions for seniors.
- Providing Housing for the Elderly. Providing supportive housing for very low-income elderly households, including frail elderly, allows seniors to age in a stable environment and helps them access human services. The Budget includes $455 million for the HUD Housing for the Elderly program (known as "Section 202"). These funds will continue all current assistance. Also included in this amount is $10 million to expand use of authorities enacted in 2014 to demonstrate a model of new housing integrated with supportive services, including enhanced partnerships with State agencies, to maintain and enhance resident health while avoiding institutional care.
The 114th Congress began well. The Senate Health, Education, Labor and Pensions Committee took up a 3-year reauthorization of the Older Americans Act (OAA) as one of its first markups of the 114th Congress, with Chairman Alexander (R-TN) enlisted the support of Ranking Member Murray (D-WA) and Sens. Burr (R-NC) and Sanders (I-VT). The Older Americans Act Reauthorization of 2015 was introduced to the Senate floor in January 2015. No action has been taken since.
The bill, S. 192, reflects a number of NCOA’s OAA reauthorization priorities, including provisions that:
- Create new support for modernizing multipurpose senior centers
- Highlight the importance of addressing economic needs
- Require that health promotion and disease prevention initiatives be evidence-based
- Promote chronic disease self-management and falls prevention
We support the bill's stronger elder justice and legal services provisions, needed clarity for caregiver support and Aging & Disability Resource Centers, and new opportunities for intergenerational shared sites. The bill also retains current language that does not place any limits on how much OAA appropriations can grow.
The legislation takes the same modest approach to OAA changes as with the 2013 bipartisan bill by scaling back language that appeared in earlier reauthorization measures.
For example, rather than authorizing a new stand-alone demonstration program to identify model senior center modernization approaches and provide training and technical assistance to help other centers adopt them, the bill simply gives the Assistant Secretary for Aging the authority to accomplish this with existing resources.
Also, instead of making “economic security” a goal of the OAA, the language clarifies that the Administration's duties include supporting research and implementation of programs that address the economic needs of older adults and creating and disseminating materials related to the economic welfare of seniors.
There are two changes from the 2013-2014 bill in S. 192 that are worth noting:
- A revision in the federal-to-state formula for Title III funding is included.
- Language to authorize a study on senior transportation was eliminated because that report was completed last year.
The current Title III formula makes allocations to states based on the size of their senior population. However, there is a “hold harmless” clause that ensures that no state receives less than its allocation in 2006.
S. 192 includes new hold harmless language, which states that for each of the next three years that OAA is authorized and the formula is adjusted to reflect changes in states’ senior populations, every state is guaranteed to receive at least 99% of its Title III allocation from the previous year.
The committee makes clear in its summary of the bill that the intent is to protect states from losing more than 1% in each of the next three years, with no further adjustments until the OAA is reauthorized again. Also, small states known as “minimum states,” which receive a guaranteed baseline amount, would not see any changes.
But as deliberations on the hold harmless clause stalled reauthorization, it became clear that Senators needed to craft a compromise to help legislation advance.
Call to Action
Congress is about to agree to a bipartisan budget for 2015 that could again reduce federal spending for many critical senior services.
With the clock still ticking, programs will have to meet growing demand for community and home-based services and the same budgets they’ve had for the past several years have diminished or been frozen (NCOA, 2015).
Lawmakers often say they want to make it easier for seniors and younger people with disabilities to live at home. It takes a substantial infrastructure of housing, transportation, meals, health, and information services to make that possible.
By and large, the fiscal plan should increase funding from the low levels driven by recent across-the-board sequester spending cuts.
This bill reauthorizes programs through 2018 and includes provisions that aim to protect vulnerable elders by strengthening the Long-Term Care Ombudsman program and existing elder abuse screening and prevention efforts.
The bill also promotes the delivery of evidence-based programs, such as falls prevention and chronic disease self-management programs. The reauthorization streamlines federal level administration of programs, promotes the efficient and effective use of transportation services, and improves coordination between programs at the federal, state, and local levels.
Here are a few examples of what the senior services budget will look like, based on the 2014 committee work and the Older Americans Act Reauthorization of 2015 (courtesy of the National Council on Aging):
- Supportive Services: This is a key program aimed at helping people with disabilities and the frail elderly remain at home. It provides grants to states for transportation, case management, information and assistance, in-home services such as personal care, legal and mental health services, and adult day care. Funding for 2014 will be about $348 million—exactly what it was under the 2013 sequester and about $20 million less than in 2012.
- Meals on Wheels. Home-delivered nutrition programs will get about $216 million in 2014. That’s about $11 million more than under last year’s sequester, but the same as they got in 2012.
- National Family Caregiver’s Support: These federal grants to states to help hard-pressed caregivers with information services, counseling, and respite care will get about $146 million this year—exactly the same as in 2013 and $10 million less than in 2012.
- State Health Insurance Assistance (SHIP) This key program provides counselors to help seniors and others understand the complexities of Medicaid and other benefits. Its budget is frozen at $52 million.
- Community Services Block Grants: These provide states and communities with funding for a wide range of services aimed at helping people in need, including employment, education, income management, housing, nutrition, emergency services, and health. It will be funded at $674 million—an increase of $40 million over 2013 but no more than in 2012.
Urge Congress to Support the Older Americans Act
Chairman Alexander has chosen to make OAA reauthorization a top priority this year, the 50th anniversary of the Act. He is doing so in a bipartisan manner that remains true to the history of this important legislation.
Our goal is for the legislation to move quickly through the Senate, and for the House to then take up and pass an identical bill.
The Senate has started quickly with a January markup, but we need the full Senate and House to keep the momentum going.
Also, funding for OAA programs has not kept pace with the increasing numbers, need, and diversity of the senior population, and it is still threatened by automatic cuts imposed by sequestration.
Please help us urge Congress to reauthorize the Older Americans Act and invest in its programs.
Call your Senators and Representative. Urge them to action.
Send your Senators and Representatives an email urging prompt passage of a reauthorization of the Older Americans Act.
Copy these bullet points into your correspondence.
- The formula adjustment should update the 2006 hold harmless by using the most recent fiscal year funding as a baseline for an annual dynamic hold harmless, reflecting more recent population trends and ensure funding better meets the nationwide needs of older adults while also protecting every state from experiencing a negative adjustment of no more than 1 percent a year. After three years, the formula’s hold harmless should again freeze in place at FY2018 funding levels. Minimum grant states are not affected.
- Update references of mental health to also include “behavioral health,” as appropriate to reflect the Aging Network’s current practice Holocaust Survivors
- Direct the Assistant Secretary to develop guidance on serving Holocaust survivors through Older Americans Act programs
- Elder Abuse To be consistent with current law, update definitions of “adult protective services,” “abuse,” “exploitation and financial exploitation,” and “elder justice”
- Promote best practices related to responding to elder abuse, neglect, and exploitation in long-term care facilities through the Administration on Aging
- Promote States’ submission of data concerning elder abuse
- Direct the Administration on Aging to include, as appropriate, training for States, area agencies on aging, and service providers on elder abuse prevention and screening Long-Term Care Ombudsman Program
- Allow ombudsmen to serve all residents of long-term care facilities, regardless of age
- Ensure private, unimpeded access to the ombudsman for all residents of long-term care facilities
- Provide for identification and resolution of potential individual and organizational conflicts of interest
- Clarify the role of ombudsman program in advocating for residents unable to communicate their wishes
- Account for geographic changes in the older population, adjust the formula for the Title III programs of supportive services, congregate meals, home meals, and preventive services
- Direct the Assistant Secretary to provide information and technical assistance to States, area agencies on aging, and service providers on providing efficient, person-centered, transportation services, including across geographic boundaries
- Improve ADRC coordination with area agencies on aging and other community-based entities in disseminating information regarding available home and community-based services for individuals who are at risk for, or currently residing in, institutional settings
- Update the definition of “Aging and Disability Resource Center” to be consistent with current practice and current law, including an emphasis on independent living and home and community-based services Health and Economic Welfare
- Make clear the Assistant Secretary’s responsibilities related to the development of plans, program implementation, and preparation and dissemination of education materials on the health and economic welfare of older individuals Senior Centers
- Direct the Assistant Secretary to provide information and technical assistance to support best practices for the modernization of multipurpose senior centers
- Encourage efforts to modernize multipurpose senior centers and promote intergenerational models National Family Caregiver Support Program
- Clarify the current law that older adults caring for adult children with disabilities and older adults raising children under 18 are eligible to participate in the Family Caregiver Support Program Preventing Fraud and Abuse
- Continue support for Medicare program integrity initiative that trains senior volunteers to prevent and identify healthcare fraud and abuse Administration Demonstration Authority
- Streamline the Act by eliminating three outdated demo programs: Computer Training, Multidisciplinary Centers and Multidisciplinary Systems, and Ombudsman and Advocacy Demonstration Projects Home Care
- Direct the Assistant Secretary to develop a consumer-friendly tool, when feasible, to assist older individuals and their families in choosing home and community-based services Emphasis on Evidence-based Programs
- Ensure that, in accordance with current practice, disease prevention and health promotion programs are “evidence-based”
- Encourage the delivery of falls prevention and chronic disease self-management programs
- Mention the aging network may include oral health screenings among disease prevention and health promotion activities
- Direct the Assistant Secretary to provide technical assistance and share best practices to improve collaboration and coordination with health care entities, such as Federally Qualified Health Centers, to enhance care coordination for individuals with multiple chronic illnesses Nutrition Services
- When feasible, encourage the use of locally grown foods in meals programs
- Clarify that, as appropriate, supplemental foods may be part of a home delivered meal at the option of a nutrition services provider
- Improve coordination of activities between the state and local aging offices
- Clarify that ombudsman may continue to serve residents transitioning from a long-term care facility to a home care setting
- Clarify that the ombudsman office is a “health oversight agency” for purposes of HIPAA Title III Grants to States Formula
Sources
Aging Program Funding Table, FY2013-FY2016proj., National Council on Aging (NCOA)
Certner, D., Tell Congress Not to Leave Seniors Stranded, AARP, http://blog.aarp.org [February 12, 2015]
Congressional Budget Office, Review of S.192, www.cbo.gov/publication/49942 [April 10, 2015]
Freedman, V.A., Martin, L.G., and Schoen, R.F. 2002, “Recent Trends in Disability and Functioning Among Older Adults in the United States; A Systematic Review” The Journal of the American Medical Association.
