,GERONTOLOGY
for the Health Care
Professional
Edited by
Regula H. Robnett, PhD, OTR/L, FAOTA
Professor, Department of Occupational Therapy
University of New England
Nancy Brossoie, PhD
Senior Research Scientist, Center for Gerontology
Virginia Tech
Walter C. Chop, MS, RRT
Professor Emeritus, Respiratory Therapy Department
Southern Maine Community College
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Library of Congress Cataloging-in-Publication Data
Names: Robnett, Regula H., editor. | Chop, Walter C., editor. | Brossoie,
Nancy, editor.
Title: Gerontology for the health care professional / [edited by] Regula H.
Robnett, Walter Chop, and Nancy Brossoie.
Description: Fourth edition. | Burlington, MA : Jones & Barlett Learning,
[2020] | Includes bibliographical references and index.
Identifiers: LCCN 2018013913 | ISBN 9781284140569 (pbk. : alk. paper)
Subjects: | MESH: Geriatrics | Aged | Aging–physiology | Geriatric Assessment
Classification: LCC RA564.8 | NLM WT 100 | DDC 618.97–dc23 LC record available at https://lccn.loc.gov/2018013913
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Dedication
This edition is dedicated to:
The older adults who have shown us how to
live productive, healthy, and happy lives and for
reminding us that age is more than just a number.
Our authors for their tireless writing efforts and
commitment in educating healthcare workers, from
students to seasoned professionals.
Our families who sacrificed their needs and wants
when our work on this edition had to come first.
We thank all of you.
–Regi, Nancy, and Walter
iii
,
,© patpitchaya/Shutterstock.
Brief Contents
Introduction xii
How to Use This Text xiv
About the Authors xvii
Acknowledgments xviii
Contributors xix
Reviewers xx
Chapter 1 Age Matters: Profiles of an Aging Society. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2 Social Gerontology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 3 Aging in Place and the Continuum of Care. . . . . . . . . . . . . . . . . . . . . . . . . . 57
Chapter 4 Loss, Grief, Death, and Dying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Chapter 5 H ealth Literacy and Clear Communication: Keys to Engaging
Older Adults and Their Families������������������������������������������������������������������ 109
Chapter 6 Policy Issues for Older Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Chapter 7 The Physiology and Pathology of Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Chapter 8 Cognitive and Psychological Changes Related to Aging�������������������������� 189
Chapter 9 F unctional Performance in Later Life: Basic Sensory,
Perceptual, and Physical Changes Associated with Aging���������������������� 233
Chapter 10 Drugs and the Older Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Chapter 11 Nutrition and Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Chapter 12 P erspectives on Oral Care in Healthy Aging and Prevention
for the Older Adult���������������������������������������������������������������������������������������� 297
v
,vi Brief Contents
Chapter 13 Sexuality and Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Chapter 14 Reframing Aging Issues to Ensure a Better Future������������������������������������ 345
Epilogue 373
Answers to Review Questions 379
Glossary 381
Index 393
,© patpitchaya/Shutterstock.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii Vaccinations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
How to Use This Text. . . . . . . . . . . . . . . . . . . . . . . . . . . xiv Self-Rated Health. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Caregivers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Long-Term Care Services. . . . . . . . . . . . . . . . . . . . 18
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . xviii Death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xx Aging Successfully . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Successful Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Chapter 1 Age Matters: Profiles Quality of Life in Old Age. . . . . . . . . . . . . . . . . . . 20
of an Aging Society. . . . . . . . . . . . 1 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Nancy Brossoie, PhD
Regula H. Robnett, PhD, OTR/L, FAOTA Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Walter C. Chop, MS, RRT References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Global Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Chapter 2 Social Gerontology . . . . . . . . . . 27
Age, Sex, and Distribution . . . . . . . . . . . . . . . . . . . 3 Nancy Brossoie, PhD
Fertility Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Walter C. Chop, MS, RRT
Longevity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Gerontology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Migration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Historical Perspectives on Aging. . . . . . . . . . . . . . . . . 29
Aging in the United States . . . . . . . . . . . . . . . . . . . . . . . 9 Theories About Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Age and Age Groups. . . . . . . . . . . . . . . . . . . . . . . . 9 Ageism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Geographic Distribution. . . . . . . . . . . . . . . . . . . . . 9 Ageist Stereotypes . . . . . . . . . . . . . . . . . . . . . . . . . 31
Sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Myths About Aging . . . . . . . . . . . . . . . . . . . . . . . . 31
Race. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Ageist Language . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Marital Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Ageist Attitudes of Healthcare Professionals. . . . 32
Living Arrangements. . . . . . . . . . . . . . . . . . . . . . . 11 Media Stereotyping of Older Adults . . . . . . . . 33
Economic Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Social Roles in the Second Half of Life. . . . . . . . . . . . 33
Poverty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Retiree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Grandparent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Sources of Income. . . . . . . . . . . . . . . . . . . . . . . . . . 13 Surrogate Parent . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Work and Retirement Status. . . . . . . . . . . . . . . . . . . . . 15 Caregiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Health Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Social Roles in Context . . . . . . . . . . . . . . . . . . . . . 36
Chronic Health Conditions . . . . . . . . . . . . . . . . . 16 Social Relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Functional Limitations. . . . . . . . . . . . . . . . . . . . . . 16 Personal Relationships . . . . . . . . . . . . . . . . . . . . . 37
vii
,viii Contents
Computers and Social Media . . . . . . . . . . . . . . . 38 Nursing Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
The Aging Couple. . . . . . . . . . . . . . . . . . . . . . . . . . 38 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Aging Parent and Adult Child. . . . . . . . . . . . . . . 40 Person-Centered Approaches
Never Married or Childless in Late Life . . . . . . 40 to Institutional Care. . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Friendships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Hogeweyk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Elder Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Eden Alternative . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Victims of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Special Topics and Issues. . . . . . . . . . . . . . . . . . . . . . . . .76
Self-Neglect Among Older Adults . . . . . . . . . . 43 Telehealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Perpetrators of Abuse . . . . . . . . . . . . . . . . . . . . . . 44 Paying for LTCSS. . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Signs of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Homelessness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Mandated Reporting . . . . . . . . . . . . . . . . . . . . . . . 44 Home Modifications. . . . . . . . . . . . . . . . . . . . . . . . 77
Employment and Civic Engagement. . . . . . . . . . . . . 46 Reverse Mortgages. . . . . . . . . . . . . . . . . . . . . . . . . 79
Workplace Discrimination . . . . . . . . . . . . . . . . . . 46 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Retirement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Chapter 4 Loss, Grief, Death,
and Dying. . . . . . . . . . . . . . . . . . 85
Chapter 3 Aging in Place and the Regula H. Robnett, PhD, OTR/L, FAOTA
Continuum of Care . . . . . . . . . . 57 Nancy Brossoie, PhD
Ann O’Sullivan, OTR/L, LSW, FAOTA Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Nancy Brossoie, PhD Loss and Grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Regula H. Robnett, PhD, OTR/L, FAOTA
Loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Grief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Aging in Place. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Theories on Managing Grief . . . . . . . . . . . . . . . . . . . . . 88
Independence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 Attachment Theory . . . . . . . . . . . . . . . . . . . . . . . . 89
Productive Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Stage Process Model . . . . . . . . . . . . . . . . . . . . . . . 89
Competency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Phase Process Model. . . . . . . . . . . . . . . . . . . . . . . 90
Person-Centered Care. . . . . . . . . . . . . . . . . . . . . . 60 Coping with Loss and Grief. . . . . . . . . . . . . . . . . . . . . . 92
Technology-Based Services. . . . . . . . . . . . . . . . . 60
Complicated Grief . . . . . . . . . . . . . . . . . . . . . . . . . .92
Universal Design. . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Supporting a Person Who Has Sustained a Loss . . . .93
Continuum of Care. . . . . . . . . . . . . . . . . . . . . . . . . 62
Rituals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Independent Living . . . . . . . . . . . . . . . . . . . . . . . . 63
Burnout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Active Adult Communities . . . . . . . . . . . . . . . . . 64
Compassion Fatigue . . . . . . . . . . . . . . . . . . . . . . . 95
Congregate Living Arrangements. . . . . . . . . . . 66
Death and Dying. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Community-Based Services and Supports. . . . . . . . 68
Death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Home and Community-Based Services . . . . . 68
