Chat with us, powered by LiveChat Older Adults Giving and Receiving Support Essay |

Please in your own words and make simple. Please don’t use paraphrasing websites and no plagiarism.

(I will provide the textbook chapter)

Page 208 in your textbook lists the seven Titles (sections) to the Older Americans Act (OAA). Pick three of the seven titles and explore further. Feel free to use the Internet for further information – please be sure your sources are reliable.

  • Title I: Declaration of Objectives; Definitions
  • Title II: Administration on Aging (AoA)
  • Title III: Grants for States and Community Programs on Aging
  • Title IV: Activities for Health, Independence, and Longevity
  • Title V: Community Service Senior Employment Program
  • Title VI: Grants for Services for Native Americans
  • Title VII: Vulnerable Elder Rights Protection Activities

For the write up:



of the following for your selected section.( do three times for the each of three title chosen)

  1. Which title did you select?
  2. Give a brief summary of what the section covers.
  3. How do you feel the information in your section of the OAA can benefit seniors?
  4. Do you have any suggestions for changes that are needed in your section?

A Positive,
Judith A. Sugar
Judith A. Sugar, PhD, received her doctoral degree in life-span developmental psychology from
York University in Toronto. A nationally recognized teacher and scholar in the field of aging, she
has been teaching introductory aging courses for more than two decades. Dr. Sugar chaired the
nascent gerontology program at Colorado State University and served as associate director of the
Borun Center for Gerontological Research at the University of California, Los Angeles (UCLA)
and as director of the Graham and Jean Sanford Center for Aging at the University of Nevada,
Reno. As a member of the Nevada Geriatric Education Center from its inception, she developed
innovative programs to support faculty across all disciplines who were already teaching courses in
gerontology, as well as faculty who were interested in adding gerontology topics to their courses.
She continues to develop innovative approaches to teaching gerontology and, most importantly,
to recruiting students into the discipline. Her national and regional reputation in the field of
aging led to her appointment to the Nevada State Commission on Aging, and she has served in
leadership roles in prominent professional gerontological organizations, including the Academy
for Gerontology in Higher Education (AGHE), the Gerontological Society of America (GSA), and
the American Psychological Association’s Division of Adult Development and Aging. Valued both
by students and faculty, she has been honored with numerous awards as a teacher and scholar,
including Fellow of the AGHE, Woman of Achievement by the University of Nevada, Reno, and the
inaugural award for Distinguished Faculty Scholar by the Sanford Center for Aging.
A Po si ti v e, I nte rd i sc ip l in a r y A p p ro a ch
Second Edition
Judith A. Sugar, PhD
Contributions by
Robert J. Riekse, EdD, Grand Rapids Community College, Emeritus
Henry Holstege, PhD, Calvin College, Emeritus
Michael A. Faber, MA, AGHEF, Gerontology Instructor,
Portland Community College
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ebook ISBN: 978-0-8261-6294-6
DOI: 10.1891/9780826162946
Instructor’s Materials: Qualified instructors may request supplements by emailing
Instructor’s Manual: 978-0-8261-6295-3
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Student Activities Answer Key is available from:
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To the memory of the late Marilyn T. Zivian, PhD
Share: Introduction to Aging: A Positive, Interdisciplinary Approach, Second Edition
1. The Longevity Dividend
Learning Objectives
The New American Revolution
Our Aging World
A New Paradigm of Aging
Practical Application
Student Activities
Suggested Resources
2. Physical Changes and the Aging Process
Learning Objectives
Normal Physical Changes That Accompany Aging and Adaptations to Them
Biological Theories of Aging
Practical Application
Student Activities
Suggested Resources
3. Health and Wellness for Older Adults
Learning Objectives
Enhancing and Maintaining Health in the Later Years
Health Promotion
Preventive Measures
Practical Application
Student Activities
Suggested Resources
4. Mental Health, Cognitive Abilities, and Aging
Learning Objectives
Mental Health and Cognitive Abilities of Older People
Mental Health
Cognitive Abilities
Positive and Negative Influences on Mental Health and Cognitive Abilities
A Positive View of Mental Health and Cognition
Practical Application
Student Activities
Suggested Resources
5. Sexuality and Aging
Learning Objectives
Let’s Talk about Sex
Sexual Expression
Sexuality and Health
Sexuality in Residential Care Facilities
Education for Everyone
Practical Application
Student Activities
Suggested Resources
6. Death, Dying, and Bereavement
Learning Objectives
Understanding Death as a Normal Part of Life
Hospice and Palliative Care
Sustaining Life: A Thorny Issue
Suicide and Aging
Organ Donation: The Gift of Life
Bereavement, Grief, and Mourning
Practical Application
Student Activities
Suggested Resources
7. Economics, Work, and Retirement
Learning Objectives
Diversity of Economic Status Among Older People
Sources of Income for Older People
Older People in the Labor Force
Practical Application
Student Activities
Suggested Resources
8. Age-Friendly Communities, Living Arrangements, and Housing Options
Learning Objectives
Living Environments: Communities, Living Arrangements, and Housing Options
Factors Affecting Where and How Older People Live
Age-Friendly Communities
Where Do Older People Live?
Living Arrangements
Housing Options for Older People
Homelessness Among Older Adults
Practical Application
Student Activities
Suggested Resources
9. Family, Friends, and Social Networks of Older Adults
Learning Objectives
Family, Friends, and Social Networks
The Family
Older Parents and Their Adult Children
Friends and Social Networks
Practical Application
Student Activities
Suggested Resources
10. Older Adults Giving and Receiving Support
Learning Objectives
Community Services and Support
The Many Ways Older Adults Contribute to Their Communities
Programs and Support for Older Americans
The Older Americans Act
Need and Unmet Need for Services
Practical Application
Student Activities
Suggested Resources
11. Medical Conditions, Assisted Living, and Long-Term Care
Learning Objectives
Medical Conditions
Chronic Medical Conditions
Other Medical Conditions
Assisted Living and Long-Term Care
Practical Application
Student Activities
Suggested Resources
12. Medicare, Medicaid, and Medications
Learning Objectives
Practical Application
Student Activities
Suggested Resources
13. Older Women and Older Minority Group Members
Learning Objectives
Who Is at Risk?
Risks to Economic Security
Risks to Health
Heterogeneity of Racial/Ethnic and LGBT Groups
Practical Application
Student Activities
Suggested Resources
14. Elder Abuse and Neglect: Crimes, Scams, and Cons
Learning Objectives
Elder Abuse and Neglect: An International and National Issue
Preventing and Responding to Elder Abuse and Neglect
Practical Application
Student Activities
Suggested Resources
15. Careers in Aging
Learning Objectives
Exploring Career Opportunities in Aging
What Kinds of Careers Are There in the Field of Aging?
Education in Gerontology
The Role of Professional Organizations in Your Career
Practical Application
Student Activities
Suggested Resources
Do not regret growing older. It is a privilege denied to many.
Aging. Everyone is doing it! We are all aging. This calls all of us to learn more about aging and
to rid ourselves of our ageist beliefs, attitudes, and behaviors. We can expect to live longer and
healthier lives than ever before, giving us an unprecedented opportunity to create a society that
takes advantage of the many benefits of that longevity dividend—the accumulated experience,
wisdom, and talents of individuals as they age.
The impetus for writing this book, as its title reflects, came from my desire to have a textbook
with a positive approach to aging for an introductory course I have been teaching for almost
20 years. I feel strongly that, in all our discourse, and especially in an introductory textbook, we
need more focus on the good fortunes presented by our increasing longevity, including the ways
that our society can foster and support those opportunities. As we age, we should continue to be
treated as citizens equal to all others in our potential to grow and contribute to our communities.
Redesigning our society to make the most of the gift of longevity will reap huge dividends for
individuals, for our communities, and for society at large.
This textbook has been developed for introductory courses in gerontology, as well as other courses
with gerontology components. It can be used with undergraduate students and master’s-level
students alike. Instructors tell us that the textbook also works well in a variety of other courses
where a broad perspective on gerontology is helpful to the course content, for example, public
health, psychology, social work, sociology, and business courses.
