Abstract and Keywords
The rapidly growing older population is more heterogeneous by health and economic status, gender, race, sexual orientation, and family and living arrangements than any other age group. Although many adults face vulnerabilities and inequities as they age, most elders are resilient. This entry reviews this diversity, discusses concepts of productive, successful, and active aging, and suggests leadership roles for social workers in enhancing the well-being of elders and their families.
The dramatic growth of the population age 65 and older is referred to as a demographic imperative because it affects all social institutions—families, the workplace, educational settings, health and mental health care delivery systems, and the leisure industry. It also has far-reaching implications for social work. Social workers in all practice arenas and with all age groups increasingly work with older adults and their families: in child welfare, family services, schools, mental health centers, AIDS treatment clinics, and among the homeless. This entry reviews the demographics of aging; vulnerabilities and challenges faced by older adults; emerging opportunities for active, productive, and resilient aging; and concludes with a discussion of the implications for social work. Although the older population is growing worldwide, the focus here is on the United States.
Demography of Aging
Americans age 65 and older comprise 13.1% of the population, compared to 4% in 1900. The population age 65 and older increased by almost 13 times during this period compared with a threefold increase in the population under age 65. With the first Baby Boomers (that is, those born between 1946 and 1964) turning 65 in 2011, the population age 65 and older is increasing significantly. Demographers predict that older adults, who now number 40.4 million, may number 88.5 million by 2050, a 100% increase over 30 years compared with a 30% increase in the total population. Those age 85 and older—the oldest-old—are the most rapidly growing age group. Now forming 13% of the older population, they are projected to increase fourfold by 2050. The population of centenarians, people age 100 or older, will also grow substantially since baby boomers are expected to survive to age 100 at rates never before achieved. One in 26 Americans can expect to live to be 100 years by 2025, compared with only 1 in 500 in 2000 (Administration on Aging [AOA], 2012; Howden & Meyer, 2011; U.S. Census Bureau, 2011b).
These demographic shifts are occurring because of increases in life expectancy (average length of time that one can expect to live based on the year born). Life expectancy at birth is expected to grow from slightly more than 78 years in 2011 to the mid-80s by 2050. On average, females born today will live 80.8 years compared to 75.7, respectively. A fairly constant 5-year gender difference in life expectancy is projected well into the future (Federal Interagency Forum on Aging-Related Statistics, 2012; U.S. Census Bureau, 2011a). Most of the gains in life expectancy have occurred in the younger ages because of better medical care and eradication of childhood diseases.
Population aging is a global phenomenon, occurring in just about every country in every part of the world as older adults grow in both real numbers and in proportion to the larger population. In 2008, the number of people 65 years and older in the world was estimated to be 506 million, or about 7% of the world’s population. By 2040, that number is projected to increase to 1.3 billion people, or 14% of the world’s population. At that time, about 76% of people 65 and older are likely to be in developing countries (Kinsella & He, 2009). The two major reasons for global aging are increased life expectancy and declining birth rates. Japan has the highest proportion of elders in the world (22%), followed by Italy (20%). It is noteworthy that the projected increase in the numbers and proportion of persons age 60 and older is higher for developing nations than for the more developed ones—increasing from 475 million in 2009 to 1.6 billion in 2050, when about 80% of the world’s older adults will be living in developing countries. Currently, 60% of older adults live in developing countries, which may increase to 75% by 2020 (United Nations, 2009).
Heterogeneity of the Older Population
Aging cannot be defined merely in chronological terms, which only partially reflects the biological, psychological, and social-cultural processes as people age. A more relevant distinction is functional age or the ability to perform activities of daily living (ADLs), such as eating, bathing, and dressing that require cognitive and physical well-being (World Health Organization [WHO], 2002). Because aging is a complex process that involves factors unique to each individual, older people are more diverse in their health and socioeconomic status, ethnicity and race, and family situations than other age groups. Some are employed; most are retired. Most are healthy; some are frail, homebound, or have dementia. Most still live in a house or apartment; a small percent are in nursing homes. Some receive large incomes from pensions and investments; most depend primarily on Social Security and have little discretionary income. Most men age 65 years and older are married, while women are more likely to be widowed and living alone. Intersections among these variables play out in the poorest group in our society: older women of color living alone in rural areas (AOA, 2012).