Kinosian, B., Stallard, E., and Wieland, D. 2007, “Projected Use of Long-Term-Care Services by Enrolled Veterans,” The Journal of the Gerontological Society of America
Lacey, T.A., and Wright, B. 2009, “Occupational Employment Projections to 2018,” Monthly Labor Review.
Quinn, J.F. 2010, “Work, Retirement, and the Encore Career, American Society on Aging,” Generations; The Journal of the American Society on Aging.
White House, The President’s 2016 Budget, www.whitehouse.gov/budget_2016 [April 9, 2015]
ARTIFACT 2: AGING & HEALTH - GERO 6169
Concordia UNIVERSITY chicago Masters Program
Student:
Trenesha Boyd
[email protected]
Course:
GERO 6169
Course Instructor:
Dr. Lydia Manning
What it means to use a life course approach to examine health and aging according to the text, “life course issues have recently come to permeate thinking about a broad number of exposures in public health. It is now common place to think of critical or sensitive periods in exposure to risk as well as to understand dynamics related to cumulative exposure.” (Berkman 2009:30).
Health is very important to aging because researchers have been looking at the relationship between childhood diseases and the diseases that come at a later age in life. This is very important because it gives the researchers insight to possibly finding a solution to this problem. “Using a life course lens for studying health in later life may enable investigators to identify early and meaningful antecedent of both chronic and infectious diseases later in life.” (Setters ten p.467).
The extent in which you explore and study aging without taking health into consideration is when the focus is on an older persons functioning level and how they are able to live or function on the daily basis. How they will be able to function independently living on their own. These are just a few of many issues that need to be explored.
The notions of inequality impact the realities of health later in life, “Some older people are experiencing improvements or seasons of stability.” (Settersten p.469). Certain socio economic groups have had the privilege to have good health as a result from good health benefits or medical insurance. It is a known fact that people who are in poverty would not qualify for or have the same healthcare as an individual from a higher social class bracket. The system in general has been unequal for as long as I can recall, for some reason or another I never paid it any attention until I got older because I was blessed to have parents that was insured and has paid into the system at that time. Minorities seem to suffer the consequences of not being able to afford adequate healthcare and therefore; due to a lack of care some possible preventative care to avoid greater suffering, heath issues or consequences later in life. Wilkerson (1997) believed that income inequality produces psychosocial stress which leads to deteriorating health and higher mortality over time. This totally makes sense because if an individual of a lower economic status not able to have the equal rights of service as someone from another socioeconomic class. The impact is not a good one and it leaves the older adults in poverty to have unaddressed health issues as they age.
Some of the most pressing issues concerning health and inequity and disparities are according to our text researchers has identified four major links to health inequality. First, “research on the relationships between discrimination and health is a major innovation for the field. Second, for the most ethnic groups, information on immigration and vitality is critical for understanding health disparities (Angel et al. 2001). Third, there is an emergent body of research on the effects of racial/ethnic segregation on health, but the findings are inconsistent. Fourth, more studies are integrating information on medical care use over the life course in studies of health.” (Settersten p.470).
Gerontologist and sociologists of age should address these issues by doing more research searching for solutions to the problems that we have identified pertaining to health and aging. There also should be more policies and procedures put in place so inequality can somehow be balanced off into all socioeconomic classes.
The linkage between health and mental health in later life can be explained as; “understanding psychological function and mental health in later life requires a life-course perspective that takes account of biological predispositions, socioeconomic status (SES) and environmental exposures, changing social conditions, and interpersonal networks” (George 1999). The linkage can also be related in certain diagnosis such as; depression or insomnia which symptoms can include lack of sleep, loss of appetite and having no energy which eventually can cause harm to an older individuals health which could be detrimental if not addressed. These are issues that could be prevented if dealt with at an earlier part of life’s course.
According to the text, Efforts to limit the increasing body size of the population cannot focus solely on individual and medical interventions. Bariatric surgery can be beneficial for individuals facing severe health consequences, but reliance on surgical and pharmaceutical solutions ignores the societal structure in which individuals will continue to live. With obesity, social scientists have the opportunity to apply their understanding of the social world to address a pressing social problem.” (Settersten, p.526).
The mysterious connection between religion and health later in life allows an older adult to have some type of relationship or belief in something or someone in their times of failing health, life issues, feeling of loneliness and having some sort of divine being to turn to. This gives not only the older population but all populations a sense of purpose or meaning to life inspite of what is going on. Sometimes ones FAITH is the only thing a person has to hold onto. “God can do everything but fail!”
References
Beckerman, Lisa F. 2009, “Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?” Annual Review of Public Health 30:27-41.
Advances in Psychiatric Treatment (2004), vol10.
Settersten R.A and Angel (Ends), Handbook of Sociology of Aging, Handbook of Sociology and Social Research.
Student:
Trenesha Boyd
[email protected]
Course:
GERO 6169
Course Instructor:
Dr. Lydia Manning
What it means to use a life course approach to examine health and aging according to the text, “life course issues have recently come to permeate thinking about a broad number of exposures in public health. It is now common place to think of critical or sensitive periods in exposure to risk as well as to understand dynamics related to cumulative exposure.” (Berkman 2009:30).
Health is very important to aging because researchers have been looking at the relationship between childhood diseases and the diseases that come at a later age in life. This is very important because it gives the researchers insight to possibly finding a solution to this problem. “Using a life course lens for studying health in later life may enable investigators to identify early and meaningful antecedent of both chronic and infectious diseases later in life.” (Setters ten p.467).
The extent in which you explore and study aging without taking health into consideration is when the focus is on an older persons functioning level and how they are able to live or function on the daily basis. How they will be able to function independently living on their own. These are just a few of many issues that need to be explored.
The notions of inequality impact the realities of health later in life, “Some older people are experiencing improvements or seasons of stability.” (Settersten p.469). Certain socio economic groups have had the privilege to have good health as a result from good health benefits or medical insurance. It is a known fact that people who are in poverty would not qualify for or have the same healthcare as an individual from a higher social class bracket. The system in general has been unequal for as long as I can recall, for some reason or another I never paid it any attention until I got older because I was blessed to have parents that was insured and has paid into the system at that time. Minorities seem to suffer the consequences of not being able to afford adequate healthcare and therefore; due to a lack of care some possible preventative care to avoid greater suffering, heath issues or consequences later in life. Wilkerson (1997) believed that income inequality produces psychosocial stress which leads to deteriorating health and higher mortality over time. This totally makes sense because if an individual of a lower economic status not able to have the equal rights of service as someone from another socioeconomic class. The impact is not a good one and it leaves the older adults in poverty to have unaddressed health issues as they age.
Some of the most pressing issues concerning health and inequity and disparities are according to our text researchers has identified four major links to health inequality. First, “research on the relationships between discrimination and health is a major innovation for the field. Second, for the most ethnic groups, information on immigration and vitality is critical for understanding health disparities (Angel et al. 2001). Third, there is an emergent body of research on the effects of racial/ethnic segregation on health, but the findings are inconsistent. Fourth, more studies are integrating information on medical care use over the life course in studies of health.” (Settersten p.470).
Gerontologist and sociologists of age should address these issues by doing more research searching for solutions to the problems that we have identified pertaining to health and aging. There also should be more policies and procedures put in place so inequality can somehow be balanced off into all socioeconomic classes.
The linkage between health and mental health in later life can be explained as; “understanding psychological function and mental health in later life requires a life-course perspective that takes account of biological predispositions, socioeconomic status (SES) and environmental exposures, changing social conditions, and interpersonal networks” (George 1999). The linkage can also be related in certain diagnosis such as; depression or insomnia which symptoms can include lack of sleep, loss of appetite and having no energy which eventually can cause harm to an older individuals health which could be detrimental if not addressed. These are issues that could be prevented if dealt with at an earlier part of life’s course.
According to the text, Efforts to limit the increasing body size of the population cannot focus solely on individual and medical interventions. Bariatric surgery can be beneficial for individuals facing severe health consequences, but reliance on surgical and pharmaceutical solutions ignores the societal structure in which individuals will continue to live. With obesity, social scientists have the opportunity to apply their understanding of the social world to address a pressing social problem.” (Settersten, p.526).
The mysterious connection between religion and health later in life allows an older adult to have some type of relationship or belief in something or someone in their times of failing health, life issues, feeling of loneliness and having some sort of divine being to turn to. This gives not only the older population but all populations a sense of purpose or meaning to life inspite of what is going on. Sometimes ones FAITH is the only thing a person has to hold onto. “God can do everything but fail!”