Gerontology is multifaceted and interdisciplinary. By necessity, it encompasses a broad range
of subjects, including psychology, sociology, architecture, biology, communications, economics,
education, humanities, law, medicine, nursing, political science, public administration and policy,
public health, public safety, social work, and vocational skills. Indeed, gerontology encompasses
every academic discipline that in some way relates to the lives of older people in contemporary
The textbook’s distinguishing features, which were also present in the first edition, are:

A positive approach to aging, with an emphasis on the advantages and opportunities
presented by the large and growing number of older Americans
An interdisciplinary approach, incorporating perspectives from multiple disciplines
Presentation of research dispelling the fallacy of negative myths and incorrect stereotypes about aging
A broad range of subject areas in the field, from biological aging processes to economics and living arrangements
A chapter devoted to women and minority group members who are particularly at
risk for poverty and poor health as they age (Chapter 13, Older Women and Older
Minority Group Members)
The separation of normal physical changes accompanying aging from medical
conditions (Chapter 2, Physical Changes and the Aging Process, and Chapter 11,
Medical Conditions, Assisted Living, and Long-Term Care, respectively)
Suggested Internet resources at the end of each chapter
In addition to more than 400 new references and the latest available data and statistics, brand-new
features in this edition include:

A new chapter on careers in aging, which explores expanding opportunities now
available in the field (Chapter 15, Careers in Aging)
Increased diversity content throughout the book, which is in addition to
the separate chapter on older women and older minority group members
(Chapter 13, Older Women and Older Minority Group Members)
New content on personality (Chapter 4, Mental Health, Cognitive Abilities, and
Aging), palliative care (Chapter 6, Death, Dying, and Bereavement), age-friendly communities and homelessness among older adults (Chapter 8, Age-Friendly Communities, Living Arrangements, and Housing Options), social networks (Chapter 9, Family,
Friends, and Social Networks of Older Adults), and Medicaid (Chapter 12, Medicare,
Medicaid, and Medications)
A new approach to elder abuse focusing on solutions to social isolation, a major cause
of abuse (Chapter 14, Elder Abuse and Neglect: Crimes, Scams, and Cons)
Enhanced content on the many ways in which older people contribute to their communities (Chapter 10, Older Adults Giving and Receiving Support)
More scenarios to introduce the content of each chapter
Expansion of the number of tables and graphs that display data and statistics
Reorganization of some topics: economics, work, and retirement are now in one
chapter (Chapter 7, Economics, Work, and Retirement), living arrangements and
housing are combined in one chapter (Chapter 8, Age-Friendly Communities,

Living Arrangements, and Housing Options), and the topics of assisted living and
long-term care have been incorporated into the chapter on medical conditions
(Chapter 11, Medical Conditions, Assisted Living, and Long-Term Care)
Policies covered throughout the book, rather than in a separate chapter, as they
apply to their role in an aging society (Chapter 1, The Longevity Dividend),
in the workplace and retirement (Chapter 7, Economics, Work, and Retirement), in providing opportunities for older people to give and receive support
(Chapter 10, Older Adults Giving and Receiving Support), in healthcare (Chapter 12,
Medicare, Medicaid, and Medications), and in addressing elder abuse (Chapter 14,
Elder Abuse and Neglect: Crimes, Scams, and Cons)
Practical applications of knowledge with activities for students throughout the text
The adoption of new language standards for referring to older people to curtail paternalistic views and engender more positive perspectives on aging: for example, use of
the terms older adults, older Americans, and older people, rather than the elderly, elderly
people, seniors, and so forth
Elimination of statements that repeat myths and stereotypes, because such repetitions
unfortunately reinforce what too many people believe to be true
More data and statistics that unmask the experiences of older women and older minorities
that are often hidden in overall averages, for example, overall poverty statistics for older
Americans disguise the fact that older women of all minority groups experience significantly higher rates of poverty than do older men, and the fact that older minority group
members experience significantly higher rates of poverty than do older majority group
Avoidance of examples of extraordinary older Americans doing extraordinary
things, to avoid the common conclusion that they are exceptions to the rule and that
becoming a high achiever is a consequence of a person’s individual efforts and personal
choices rather than a complex interplay of multiple factors, including social and
economic determinants
Use of Bloom’s latest taxonomy for learning objectives, incorporating a range of knowledge and cognitive process dimensions
I deeply appreciate the help and support I have received from so many people throughout the
development of this second edition. First and foremost, I thank Sheri W. Sussman, executive
editor at Springer Publishing Company, who encouraged me to write this second edition. Her
insights, prodding, and patience are much appreciated. Rhonda Dearborn, senior acquisitions
editor, behavioral sciences, and Mindy Chen, assistant editor, behavioral sciences, shepherded
the book to completion.
I also thank my colleagues at the University of Nevada, Reno, especially my dean and fellow
faculty in the School of Community Health Sciences, and the faculty and staff of the Sanford Center for Aging for their support. National and international colleagues and friends in academia and
in aging services, too numerous to name, contributed much to the subject matter of this second
edition through our many conversations, discussions, and debates about gerontology over the
years. I have also benefited greatly from the work of the FrameWorks Institute, which, on behalf
of eight national organizations dedicated to the field of aging, has undertaken extensive research
and analyses to identify effective ways for us to improve our perspectives and communications
about aging. The institute’s resulting recommendations on reframing aging have informed content throughout this edition. Undergraduate students in my introductory aging course at the University of Nevada, Reno, regularly provide feedback that I have used to refine the book’s subject
matter. My students always inspire my passion to engage them in the aging enterprise.
Helpful contributions in preparing several chapters of the book were made by lecturer Susan G.
Harris, PhD, and psychology doctoral student Jonathan Singer, both from the University of Nevada,
Reno. As coauthors of the first edition of this textbook, special thanks go to Robert J. Riekse, EdD,
Henry Holstege, PhD, and Michael A. Faber, MA, AGHEF, for helping to make that edition successful and, thus, helped to make this second edition possible.
And, of course, I send my love and appreciation to my family and friends who provided support, encouragement, tolerance of many curtailed engagements, and a myriad of illustrations
from everyday living.
Judith A. Sugar, PhD
Qualified instructors may obtain access to supplementary material
(Instructor’s Manual, Test Bank, and PowerPoints) by emailing
Student Activities Answer Key can be accessed by visiting the following url:
Introduction to Aging: A Positive,
Interdisciplinary Approach, Second Edition
Age has no reality except in the physical world. The essence of a human being is resistant to
the passage of time. Our inner lives are eternal, which is to say that our spirits remain as
youthful and vigorous as when we were in full bloom.
—Gabriel García Márquez, Love in the Time of Cholera
(1985 Spanish/1988 English)
It is not by muscle, speed, or physical dexterity that great things are achieved, but by
reflection, force of character, and judgement; and in these qualities old age is usually not
only not poorer, but is even richer.
—Cicero, 106–143 BCE
• Describe what is meant by the longevity dividend.
• Summarize the concept of ageism and describe your awareness of its role in our
• Contrast the demographics of aging in the United States with those of other countries
around the world.
• Discuss the opportunities and challenges of an aging population.
• Explain the importance of mobilizing all sectors of society to realize the opportunities
and address the challenges of an aging society.
America is going through a revolution. No, we are not being overthrown by some sinister internal
plot or another nation. And no, we are not referring to the technological revolution that swept
business, industry, and education beginning in earnest in the 1990s. We are referring to the aging
of America. It is a paradigm shift in the overall composition of the U.S. population. As a whole,
Americans are living longer, and, as a result there are many more older people among us than ever
before in our history.
Upon first hearing this news, it may not sound too exciting or even interesting. But, we now
have the opportunity to make the most of the potential of an aging America, and what it can mean
I We Are All Aging
to the lives of each of us, as individuals, family members, friends, neighbors, students, workers,
retirees, and citizens. In the new paradigm of aging, it simply means that, as a society, we have to
be joyful for our extended years, realistic about the challenges of longer life, and creative in mobilizing and using our vast national resources for the good of all sectors of our growing population.
An important aspect of this new paradigm is the concept known as the longevity dividend. The
longevity dividend refers to benefits that can result from living longer lives. Older adults who are
not only living longer, but actually in better health too, could boost the economy by virtue of their
longer periods of productivity, their ability to earn and save more income over time, and their
purchases and consumption of more goods. Furthermore, because of their accumulated wisdom,
skills, and talents, they have much that they can contribute to our social environment. Thus,
discussions pertaining to the aging population should take into account the potential economic
and social benefits that older adults are able to offer to their communities, and to society at large.
Longevity and Life Expectancy
There have always been a few individuals who lived especially long lives—Jeanne Calment
(1875–1997) comes to mind, a French woman who lived to age 122, confirmed to be the longest
human life span to date. But what is more important than some individuals living longer is that
the average life span across all individuals has been increasing throughout the world. More people
are living longer than ever before in human history. Most of the increases in longevity have come
about because of improvements in living conditions and socioeconomic conditions, as well as
decreases in deaths due to infectious diseases. Given that large differences exist among countries
in the extent to which living and socioeconomic conditions have improved, on the one hand, and
deaths due to infectious disease have decreased, on the other, as we might expect, there are large
differences among countries in the average life expectancy of their citizens.
Life expectancy is the average number of additional years of life a person at a specific age can
expect to live. Thus, life expectancy can be calculated at any age—given that a person is age X,
how many more years can we expect that person to live, on average, beyond age X? For 24 countries around the world, life expectancy at birth now exceeds 80 years (He, Goodkind, & Kowal,
2016). Over the past 100-plus years we have increased the average American’s life span by several
decades. Gains in longevity during recent decades have come about primarily due to advancements in tobacco control, motor vehicle safety, workplace safety, family planning, maternal and
child health, and prevention of cardiovascular disease and cancer. Although the average life expectancy at birth is now 80 years in the United States, there are differences between men and women
and between people of different races and ethnicities. Table 1.1 compares men’s average life expectancy at birth in 1900 with their average life expectancy at birth in 2016, by race and ethnicity.
Table 1.2 shows the same data for women. Note that life expectancy has increased dramatically for
everyone. Women live longer than do men in all racial and ethnic groups. There are also race and
ethnicity differences, such that Hispanic Americans have the longest life expectancy, followed by
White Americans, and then Black Americans.
In recent decades, reduced mortality rates at older ages have also increased the number of
people living to very old ages. Those who are living to 100 years or more are called centenarians.
Centenarians make up a small percentage of the older population—0.2%. But researchers want
to learn from their experiences. What has helped them to live so long? In 1980, there were 32,000
centenarians in the United States. By 2016, there were almost 82,000 American centenarians
(Administration on Aging, U.S. Department of Health and Human Services, 2016).