As adults live longer, they also tend to manage their chronic conditions without resulting in frailty or physical disability. Disability rates have declined since 2002 in all age groups 65 years and older, especially among the oldest-old (Crimmins & Beltrán-Sánchez, 2010; Fuller-Thomson, Yu, Nuru-Jeter, Guralnik, & Minler, 2009; Manton, Gu, & Lowrimore, 2008). Although more than 80% of older adults have at least one chronic condition and 37% report some type of disability, only about 2% are bedbound. The vast majority are functionally able to conduct activities of daily living (ADLs) (AOA, 2012). The need for assistance with ADLs, which generally increases with age, typically determines whether older adults can remain in their homes. Although the baby boomers are currently healthier than prior cohorts, their sheer numbers, combined with increasing obesity rates, mean that by 2030, about 30% of them will have activity limitations that require some assistance and 20% of this group will have severe limitations. In sum, while people are living longer, many are also living longer with chronic illness and disability (Manton, Gu, & Lamb, 2006; National Institutes of Health [NIH], 2011).
Ethnicity, Race, Gender, and Sexual Orientation
Ethnic minorities comprise slightly less than 20% of the total older population (8.4% African American, 6.9% Latino, 3.1% Asian or Pacific Islander, and less than 1% American Indian or Native Alaskan) (AOA, 2012). These low rates result from higher fertility and mortality rates among young adults and high rates of immigration of younger adults, creating a smaller proportion of elders compared with Caucasian population. In addition, elders of color have a lower life expectancy, as noted earlier, generally because of lifelong inequities in access to economic resources, health care, and preventive services. However, by 2050, the percent of people of color age 65 and older is projected to increase to almost 42%, faster than the rate of growth among the Caucasian population. This will occur because of the large percent of children in these groups, who, unlike their parents and especially their grandparents, are expected to reach old age (AOA, 2012).
Women form the fastest growing segment of the older population, especially among the oldest-old, making the aging society a largely female society: they represent 58% of the population age 65 and older and 70% of those ages 85 and older. Women at age 85 and older outnumber their male counterparts by five to two and among centenarians by three to one (U.S. Census Bureau, 2011b).
Estimates of the number of older gay, lesbian, bisexual, and transgender (GLBT) adults range from as low as 3% to as high as 18–20%. This translates into at least 2 million older lesbians and gay men, which will likely increase to over 6 million by the year 2030 (Fredriksen-Goldsen & Muraco, 2010). Prevalence rates are probably underestimates because of the taboo of identifying as GLBT in a survey. The general invisibility of being old in our society is heightened for those who are old and GLBT, the most “invisible of an already invisible minority” (Blando, 2001; Gates, 2011). Because of the double stigma of being “twice hidden,” some studies find that the aging experience is more difficult for GLBT adults who may experience higher rates of social isolation and mental distress while others suggest that lifelong marginalization and skills in managing a stigmatized status may stimulate adaptive strategies to the challenges of aging (Fredriksen-Goldsen, Kim, Emlet, et al., 2011; Gabbay & Wahler, 2002; McFarland & Sanders, 2003; Thompson, 2006). Although gains have been made in many states in terms of domestic partnerships, LGBT elders still encounter legal and attitudinal obstacles in receiving and providing care in health and long-term care settings, largely because of lacking the legal protection of marriage, and service providers must have the knowledge and skills to work effectively with GLBT elders (Cahill, South, & Spade, 2001; SAGE, 2010; Zodikoff, 2006).
Geographic Location and Type of Living Situation
About 57% of all adults aged 65 and older live in 11 states, with the highest proportion in Florida (17.4%), followed by West Virginia (16.1%) and Maine (15.9%), and lowest in Alaska (7%) and Utah (8.8%). In some states, such as Florida, in-migration of older adults explains the increase, while in others, such as West Virginia and Maine, the increase is due to the migration of young people out of the state. These regional differences are expected to continue (AOA, 2012). Residential relocation is relatively rare; in a typical year, less than 6% of people age 65 and older move, usually within the same region, compared with nearly 17% of people under age 65. The vast majority of older persons (80%) live in metropolitan areas. The oldest-old are most likely to relocate, often into or near their children’s homes, which is typically precipitated by widowhood, significant deterioration in health, or disability (AOA, 2012; Frey, 2010).