References
Beckerman, Lisa F. 2009, “Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?” Annual Review of Public Health 30:27-41.
Advances in Psychiatric Treatment (2004), vol10.
Settersten R.A and Angel (Ends), Handbook of Sociology of Aging, Handbook of Sociology and Social Research.
ARTIFACT 3: ALZHEIMER'S THE DISEASE
According to the Alzheimer’s disease Health Center, Alzheimer’s is defined as a progressive decline in cognitive ferodes memory and reduces the ability to perform task over a period of several years. There are many stages of this disease, just like any other; the way that it affect individuals will be different. In pre-Alzheimer’s stage, some possible signs to look are memory is a person being able to remember certain smells, sounds, taste, people, places and things. A persons language in pre-Alzheimer’s should be clear , respectful with these individuals being able to communicate effectively with good insight to what others are saying to them as well. Understanding is a must when it comes down to communicating. Another sign that one should be able to identify in this early stage of Alzheimer’s is being able to observe the way that an individual uses their decision making skills, and how they accomplish any given task. One’s ability to remain social in the pre-Alzheimer’s can be detected through an individual’s appearance and how they relate to others. Has there been changes, are these individual isolating, and simply knowing the behavior patterns of these sufferers can be very beneficial for early detection. There are a number of signs to be aware of that gives you insight when making an evaluation of whether or not a person could be in pre stages of Alzheimer.
Lee is an 87 year old, African-American female who was raised 11 children basically on her own. She had been a very independent woman, who did her very best with what she had. Lee always had the right thing to say to her children, great-grandchildren and several others that surrounded her. Lee was a great matriarch and she motivated everyone who was in her presence. One day Lee could not remember her daughter’s name, she called her other children names. This went on for a while and no one really paid it any attention. Now, if Lee’s children or other people in her network were aware of the pre-Alzheimer’s signs, some of the stress later on down the line could have been avoided or lessened with education and treatment. Although Lee could not avoid this horrible disease, there could have been preventative measures to prepare some for what was about to come.
Neurological aspects of Alzheimer’s
Alzheimer’s disease is the most common form of dementia. The most neurological aspect of the disease is the loss of memory which progresses over a period of time. “The most common cause of dementia and characterized clinically by progressive intellectual deterioration together with declining activities of daily living and neuropsychiatric symptoms or behavioral changes.”(Global Oneness). This is detrimental in itself because one does not always pay attention to memory loss which is a major sign for pre-Alzheimer. According to the Alzheimer’s Disease, beyond a simple loss of memory, are problems with verbal expressions/ forgetting or misusing words, being unable to construct complex sentences, just to name a few. These unexplained behaviors can change the individual mood with them not knowing exactly what they are experiencing. Let’s take another look at Lee’s progression. Lee has always been a nice lady but when dementia began to progress, Lee began to regress; she became very irritated, and exhibited many mood swings. This type of behavior took me back to one of the chapters in the book that referred back to the process of aging and how difficult it is when an elderly person feels the sense of having no control. The neurological concerns that take effect as it relates to Alzheimer’s can be a very dark and lonely place.
Social Aspects of Alzheimer’s
With the current aging population in the US, it is safe to say that number of cases of Alzheimer’s is increasing as well as the impact that it has on society. Many families are affected by this disease because many of them must work towards a plan of action which best works for the family member who is suffering. It is reported that more than 75% of people who suffers with Alzheimer’s are cared for by family members. When a family is affected by this, they need to be educated on the disease, cause and effects, treatments, etc. to get a better understanding of what lies ahead. If the family chooses to take on the role as the caregivers, then they can look forwards to a bumpy road. When a family member decides to take on the responsibility to take care of the person who is suffering, then they have basically agreed to set aside what plans they have of their own. Speaking from my own personal experience, I have made a decision to take care of my dad and before my granddad passed away, I was my mom’s right hand man. It is a heavy burden to take on but hey, I need to do, what I have to do for my loved ones. Simple , it the sacrifice that I feel needs to be made in order for me to get to the next level in my life, and doing what I know is right with a sincere heart is a reward in itself. Caregivers can and do become very overwhelmed with all of the responsibilities that follows the care of a loved one. Caregivers understand that this is a disease and getting the proper support from family and professionals if necessary proven to be effective. “Given the burden of care, even small interventions may translate into improvements in the quality of life or confidence of caregivers.”(PubMed).
Social service organizations which help to assist with the care and management of persons who suffer from Alzheimer’s have proven to be effective. There are web sites which have expanded recently in which individuals are able to get answers for many questions or concerns. Other services that can be beneficial are religion/spirituality that is good for both caregiver as well as the individual who suffers from the disease. Music is also known to assist in calming and relaxing. Believe it or not, just a gentle touch can produce a soothing effect, just as petting an animal. (ProQuest, AlzheimersDisease). With the current population of aging and recent advances in treatment of the disease, R. Calder suggest that social policy should take a public health approach to aid medical research on Alzheimer’s.(ProQuest, Alzheimer’s Disease). Research has increased with the public as well as the populations demand on solutions for this troubling disease.
Psychological Aspect of Alzheimer’s Disease
“The physical manifestation of progressing Alzheimer’s includes loss of strength and balance, inability to perform simple tack and physical activities, diminishing bladder and bowel control and loss of smell.”(p.6). Once these symptoms develops Alzheimer’s eventually breakdown in the mind and other body functions. This is a hard pill to swallow, especially for the people who have chosen to take on the challenges that come with being a caregiver. . Bob Wood writes, “Dementia challenges assumptions about what it means to be a person.” Some people look at Alzheimer’s as a gloom like an individual is suffering so bad that it’s like a ‘living death’. A living death seems so morbid and hopeless for the person who suffers from this disease. It is very important for a person to detect the pre-Alzheimer’s signs and symptoms in recent studies it is suggested that 90% of the Alzheimer’s patients will experience significant psychological symptoms. Reflecting back to Lee as her disease progress, she no longer is able to take care of her personal hygiene on her own. Where she use to be able to get around on her own, no longer exists because she needs to be monitored at all times, she won’t wall out of the house on her on like she has on several occasions. She wears depends because she no longer has control of her bladder or her bowels. She has hallucinations which cause her to revert back to childlike behavior. This is only a glimpse of the affect that this disease can have on an individual well being and state of mind. There is also an indescribable affect that is carried on through caregivers and other loved ones.
In conclusion, Alzheimer’s is a disease that causes a decline in cognitive memory and reduces the ability for an individual to perform task that they once did. At this present time the cause of this disease is not known and there is no known cure. What is known for a fact is this disease affects a person in many areas, mainly neurologically, socially and psychologically. This disease attacks until a person is no longer able to care for themselves, remember anything and eventually give up. Society is putting time in research to assist with this ongoing problem and allows possible solutions for not giving in to this uphill battle. Caregivers have a challenging job, and should not hesitate government assistant program which helps with their own personal growth in that area. Making the best out of the situation that the sufferer and having some spiritual foundation can be beneficial in the perception of accepting the actual event. Finally, look for healthy ways to deal with this disease and the stages that take place while going through. Education is the key to success, learn about the disease!
References
Patricia R. Calloe, A caregiver’s guide to Alzheimer’s disease: 300 tips for making life easier. Julie A. Suhr a Psychological Aspect of Alzheimer’s disease November 1, 2004.
http://www.csa.com/discoveryguides/alza/overview.php Alzheimer’s disease.
Lee is an 87 year old, African-American female who was raised 11 children basically on her own. She had been a very independent woman, who did her very best with what she had. Lee always had the right thing to say to her children, great-grandchildren and several others that surrounded her. Lee was a great matriarch and she motivated everyone who was in her presence. One day Lee could not remember her daughter’s name, she called her other children names. This went on for a while and no one really paid it any attention. Now, if Lee’s children or other people in her network were aware of the pre-Alzheimer’s signs, some of the stress later on down the line could have been avoided or lessened with education and treatment. Although Lee could not avoid this horrible disease, there could have been preventative measures to prepare some for what was about to come.
Neurological aspects of Alzheimer’s
Alzheimer’s disease is the most common form of dementia. The most neurological aspect of the disease is the loss of memory which progresses over a period of time. “The most common cause of dementia and characterized clinically by progressive intellectual deterioration together with declining activities of daily living and neuropsychiatric symptoms or behavioral changes.”(Global Oneness). This is detrimental in itself because one does not always pay attention to memory loss which is a major sign for pre-Alzheimer. According to the Alzheimer’s Disease, beyond a simple loss of memory, are problems with verbal expressions/ forgetting or misusing words, being unable to construct complex sentences, just to name a few. These unexplained behaviors can change the individual mood with them not knowing exactly what they are experiencing. Let’s take another look at Lee’s progression. Lee has always been a nice lady but when dementia began to progress, Lee began to regress; she became very irritated, and exhibited many mood swings. This type of behavior took me back to one of the chapters in the book that referred back to the process of aging and how difficult it is when an elderly person feels the sense of having no control. The neurological concerns that take effect as it relates to Alzheimer’s can be a very dark and lonely place.