1 The Longevity Dividend
TABLE 1.1 Life Expectancy for Men at Birth, by Race and Ethnicity: 1900 Versus 2016
* Data not available for Hispanic men and women in 1900.
SOURCE: National Center for Health Statistics. (2018). Health, United States, 2017: With special feature on mortality.
Hyattsville, MD: Author. Retrieved from
TABLE 1.2 Life Expectancy for Women at Birth, by Race and Ethnicity: 1900 Versus 2016
* Data not available for Hispanic men and women in 1900.
SOURCE: National Center for Health Statistics. (2018). Health, United States, 2017: With special feature
on mortality. Hyattsville, MD: Author. Retrieved from
Living for more years can be a wonderful gift. But let’s face it, no one wants to live to be 80, 90,
or 100 if they will be spending all those added years in ill health. The good news is that, around the
world, those “extra” years are increasingly becoming healthier years. To differentiate between life
span and those years of life during which a person is healthy, the term healthspan has been coined.
Healthspan is the portion of a person’s life during which he or she is healthy, and by healthy we
mean free of a leading cause of death, for example, heart disease or lung cancer.
Figure 1.1 shows the increases in healthspan in world regions over the previous 16 years. The
largest increases have been in African countries, with an average gain of over 9 years of additional
healthy years of life. The longest healthspans are among people living in the Western Pacific,
Europe, and the Americas. Although the gains in countries in the latter regions have not been
as dramatic, even people living in the Americas have seen, in less than two decades, an average
increase of about two-and-a half additional years of life during which they are free of any of
the leading causes of death. Furthermore, promising research is being conducted in the basic
biology of aging, with the goal of delaying aging processes. Achieving this goal would take care
of age-related diseases such as cancer, heart disease, and diabetes, and lead to dramatic improvements in healthspan for current and future generations of older people.
Not only are healthspans getting longer, but current and future generations of older people are
becoming more and more educated. In the United States, between 1965 and 2015, the percentage
of older people who had completed high school more than tripled, rising from 24% to 85% (Federal
Interagency Forum on Aging-Related Statistics, 2016). This is important because there is a strong
relationship between level of education and health such that the more education people have, the
healthier they are. Furthermore, education increases our ability to be problem solvers and innovators, key functions if we are to address the challenges of our increasingly complex world.
I We Are All Aging
Years of Age
Western Pacific
Eastern Mediterranean
South-East Asia
FIGURE 1.1 Average human healthspan, in selected years by world region.
SOURCE: World Health Organization. (2018). Healthy life expectancy (HALE): Data by WHO region. Retrieved from
Increased longevity is a human achievement that should be celebrated. Yet, to paraphrase a quote
attributed to Dr. Edward Stieglitz (1946) in his book, The Second Forty Years, what is important is
not just to add years to our life, but life to our years. The question, then, is what are we going to
do with all those extended years of our lives? To take advantage of the opportunities those years
afford us, one of the most important things we need to do is to change the negative attitudes and
inaccurate stereotypes about aging that are far too pervasive in our society.
Ageism is discrimination against people based on their age and it is most commonly directed at
older people. The term, of course, can also be used to describe discrimination directed at younger
people, for example, paying younger workers lower wages based solely on their age. The late
Dr. Robert N. Butler, a leading expert in gerontology and geriatric medicine and a Pulitzer Prize–
winning author and founder of the International Longevity Center-USA, coined the term ageism
in 1969. He described three aspects to this prejudice: negative attitudes toward older people, old
age, and the aging process; discriminatory practices against older people; and, institutional practices and policies that perpetuate negative stereotypes and attitudes about older people. Although
ageist attitudes and stereotypes can be positive or negative, when it comes to older people, they
are mostly negative.
Throughout our lives, we are all exposed to negative stereotypes about people based on their
age, stereotypes that are conveyed through news stories, movies and TV programs, and even
music. Many of the things we come to believe about older people are wrong. For example, in
this textbook we will learn that most older people regard their physical health as good; they are
happy; they enjoy and engage in sexual activities; most live in their own homes and have close
1 The Longevity Dividend
relationships with family members; and, they are very good workers. Older people themselves are
not exempt from ageism. Because they are part of our ageist culture, they too have been subjected
to messages in our society that denigrate older adults.
One way that ageism is exacerbated is when everyone who is age 65 and over is lumped together as “older adults.” This obscures important differences among people as they age. Gerontologists, and the U.S. Census Bureau, use three subcategories when studying aging:

The young-old, people 65 through 74 years of age
The old-old, people 75 through 84 years of age
The oldest-old, people 85 years of age or older
The reason these subcategories are important is because the characteristics, desires, strengths,
and needs of people at different stages of life can be very different. There can be great differences
between the young-old, the vast majority of whom are living active lives and are in good health,
and the oldest-old, many of whom may have multiple chronic conditions and rely on the assistance and support of their families, friends, and communities. This obviously does not mean that
all persons who are in the young-old category are vigorous and healthy, but there is a greater
likelihood of this being the case. Nor does it mean that most of the oldest-old are frail and living
in residential care settings, but there is a greater likelihood of needing more support as a person
moves into the oldest years of life. Certainly, all age groups within our population—youth, young
adults, middle-aged people, the young-old, the old-old, and the oldest-old—are heterogeneous.
We would do well to remember that all age groups are made up of different people with a wide
range of resources and needs.
Ageism can be implicit or explicit. When it is implicit, it is part of our subconscious thoughts
and feelings so we usually fail to recognize it. We are quick to call instances of forgetting in older
people a possible outcome of Alzheimer’s, when we would not think twice about a younger person
forgetting something. We ignore the fact that lost and found repositories on college and university
campuses are testimony to just how often younger people forget. And, not just forget, but forget
important and valuable possessions! Ageism is so ingrained in us that we will need to make an
effort to overcome these long-held and counterproductive views. And, we can, and we must, do
America is committed to being a just society for all. Ageist attitudes and stereotypes, however,
get in the way of treating older people as equal members of our society. They affect all aspects of
older people’s lives and prevent them from fully participating in our society. We can ill afford to
squander the experience, talents, and energy of this increasingly large segment of our population
that is older adults.
Negative Effects of Ageism
Ageism has a major detrimental effect on all aspects of older people’s lives. For example, negative attitudes and stereotypes about older workers—attitudes and stereotypes that are just plain
incorrect—keep older people from being promoted, result in pressuring them to retire, and make
it difficult for them to find employment. Ageism in healthcare settings leads to unnecessary morbidity and premature mortality among older people because they are less likely to be screened
for chronic conditions and thus less likely to be diagnosed at early stages of their condition when
treatments can be more effective.
I We Are All Aging
Physical and cognitive functions are also affected by ageism. Negative stereotypes accelerate
cellular aging, and predict signs of Alzheimer’s disease (Levy, Pilver, & Pietrzak, 2014; Pietrzak
et al., 2016). A lifetime of exposure to ageist messages about memory has been demonstrated to
negatively affect actual performance on tests of memory (Levy & Langer, 1994). On the other hand,
research has demonstrated that positive views of aging can increase longevity, hasten recovery
from disability, and improve driving performance (Lakra, Ng, & Levy, 2012; Levy, Ng, Myers, &
Marottoli, 2013; Levy, Slade, Murphy, & Gill, 2012).
Several studies have found that ageist attitudes and stereotypes held early in life have detrimental consequences on our cognitive abilities and physical health later in life. These consequences
include poorer memory and more cardiovascular events (Levy, Zonderman, Slade, & Ferrucci,
2009, 2012). Imagine, the negative views you hold about older people when you are young can
affect your cognitive and physical health in later life! Best, then, to adopt positive views of aging,
and if that proves difficult, then act as if you hold positive views, because you will reap the benefits
of these views throughout your life.
In the United States, age 65 is often used as a demarcation for older adults, mainly due to this age
being used in the past as the so-called “traditional” age for retirement. The fact is that the age 65
has no physical or psychological significance. But, we will use that age frequently throughout the
textbook because this age is used in so many of the surveys and reports of data and statistics about
older people.
To better understand aging in the United States, it is helpful to look at aging trends around the
world. In the year 2000, 420 million people in the world were 65 or older, which was about 7% of
the world’s population. By 2050, that number is expected to rise to 1.6 billion, which will then be
about 17% of the world’s population (He et al., 2016). With declining fertility (birth) and mortality (death) rates in most countries, populations are aging in virtually all countries—although at
different rates. Developed countries tend to have higher proportions of people 65 and older. But
the most rapid increases in the proportions of older populations are in the developing countries.
Even in countries where the percentage of people age 65 and older remains low, the actual numbers of older people are increasing rapidly.