Most elders prefer to remain in their own home, regardless of its condition, which reflects the almost universal desire to “age in place.” As a result, 93.5% of those ages 65 and older live in independent housing, which they typically own, followed by 41% in long-term care facilities, and 2.4% in senior housing with services, such as assisted living. The lifetime risk of admission to a nursing home increases with age and for women, who are the majority of residents. Of these residents, about 87% are White (AOA, 2012).
Educational, Employment, and Economic Status
Today’s older population is better educated, with nearly 80% of those ages 65 and older having a high school degree, compared with less than 20% in 1960, and 22.5% holding a bachelor’s degree or more. Racial and generational differences are striking, however. Among Whites, 84% of older adults have at least a high school diploma. Because of historical patterns of discrimination in educational opportunities, 65% of older African Americans and 47% of Latinos today have less than a high school education (AOA, 2012). Because educational level is so closely associated with economic well-being, these racial differences have a major impact on poverty levels of persons of color across the life course and particularly in old age. Not surprisingly, the baby boomers who began to turn 65 in 2010 and the adults currently aged 65–69 years are better educated than the oldest-old, which has implications for economic well-being of future generations of elders. The proportion of older people in the labor force has increased to 17% in recent years, in part because of the recession and the financial necessity to keep working longer than many older adults had anticipated: approximately 22% of men and almost 14% of women age 65 and older now work full- or part-time outside the home. The majority of these) are employed in a part-time or temporary capacity (Bureau of Labor Statistics, 2011; Hicks & Kingson, 2009).
Older adults’ economic status has generally improved in the last 50 years, largely because of Social Security and its annual cost of living increases, although income has declined slightly due to the recession. Social Security is a source of income for 87% of elders. Today about 9% of older people subsist on incomes below the poverty level, compared with 35% in the late 1950s. Another 5.8% of older adults are classified as “near-poor.” Poverty rates increase among women and elders of color (AOA, 2012; Johnson & Wilson, 2010).
Families and Family Caregiving
The family is the primary source of social support for older adults: over 90% of elders have living family members and about 60% reside in a family setting, typically with a spouse/partner. Nearly 55% of those ages 65 and older are married and living with a spouse in an independent household, while about 4% have never married. Although 80% of adults ages 65 and older have children, only about 6% of older men and 17% of women live with children, siblings, or other relatives. Significant differences exist, however, in living arrangements by gender and age. Because of women’s longer life expectancy, higher rates of widowhood, and fewer options for remarriage, only 41% of women over age 65 are married and living with a spouse as compared with nearly 70% of men. Accordingly, 37% of women live alone compared with 19% of men. The percentages living with a spouse also decline markedly with age and among African Americans and Latinos (AOA, 2012; Uhlenberg, 2004). Marital status affects living arrangements and the nature of caregiving readily available in case of illness. Marriage appears to be a protective factor, associated with physical and mental health, life satisfaction, and happiness, especially for men (Lyyra & Heikkinen, 2006). Although lacking the legal option of marriage, GLBT elders who have partners tend to be less lonely and enjoy better physical and mental health than those living alone (Metlife Mature Market Institute, 2006). The aging family of the future will be profoundly affected by the growing incidence of younger adults who are single and never-married, divorced, and single parents along with reduced fertility and smaller family size.
With increased life expectancy, multigenerational families—composed of four or even five generations—are more common now, a pattern that crosses racial and ethnic groups and social classes. The percent of Americans living in multigenerational households had declined from 1940 to 1980 to about 12% of the population. But from 1980 to 2000, such households increased by 39%. As a result, 16% of the total population—about 6.6 million U.S. households—now encompasses three or more generations. The percent of children under 18 who lived in a household that included a grandparent increased from 8% in 2001 to 10% in 2010. The growth of multigenerational families means that some parents and children now share five decades of life, siblings perhaps eight decades, and the grandparent–grandchild bond lasts three or more decades (Pew Research Center, 2010b).