Perspectives on Death. . . . . . . . . . . . . . . . . . . . . . 96
Home Health Services. . . . . . . . . . . . . . . . . . . . . . 68
Program of All-Inclusive Care Seeking a Good Death . . . . . . . . . . . . . . . . . . . . . . . . . . 97
for the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Advanced Directives. . . . . . . . . . . . . . . . . . . . . . . . 99
Aging Network Services. . . . . . . . . . . . . . . . . . . . 69 End-of-Life Care Options. . . . . . . . . . . . . . . . . . . . . . . . 101
Service-Enriched Communities. . . . . . . . . . . . . . . . . . 71 Hospice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Continuing Care Retirement Community. . . 71 Working with Dying Patients. . . . . . . . . . . . . . . 103
Assisted Living Facility. . . . . . . . . . . . . . . . . . . . . . 71 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
, Contents ix
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 The Ever-Evolving Nature of Policy. . . . . . . . . 130
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Historical Perspectives on Elder Policy. . . . . 131
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Policy Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Income Policies. . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Chapter 5 Health Literacy and Clear
Healthcare Policies . . . . . . . . . . . . . . . . . . . . . . . . 136
Communication: Keys Older Adults and Disabilities
to Engaging Older Adults Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
and Their Families. . . . . . . . . . 109 Long-Term Services and Supports . . . . . . . . . 144
Audrey Riffenburgh, PhD Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Sue Stableford, MPH, MSB Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
A Patient’s Experience of Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Health Communication. . . . . . . . . . . . . . . . . . . . . . 110
Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Understanding and Using Health Care:
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Why Older Adults Often Struggle. . . . . . . . . . . . . 111
Health Literacy Challenges. . . . . . . . . . . . . . . . . 111
Chapter 7
The Physiology and
Organizational Barriers . . . . . . . . . . . . . . . . . . . . 112
Pathology of Aging. . . . . . . . . 153
Individual Factors. . . . . . . . . . . . . . . . . . . . . . . . . . 112
Literacy, Numeracy, and Health Literacy Kimberly Wilson, DNP, RN
Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Theories of Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Numeracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Programmed Theories of Aging. . . . . . . . . . . . 158
Impacts of Literacy and Health Literacy Environmental Theories of Aging. . . . . . . . . . 158
Skills: Two Major Keys to Good Health . . . . . . . . 114 Physiological Changes of Aging. . . . . . . . . . . . . . . . . 160
The Impact of National Policies Cardiovascular System . . . . . . . . . . . . . . . . . . . . 160
on Health Literacy Practice . . . . . . . . . . . . . . . . . . 114
Respiratory System. . . . . . . . . . . . . . . . . . . . . . . . 162
Accrediting, Standard Setting, Gastrointestinal System . . . . . . . . . . . . . . . . . . . 164
and Policy Organizations . . . . . . . . . . . . . . . . . . . . 115
Genitourinary System. . . . . . . . . . . . . . . . . . . . . . 167
Federal Government Agencies . . . . . . . . . . . . . . . . . 116
Musculoskeletal System . . . . . . . . . . . . . . . . . . . 169
The Business and Legal Case for Health Literacy. . . 117 Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Clear Health Communication: Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . 173
An Often Overlooked Necessity. . . . . . . . . . . . . . 118 Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . 175
What Is Plain Language? How Will I Know Integumentary System . . . . . . . . . . . . . . . . . . . . 176
It If I Hear It?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Sensory Organs. . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
What Is Plain Language? How Will I Know Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
it if I See it?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
A Call to Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Chapter 8 Cognitive and Psychological
Chapter 6 Policy Issues for Changes Related to Aging. . . 189
Older Adults. . . . . . . . . . . . . . . 129 Regula H. Robnett, PhD, OTR/L, FAOTA
Laney Bruner Canhoto, PhD, MSW, MPH Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Typical Cognitive Changes of Aging. . . . . . . . . . . . . 191
Policy Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Typical Cognition Overview. . . . . . . . . . . . . . . . 192
for the Health Care
Professional
Edited by
Regula H. Robnett, PhD, OTR/L, FAOTA
Professor, Department of Occupational Therapy
University of New England
Nancy Brossoie, PhD
Senior Research Scientist, Center for Gerontology
Virginia Tech
Walter C. Chop, MS, RRT
Professor Emeritus, Respiratory Therapy Department
Southern Maine Community College
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Library of Congress Cataloging-in-Publication Data
Names: Robnett, Regula H., editor. | Chop, Walter C., editor. | Brossoie,
Nancy, editor.