Among the world’s countries with a total population of at least 1 million people, Table 1.3 lists
the ones in which at least 10% of their population is age 65 and older, a total of 53 countries. The
United States is 34th on that list, with 15% of its population age 65 or older (Federal Interagency
Forum on Aging-Related Statistics, 2016). The country with the highest percentage of older people on the list is Japan, with almost 27%. Five other countries have at least 20%—Germany, Italy,
Greece, Finland, and Sweden. The country with the highest percentage of older people, however, is a much smaller country than those included in Table 1.3. In Monaco, which has a total
population of just under 31,000 people, over 32% are 65 or older (Central Intelligence Agency,
2017). You might be surprised to see that China, the most populous country in the world, is at
the very bottom of the list in Table 1.3. It has the greatest number of people age 65 and older in
the world—137 million—but they comprise only 10% of China’s population. On the other hand,
India, which is not on the list, has just over 6% (80 million) of its population of 1.3 billion people
who are 65 years of age or older. The biggest factor in the size of the older population in these two
countries is the difference in their fertility rates, China’s is 1.6 per woman and India’s is 2.4 per
1 The Longevity Dividend
TABLE 1.3 Population of Countries or Areas With At Least 10% of Their Population
Age 65 and Over, 2015
Czech Republic
(continued )
I We Are All Aging
TABLE 1.3 Population of Countries or Areas With At Least 10% of Their Population
Age 65 and Over, 2015 (continued )
United Kingdom
Puerto Rico
United States
New Zealand
Bosnia & Herzegovina
Korea, South
Hong Kong
(continued )
1 The Longevity Dividend
TABLE 1.3 Population of Countries or Areas With At Least 10% of Their Population
Age 65 and Over, 2015 (continued )
NOTE: Table excludes countries/areas with less than 1 million total population.
SOURCE: Federal Interagency Forum on Aging-Related Statistics. (2016). Older Americans. Key indicators of
well-being. Washington, DC: U.S. Government Printing Office. Retrieved from
woman. This factor will continue to play a role in the size and proportion of their older populations for decades to come.
Why pay attention to population aging around the world? First, we are a global society so
what happens in other countries affects everyone around the world—young people, middle-aged
people, older people, consumers, workers, tourists, and business owners, among many others.
Secondly, there is much Americans can learn from all of those countries whose older populations
are already proportionately much larger than ours, and from many others, such as South Korea,
where older people will become a much larger proportion of their population than ours in the not
too distant future.
The largest group of individuals ever born in one period of American history is the baby boomers, a generation of individuals born between 1946 and 1964, numbering approximately 78 million.
The “boom” in births began the year following the end of World War II and resulted in 70% more
babies being born than there were in the previous two decades. The first of the baby boomers
began turning age 65 in 2011 and beginning in that year, and continuing for many more years, approximately 10,000 of them will turn age 65 every day. The year 2030 marks a demographic turning point for the United States. Beginning that year, all baby boomers will be older than 65, thereby
expanding the size of our older population to one in every five Americans. Later that decade, by
2035, older adults are expected to outnumber children under 18 for the first time in U.S. history.
I We Are All Aging
Opportunities and Challenges Presented by an Aging Population
People in all generations have something to contribute to enrich our society and create greater
social, economic, and civic well-being for everyone. Each generation has its own set of assets, and
older people are no exception. As we age, we build up wisdom, experience, skills, and talents that
we should put to good use to move our society forward. We need to remove the barriers to older
people participating fully in our communities.
There are many things we can do to mobilize the energy of older people to share their talents for the benefit of our communities. Creating intergenerational programs that bring older
and younger people together in community centers that welcome people of all ages is but one
example. Changing our policies and practices regarding the workplace is another. Older people
are among the best workers in America, and yet we limit their ability to stay in the workforce
and to rejoin the workforce when they retire too soon. Building housing to accommodate
people of all ages and creating innovative transportation options will benefit people of all ages.
Such initiatives will also decrease the isolation that people can experience as they get older,
and reducing isolation can remove a major cause of the abuse to which older people are all too
often subjected.
Liberating the Talents of All
What does it mean to grow older in the 21st century—as society begins to realize the social revolution it is undergoing, at a time when more and more people are reaching the oldest-old years
(85 years of age and older), and the ranks of the youngest-old (65–74 years of age) are beginning to be populated with millions of baby boomers with more vigor, vitality, and better health
than any previous generation? Growing older needs to be viewed as simply another phase of life.
People need to be encouraged to continue to participate in the labor force if they need to or want
to. To secure or retain employment, job training and retraining should be open to all, regardless of
age. It means that our society needs to stop closing doors to people simply because of advancing
years. The technologies of the new age, including the information superhighway, promise to open
even more opportunities for older people to play a vital role in determining their own destinies
and to have an impact on their communities and on our society.
Recognizing the diversity of the older population, a new perception of aging needs to be developed that avoids the stereotypes that have molded society’s perception of older people, as well
as older people’s perception of themselves. In a complex society with all of the challenges that are
evident every day, our nation cannot afford to discard or ignore the ongoing contributions all our
citizens, of all ages, can make.
Challenges of an Aging Population
Let us not be naïve or unrealistic. There are huge opportunities for us to benefit from our aging
population. But, there are challenges too. It is within our ability to address all of these challenges,
some of which have already been mentioned: workplace discrimination; isolation, which can lead
to abuse and neglect; poverty, especially among older women and older minority group members; and issues that arise in widowhood, among many others. Both younger and older people
are facing economic hardships. Younger people are saddled with student loans and wages are not
keeping up with increases in the costs of living, especially housing, making it harder to enjoy the
quality of life that many of their parents had. Living longer produces additional strains on older
1 The Longevity Dividend
people’s economic resources, so we see many older people continuing to be part of the labor force
because that is the only way they can make ends meet.
Another challenge that is often raised when our aging society is being discussed is how can
a proportionately smaller population of younger people support a growing population of older
people? This issue is usually brought up in the context of what is termed dependency ratios.
Dependency ratios are measures of the population of dependents, that is, people who are not
employed because they are considered too young or too old, as a percentage of the population
of people who are employed at any given point in time. Importantly, dependency ratios are
affected by the need for certain kinds of supports at both ends of the life span. Figure 1.2 displays these ratios for the United States in selected years between 1940 and 2010, and projected
through 2060. What we can see in this figure is that the highest ratios took place in the 1960s
and 1970s, and that the primary drivers of these ratios were dependents who were young. In
fact, they were those baby boomers! Although the dependency ratio in the United States is expected to increase over the next few decades, it is not projected to rise as high as it did during
the 1960s and 1970s. So the story that the sky is falling as a consequence of our increasing dependency ratio is not legitimate. We made it through those decades of baby boomers growing
into young adults and subsequently taking their place in the workforce, and we were just fine.
And, we will also be just fine in terms of our dependency ratio going forward. We will be in
even better shape if we alter some of the ways that we limit the contributions of older people in
our society—for example, by removing the barriers that keep many older people unemployed
when they want to be working.
To address the challenges and to take advantage of the opportunities as we age, we will
need to develop new policies and practices. One approach is to modify existing legislative acts
such as Medicare, Social Security, the Older Americans Act (OAA), the Patient Protection and
Dependency Ratio
Total Dependency
Youth Dependency
Older Adult Dependency
1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060
FIGURE 1.2 Youth, older adult, and total dependency ratios: 1940 to 2060.
NOTE: Dependency ratios are measures of the population of dependents (people who are not employed because
they are considered too young or too old) as a percentage of the population of people in the workforce.
SOURCE: Vespa, J., Armstrong, D. M., & Medina, L. (2018). Demographic turning points for the United States: Population projections for 2020 to 2060 (Current Population Reports P25-1144). Washington, DC: U.S. Census Bureau.
Retrieved from
I We Are All Aging
Affordable Care Act (PPACA), and the Americans with Disabilities Act (ADA). Another approach is to encourage new practices and introduce new legislative acts.
One example of the first approach is the 2016 amendments to the OAA, which included the
establishment of Aging and Disability Resource Centers (ADRCs). ADRCs coordinate with local
Area Agencies on Aging (AAA) in order to promote home- and community-based services and
enable older adults to live as independently as possible. The amendments also facilitate ways of
addressing elder abuse and provide support for family caregivers. In the case of Medicare, we
may need to consider new ways to address rising healthcare costs in order to maintain its value in
providing essential healthcare benefits for older adults and people living with serious disabilities.
Chapter 7, Economics, Work, and Retirement , includes a discussion of the importance of Social
Security to all generations of Americans, and thus the significance of possible modest legislative
changes that would keep the program financially sound.
When it comes to encouraging new practices, one good place to do that would be the workplace. Older workers, as we will see in Chapter 7, Economics, Work, and Retirement, are valuable
assets for employers, so offering them the same continuing education and training opportunities
as younger workers receive, as well as creating age-friendly work environments, would go a long
way in motivating older workers to stay a little longer in the workplace—a major win for everyone—employees of all ages, employers, communities, and societies.
One example of somewhat newer legislation to address the growing problem of elder mistreatment (which includes abuse, exploitation, and neglect) is the Elder Justice Act, which was
passed in 2003 as part of the PPACA. This act provides for the establishment of forensic centers, the Elder Justice Coordinating Council, funding for state agencies to collect data on elder
abuse, and a nurses’ aide registry of those who have completed training on elder abuse. And,
an even newer piece of federal legislation, which was signed into law on July 7, 2018, is the federal Supporting Grandparents Raising Grandchildren Act. The number of grandparents raising
grandchildren has been rising steadily. In 2017, 7.3 million grandparents reported living with
grandchildren under 18 (compared with 6.5 million in 2010). Of those, 36% are solely responsible for their grandchildren. Existing programs, such as the Temporary Assistance for Needy
Families (TANF) can be helpful, as can cooperative extension programs and initiatives such
as Cornell University’s Parenting the Second Time Around (PASTA) and Relatives as Parents
Program (RAPP). This new act will establish a Federal Advisory Council to provide support
for grandparents raising children, including providing information about best practices and
available resources.
