Aging and Older Adults

Adult day care centers provide important health, social, and support services for functionally and cognitively impaired adults and their caregivers. The adult day care services are underutilized, however, because of the shortage of centers, caregivers' lack of awareness of and resistance to using services, and the mismatch between the needs of potential consumers and their informal caregivers and the services provided by the centers. To foster and support the expansion of adult day care centers, lessons learned from national demonstration programs need to be disseminated, and social workers need to be trained to provide essential services at the centers.

Adult Protective Services (APS) are empowered by states and local communities to respond to reports and cases of vulnerable adult abuse, neglect, and self-neglect. While incorporating legal, medical, and mental health services, APS programs are part of the social services delivery system and incorporate principles and practices of the social work profession.

Various models and theories of adult development exist but they are more assumptions about development than theories. The most popular age and stage theories have lost favor to contextual theories that put more emphasis on interaction with the environment. It has also become recognized that adults are a diverse group and do not follow universal stages of development. The usefulness of chronological age is also questionable as it does not tell us much about any particular person. Instead, we have to know their concerns and the events they are dealing with, and their dreams and aspirations.

This entry presents information about group settings that provide residential long-term care for older adults, focusing on nursing homes and residential care/assisted living communities. It provides an overview of both settings, and describes their scope of services, funding, and clientele. The section Issues in Residential Long-Term Care addresses issues of special relevance to social workers: dementia and other psychosocial care needs; quality of life and quality of care; access to and disparities in care; end-of-life care; family involvement; and abuse and neglect. It ends with a section on the role of the social worker in residential long-term care.

Advance care planning (ACP) is the process of determining and documenting desired wishes for the end of one’s life. Referred to by such terms as end-of-life planning, advance (health) directives, and living wills, ACP is a relatively new concept within our society, having emerged as a social, political, and ethical issue in the United States only since the 1960s. Researchers and legislators have been challenged in their efforts to examine healthcare decision-making and design appropriate policy to guide practice. This article will define ACP, provide an overview of the history and evolution of the process and the associated legal and ethical issues, and describe the process with three specific populations. In addition, it examines the role of the social work profession in working with individuals and families on planning for the end of one’s life.

Retirement is a modest social institution that appeared in most industrialized nations near the start of the 20th century. The aim of retirement was to solve the societal dilemma of an increasingly aged labor force by moving older workers systematically out of their jobs so as to not cause them financial harm (Atchley, 1980, p. 264). Although retirement has been considered benign since its inception, the history of retirement indicates that it is one of the main progenitors of ageism in society today (Atchley, 1982, 1993; Haber & Gratton, 1994; McDonald, 2013; Walker, 1990). Retirement and its accompanying stereotypes have been used as a tool for the management of the size and composition of the labor force contingent on the dictums of current markets in any given historical era. Ever-changing ideologies about older adults that extend from negative to positive ageism have been utilized by business, government, the public, and the media to support whatever justification is required in a particular era, with little thought to the harm perpetrated on older adults. Unfortunately, society has subscribed to these justifications en masse, including older adults themselves. In this article the ageism embedded in retirement is examined to make what is implicit explicit to social work practitioners and policymakers in the field of aging.

The rapidly growing older population is more heterogeneous than any other age group. Although many face vulnerabilities and inequities as they age, most are resilient. This entry explores the “greying of America,” examines the definition and measurement of aging, reviews the diversity among older adults in the United States, discusses productive, successful, and active aging, and suggests leadership roles for social workers in enhancing the well-being of elders and their families.

Social workers address older adult issues at all levels of service planning, policy-making, and delivery and across a wide range of community and institutional settings. While various models of practice intervention with older adults exist, more recently the focus is on the integration of micro and macro strategies with an emphasis on strength-based perspectives to geriatric social work practice. The older adult population will expand dramatically and become increasingly culturally, racially, and ethnically diverse in the future and social work services will need to be sensitive to the variety of issues faced by a more heterogeneous and sophisticated older adult population.

Public policy advances in the field of aging in the United States have lagged compared to the growth of the older adult population. Policy adjustments have been driven by ideological perspectives and have been largely incremental. In recent years, conservative policy makers have sought through various legislative vehicles to eliminate or curb entitlement programs, proposing private sector solutions and touting the importance of an “ownership society” in which individual citizens assume personal responsibility for their economic and health security. The election of a Democratic majority in the U.S. House and the slim margin of votes held by Democrats in the U.S. Senate may mean a shift in aging policy directions that strengthens Social Security, Medicare, and Medicaid, if the newly elected members are able to maintain their seats over time. The results of the 2008 presidential election will also determine how the social, economic, and other policy concerns will be addressed as the baby boomers join the ranks of older Americans.