Title: Gerontology for the health care professional / [edited by] Regula H.
Robnett, Walter Chop, and Nancy Brossoie.
Description: Fourth edition. | Burlington, MA : Jones & Barlett Learning,
[2020] | Includes bibliographical references and index.
Identifiers: LCCN 2018013913 | ISBN 9781284140569 (pbk. : alk. paper)
Subjects: | MESH: Geriatrics | Aged | Aging–physiology | Geriatric Assessment
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Dedication
This edition is dedicated to:
The older adults who have shown us how to
live productive, healthy, and happy lives and for
reminding us that age is more than just a number.
Our authors for their tireless writing efforts and
commitment in educating healthcare workers, from
students to seasoned professionals.
Our families who sacrificed their needs and wants
when our work on this edition had to come first.
We thank all of you.
–Regi, Nancy, and Walter
iii
,
,© patpitchaya/Shutterstock.
Brief Contents
Introduction xii
How to Use This Text xiv
About the Authors xvii
Acknowledgments xviii
Contributors xix
Reviewers xx
Chapter 1 Age Matters: Profiles of an Aging Society. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2 Social Gerontology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 3 Aging in Place and the Continuum of Care. . . . . . . . . . . . . . . . . . . . . . . . . . 57
Chapter 4 Loss, Grief, Death, and Dying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Chapter 5 H ealth Literacy and Clear Communication: Keys to Engaging
Older Adults and Their Families������������������������������������������������������������������ 109
Chapter 6 Policy Issues for Older Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Chapter 7 The Physiology and Pathology of Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Chapter 8 Cognitive and Psychological Changes Related to Aging�������������������������� 189
Chapter 9 F unctional Performance in Later Life: Basic Sensory,
Perceptual, and Physical Changes Associated with Aging���������������������� 233
Chapter 10 Drugs and the Older Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Chapter 11 Nutrition and Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Chapter 12 P erspectives on Oral Care in Healthy Aging and Prevention
for the Older Adult���������������������������������������������������������������������������������������� 297
v
,vi Brief Contents
Chapter 13 Sexuality and Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Chapter 14 Reframing Aging Issues to Ensure a Better Future������������������������������������ 345
Epilogue 373
Answers to Review Questions 379
Glossary 381
Index 393
,© patpitchaya/Shutterstock.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii Vaccinations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
How to Use This Text. . . . . . . . . . . . . . . . . . . . . . . . . . . xiv Self-Rated Health. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Caregivers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Long-Term Care Services. . . . . . . . . . . . . . . . . . . . 18
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . xviii Death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xx Aging Successfully . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Successful Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Chapter 1 Age Matters: Profiles Quality of Life in Old Age. . . . . . . . . . . . . . . . . . . 20
of an Aging Society. . . . . . . . . . . . 1 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Nancy Brossoie, PhD
Regula H. Robnett, PhD, OTR/L, FAOTA Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Walter C. Chop, MS, RRT References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Global Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Chapter 2 Social Gerontology . . . . . . . . . . 27
Age, Sex, and Distribution . . . . . . . . . . . . . . . . . . . 3 Nancy Brossoie, PhD
Fertility Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Walter C. Chop, MS, RRT
Longevity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Gerontology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Migration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Historical Perspectives on Aging. . . . . . . . . . . . . . . . . 29
Aging in the United States . . . . . . . . . . . . . . . . . . . . . . . 9 Theories About Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Age and Age Groups. . . . . . . . . . . . . . . . . . . . . . . . 9 Ageism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Geographic Distribution. . . . . . . . . . . . . . . . . . . . . 9 Ageist Stereotypes . . . . . . . . . . . . . . . . . . . . . . . . . 31
Sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Myths About Aging . . . . . . . . . . . . . . . . . . . . . . . . 31
Race. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Ageist Language . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Marital Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Ageist Attitudes of Healthcare Professionals. . . . 32