Our nation is facing the reality of a new paradigm of aging in the 21st century—a new view of
what it means to be older. In previous generations, older people were often viewed as unique or a
separate group from the population as a whole. But all this is changing with our increasing longevity and the opportunities and challenges that our longevity presents to our society.
The late Dr. Robert Butler outlined the changes and challenges of an aging society. He believed
that society will adapt to the great achievements in longevity—so many people living much longer. To Dr. Butler, the greatest challenges of the new longevity are facing head-on the fallacies and
outright myths about old age that permeate so much of our culture, and promoting an “active,
engaged, and productive older population” (Butler, 2008, p. 34). Butler goes on to say that this is
1 The Longevity Dividend
possible by calling for new responsibilities, new goals, and new achievements. Developing new
roles and new attitudes toward work and civic engagement for people of all ages will enhance the
human condition in ways that society is just beginning to explore.
We can make the most of our aging population only if most of our citizens—civic leaders, politicians, policy makers, and citizens in general, including older people themselves—develop a new
paradigm of growing older in America. This paradigm consists of looking at aging and all older
people as an integral part of our whole society. A new paradigm of aging in America envisions
older people playing vital roles in all aspects of life—personal relationships, family life, play, civic
engagement, worship, and overall citizenship.
We need a new view of aging—a view that takes into account the diversity and potential of
people of all ages. Some people are “burned out” at age 50. Others are in their prime at ages 68 or
70. Some are vulnerable in their late middle years due to chronic health conditions. Others find
work the most important part of their lives in their late 60s and 70s. Some 40-year-olds would
like to take a break from employment and then return to the workforce. Some have experienced
discrimination all their lives because of their sex, race, or ethnic background. With the booming
growth of the oldest-old, and the young-old entering their later years as a pioneering generation
in better health, affluence, and vitality than previous generations experienced, we need a new and
broader view of what growing older in America means. All who study aging must realistically
understand the aging process; be aware of the major and rapid population changes that are occurring; examine what growing older currently means to society and to older people themselves;
be aware of the resources and supports that are available; realize the impacts of an aging society
on business, government, and family structures; and participate in the discussions and debates
that surround the issues affecting older people. This book is designed to guide the reader in these
Chapter 1 focuses on the longevity dividend and the importance of mobilizing all sectors of the
society to realize the opportunities and address the challenges of an aging society. It includes
demographic information related to aging in the United States as compared with that of other
countries, as well as a discussion about the detrimental effects of ageism on older adults and
on society as a whole. It is especially important for gerontology professionals to understand and
avoid ageism; therefore, it is the focus of this Practical Application.
Being aware of harmful labels and misconceptions is important; yet putting a stop to them
holds the most relevance to the actual day-to-day practice of gerontology. Whether you are
a student considering entry into the field, or a seasoned professional, you should always ask
yourself: Am I doing or saying anything that perpetuates a negative stereotype of aging? This
could come in the form of off-hand jokes, making disparaging remarks about your own aging
process (“I’m getting so old!”), or using elderspeak, belittling terms such as “sweetie” or
“dear” when speaking to an older adult. According to Dr. Becca Levy, professor of epidemiology
and psychology at Yale University, “little insults [like these] lead to more negative images of
I We Are All Aging
aging. . . [a]nd those who have more negative images of aging have worse functional health
over time, including lower rates of survival” (as cited in Leland, 2008, para. 4).
Unfortunately, middle- and younger-aged people are not alone in perpetuating the myths and stereotypes of aging. Often older persons themselves are unintentional culprits. An example of this is
an 89-year-old woman with Parkinson’s disease and poor hearing. When asked if she is exercising regularly, or invited to go somewhere away from her nursing home, her usual response is, “I’m
too old to do that.” While she does have some very real physical challenges due to her condition,
she is able to do much more than she allows herself to do. This response is not completely due
to her view of aging. It is also the result of her fear of falling and not being able to communicate
effectively with others due to her hearing loss. Yet her quality of life could be much better than it is
today if she had a more positive view of aging and greater confidence in her abilities.
1. Write a description of a hypothetical older adult who is currently benefiting from a lon-
ger healthspan. Come up with a name, age, and gender for this person, and describe in
detail how his or her activities contribute to the longevity dividend. In what ways does
he or she positively impact the U.S. economy and society?
Describe a situation in which either you or someone around you engaged in a) implicit
ageism and b) explicit ageism.
Imagine you are designing a demographics study of another country where the population of older adults is proportionately larger than that of the United States. What question
would you like to ask in your research? How would answering this question contribute
to the current understanding of the demographics of aging in the United States?
Describe an ideal workplace that is inclusive of all age groups. Then list four ways employees would benefit from working in such an environment.
Outline a proposed initiative designed to promote civic engagement of older people in
your community. Focus on a current need in your community and consider ways older
adults could help address it.
Administration for Community Living. Profile of older Americans. Retrieved from
Each year, the U.S. Administration on Aging (AoA) compiles the latest statistics on older Americans,
based primarily on data from the U.S. Census Bureau. The profiles include data on demographics,
income and poverty, living arrangements, education, health, and caregiving.
1 The Longevity Dividend
International Longevity Center-USA. Retrieved from
Founded in 1990 by world-renowned gerontologist, the late Robert N. Butler, the Center was created
to educate individuals on how to live longer and better, and advise society on how to maximize the
benefits of today’s longer life spans.
National Centenarian Awareness Project. Retrieved from
This nonprofit organization celebrates active centenarians as role models for the future of aging.
National Council on Aging (NCOA). Retrieved from
NCOA is a nonprofit service and advocacy organization. Bringing together nonprofit organizations,
businesses, and government, it champions issues and creates innovative programs that focus on
making life better for older adults, especially those who are vulnerable and disadvantaged.
U.S. Census Bureau. Retrieved from
The Census Bureau’s website provides many resources on population information, including a
dynamic U.S. population clock that reports the overall population count, and numbers of new births,
deaths, and immigrants, as well as a dynamic world population clock with the overall numbers for the
10 most populous countries in the world.
Administration on Aging, U.S. Department of Health and Human Services. (2016). A profile of older
Americans. Retrieved from
Butler, R. N. (2008). The longevity revolution. Philadelphia, PA: Public Affairs, Perseus Books Group.
Central Intelligence Agency. (2017). The world factbook. Retrieved from
Federal Interagency Forum on Aging-Related Statistics. (2016). Older Americans. Key indicators of wellbeing. Washington, DC: U.S. Government Printing Office. Retrieved from
He, W., Goodkind, D., & Kowal, P. (2016). An aging world: 2015 (International Population Reports,
P95/16-1). U. S. Census Bureau. Washington, DC: U.S. Government Publishing Office. Retrieved
Lakra, D. C., Ng, R., & Levy, B. R. (2012). Increased longevity from viewing retirement positively. Ageing
and Society, 32(8), 1418–1427. doi:10.1017/S0144686X11000985
Leland, J. (2008, October 6). In “Sweetie” and “Dear,” a hurt for the elderly. The New York Times.
Retrieved from
Levy, B. R., & Langer, E. (1994). Aging free from stereotypes: Successful memory in China
and among the American deaf. Journal of Personality and Social Psychology, 66(6), 989–997.
Levy, B. R., Ng, R., Myers, L., & Marottoli, R. A. (2013). A psychological predictor of elders’ driving
performance: Social comparisons on the road. Journal of Applied Social Psychology, 43(3), 556–561.
Levy, B. R., Slade, M., Murphy, T. E., & Gill, T. (2012). Association between positive age stereotypes
and recovery from disability in older persons. Journal of the American Medical Association, 308(19),
1972–1973. doi:10.1001/jama.2012.14541.
Levy, B. R., Pilver, C. E., & Pietrzak, R. H. (2014). Lower prevalence of psychiatric conditions when
negative age stereotypes are resisted. Social Science and Medicine, 119, 170–174. doi:10.1016/j
Levy, B. R., Zonderman, A. B., Slade, M. D., & Ferrucci, L. (2009). Age stereotypes held earlier in life
predict cardiovascular events in later life. Psychological Science, 20(3), 296–298.
I We Are All Aging
Levy, B. R., Zonderman, A. B., Slade, M. D., & Ferrucci, L. (2012). Memory shaped by age stereotypes
over time. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 67(4), 432–436.
National Center for Health Statistics. (2018). Health, United States, 2017: With special feature on
mortality. Hyattsville, MD: Author. Retrieved from
Pietrzak, R. H., Zhu, Y., Slade, M. D., Qi, Q., Krystal, J. H., Southwick, S. M., & Levy, B. R. (2016).
Association between negative age stereotypes and accelerated cellular aging: Evidence from two
cohorts of older adults. Journal of the American Geriatrics Society, 64(11), e228–e230.
Stieglitz, E. J. (1946). The second forty years. Philadelphia, PA: J. B. Lippincott.
Vespa, J., Armstrong, D. M., & Medina, L. (2018). Demographic turning points for the United States:
Population projections for 2020 to 2060 (Current Population Reports P25-1144). Washington,
DC: U.S. Census Bureau. Retrieved from
World Health Organization. (2018). Healthy life expectancy (HALE): Data by WHO region. Retrieved
• Compare normal physical changes that accompany aging and diseases and
conditions that become more common with age.
• Identify the usual, normal physical changes that accompany aging.