Social Aspects of Alzheimer’s
With the current aging population in the US, it is safe to say that number of cases of Alzheimer’s is increasing as well as the impact that it has on society. Many families are affected by this disease because many of them must work towards a plan of action which best works for the family member who is suffering. It is reported that more than 75% of people who suffers with Alzheimer’s are cared for by family members. When a family is affected by this, they need to be educated on the disease, cause and effects, treatments, etc. to get a better understanding of what lies ahead. If the family chooses to take on the role as the caregivers, then they can look forwards to a bumpy road. When a family member decides to take on the responsibility to take care of the person who is suffering, then they have basically agreed to set aside what plans they have of their own. Speaking from my own personal experience, I have made a decision to take care of my dad and before my granddad passed away, I was my mom’s right hand man. It is a heavy burden to take on but hey, I need to do, what I have to do for my loved ones. Simple , it the sacrifice that I feel needs to be made in order for me to get to the next level in my life, and doing what I know is right with a sincere heart is a reward in itself. Caregivers can and do become very overwhelmed with all of the responsibilities that follows the care of a loved one. Caregivers understand that this is a disease and getting the proper support from family and professionals if necessary proven to be effective. “Given the burden of care, even small interventions may translate into improvements in the quality of life or confidence of caregivers.”(PubMed).
Social service organizations which help to assist with the care and management of persons who suffer from Alzheimer’s have proven to be effective. There are web sites which have expanded recently in which individuals are able to get answers for many questions or concerns. Other services that can be beneficial are religion/spirituality that is good for both caregiver as well as the individual who suffers from the disease. Music is also known to assist in calming and relaxing. Believe it or not, just a gentle touch can produce a soothing effect, just as petting an animal. (ProQuest, AlzheimersDisease). With the current population of aging and recent advances in treatment of the disease, R. Calder suggest that social policy should take a public health approach to aid medical research on Alzheimer’s.(ProQuest, Alzheimer’s Disease). Research has increased with the public as well as the populations demand on solutions for this troubling disease.
Psychological Aspect of Alzheimer’s Disease
“The physical manifestation of progressing Alzheimer’s includes loss of strength and balance, inability to perform simple tack and physical activities, diminishing bladder and bowel control and loss of smell.”(p.6). Once these symptoms develops Alzheimer’s eventually breakdown in the mind and other body functions. This is a hard pill to swallow, especially for the people who have chosen to take on the challenges that come with being a caregiver. . Bob Wood writes, “Dementia challenges assumptions about what it means to be a person.” Some people look at Alzheimer’s as a gloom like an individual is suffering so bad that it’s like a ‘living death’. A living death seems so morbid and hopeless for the person who suffers from this disease. It is very important for a person to detect the pre-Alzheimer’s signs and symptoms in recent studies it is suggested that 90% of the Alzheimer’s patients will experience significant psychological symptoms. Reflecting back to Lee as her disease progress, she no longer is able to take care of her personal hygiene on her own. Where she use to be able to get around on her own, no longer exists because she needs to be monitored at all times, she won’t wall out of the house on her on like she has on several occasions. She wears depends because she no longer has control of her bladder or her bowels. She has hallucinations which cause her to revert back to childlike behavior. This is only a glimpse of the affect that this disease can have on an individual well being and state of mind. There is also an indescribable affect that is carried on through caregivers and other loved ones.
In conclusion, Alzheimer’s is a disease that causes a decline in cognitive memory and reduces the ability for an individual to perform task that they once did. At this present time the cause of this disease is not known and there is no known cure. What is known for a fact is this disease affects a person in many areas, mainly neurologically, socially and psychologically. This disease attacks until a person is no longer able to care for themselves, remember anything and eventually give up. Society is putting time in research to assist with this ongoing problem and allows possible solutions for not giving in to this uphill battle. Caregivers have a challenging job, and should not hesitate government assistant program which helps with their own personal growth in that area. Making the best out of the situation that the sufferer and having some spiritual foundation can be beneficial in the perception of accepting the actual event. Finally, look for healthy ways to deal with this disease and the stages that take place while going through. Education is the key to success, learn about the disease!
References
Patricia R. Calloe, A caregiver’s guide to Alzheimer’s disease: 300 tips for making life easier. Julie A. Suhr a Psychological Aspect of Alzheimer’s disease November 1, 2004.
http://www.csa.com/discoveryguides/alza/overview.php Alzheimer’s disease.
ARTIFACT 4: PERSPECTIVES IN GERONTOLOGY -GERO 6000
GERONTOLOGY AND SUCCESSFUL AGING
Trenesha S. Boyd
Perspectives in Gerontology – GERO 6000
Concordia University
A 65 and Better Population
During the past century the number of people over the age of 65 has been steadily increasing in the United States as well as much of the rest of the world. This phenomenon, known as the “graying of America” (Himes, 2001) is also being observed in many other countries of the world (Bosworth & Burtless, 1998). Since 1870 the over-65 population in the United States alone has increased from 1 million to 35 million in 2000, and in recent decades, this population group has been increasing at twice the rate as the rest of the population (Moody & Sasser, 2012). As the population has been growing older, it has also been growing healthier and more active. Looking at college campuses alone over a half million people over the age of sixty are enrolled as students. There are “needers” who require services as well as those we call “growers”, that is those folks interested in new learning, such as computer use, college courses, and new technologies.
Gerontology is one of the most complex subjects facing science in the 21st century. This paper will give some historical context, define some societal aspects, and offer insight to the government’s role in accommodating an ever more active, vibrant, and demanding aging population. “Seventy is the new 40”, some would say. The study of the aging population from a societal, psychological, biological and spiritual point of view, has also been increasing as a profession in recent decades. Since the 1950s the number of psychologists specializing in the study of aging has increased at a faster rate than did the number in psychology by and large.
Central to discussions of aging is a basic definition of age itself. A chronological number does more than simply identifying the years since birth. It is also a “powerful social and psychological dimension of our lives” (Moody & Sasser, 2012). Age grading refers to the way people are assigned different roles in society depending on their age. Theorists of age stratification emphasize that a person’s position in the age structure affects behavior or attitudes (Streib & Bourg, 1984). It may not be considered appropriate for septuagenarians to crash a high school dance, or physically possible for an octogenarian to try out for the college football team.
The Handbook of Aging and the Individual ( Birren, 1959) was published in 1959 only after protracted discussions with numerous publishers who shied away from publishing in the field of aging. The first printing by The University of Chicago Press was sold out in 6 months.
Despite the general academic lack of interest in studies of aging, several areas of interest were forming by the 1960s. Questions were beginning to be raised in Congress and other public arenas about meeting the ‘needs of an aging population. In 1975 Congress approved the creation of the National Institute on Aging. The body was responding to the rising social pressures of an older society.
An Aging Demographic
Data from modern hunter-gatherers, as well as analysis of ancient skeletal remains, agreed that life expectancy for most of human history was around 20 years (Gage, 1988: Lovejoy et al., 1977).
Life was inherently more dangerous at all ages.
Consequently, just because life expectancy was only 20 years in Paleolithic times does not mean that 30-year-olds in those times had the physical capabilities of today’s 80- or 90-year olds. Those 30-year olds that had been lucky enough to survive childhood and adolescence were physically probably pretty much like 30-year-olds today.
Clearly, the rapid expansion of life expectancy in the past 100 years has been the result of the influences of a better medical environment, clean water, and medical advances in antibiotics.
For instance, a comparison of Civil War veterans who were 65 or older in 1910 and World War II veterans who were 65 or older during 1985-1988 revealed that heart disease among old soldiers was about 3 times as prevalent, musculoskeletal and respiratory disease is about 1.6 times as prevalent, and digestive diseases almost 5 times as prevalent in the early part of the century relative to the latter part (Fogel & Costa, 1977).
Aging, Concepts and Controversies (Moody & Sasser, 2012) describe three major cognitive functions which relates to attention, psychomotor speed, and memory, which all are very vital as we age. “These three factors findings in cognitive aging research have been of limited utility because of an overwhelming reliance on cross-sectional age-comparative research designers.” (Sheets, Bradley & Hendricks. 2006. P. 98). The decline in disability among the elderly in the United States was even more rapid during the early 1990s than during the 1980s (Manton & Gu, 2001). Perhaps less tangible but no less important, aspects of life such as amount of chronic pain and degree of sensory acuity have been improved by the development of better analgesics, joint replacement surgery, and widespread availability of effective treatment for cataracts and glaucoma, as well as continuously improving hearing technology. One of the greatest scientific, and Nobel Prize Winning achievements of the past several decades has been the mapping of the human genome. The growth of the ageing population, worldwide, is often referred to as an “age quake”. Currently California has about 3.5 million persons over the age of 65 and this expected to double to at least 7 million by the 2030s. There are some expert demographers, who are more convinced in life expectancy from the mid-80s to as high as 100 years within this century (Lee & Carter, 1992; Manton, Stallard, & Tolley, 1991: Oeppel & Vaupel, 2002).
An example of aging in a developing country is India. India has shown a rapid increase in the number of older persons. Those over 60 years have risen from 12 million in 1901, to 20 million in 1951, and to 75 million in 2001 (Liebig & Rajan, 2003). It is expected to be 179 million in 2031.
Social Networks
Social networks help maintain the quality of life and mental health. Rapid societal change has been a characteristic of America. Social networks also tap into the collective and latent “wisdom” of an older population. One standard definition is that wisdom consist of “making the best use of available knowledge.” (Moody & Sasser, 2006. P.121). “Creativity in this article is defined as the ability to transcend traditional ways of thinking by generating ideas, methods, and forms that are meaningful and new to others.” (Moody & Sasser, p. 122).
The main thing that has to be acknowledged is the respect and honor that should follow certain decisions in our society for the greater good. For example, there are many programs, both public and private sector, in place that benefit the older populations. There are many food franchises that have senior’s discount and allows the chance to feel special. This is just a minor example of a social construct that is socially accepted.