Living Arrangements. . . . . . . . . . . . . . . . . . . . . . . 11 Media Stereotyping of Older Adults . . . . . . . . 33
Economic Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Social Roles in the Second Half of Life. . . . . . . . . . . . 33
Poverty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Retiree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Grandparent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Sources of Income. . . . . . . . . . . . . . . . . . . . . . . . . . 13 Surrogate Parent . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Work and Retirement Status. . . . . . . . . . . . . . . . . . . . . 15 Caregiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Health Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Social Roles in Context . . . . . . . . . . . . . . . . . . . . . 36
Chronic Health Conditions . . . . . . . . . . . . . . . . . 16 Social Relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Functional Limitations. . . . . . . . . . . . . . . . . . . . . . 16 Personal Relationships . . . . . . . . . . . . . . . . . . . . . 37
vii
,viii Contents
Computers and Social Media . . . . . . . . . . . . . . . 38 Nursing Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
The Aging Couple. . . . . . . . . . . . . . . . . . . . . . . . . . 38 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Aging Parent and Adult Child. . . . . . . . . . . . . . . 40 Person-Centered Approaches
Never Married or Childless in Late Life . . . . . . 40 to Institutional Care. . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Friendships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Hogeweyk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Elder Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Eden Alternative . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Victims of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Special Topics and Issues. . . . . . . . . . . . . . . . . . . . . . . . .76
Self-Neglect Among Older Adults . . . . . . . . . . 43 Telehealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Perpetrators of Abuse . . . . . . . . . . . . . . . . . . . . . . 44 Paying for LTCSS. . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Signs of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Homelessness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Mandated Reporting . . . . . . . . . . . . . . . . . . . . . . . 44 Home Modifications. . . . . . . . . . . . . . . . . . . . . . . . 77
Employment and Civic Engagement. . . . . . . . . . . . . 46 Reverse Mortgages. . . . . . . . . . . . . . . . . . . . . . . . . 79
Workplace Discrimination . . . . . . . . . . . . . . . . . . 46 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Retirement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Chapter 4 Loss, Grief, Death,
and Dying. . . . . . . . . . . . . . . . . . 85
Chapter 3 Aging in Place and the Regula H. Robnett, PhD, OTR/L, FAOTA
Continuum of Care . . . . . . . . . . 57 Nancy Brossoie, PhD
Ann O’Sullivan, OTR/L, LSW, FAOTA Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Nancy Brossoie, PhD Loss and Grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Regula H. Robnett, PhD, OTR/L, FAOTA
Loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Grief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Aging in Place. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Theories on Managing Grief . . . . . . . . . . . . . . . . . . . . . 88
Independence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 Attachment Theory . . . . . . . . . . . . . . . . . . . . . . . . 89
Productive Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Stage Process Model . . . . . . . . . . . . . . . . . . . . . . . 89
Competency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Phase Process Model. . . . . . . . . . . . . . . . . . . . . . . 90
Person-Centered Care. . . . . . . . . . . . . . . . . . . . . . 60 Coping with Loss and Grief. . . . . . . . . . . . . . . . . . . . . . 92
Technology-Based Services. . . . . . . . . . . . . . . . . 60
Complicated Grief . . . . . . . . . . . . . . . . . . . . . . . . . .92
Universal Design. . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Supporting a Person Who Has Sustained a Loss . . . .93
Continuum of Care. . . . . . . . . . . . . . . . . . . . . . . . . 62
Rituals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Independent Living . . . . . . . . . . . . . . . . . . . . . . . . 63
Burnout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Active Adult Communities . . . . . . . . . . . . . . . . . 64
Compassion Fatigue . . . . . . . . . . . . . . . . . . . . . . . 95
Congregate Living Arrangements. . . . . . . . . . . 66
Death and Dying. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Community-Based Services and Supports. . . . . . . . 68