• Outline adaptations that older people can make to accommodate normal physical
• Explain how attention to normal physical changes can prevent serious consequences
for older people.
• Summarize the two basic paradigms of biological theories of aging.
I am now, probably for the first time in my life, the person I have always wanted to be. Oh,
not my body! I sometimes despair over my body, the wrinkles, the baggy eyes, the skinny arms.
And, often, I am taken aback by that old person who lives in my mirror, but I don’t agonize
over those things for long.
I would never trade my amazing friends, my wonderful life, for less gray hair. As I’ve aged, I’ve
become kinder to myself and less critical of myself. I’ve become my own friend.
I am blessed to have lived long enough to have my hair turn white, and to have my youthful
laugh be forever etched into the deep grooves of my face. So many have never laughed, and so
many have died before their hair could turn silver.
(continued next page )
II Physical and Mental Well-Being
As we get older, it is easier to be positive. We care less about what other people think. I don’t
question myself anymore. I’ve earned the right to be wrong.
I like being old. It has set me free. I am not going to live forever, but while I am still here,
I will try not to waste time lamenting too much or too long about what could have been, or
worrying too long about what will be. I shall eat dessert and a piece of bread every single day,
if I feel like it.
May you have a rainbow of smiles on your face and in your heart forever and ever.
—Margaret Berry, age 100 (2015)
Aging is accompanied by physical changes to the body—no surprise there! But, the physical
changes that normally occur as we grow older, such as our feet getting larger, can and should
be differentiated from medical conditions that are more likely as we age, such as heart disease. Some physical changes are part of the normal aging process and occur for a majority of
people, and sometimes for all people, as they age. For these changes there are mostly simple
adaptations—in the case of larger feet, buying shoes in a bigger size. On the other hand, some
medical conditions become more common with age, which means that the chances of acquiring them increase with age, but not every older person acquires them. Medical conditions are
presented and discussed in Chapter 11, Medical Conditions, Assisted Living, and Long-Term
Care. In this chapter, we focus on the physical changes that accompany the normal aging
There is no specified common timetable for human aging; instead, there are enormous individual differences in the aging process, and all older people do not experience all possible changes.
Nevertheless, as people grow older, changes that may be hardly noticeable at first tend to occur
throughout the physical systems of the body. Among the physical changes that can be expected to
occur as we age, some, such as gray hair and wrinkling skin, are more visible, while others, such
as hearing loss and hypothermia, may be less visible.
One of the most noticeable physical changes that occur with aging is hair color turning gray,
silver, or white. Although this change is usually a phenomenon of aging, young people’s hair can
turn gray too, sometimes as a result of severe physical or emotional stress. No one knows why
specific hairs turn gray or white and others do not. Within each hair follicle (tubelike organs in
the skin) are cells that add color to the hair shaft. Each specific hair grows for about 3 years, then
rests for several months before it starts growing again. As one ages, the color-producing cells cease
functioning, and the hair grows out gray or white. At the present time, there is no known process
to help those cells continue producing their original color. It is known that there is a genetic component to the action of those cells, and as a result, those whose ancestors’ hair turned gray early
2 Physical Changes and the Aging Process
in life have a higher probability of their hair turning gray early in life (Saxon, Etten, & Perkins,
2010). One way people adapt to this change is by coloring or dyeing their hair. Others wear their
new hair color with pride.
Another noticeable aging change with respect to hair is thinning or hair loss, which, like most
normal aging changes, occurs gradually over time. Hair thinning can lead to baldness, especially
in men. Being bald is distressing for some people, so various ways to manage hair loss have been
developed, from hair pieces and home remedies to drugs and transplants. Existing drugs have
only marginal effects and must be taken continuously to work at all. Hair transplantation is a surgical procedure that moves hair from one part of the head to the balding areas; it can be painful
and there are risks of scarring and infection. Low-level laser therapy is another treatment and
seems to stimulate hair growth but the most effective way to use it and its long-term effectiveness
and safety have yet to be determined (Avci, Gupta, Clark, Wikonkal, & Hamblin, 2014). Lots of
research is in the works, so new solutions for those who want to remedy their hair loss may be on
the horizon. An entirely different approach is to embrace baldness, and more and more men are
doing that.
As people grow older, their skin begins to change. It becomes thinner, loses fat, and wrinkles,
losing some of its plumpness and smoothness. For most people these changes begin in their 20s,
and are accelerated by smoking and frequent, extended exposure to the sun and very dry air.
Thinner skin means that veins and bones can be seen more easily, and scratches, cuts, or bumps
can take longer to heal. The wrinkling process varies depending on a person’s genetic heritage.
The skin of blonde, pale-skinned people tends to wrinkle sooner than it does for those with
darker skin.
Adaptations for age-related changes to our skin abound (National Institute on Aging, 2017b).
Not smoking, or quitting smoking, is an obvious one. Another is to minimize the effects of the sun
by avoiding prolonged direct exposure and using a sunscreen lotion or protective clothing that
offer good protection from ultraviolet A and B solar radiation. Tanning parlors are also something
to be avoided. Indoors, rooms should be kept moist so that dry skin will not crack. If a humidifier
is unaffordable, pans of water placed on a heat register can be used to put moisture into the air.
In addition, daily use of moisturizers, such as lotions, creams, and ointments, softens dry skin.
Massages and facials are excellent choices for hydrating the skin. Manicures and pedicures can
also be helpful because they involve massaging hands and feet with moisturizers.
Older people do not adjust to temperature changes as well as young people do, and they are more
likely to take prescription medications or have a chronic medical condition that further changes
their body’s ability to regulate its temperature. For these reasons, older people are more prone to
the negative effects of cold temperatures, which can result in hypothermia, and also to hot temperatures, which can result in hyperthermia. The loss of subcutaneous fat and a diminished flow
of blood to the skin and extremities, both of which occur with aging, are important contributors
to older people’s reduced thermoregulatory abilities. Both hypothermia and hyperthermia can
be fatal, so steps should be taken to avoid them. If they occur, they require immediate medical
II Physical and Mental Well-Being
Hypothermia is a reduction in core body temperature, with a danger that the body’s temperature
will get so low that a person’s life may become endangered. Research seems to indicate that the danger of hypothermia among older persons is much greater than previously believed. Hypothermia
can even result in death, although it is often overlooked as a cause of death. Thus, it is important
to know the symptoms of hypothermia. One should be alert for the umbles—stumbles, mumbles,
fumbles, and grumbles. Check for slowed or slurred speech; sleepiness or confusion; shivering or
stiffness in the arms and legs; poor control over body movements; slow reactions; or a weak pulse.
Whenever an older person has any of these symptoms and his or her temperature drops to 95°F or
lower, immediate medical attention should be sought (National Institute on Aging, 2017a).
Prevention of hypothermia among older adults can be quite simple: Indoors, room temperatures should be maintained at no less than 68°F, and additional clothing such as long underwear,
socks, slippers, and a hat can be helpful. When it is cold outdoors, wearing layers of loose clothing
and a hat, scarf, and gloves or mittens can reduce loss of body heat.
Hyperthermia is an abnormally high body temperature due to hot conditions in the environment
in conjunction with imperfect heat-regulating mechanisms in the body, and, like hypothermia, it
can be life-threatening. Symptoms of hyperthermia to watch out for include: a strong, rapid pulse
or a slow, weak pulse; lack of sweating; dry, flushed skin; change in behavior—agitation, combativeness, or confusion; staggering; and faintness. Whenever an older person has any of these
symptoms and his or her temperature reaches above 104°F, immediate medical attention should
be sought (National Institute on Aging, 2016a).
Some ways to prevent hyperthermia are to stay indoors on hot days in cooled or air-conditioned
rooms; drink plenty of fluids, but avoid caffeine and alcoholic beverages; apply cold, wet cloths to
the wrists, neck, armpits, and/or groin; and bathe or sponge off with cool water. People without
air-conditioning can go to places in the community that can offer a cooler setting, such as senior
centers, shopping malls, and libraries.
The Low-Income Home Energy Assistance Program (LIHEAP), a federally funded program
that operates through state governments, the District of Columbia, tribes and tribal organizations, and U.S. territories, can help families stay warm in the winter and cool in the summer,
reducing the risk of health and safety problems that can arise from unsafe heating and cooling
practices. This program provides assistance in managing costs associated with:

Home energy bills
Energy crises, for example, as a result of a natural disaster
Weatherization and energy-related minor home repairs
During the hot summer months, New York State used a portion of its LIHEAP funding to
help low-income residents with documented medical needs keep their homes at a healthy
temperature. Prolonged exposure to very high indoor temperatures is a health risk that
disproportionately affects those already suffering from medical ailments. New York State
Homes and Community Renewal installed more than 3,200 window air conditioner units,
helping to keep some of New York’s most vulnerable people healthy and safe during summer heat waves. (Office of Community Services, n.d.)
2 Physical Changes and the Aging Process
More information about the LIHEAP program is available at
liheap (U.S. Department of Health and Human Services, Administration for Children and
Only 15% of older adults report any trouble seeing (National Center for Health Statistics [NCHS],
2017). Even so, several changes occur in our eyes as we age, including presbyopia (farsightedness),
dry eyes, and cataracts, all of which can be dealt with relatively simply nowadays. These changes
usually occur after the age of 40, but younger people can also experience them. There are numerous ways to adapt to aging eyes so that a good quality of life can be maintained throughout the life
span. More serious eye conditions, including glaucoma and macular degeneration, are discussed
as medical conditions in Chapter 11, Medical Conditions, Assisted Living, and Long-Term Care .