The role that wisdom and creativity play in the meaning making process related to aging is one of motivation, understanding and guidance as we age and look a life in a different light; a more positive one. “That when information is meaningful, it is more likely to be remembered by older and younger adult’s alike (Hultsch & Dixon, 1990).
Social support interventions involve comprehensive “team” support and may include elements like community groups, volunteer activities, houses of worship, and community and municipal outreach programs. Research suggests that volunteering and civic engagement offer benefits for increasing resilience in older adults by providing purposeful living and community involvement. Through personal connections, older adults learn from others about their potentials and gifts; this awareness increases their self-efficacy and perseverance in the face of adversity (Lavretsky 2014). Exercise classes such as yoga, spinning and water workouts can also mitigate stresses associated with risks to successful aging. Spirituality is also a powerful coping mechanism providing older adults with the ability to adapt to changing individual needs, an important and unique feature of resilience (Manning 2013).
One study of the effects of yoga and Ayurveda on geriatric depression evaluated 69 persons aged at least 61 years old living in the same residential group home (Krishnamurthy & Telles 2007). Results showed depression-symptom scores of the yoga group and three months and six months significantly, from a baseline of 10.6 to 8.1 for the former and 6.7 the latter. Other control groups showed no change, suggesting a comprehensive approach of exercise, including mental and philosophical aspects in addition to physical practices was useful to members of congregate care facilities. Responding to the needs of older adults, the federal government has developed programs to address many needs never before encountered by societies populated mainly with 20- and 30-somethings. At the beginning of the 20th century, life expectancy in the United States was about 48 years (47 for men, 49 for women) (Faber, 1982). Age 65 was adopted as the age of retirement for Social Security in the 1930s, when life expectancy was much lower than it is today.
Enacted in 1965 along with Medicare and Medicaid, the Older Americans Act (OAA) has been the primary vehicle for services and funding in every state that support the dignity and welfare of individuals age 60 and older. These services include programs that protect vulnerable seniors, such as the long-term care ombudsman program, nutritional programs, home-and-community based services, as well as health promotion and disease prevention activities for seniors. The OAA is required to be reauthorized every four years in order to provide Congress this opportunity. Reauthorizing the Older Americans Act allows Congress to update and improve upon the law's vital programs and services. The Older Americans Act expired in 2011, as Congress failed to act on this requirement. Since then legislation to continue this valuable service to our age 60-and-better Americans has stalled in House Subcommittees and Senate brinksmanship. With every day that passes the future of critical programs that serve seniors is more uncertain. Congress must restart the reauthorization process in 2015. This legislation reauthorizes the Older Americans Act of 1965, a federal law with longstanding bipartisan support. The law provides for the organization and delivery of social and nutrition services to older Americans and their caregivers. The federal Older Americans Act (and its reauthorization) would provide nearly $2 billion a year to support important services for senior citizens including support for family caregivers, community based programs, and particularly for long-term care services for Veterans. A study commissioned by the US Department of Veterans Affairs concluded that between 2007 and 2017 the number of oldest veterans (aged 85+) will double, and Veterans Health Administration (VHA) enrolled veterans aged 85 and older will increase sevenfold, resulting in a 20-25% increase in use for both home- and community-based services (Kinosian,Stallard and Wieland, 2007).
Further, the face of the American workforce is changing as people work longer in life. People are healthier, on average, at every age (Freedman, Martin, and Schoeni, 2002). Jobs are trending toward service occupations and away from a more physically demanding manufacturing sector (Lacey and Wright, 2009). And with older women in the labor, hence more couples working, should they chose to retire together a delayed retirement may be in store for husbands (Quinn, 2010). Every day older Americans are making a positive impact in their communities, using the skills they have developed over a lifetime. The Budget expands opportunities for seniors to serve their communities through the Corporation for National and Community Service.
The Budget maintains funding for Senior Corps, whose volunteers engage in activities like mentoring at-risk youth and helping other seniors with daily tasks so that they can stay in their own homes rather than entering costly congregate care. The Budget provides an opportunity for successful Senior Corps programs to grow through AmeriCorps which is providing over 4,000 more positions for seniors.
Every day older Americans are making a positive impact in their communities, using the skills they have developed over a lifetime. The Budget expands opportunities for seniors to serve their communities through the Corporation for National and Community Service. The Budget maintains funding for Senior Corps, whose volunteers engage in activities like mentoring at-risk youth and helping other seniors with daily tasks so that they can stay in their own homes rather than entering costly congregate care. The Budget provides an opportunity for successful Senior Corps programs to grow through AmeriCorps which is providing over 4,000 more positions for seniors.
Here are a few examples of what the senior services budget will look like, based on the 2014 committee work and the Older Americans Act Reauthorization of 2015 (courtesy of the National Council on Aging):
Conclusion
An ever increasing population of 60, 70 and 80 years young members of the community not only offer an unprecedented opportunity to observe and study, but also will demand society help them age gracefully, with dignity, and with a quality of life well deserved. While there is a substantial role for government to play in providing services to this aging population, society will also adjust to the needs and demands of an increasingly active older America, and the field of Gerontology will continue to expand and study this paradigm.
References
Atchley, R.C. (1999) Incorporating spirituality into professional work in aging. Aging Today, 20(4), 123-24.
Callero, P.L., (2009) The myth of individualism: How social forces shape our lives. Lanham, MD: Rowman and Littlefield.
Curtis, W.J., & Cicchetti, D., (2003) Moving research into the 21st century. Theoretical and methodological considerations in examination the biological contributors to resilience. Developmental Psychopathology, 15; 773-810.
Depp, C.A., & Jeste, D.V., (2006) Definitions and predictors of successful aging: A comprehensive review of larger quantitative studies. American Journal of Geriatric Psychiatry, 14(1), 6-20.
Gardner, K. (2002). Age, Narrative, and Migration. Oxford: Berg.
Hardy, S.E., Concato, J., & Gill, T.M., (2004) Resilience of community-dwelling older persons. Journal of the American Geriatric Society 52(2), 257-62.
Jopp, Daniela; Rott, Christoph (2006). Adaptation in very old age: Exploring the role of resources, beliefs, and attitudes for centenarians' happiness. Psychology and Aging, 21, 266-280.
Krishnamurthy, M.N., & Telles, S. (2007) Assessing depression following two ancient Indian interventions: Effects of yoga and Ayurveda on older adults in a residential home. Journal of Gerontological Nursing, 33(2), 17-23.
Lavretsky, H., MD, MS, (2014). Resilience and Aging; Research and Practice. Baltimore, MD: Johns Hopkins University Press.
Lynott, R. J. & Lynott, P. P. (1996). Tracing the course of theoretical development in the sociology of aging. The Gerontologist, 36(6), 749-760.
Manning, Lydia K., (2013), Navigating Hardships in Old Age, Exploring the Relationship Between Spirituality and Resilience in Later Life. Duke University Center for the Study
of Aging and Human Development, Retrieved from Qualitative Health Research Journals Online; http://qhr.sagepub.com/content/23/4/568
Minn, R. (2001). The cold war in welfare: Stock markets verses pensions. London: Verso.
Moody, H & Sasser, J. 2012. Aging Concepts and Controversies 7th Ed. Sage Publication, Inc.
Negash, Selamawit, Bennett, David A., Wilson, Robert S., Schneider, Julie A., Steven E., (2015) Cognition and Neuropathology in Aging: Multidimensional Perspectives from the Rush Religious Orders Study and Rush Memory and Aging Project. National Center For
Biotechnical Information, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157574/
Ong,D.A., Bergeman, C.S., Bisconti, T.L., & Wallace, K.A. (2006) Psychological Resilience, Positive Emotions, and Successful Adaptation to Stress in Later Life, Journal of Personality and Social Psychology, 91(4) 730-749
Patterson, T.L., & Jeste, D.V., (1999) The potential impact of the baby-boom generation on substance abuse among elderly persons. Psychiatric Services, 50, 1184-88.
Puterman, Eli; Epel, Ellisa (2012). An intricate dance: Life experience, multisystem resiliency, and rate of telomere decline throughout the lifespan. Social and Personality Psychology Compass, 807–825.
Rubinstein, R.L., & Medeiros, K., (2014) “Successful Aging,” Gerontological Theory and
Neoliberalism: A Qualitative Critique, The Gerontologist, 2015, Vol. 55, No. 1,
Retrieved from http://gerontologist.oxfordjournals.org/
Ryff, C.D., (1989) Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069-81.
Sheets D., Bradley, D. B. &, Hendricks, J. (Eds) (2006). Enduring Questions in Gerontology. New York, N.Y.: Springer Publishing Company, Inc.
Staudinger, U.M., Masiske, M., & Baltes, P.B., (1995) Resilience and reserve capacity in later adulthood: Potentials and limits of development across the life span. In D. J. Cohen & D. Cicchetti (Eds.), Developmental psychopathology: Risk, disorder, and adaptation (Vol. 2, pp. 801–847).
Wagnild, G.M., & Collins, J.A., (2009) Assessing resilience. Journal of Psychosocial Nursing, 47(12)
Wiles, J.L., Wild, K., Kerse, N., Allen, R.E.S., (2011) Resilience from the point of view of older people: ‘There’s still life beyond a funny knee’, Journal of Social Science and Medicine, The University of Aukland, New Zealand.
Windle, G. (2011) What is resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21, 152-169.