Among parents ages 65 and older, 80% are grandparents, with some women experiencing grandmotherhood for more than 40 years. This is because the transition to grandparenthood typically occurs in middle age, not old age, with about 50% of all grandparents younger than 60 years. As a result, there is wide diversity among grandparents, who vary in age from their late 30s to over 100 years old, with grandchildren ranging from newborns to retirees. Most grandparents derive satisfaction from their role and interaction with grandchildren (Pew Research Center, 2010b; Reitzes & Mutran, 2004).
Grandparents have traditionally provided care for grandchildren, especially within families of color and immigrant families (Cox, 2002). What has shifted since the mid-1990s is the dramatic increase in grandparents who assume primary responsibility for their grandchildren. With almost 2.9 million custodial grandparents providing such primary care, skipped-generation households—the absence of the parent generation—are currently the fastest growing type. This means that about 7.8 million children live in households headed by grandparents or other relatives. Custodial grandparenting crosscuts social class, race, and ethnicity. The majority of sole grandparent caregivers are White (53%), but Latinos (18%) and African Americans (24%) are disproportionately represented, given their percentage of the total population. In most instances, the parents—an invisible middle generation—are absent because of substance use or incarceration. Most custodial grandparents are women, even among older couples, and are younger than 65; the 30% who are age 65 and older typically deal with age-related changes along with the emotional stress of feeling alone and isolated from age peers. Grandparent caregivers have been called the “silent saviors” of the family; in addition to a greater likelihood of living in poverty, they face numerous legal, health-care, and financial barriers. These challenges are even greater for grandparents who are raising a chronically ill or “special needs” child, which is common since the incidence of emotional or behavioral problems is high (Generations United, 2012; Hayslip & Kaminski, 2005; Kropf & Yoon, 2006; Musil, Warner, Zauszniewski, Jeanblanc, & Kercher, 2006; Pew Research Center, 2010a).
Generally, families experience a pattern of reciprocal support between older and younger members, with older adults providing support to children and grandchildren as long as they are able (Silverstein, Conroy, Wang, Giarrusso, & Bengston, 2002). As another example of this pattern, increasing numbers of elders are providing care for their adult children with developmental disabilities or mental illness who are now living longer (McCallion, 2006).
The reciprocal nature of caregiving shifts as more adults—especially the oldest-old—live longer with chronic illness and seek to remain in the community. Families, who provide 80% of such care, are a significant factor influencing whether an older adult will live in a long-term care facility home. Over 80% of older adults with limitations in three or more ADLs are able to live in the community primarily because of family assistance; moreover, 66% of older people who receive long-term services and supports at home get all their care exclusively from family members. Informal caregiving has been shown to help delay or prevent the use of skilled nursing home care. The economic value contributed by family caregivers to society is estimated to be $450 billion, far more than the total expenditures for formal services. Family caregivers, then, constitute a large and often overlooked component of the American economy and systems of health care and long-term services and supports (Feinberg, Reinhard, Houser, & Choula, 2011; Gonyea, 2008; Hargrave, 2008; Raphael & Cornwell, 2008; Van Houtven & Norton, 2008).
Among caregivers, about 36% of them care for a parent and about 23% for a partner. Women form about 66% of the caregivers who have primary responsibility, providing more hours of assistance than their male counterparts. Women are more likely to provide emotional support and personal care, while men assist with instrumental tasks such as transportation, home maintenance, and finances. The average caregiver is 47 years old, female, married, earning an income outside the home of $35,000, and has performed their role for 4.6 years, devoting 25 hours per week of care (Family Caregiver Alliance, 2009). Caregiving for elders occurs across the life course, however; a growing number of young caregivers, age 8–18, are helping a parent or grandparent and caregivers who are in their 60s or even 70s are caring for centenarians (NAC & AARP, 2009).
Although there are gains from caregiving, the physical and mental health, financial and emotional costs of care—conceptualized as objective and subjective burden—generally exceed benefits for the caregiver, with approximately 30% of caregivers experiencing stress or burden. Caregiving is associated with a range of illnesses, including higher rates of depression, anxiety, heart disease, and even mortality (Feinberg et al., 2011; Pinquart & Sorenson, 2006). Financial costs encompass the direct costs of medical care, adaptive equipment, or hired help and as indirect opportunity costs of lost income, missed promotions, or unemployment. Averaging 12 years out of the paid workforce to provide care to family members, women suffer long-term economic costs of caregiving, including higher rates of poverty in old age. The caregiver’s appraisal of the situation or subjective burden, such as feeling alone and overwhelmed, is more salient than objective burden or the actual tasks performed. On the other hand, living with the care recipient, being a woman, coping with an elder’s behavioral problems, especially those associated with dementia, and long hours of intensive levels of care are associated with increased caregiver stress (Family Caregiver Alliance, 2009; Family Caregiver Alliance & National Center on Caregiving, 2011).