Presbyopia, or farsightedness, is a normal condition, not a disease, and should not disrupt the
daily lives of most people. It usually begins to develop when a person is about 40 years of age.
As we age, our eyes begin to lose the ability to adjust for different distances, and eventually most
people will need bifocals or trifocals to maintain good vision. Presbyopia also means that as a
person grows older, it is more difficult to adjust to darkness and to glare, and it takes more time
to adapt to changes in light and darkness. These changes in vision make nighttime driving more
hazardous for older people.
Cataracts are very common in older adults, though they can occur in children too. Research has
shown that the risk of cataracts is related to frequent sun exposure, which has its greatest effects
on younger people (Neale, Purdie, Hirst, & Green, 2003). Protecting our eyes from intense sunlight throughout our life span will decrease susceptibility to cataracts. Eventually, though, most
people will develop cataracts if they live long enough. Cataracts result in increasingly blurred
or misty vision as the eye’s lens becomes milky. Some cataracts grow larger or denser over time,
causing severe vision changes. These cataracts can cause loss of independence for older adults
because decreased vision may affect driving, working, reading, and hobbies. Cataract growth can
be slowed by protecting our eyes from the sun and from sunlamps, eating healthy foods, limiting
alcoholic drinks, and avoiding smoking (Kline & Wenchen, 2005). In the United States, cataract
surgery, which replaces the clouded lens with a synthetic one, is the most commonly performed
surgery in adults over age 65. Its success rate is very high.
Dry Eyes
Some people develop dry eyes as they grow older. This dryness can also cause redness in the eye.
Mild cases can usually be treated with over-the-counter artificial tear solutions. Optometrists can
diagnose and recommend other treatments for more serious cases of dry eye (American Optometric Association, n.d.).
In general, a complete eye examination is recommended for those older than age 45, with
follow-up examinations every 2 to 4 years thereafter. As noted, some age-related changes in vision
II Physical and Mental Well-Being
can be dealt with fairly easily—by wearing bifocals or trifocals for presbyopia, by having surgery
for cataracts, and by using artificial tears for dry eyes. Most other changes are best dealt with by
changes to our environment. Our built environment has been constructed using parameters that
work best for young people. Thus, the amount of light, the existence of stairs and escalators, and
the typical size of print, for example, have all been determined for the society we used to be—a
society of mostly young people. With our changing demographics, and our desire to make our
environment more accessible to people with disabilities, it is time for us to make changes to our
existing environment, and rethink parameters for future built environments, to accommodate
people of all ages and ability levels.
As we age, we require more light to see as well as we did when we were younger (as much as
three times more light). Thus, simply increasing the amount of light assists older eyes to see better.
Depth perception is also affected, so constructing environments that clearly differentiate changes
in levels, for example on stairways, is a good way to increase visibility of those changes, and thus
help decrease falls in older people. Varying textures, materials, and colors are helpful ways to
signal changes in levels. Also, ramps are preferable, especially to escalators, for moving from one
level to another because they are much safer for everyone.
As we age, limitations in our hearing become much more common than limitations in our vision.
In 2015, 30% of people age 65 to 74 years reported trouble hearing, and that percentage rises to
47% for people age 75 and over. Older men are more likely to have hearing problems than are older
women—41% of men and 21% of women age 65 to 74, and 55% of men and 41% of women age
75 and over (NCHS, 2017). Most people lose the ability to hear high-pitched sounds first, which
leads to poor hearing when there is background noise. They also experience difficulty in hearing
higher pitched sounds which are common in women’s and children’s voices, and difficulty in distinguishing between some words because consonants, such as Bs and Ps, and Cs and Ks, tend to
be higher pitched than vowels are. Presbycusis, the most common type of sensorineural hearing
loss, can occur because of changes in the inner ear, auditory nerve, middle ear, or outer ear. Some
of its causes are aging, repeated exposure to loud noise, heredity, head injury, infection, illness,
and certain prescription drugs. A recent analysis of national data shows that hearing impairment
is declining among adults between ages 20 and 69, a positive sign for the future (Hoffman, Dobie,
Losonczy, Themann, & Flamme, 2017). Reasons for this decline may be reduced exposure to loud
noise in the workplace, lower rates of smoking, and better management of chronic conditions,
such as hypertension, that can impact hearing.
Hearing is an essential component of well-being, especially for people who have enjoyed normal hearing for most of their lives. Losing the ability to hear adequately in the routine activities of
daily life can be very detrimental. Older adults with moderate to severe hearing loss report more
difficulty with tasks such as preparing meals, shopping, and using the telephone than do those
with no hearing loss (Gopinath et al., 2012). Once daily activities such as these become compromised, independence and quality of life can be reduced. Thus, an important factor in hearing loss
is the increasing isolation of the person with impaired hearing. For most people, hearing loss
is gradual. At the beginning of the loss of hearing, it is not unusual for people to be irritable, to
seem to be distracted from conversation, and to be unsociable. Often a person may be unaware of
the hearing loss and frequently give inappropriate answers to questions that were not heard well
enough. As a result, relationships may become strained as others believe the person to be a bit
2 Physical Changes and the Aging Process
confused. As this process continues, the person may begin to feel rejection conveyed in the nonverbal communication of others, and there is a real danger that depression may set in (Gopinath
et al., 2009), leading to a cyclical process of increasing isolation and depression.
Adaptations to age-related changes in hearing involve those communicating with older people
as well as the older people themselves. In communicating with people who have hearing problems, it is helpful to speak more slowly and enunciate clearly. Shouting should be avoided. It is
beneficial to speak face to face, so the person can see lip movements. Because much communication is nonverbal, one can attempt to communicate emotions, moods, and acceptance by body
language and facial expressions. It is always helpful to eliminate background noise, including
noise created by fans, air conditioners, and other appliances. It is important that the acoustics as
well as the sound equipment in an auditorium be very good for presentations to older persons.
Older persons who believe they are suffering hearing loss can benefit from having a hearing
checkup with an audiologist or with an ear, nose, and throat specialist. If there is significant organic reason for hearing loss, many aids are available today that can help. It is important for a person to be diagnosed by a certified specialist, such as an audiologist, and not by a person who only
sells hearing aids. Unfortunately, most people who could benefit from some type of hearing aid do
not have one. In the first national study that included audiometric testing of a large, representative
sample, Chien and Lin (2012) analyzed data from the National Health and Nutritional Examination Surveys (NHANES) on hearing loss and hearing aid use. Of the 27 million Americans 50
years of age or older with a hearing loss, they found that fewer than 4 million (14%) used hearing
aids. Hearing aid use does seem to be higher for those age 70 and older, with researchers in one
study reporting that of those who could benefit from using a hearing aid, one third were wearing
one for at least 5 hours per week (Bainbridge & Ramachandran, 2014), though that still leaves a
lot of people without the improvements that hearing aids would afford them. A variety of reasons have been suggested for the relatively low-level use of hearing aids. Some people think their
hearing loss is relatively minor, and they would rather not bother with hearing aids, which do not
restore the entire range of lost frequencies and still do not fully eliminate distracting background
sounds in a noisy environment. Others are concerned about the stigma associated with wearing a
hearing aid. There are also those who cannot afford them—good hearing aids are expensive and
are not covered by Medicare.
At first, a hearing aid may seem unnatural and strange because it amplifies sounds other than
speech. It usually takes some time to adjust to a hearing aid, and families and friends, as well as
the user of the aid, need patience during the adjustment process. Modern hearing aids are marvels
of technological advancement. Many types are available, including ones that fit in the ear canal
(completely or partially), in the ear, or behind the ear. Most have been miniaturized so that they
are comfortable to wear and are cosmetically acceptable. Hearing aids can be indistinguishable
in their appearance from earpieces for electronic devices, so the stigma of wearing a hearing aid
may disappear in the near future!
Chemical Senses: Smell and Taste
Our senses of smell and taste are intimately connected and interact with one another. For example, what we experience as the flavor of a food is actually a consequence of both the smell and the
taste of the food. Just think about how our food does not seem to taste the same when our sense
of smell is disrupted by a head cold. Nevertheless, smell and taste are separate senses and each has
its own receptors and physiological underpinnings.
II Physical and Mental Well-Being
Our sense of smell (olfaction) begins to decrease beginning around age 50, with women having a lower risk of their ability being diminished over time compared to men (Liu, Zong, Doty, &
Sun, 2016). Although olfactory cells regenerate throughout the life span, it seems that the ability
for them to do so decreases over time. In addition, age-related changes in the brain where information about smell is processed—in the orbitofrontal cortex, hippocampus, and amygdala—may
contribute to an age-related decrease in sensitivity to smells (Gunzer, 2017). Estimates of the
prevalence of olfactory impairments range from 17% for men in their 60s to 37% for men age 70
and over. Estimates range from 11% for women in their 60s to 25% for women age 70 and over.
In addition to gender, prevalence is also affected by race and ethnicity, socioeconomic status, a
history of asthma and hypertension, medication use, smoking, and alcohol consumption (Liu
et al., 2016).