Zeng, Yi., Shen Ke. (2010) Resilience Significantly Contributes to Exceptional Longevity. Current Gerontology & Geratrics Research, p.1
Aging Program Funding Table, FY2013-FY2016proj., National Council on Aging (NCOA)
Certner, D., Tell Congress Not to Leave Seniors Stranded, AARP, http://blog.aarp.org [February 12, 2015]
Congressional Budget Office, Review of S.192, www.cbo.gov/publication/49942 [April 10, 2015]
Freedman, V.A., Martin, L.G., and Schoen, R.F. 2002, “Recent Trends in Disability and Functioning Among Older Adults in the United States; A Systematic Review” The Journal of the American Medical Association.
Kinosian, B., Stallard, E., and Wieland, D. 2007, “Projected Use of Long-Term-Care Services by Enrolled Veterans,” The Journal of the Gerontological Society of America
Lacey, T.A., and Wright, B. 2009, “Occupational Employment Projections to 2018,” Monthly Labor Review.
Quinn, J.F. 2010, “Work, Retirement, and the Encore Career, American Society on Aging,” Generations; The Journal of the American Society on Aging.
White House, The President’s 2016 Budget, www.whitehouse.gov/budget_2016 [April 9, 2015]
Trenesha S. Boyd
Perspectives in Gerontology – GERO 6000
Concordia University
A 65 and Better Population
During the past century the number of people over the age of 65 has been steadily increasing in the United States as well as much of the rest of the world. This phenomenon, known as the “graying of America” (Himes, 2001) is also being observed in many other countries of the world (Bosworth & Burtless, 1998). Since 1870 the over-65 population in the United States alone has increased from 1 million to 35 million in 2000, and in recent decades, this population group has been increasing at twice the rate as the rest of the population (Moody & Sasser, 2012). As the population has been growing older, it has also been growing healthier and more active. Looking at college campuses alone over a half million people over the age of sixty are enrolled as students. There are “needers” who require services as well as those we call “growers”, that is those folks interested in new learning, such as computer use, college courses, and new technologies.
Gerontology is one of the most complex subjects facing science in the 21st century. This paper will give some historical context, define some societal aspects, and offer insight to the government’s role in accommodating an ever more active, vibrant, and demanding aging population. “Seventy is the new 40”, some would say. The study of the aging population from a societal, psychological, biological and spiritual point of view, has also been increasing as a profession in recent decades. Since the 1950s the number of psychologists specializing in the study of aging has increased at a faster rate than did the number in psychology by and large.
Central to discussions of aging is a basic definition of age itself. A chronological number does more than simply identifying the years since birth. It is also a “powerful social and psychological dimension of our lives” (Moody & Sasser, 2012). Age grading refers to the way people are assigned different roles in society depending on their age. Theorists of age stratification emphasize that a person’s position in the age structure affects behavior or attitudes (Streib & Bourg, 1984). It may not be considered appropriate for septuagenarians to crash a high school dance, or physically possible for an octogenarian to try out for the college football team.
The Handbook of Aging and the Individual ( Birren, 1959) was published in 1959 only after protracted discussions with numerous publishers who shied away from publishing in the field of aging. The first printing by The University of Chicago Press was sold out in 6 months.
Despite the general academic lack of interest in studies of aging, several areas of interest were forming by the 1960s. Questions were beginning to be raised in Congress and other public arenas about meeting the ‘needs of an aging population. In 1975 Congress approved the creation of the National Institute on Aging. The body was responding to the rising social pressures of an older society.
An Aging Demographic
Data from modern hunter-gatherers, as well as analysis of ancient skeletal remains, agreed that life expectancy for most of human history was around 20 years (Gage, 1988: Lovejoy et al., 1977).
Life was inherently more dangerous at all ages.
Consequently, just because life expectancy was only 20 years in Paleolithic times does not mean that 30-year-olds in those times had the physical capabilities of today’s 80- or 90-year olds. Those 30-year olds that had been lucky enough to survive childhood and adolescence were physically probably pretty much like 30-year-olds today.
Clearly, the rapid expansion of life expectancy in the past 100 years has been the result of the influences of a better medical environment, clean water, and medical advances in antibiotics.
For instance, a comparison of Civil War veterans who were 65 or older in 1910 and World War II veterans who were 65 or older during 1985-1988 revealed that heart disease among old soldiers was about 3 times as prevalent, musculoskeletal and respiratory disease is about 1.6 times as prevalent, and digestive diseases almost 5 times as prevalent in the early part of the century relative to the latter part (Fogel & Costa, 1977).
Aging, Concepts and Controversies (Moody & Sasser, 2012) describe three major cognitive functions which relates to attention, psychomotor speed, and memory, which all are very vital as we age. “These three factors findings in cognitive aging research have been of limited utility because of an overwhelming reliance on cross-sectional age-comparative research designers.” (Sheets, Bradley & Hendricks. 2006. P. 98). The decline in disability among the elderly in the United States was even more rapid during the early 1990s than during the 1980s (Manton & Gu, 2001). Perhaps less tangible but no less important, aspects of life such as amount of chronic pain and degree of sensory acuity have been improved by the development of better analgesics, joint replacement surgery, and widespread availability of effective treatment for cataracts and glaucoma, as well as continuously improving hearing technology. One of the greatest scientific, and Nobel Prize Winning achievements of the past several decades has been the mapping of the human genome. The growth of the ageing population, worldwide, is often referred to as an “age quake”. Currently California has about 3.5 million persons over the age of 65 and this expected to double to at least 7 million by the 2030s. There are some expert demographers, who are more convinced in life expectancy from the mid-80s to as high as 100 years within this century (Lee & Carter, 1992; Manton, Stallard, & Tolley, 1991: Oeppel & Vaupel, 2002).
An example of aging in a developing country is India. India has shown a rapid increase in the number of older persons. Those over 60 years have risen from 12 million in 1901, to 20 million in 1951, and to 75 million in 2001 (Liebig & Rajan, 2003). It is expected to be 179 million in 2031.
Social Networks
Social networks help maintain the quality of life and mental health. Rapid societal change has been a characteristic of America. Social networks also tap into the collective and latent “wisdom” of an older population. One standard definition is that wisdom consist of “making the best use of available knowledge.” (Moody & Sasser, 2006. P.121). “Creativity in this article is defined as the ability to transcend traditional ways of thinking by generating ideas, methods, and forms that are meaningful and new to others.” (Moody & Sasser, p. 122).
The main thing that has to be acknowledged is the respect and honor that should follow certain decisions in our society for the greater good. For example, there are many programs, both public and private sector, in place that benefit the older populations. There are many food franchises that have senior’s discount and allows the chance to feel special. This is just a minor example of a social construct that is socially accepted.
The role that wisdom and creativity play in the meaning making process related to aging is one of motivation, understanding and guidance as we age and look a life in a different light; a more positive one. “That when information is meaningful, it is more likely to be remembered by older and younger adult’s alike (Hultsch & Dixon, 1990).
Social support interventions involve comprehensive “team” support and may include elements like community groups, volunteer activities, houses of worship, and community and municipal outreach programs. Research suggests that volunteering and civic engagement offer benefits for increasing resilience in older adults by providing purposeful living and community involvement. Through personal connections, older adults learn from others about their potentials and gifts; this awareness increases their self-efficacy and perseverance in the face of adversity (Lavretsky 2014). Exercise classes such as yoga, spinning and water workouts can also mitigate stresses associated with risks to successful aging. Spirituality is also a powerful coping mechanism providing older adults with the ability to adapt to changing individual needs, an important and unique feature of resilience (Manning 2013).
One study of the effects of yoga and Ayurveda on geriatric depression evaluated 69 persons aged at least 61 years old living in the same residential group home (Krishnamurthy & Telles 2007). Results showed depression-symptom scores of the yoga group and three months and six months significantly, from a baseline of 10.6 to 8.1 for the former and 6.7 the latter. Other control groups showed no change, suggesting a comprehensive approach of exercise, including mental and philosophical aspects in addition to physical practices was useful to members of congregate care facilities. Responding to the needs of older adults, the federal government has developed programs to address many needs never before encountered by societies populated mainly with 20- and 30-somethings. At the beginning of the 20th century, life expectancy in the United States was about 48 years (47 for men, 49 for women) (Faber, 1982). Age 65 was adopted as the age of retirement for Social Security in the 1930s, when life expectancy was much lower than it is today.
Enacted in 1965 along with Medicare and Medicaid, the Older Americans Act (OAA) has been the primary vehicle for services and funding in every state that support the dignity and welfare of individuals age 60 and older. These services include programs that protect vulnerable seniors, such as the long-term care ombudsman program, nutritional programs, home-and-community based services, as well as health promotion and disease prevention activities for seniors. The OAA is required to be reauthorized every four years in order to provide Congress this opportunity. Reauthorizing the Older Americans Act allows Congress to update and improve upon the law's vital programs and services. The Older Americans Act expired in 2011, as Congress failed to act on this requirement. Since then legislation to continue this valuable service to our age 60-and-better Americans has stalled in House Subcommittees and Senate brinksmanship. With every day that passes the future of critical programs that serve seniors is more uncertain. Congress must restart the reauthorization process in 2015. This legislation reauthorizes the Older Americans Act of 1965, a federal law with longstanding bipartisan support. The law provides for the organization and delivery of social and nutrition services to older Americans and their caregivers. The federal Older Americans Act (and its reauthorization) would provide nearly $2 billion a year to support important services for senior citizens including support for family caregivers, community based programs, and particularly for long-term care services for Veterans. A study commissioned by the US Department of Veterans Affairs concluded that between 2007 and 2017 the number of oldest veterans (aged 85+) will double, and Veterans Health Administration (VHA) enrolled veterans aged 85 and older will increase sevenfold, resulting in a 20-25% increase in use for both home- and community-based services (Kinosian,Stallard and Wieland, 2007).