Death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Home and Community-Based Services . . . . . 68
Perspectives on Death. . . . . . . . . . . . . . . . . . . . . . 96
Home Health Services. . . . . . . . . . . . . . . . . . . . . . 68
Program of All-Inclusive Care Seeking a Good Death . . . . . . . . . . . . . . . . . . . . . . . . . . 97
for the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Advanced Directives. . . . . . . . . . . . . . . . . . . . . . . . 99
Aging Network Services. . . . . . . . . . . . . . . . . . . . 69 End-of-Life Care Options. . . . . . . . . . . . . . . . . . . . . . . . 101
Service-Enriched Communities. . . . . . . . . . . . . . . . . . 71 Hospice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Continuing Care Retirement Community. . . 71 Working with Dying Patients. . . . . . . . . . . . . . . 103
Assisted Living Facility. . . . . . . . . . . . . . . . . . . . . . 71 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
, Contents ix
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 The Ever-Evolving Nature of Policy. . . . . . . . . 130
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Historical Perspectives on Elder Policy. . . . . 131
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Policy Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Income Policies. . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Chapter 5 Health Literacy and Clear
Healthcare Policies . . . . . . . . . . . . . . . . . . . . . . . . 136
Communication: Keys Older Adults and Disabilities
to Engaging Older Adults Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
and Their Families. . . . . . . . . . 109 Long-Term Services and Supports . . . . . . . . . 144
Audrey Riffenburgh, PhD Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Sue Stableford, MPH, MSB Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
A Patient’s Experience of Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Health Communication. . . . . . . . . . . . . . . . . . . . . . 110
Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Understanding and Using Health Care:
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Why Older Adults Often Struggle. . . . . . . . . . . . . 111
Health Literacy Challenges. . . . . . . . . . . . . . . . . 111
Chapter 7
The Physiology and
Organizational Barriers . . . . . . . . . . . . . . . . . . . . 112
Pathology of Aging. . . . . . . . . 153
Individual Factors. . . . . . . . . . . . . . . . . . . . . . . . . . 112
Literacy, Numeracy, and Health Literacy Kimberly Wilson, DNP, RN
Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Theories of Aging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Numeracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Programmed Theories of Aging. . . . . . . . . . . . 158
Impacts of Literacy and Health Literacy Environmental Theories of Aging. . . . . . . . . . 158
Skills: Two Major Keys to Good Health . . . . . . . . 114 Physiological Changes of Aging. . . . . . . . . . . . . . . . . 160
The Impact of National Policies Cardiovascular System . . . . . . . . . . . . . . . . . . . . 160
on Health Literacy Practice . . . . . . . . . . . . . . . . . . 114
Respiratory System. . . . . . . . . . . . . . . . . . . . . . . . 162
Accrediting, Standard Setting, Gastrointestinal System . . . . . . . . . . . . . . . . . . . 164
and Policy Organizations . . . . . . . . . . . . . . . . . . . . 115
Genitourinary System. . . . . . . . . . . . . . . . . . . . . . 167
Federal Government Agencies . . . . . . . . . . . . . . . . . 116
Musculoskeletal System . . . . . . . . . . . . . . . . . . . 169
The Business and Legal Case for Health Literacy. . . 117 Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Clear Health Communication: Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . 173
An Often Overlooked Necessity. . . . . . . . . . . . . . 118 Immune System . . . . . . . . . . . . . . . . . . . . . . . . . . 175
What Is Plain Language? How Will I Know Integumentary System . . . . . . . . . . . . . . . . . . . . 176
It If I Hear It?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Sensory Organs. . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
What Is Plain Language? How Will I Know Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
it if I See it?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
A Call to Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Case Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Test Your Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Chapter 8 Cognitive and Psychological
Chapter 6 Policy Issues for Changes Related to Aging. . . 189
Older Adults. . . . . . . . . . . . . . . 129 Regula H. Robnett, PhD, OTR/L, FAOTA
Laney Bruner Canhoto, PhD, MSW, MPH Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Typical Cognitive Changes of Aging. . . . . . . . . . . . . 191
Policy Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Typical Cognition Overview. . . . . . . . . . . . . . . . 192