Our sense of taste is important for the pleasures we derive from consuming good food as well
as for helping us to avoid consuming harmful substances. In comparison to smell, our ability to
taste seems to be less affected by age (Seiberling & Conley, 2004), though much less is known
about age-related changes that may take place, or their causes. Taste perception may be affected
if saliva production goes down, which happens in some older adults. Illnesses, medications, and
smoking can also negatively affect the ability to taste food. Older adults may need a much higher
concentration of salt to detect its presence in food (Stevens, Cain, Demarque, & Ruthruff, 1991),
which could, for example, negatively affect the likelihood that hypertensive patients will maintain
a low-salt diet.
Potentially serious problems can arise as a result of changes in our sense of smell and taste. A
reduction in these chemosensory abilities can result in decreases in appetite, food consumption,
and overall quality of life, and can even endanger an older person’s health and safety. Some older
people may lose the pleasure of smelling flowers, perfumes, and well-cooked and seasoned food. At
the same time, they may have difficulty smelling gas leaks, smoke, and spoiled food (Seiberling &
Conley, 2004). Given these negative effects, it is encouraging that there has been some research
into possible ways to ameliorate older adults’ sense of smell. It turns out that exercise seems to be
one way. In a study of more than 1,600 older adults over a 10-year period, Schubert et al. (2013)
found that those who worked up a sweat exercising at least once per week had a reduced risk of
olfactory impairment, and exercising more frequently reduced the risk even more. Thus, these
researchers concluded that regular exercise may prevent some decrements in olfaction that otherwise would accompany aging. Another way of reducing aging effects on olfaction seems to be by
eating more fish and nuts (Gopinath, Sue, Flood, Burlutsky, & Mitchell, 2015).
Adaptations for older adults with a decreased sense of smell include ensuring that smoke detectors are in place and working well, and paying attention to food safety guidelines as well as expiration dates on food products. Friends, neighbors, and family members can be helpful in detecting
problematic smells or tastes, too. In addition, when taste seems to be affected, the enjoyment of
food can be enhanced by adding spices and incorporating a diversity of food flavors, textures, and
temperatures during meal preparation. “Eye appeal” can also positively affect enjoyment, so garnishes, variety in food colors, and placement of food on a plate should not be overlooked.
When it comes to aging, touch is often an overlooked sense, and yet, our skin, through which
we experience touch, is the largest of our sense organs. The frequency of touch and responses
to it are affected by the context in which it occurs, the relationship between people who are
2 Physical Changes and the Aging Process
engaged in touching, and culture, with some societies, like the American society, actively
discouraging touch (Field, 2010). The positive effects of touching are many. It decreases
blood pressure, heart rate, and cortisol (stress hormone) levels; increases oxytocin (“love
hormone”) levels; improves immune function; increases attentiveness, leading to improved
performance on cognitive tasks; decreases depression; reduces pain; and may extend time in
deep sleep, the most restful stage of sleep (Field, 2010). What older person could not benefit
from these effects? Regrettably, however, little research into touch has been conducted with
older people.
Two studies give us a glimpse into the value of investing in more research in this arena: a
study of older adults giving massages to infants, and another investigating the affective responses
to touch of older adults. In the first of these studies, having already learned that massage has
positive effects on those receiving it, the researchers wanted to know whether massage also has
positive effects on those giving it (Field, Hernandez-Reif, Quintino, Schanberg, & Kuhn, 1998).
They recruited older retired volunteers who were taught Swedish massage techniques and then
each massaged a 1- to 3-month-old infant for 15 minutes three times a week for 3 weeks. Giving
those massages affected the older volunteers immediately, improving their emotional well-being
and decreasing anxiety and stress levels. In the second, more recent study, the researchers asked
people aged between 13 and 82 years, to rate from unpleasant to pleasant on a 20-point scale,
their experience of being gently stroked on their forearm (Sehlstedt et al., 2016). They found
that older people gave significantly higher ratings, indicating that the subjective appreciation
of touch increases with age. This finding may not be that surprising given that it has previously
been noted that older people may be deprived of touch, especially after a partner or other loved
ones die.
Feet get bigger as we age. If you are in your 20s and wear a size 7 shoe now, you may wear a size 8
or even a size 9 by the time you are in your 60s! Over our lifetime, feet tend to flatten out, and
may get wider, due to some loss of elasticity in the tendons and ligaments that support them.
Other factors that can increase the size of feet are pregnancy and weight gain. Aging also tends to
diminish the fat tissue on the bottoms of our feet, leading to soreness when walking for a while
on hard surfaces wearing shoes that have thin soles. Sometimes, foot problems are the first sign
of more serious medical conditions such as arthritis, diabetes, and nerve or circulatory disorders.
In addition, foot pain contributes to falls in older adults (Mickle, Munro, Lord, Menz, & Steele,
2010). If there seems to be a problem, a podiatrist, who specializes in diagnosing and treating foot
problems, can be consulted.
Foot pain and discomfort, though, need not be a normal part of aging. By the time we reach
old age, our feet have had years of wear and tear, so good foot care becomes especially important.
Checking regularly for cuts, blisters, and ingrown toenails is a good practice. Some adaptations
work well for people of all ages, especially wearing comfortable shoes that fit properly, which can
prevent many foot problems. Add insoles, if necessary, to help cushion feet. Podiatrists can prescribe orthotics that are custom-made for a patient based on a complete assessment of his or her
feet, ankles, and legs. Research supports the value of these custom orthotics in reducing foot pain
and improving function and so some health insurance plans will help pay for them. Raising feet
when sitting helps keep blood moving to the feet. Stretching, walking, and gentle foot massages
can serve a similar function. Warm footbaths are helpful, too.
II Physical and Mental Well-Being
The Urinary Tract
Although some age-related changes occur in our kidneys, in the absence of disease, they usually
continue to function quite well throughout the later years of life. “Exercise; proper diet, including
adequate fluid intake; limited use of medications; and quitting smoking help the urinary system
maintain adequate functioning” (Saxon et al., 2010, p. 218). Bladder capacity does decline by 30%
to 40%, but this is not a symptom of disease; it is simply a result of the aging process (Saxon et al.,
2010). Most elderly persons need to get up in the night to empty their bladder. Older persons
should know that having to arise in the night to go to the bathroom is not in itself an indication of
any serious disease. If they have to arise more frequently than twice a night, however, they ought
to see a healthcare professional.
The micturition reflex changes as one ages. Micturition is the signal a person receives when he
or she has to urinate. For a young person, the signal is usually sent when the bladder is about half
full. As a result, young people have some time left before they must absolutely get to a bathroom.
Not so for the elderly. The signal to urinate is given when the bladder is nearly full. Obviously that
means when they receive the signal, there is not much time for delay. The reduced capacity of the
bladder, coupled with a delayed signal to urinate, can lead to problems of frequent urination and
the need to urinate immediately (Saxon et al., 2010).
Dribbling urine or urinary incontinence (UI) can be a problem for some older people. This can
be viewed as both physiologically and psychologically damaging. Women have a higher probability than men of having incontinence, likely the result of childbirth and the associated weakening
of the bladder outlet and pelvic musculofascial attachments. Although UI is more common in
older adults, people of any age can experience it. The most common type is stress incontinence,
which is brought about by a laugh, a cough, a sneeze, or lifting. In addition to stress incontinence,
some older persons suffer from urge incontinence, the sudden urge to go to the bathroom without time to get there. Others suffer from overflow incontinence, a condition in which the bladder
becomes too full and urine leaks out (Saxon et al., 2010).
There is an increased chance of urinary tract infections as a person grows older. Symptoms
of a bladder infection include cloudy or bloody urine, a low-grade fever, pain, or a burning
sensation during urination, and a strong need to urinate often, even right after the bladder
has been emptied. If the infection spreads to the kidneys, symptoms may include chills and
shaking or night sweats; fatigue; fever above 100°F; mental changes or confusion; nausea and
vomiting; and side, back, or groin pain. In either case, a healthcare professional should be consulted for diagnosis and treatment. A course of antibiotics usually clears up infections fairly
Older people, especially older men, are at higher risk than younger people of developing kidney stones. Kidney stones are hard masses that form in the kidney out of substances in the urine.
They may be as small as a grain of sand or as large as a pearl. Some stones are even as big as golf
balls! Most kidney stones pass out of the body with urine. But sometimes a stone will not pass by
itself and then medical attention is necessary. The larger the stone, the more likely it is to cause
severe pain, in the back or side, that will not go away. Other symptoms include fever and chills,
vomiting, urine that smells bad or looks cloudy, a burning sensation during urination, or blood
in the urine. The most common treatment is extracorporeal shockwave lithotripsy (ESWL), in
which a machine sends shock waves to the stone and breaks it into smaller pieces, which can then
be passed out of the body in urine. The best way to prevent kidney stones is to drink lots of water,
which helps to flush away the substances that form kidney stones (National Kidney & Urologic
2 Physical Changes and the Aging Process
Diseases Information Clearinghouse, 2011). Producing at least a liter (slightly more than a quart)
of urine per day is indicative of drinking adequate fluids.
Awareness of age-related changes in the urinary tract, including its reduced capacity, can also be
helpful because then older people can plan to regularly visit lavatory facilities, and avoid foods and
drinks that may cause them to urinate more often, thereby avoiding the incontinence that might
ensue. Another adaptation older people can make to changes in their urinary tracts is to learn to
do Kegel exercises to strengthen pelvic muscles, which can even prevent UI. Kegel exercises also
strengthen the uterus and large intestine. More information and instructions on how to do the
exercises can be found online at…
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