Further, the face of the American workforce is changing as people work longer in life. People are healthier, on average, at every age (Freedman, Martin, and Schoeni, 2002). Jobs are trending toward service occupations and away from a more physically demanding manufacturing sector (Lacey and Wright, 2009). And with older women in the labor, hence more couples working, should they chose to retire together a delayed retirement may be in store for husbands (Quinn, 2010). Every day older Americans are making a positive impact in their communities, using the skills they have developed over a lifetime. The Budget expands opportunities for seniors to serve their communities through the Corporation for National and Community Service.
The Budget maintains funding for Senior Corps, whose volunteers engage in activities like mentoring at-risk youth and helping other seniors with daily tasks so that they can stay in their own homes rather than entering costly congregate care. The Budget provides an opportunity for successful Senior Corps programs to grow through AmeriCorps which is providing over 4,000 more positions for seniors.
Every day older Americans are making a positive impact in their communities, using the skills they have developed over a lifetime. The Budget expands opportunities for seniors to serve their communities through the Corporation for National and Community Service. The Budget maintains funding for Senior Corps, whose volunteers engage in activities like mentoring at-risk youth and helping other seniors with daily tasks so that they can stay in their own homes rather than entering costly congregate care. The Budget provides an opportunity for successful Senior Corps programs to grow through AmeriCorps which is providing over 4,000 more positions for seniors.
Here are a few examples of what the senior services budget will look like, based on the 2014 committee work and the Older Americans Act Reauthorization of 2015 (courtesy of the National Council on Aging):
- Supportive Services: This is a key program aimed at helping people with disabilities and the frail elderly remain at home. It provides grants to states for transportation, case management, information and assistance, in-home services such as personal care, legal and mental health services, and adult day care. Funding for 2014 will be about $348 million—exactly what it was under the 2013 sequester and about $20 million less than in 2012.
- Meals on Wheels. Home-delivered nutrition programs will get about $216 million in 2014. That’s about $11 million more than under last year’s sequester, but the same as they got in 2012.
- National Family Caregiver’s Support: These federal grants to states to help hard-pressed caregivers with information services, counseling, and respite care will get about $146 million this year—exactly the same as in 2013 and $10 million less than in 2012.
- State Health Insurance Assistance (SHIP) This key program provides counselors to help seniors and others understand the complexities of Medicaid and other benefits. Its budget is frozen at $52 million.
Conclusion
An ever increasing population of 60, 70 and 80 years young members of the community not only offer an unprecedented opportunity to observe and study, but also will demand society help them age gracefully, with dignity, and with a quality of life well deserved. While there is a substantial role for government to play in providing services to this aging population, society will also adjust to the needs and demands of an increasingly active older America, and the field of Gerontology will continue to expand and study this paradigm.
References
Atchley, R.C. (1999) Incorporating spirituality into professional work in aging. Aging Today, 20(4), 123-24.
Callero, P.L., (2009) The myth of individualism: How social forces shape our lives. Lanham, MD: Rowman and Littlefield.
Curtis, W.J., & Cicchetti, D., (2003) Moving research into the 21st century. Theoretical and methodological considerations in examination the biological contributors to resilience. Developmental Psychopathology, 15; 773-810.
Depp, C.A., & Jeste, D.V., (2006) Definitions and predictors of successful aging: A comprehensive review of larger quantitative studies. American Journal of Geriatric Psychiatry, 14(1), 6-20.
Gardner, K. (2002). Age, Narrative, and Migration. Oxford: Berg.
Hardy, S.E., Concato, J., & Gill, T.M., (2004) Resilience of community-dwelling older persons. Journal of the American Geriatric Society 52(2), 257-62.
Jopp, Daniela; Rott, Christoph (2006). Adaptation in very old age: Exploring the role of resources, beliefs, and attitudes for centenarians' happiness. Psychology and Aging, 21, 266-280.
Krishnamurthy, M.N., & Telles, S. (2007) Assessing depression following two ancient Indian interventions: Effects of yoga and Ayurveda on older adults in a residential home. Journal of Gerontological Nursing, 33(2), 17-23.
Lavretsky, H., MD, MS, (2014). Resilience and Aging; Research and Practice. Baltimore, MD: Johns Hopkins University Press.
Lynott, R. J. & Lynott, P. P. (1996). Tracing the course of theoretical development in the sociology of aging. The Gerontologist, 36(6), 749-760.
Manning, Lydia K., (2013), Navigating Hardships in Old Age, Exploring the Relationship Between Spirituality and Resilience in Later Life. Duke University Center for the Study
of Aging and Human Development, Retrieved from Qualitative Health Research Journals Online; http://qhr.sagepub.com/content/23/4/568
Minn, R. (2001). The cold war in welfare: Stock markets verses pensions. London: Verso.
Moody, H & Sasser, J. 2012. Aging Concepts and Controversies 7th Ed. Sage Publication, Inc.
Negash, Selamawit, Bennett, David A., Wilson, Robert S., Schneider, Julie A., Steven E., (2015) Cognition and Neuropathology in Aging: Multidimensional Perspectives from the Rush Religious Orders Study and Rush Memory and Aging Project. National Center For
Biotechnical Information, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157574/
Ong,D.A., Bergeman, C.S., Bisconti, T.L., & Wallace, K.A. (2006) Psychological Resilience, Positive Emotions, and Successful Adaptation to Stress in Later Life, Journal of Personality and Social Psychology, 91(4) 730-749
Patterson, T.L., & Jeste, D.V., (1999) The potential impact of the baby-boom generation on substance abuse among elderly persons. Psychiatric Services, 50, 1184-88.
Puterman, Eli; Epel, Ellisa (2012). An intricate dance: Life experience, multisystem resiliency, and rate of telomere decline throughout the lifespan. Social and Personality Psychology Compass, 807–825.
Rubinstein, R.L., & Medeiros, K., (2014) “Successful Aging,” Gerontological Theory and
Neoliberalism: A Qualitative Critique, The Gerontologist, 2015, Vol. 55, No. 1,
Retrieved from http://gerontologist.oxfordjournals.org/
Ryff, C.D., (1989) Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069-81.
Sheets D., Bradley, D. B. &, Hendricks, J. (Eds) (2006). Enduring Questions in Gerontology. New York, N.Y.: Springer Publishing Company, Inc.
Staudinger, U.M., Masiske, M., & Baltes, P.B., (1995) Resilience and reserve capacity in later adulthood: Potentials and limits of development across the life span. In D. J. Cohen & D. Cicchetti (Eds.), Developmental psychopathology: Risk, disorder, and adaptation (Vol. 2, pp. 801–847).
Wagnild, G.M., & Collins, J.A., (2009) Assessing resilience. Journal of Psychosocial Nursing, 47(12)
Wiles, J.L., Wild, K., Kerse, N., Allen, R.E.S., (2011) Resilience from the point of view of older people: ‘There’s still life beyond a funny knee’, Journal of Social Science and Medicine, The University of Aukland, New Zealand.
Windle, G. (2011) What is resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21, 152-169.
Zeng, Yi., Shen Ke. (2010) Resilience Significantly Contributes to Exceptional Longevity. Current Gerontology & Geratrics Research, p.1
Aging Program Funding Table, FY2013-FY2016proj., National Council on Aging (NCOA)
Certner, D., Tell Congress Not to Leave Seniors Stranded, AARP, http://blog.aarp.org [February 12, 2015]
Congressional Budget Office, Review of S.192, www.cbo.gov/publication/49942 [April 10, 2015]
Freedman, V.A., Martin, L.G., and Schoen, R.F. 2002, “Recent Trends in Disability and Functioning Among Older Adults in the United States; A Systematic Review” The Journal of the American Medical Association.
Kinosian, B., Stallard, E., and Wieland, D. 2007, “Projected Use of Long-Term-Care Services by Enrolled Veterans,” The Journal of the Gerontological Society of America
Lacey, T.A., and Wright, B. 2009, “Occupational Employment Projections to 2018,” Monthly Labor Review.
Quinn, J.F. 2010, “Work, Retirement, and the Encore Career, American Society on Aging,” Generations; The Journal of the American Society on Aging.
White House, The President’s 2016 Budget, www.whitehouse.gov/budget_2016 [April 9, 2015]
ARTIFACT 5: Advanced Topics in Gerontology – GERO 6750
Resilience and Aging
Trenesha S. Boyd
Advanced Topics in Gerontology – GERO 6750
Resilience and Aging
This paper will describe various challenges the aging population face within the community at large due to typical and atypical stresses. Based upon assigned readings and scholarly sources during the course of this term, a review will be presented regarding the adaptation to emotional and physical stresses of an aging population, and the impact ones community has on the resilience of the aged.
Stresses and Resilience Life expectancy worldwide, and particularly in developing nations such as the United States, has increased dramatically in the past two centuries. Clearly advancements in medicine, vaccinations against disease, and nutritional factors have contributed significantly to this trend. Improved socio-economic conditions also contribute to the increase (Lavretsky 2014). With this increase in years, however, there are often increasing physical and emotional stresses that can affect mortality of individuals as they reach their golden years.
The current population of Baby Boomers, those born between 1946 and 1965, number approximately 75 million in the United States (Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2004, 2005). In 2000 an estimated 35 million people age 65 or older in the United States accounted for almost 13% of the population. In 2011, the “baby-boom” generation began turning 65, and by 2030, it is projected that one in five people will be aged 65 or older. The oldest-old population, 85 years and better, is currently the fastest growing segment of the elderly population (Nagesh, et.al. 2015).
The risks of posttraumatic stress disorder (PTSD), anxiety disorders, and depression are expected to increase as the Baby Boomer generation ages (Patterson & Jeste, 1999). Competition in the workplace and for education has been greater for them than any other generation, suggests to a Pew Research Center report, leading to stress and less contentment on average than their counterparts in those older adults known as the Greatest Generation, and younger Millennials (Wagnild & Collins, 2009).
Quality of life, pursuit of happiness, aging with grace, and self-sufficiency in one’s golden years are not only increasingly desired but expected by an aging population. Normal physical changes such as mobility issues, failing eyesight, and chronic disease introduce stress. Emotional stresses may also emerge and take a toll on an aging individual. Resilience significantly contributes to longevity at all ages, and it becomes even more profound at very advanced ages (Zeng 2010).
The term resilience originates from the Latin ‘resilire’ (to leap back). General dictionary definitions note that the noun ‘resilience’ is a derivative of the adjective ‘resilient’, which has two uses:
- 1.able to recoil or spring back into shape after bending, stretching, or being compressed; 2.(Of a person) able to withstand or recover quickly from difficult situations.
- 1.(Of a person) recovering easily and quickly from misfortune or illness; 2.(Of an object) capable of regaining its original shape or position after bending or stretching.
Resilience is also defined in discipline-specific dictionaries as:
- The personal quality of a person exposed to high risk factors that often lead to delinquent behavior, but they do not do so.
(Windle, 2011).
Resilience is generally defined in the context of aging populations as the ability to adapt to these stresses, or to “bounce back” following life challenges and adversities. Resilience implies flexibility, optimism, coping skills and an inner strength when faced with adversity. Resilient adults are able to adapt successfully to stress and adversity (Hardy, Concato & Gill, 2004).
Rowe and Kahn note that successful aging “can be attained through individual choice and effort” (1998, p. 37). While this may be true, Rubinstein and Medeiros argue that several other factors including an individual’s biography, personal meanings, or life-experience might relate to successful aging outcomes. Further, a history of trauma, lack of access to resources or medical care, and early-life violence, as well as continuing economic or social marginality are often involved. In layman’s terms, forces outside the individuals’ control may limit their ability to pull themselves up by their own bootstraps.
Certainly there are people who may overcome these experiences on their own and age successfully, but in some cases they may need help to do so. Often a social mechanism might promote the individual changes required to age successfully, other than a person’s own actions (Callero, 2009).
Current Scholarship Risks and Protective Factors
Risk factors, as elements of the process of resilience and successful adaptation in aging, that predict negative outcomes include such events as the death of a spouse or loved one, declines in physical health and functioning, a predisposition to an early death, and even loss of social status and prestige or financial insecurity (Staudinger, Masiske, & Baltes, 1995).
Perhaps a less than obvious risk factor in achieving successful aging is the increasing income inequality over the past three decades. Rubinstein and Medeiros put it this way;
‘Income inequality is one of the central public policy issues in the United States at this time due to the changes that have occurred in public support for health and welfare; wealth redistribution to a very small minority due to regressive tax codes and selective investment opportunities; an increase in corporate power; privatization of public services; and political fractioning and legislative stalemate. A concern in much writing about neoliberalism worldwide has been the creation of new classes with extreme wealth and the creation of a new, immobilized poor class without much chance of upward mobility, a transformation that has also greatly affected American society. What is generally known about this neoliberal adjustment is that those who are disaffected by such changes receive diminished or little attention from public media and government.’
The same is certainly true for any persons who might end up labeled as aging unsuccessfully which research…has shown to be numerous’ (Rubinstein & Medeiros, 2014).
Positive outcomes, conversely, are marked by protective factors in the resilience process paradigm. Protective factors are defined as characteristics of an individual or environment that predict positive outcomes. An active community involvement with church, outreach organizations, social groups and close family ties can provide environmental protective factors. Emotional and psychological well-being, individual characteristics, are strongly correlated to successful aging and adaptation. Six key dimensions of what constitutes well-being were proposed by Ryff (1989);
- autonomy (capacity for self-determination)
- environmental mastery (ability to manage one’s surrounding world)
- personal growth (realization of potential)
- positive relationship with others (high-quality relationships)
- purpose in life (meaning and direction in life)
- self-acceptance (positive self-regard).
Conditions
According to the Ohio Longitudinal Study of Aging and Adaptation (OLSAA) involving a 20-year follow-up of persons 50 years of age and older, both men and women, ‘continuity of resilience into retirement years is unaffected by gender and education’ (Atchley 1999). The most frequent indicators of successful aging in a review of 28 separate studies on aging included age (young-old), nonsmoking, and absence of disability, arthritis and diabetes. Further, this particular review by Depp and Jeste (2006) indicated that successful aging was indeed affected by greater physical activity, more social contacts, better ‘self-rated’ health, absence of depression and/or cognitive impairment, and fewer diagnosed medical conditions. Income, education, and marital status did not generally relate to successful aging, according to the Depp and Jeste review, however they did concur with the OLSAA study that gender had no correlation whatsoever (Depp & Jeste 2006).
Interventions
There are several psychotherapeutic approaches to building resilience on an individual
basis involving cognitive behavioral and others which show promise. These include such procedures as Broad-Minded Affective Coping (BMAC), Well-Being Therapy, Learned Optimism Training, and Hardiness Training.
In their paper Resilience from the point of view of older people: ‘There’s still life beyond
a funny knee’, Wiles, Wild, et.al. argue that ‘the most significant risk in using resilience as a measure of ageing well is that by focusing exclusively on individual characteristics and behaviors, we risk blaming individuals for not achieving resilience in later life. What our participants’ engagement with the concept of resilience highlights is that we must pay adequate attention to the broader physical and social contexts and scales that underpin and foster individual resilience’ (Wiles, Wild, et.al. 2011).
Social support interventions on the other hand involve comprehensive “team” support and may include elements like community groups, volunteer activities, houses of worship, and community and municipal outreach programs. Research suggests that volunteering and civic engagement offer benefits for increasing resilience in older adults by providing purposeful living and community involvement. Through personal connections, older adults learn from others about their potentials and gifts; this awareness increases their self-efficacy and perseverance in the face of adversity (Lavretsky 2014). Exercise classes such as yoga, spinning and water workouts can also mitigate stresses associated with risks to successful aging. Spirituality is also a powerful coping mechanism providing older adults with the ability to adapt to changing individual needs, an important and unique feature of resilience (Manning 2013).
One study of the effects of yoga and Ayurveda on geriatric depression evaluated 69 persons aged at least 61 years old living in the same residential group home (Krishnamurthy & Telles 2007). Results showed depression-symptom scores of the yoga group and three months and six months significantly, from a baseline of 10.6 to 8.1 for the former and 6.7 the latter. Other control groups showed no change, suggesting a comprehensive approach of exercise, including mental and philosophical aspects in addition to physical practices was useful to members of congregate care facilities.
Figure 1. Theoretic model of resilience, Adapted from Lavretsky 2014.
Limitations
Research for this paper revealed many schools of thought on the subject of resilience in aging. Individual therapies, learned happiness and pull-up-your-own-bootstraps on one hand and social intervention on the other. Resilience itself, as applied to aging, is an extension of the study of resilience in children, which has been familiar to researchers for many decades. Resilience in aging, on the other hand, has only been the subject of scientific study for two to three decades, providing only limited results. As baby boomers age more studies will reveal useful data that can certainly further the field, particularly for following generations as they reach retirement age in the middle of this century. Research needs to be conducted which seeks to identify (1) motivations and volunteer behaviors of baby boomers; (2) effective mobilization strategies; (3) “best practices” for volunteer program structures and designs that will attract and support older volunteers; and (4) the extent of inclusion of diverse older adults by ethnicity and ranges of education, income, and functional abilities (Lavretsky 2014).
The education and experience of the collective Baby Boomer generation has the potential of solving many problems facing our society. Policies and programs, politicians and stakeholders should be diligent in their efforts and willingness to capture this opportunity.
Implications
In a recent review of the resilience research conducted over the past 30 years, Curtis and Cicchetti (2003) concluded with the following statement: “If we are to grasp the true complexity of the concept of resilience, then we must investigate it with a commensurate level of complexity” (p. 803). Ong, Bergeman, Bisconti, and Wallace put it well in emphasizing that ‘the time has come for researchers to maximize the potential advantages of combining a variety of methodological (e.g., experimental, daily diary, life story narratives) and innovative data analytic (e.g., multilevel modeling, growth mixture modeling, dynamical systems analysis) techniques for tackling the complex theoretical questions surrounding the measurement and modeling of adaptive processes’ (Ong, Bergeman, Bisconti, and Wallace, 2006).
These studies must continue and extend long term. Regardless of its source – either external repeated exposure to environmental and social stressors or individual tendencies to prolong the stress response – chronic stress across human development and its biological correlates must be examined from a lifespan perspective (Puterman & Epel 2012).
An ever increasing population of 60, 70 and 80 years young members of the community not only offer an unprecedented opportunity to observe and study, but also will demand society help them age gracefully, with dignity, and with a quality of life well deserved.
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