Children and partners typically turn to skilled nursing care as a “last resort” when faced with their own illness or severe family strain. Although most caregivers do not use formal services, psycho-educational programs, support groups, and respite care are relatively effective interventions in reducing caregiver stress, all of which have implications for social work roles (Belle et al., 2006; Gonyea, Connor, & Boyle, 2006; Kuhn & Fulton, 2004; Mittelman, Roth, Coon, & Haley, 2004; Parker, Mills, & Abbey, 2008; Zarit & Femia, 2008).
Vulnerabilities and Challenges of Aging
Inequities Across the Life Course
The concept of life course is central to understanding the vulnerabilities faced by some groups of elders. A life course approach captures how earlier life experiences and decisions affect options in later life and for future generations within and across cultures and time. It recognizes that gender or racial inequities, which limit earlier opportunities, are intensified in old age, resulting in increased economic and health disparities and cumulative disadvantage for older women and persons of color. Gender, ethnic minority status, sexual orientation, low educational and socioeconomic levels, and increased age are all associated with reduced social capital and increased health disparities (Ferraro, Shippee, & Schafer, 2009; George, 2007; O’Rand, 2006; Williams, 2005). Nevertheless, many older adults who have experienced cumulative adversity lifetime inequities demonstrate remarkable resilience and optimism.
The overall economic status of older people masks growing rates of poverty among women, elders of color, the oldest-old, and those living alone. Older women (nearly 11%) are more likely to be poor than men (6.7%). Older African Americans (nearly 15%) and Latinos (18%) are far more likely to be poor than Whites (6.8%) (AOA, 2012). Women and persons of color are least likely to have held jobs with private pensions and most likely to depend on Social Security as the primary source of income. Because of economic, family caregiving, and health disparities experienced across the life course, older women, elders of color, and the oldest-old are most likely to experience disabling illness along with poverty and inadequate housing (Ferraro et al., 2009; Johnson & Wilson, 2010; Walker, 2009). Although the likelihood of chronic illness grows with age, the origins of risk for such conditions and early mortality begin in early childhood. Regardless of age, chronic disability then magnifies the risk of poverty throughout the life course. When the intersections among structural variables are examined, it is not surprising that poor women of color age 85 and older have the highest prevalence of multiple chronic illnesses and functional limitations (Centers for Disease Control and Health Promotion [CDC], 2010; Whitfield, Angel, Burton, & Hayward, 2006; Williams, 2005).
Physical and Mental Challenges
More than 80% of persons age 65 and older have at least one chronic illness, and 66% have multiple illnesses. The most frequently reported chronic conditions, which limit ADLs among older adults and are rooted in health practices across the life course, are hypertension, arthritis, and heart disease. Heart disease, cancer, and strokes account for more than two-thirds of all deaths among people age 65 and older (CDC, 2010; Federal Interagency Forum on Aging-Related Statistics, 2012).
Heart disease is the number-one risk factor among adults age 65 and older, killing 40% more people than all forms of cancer combined, and accounting for 20% of adult disabilities, with the highest rates among the oldest-old and among African Americans (American Heart Association, 2012). Disabling chronic diseases tend to occur earlier among African Americans, Latinos, and American Indians than among Whites. Comorbidity—coping with two or more chronic conditions—is a concept central to understanding health status and its secondary consequences, such as depression and anxiety, and is more common in older women and elders of color than in Caucasian men.
Although normal aging does not result in significant declines in intelligence, learning, and memory, the prevalence of mental disorders ranges from 15 to 25% of the older population, depending on whether samples include older residents in institutional settings. In some instances, these represent mental illnesses that have occurred across the life course, while others are often precipitated by losses of old age. Anxiety and depression are the most common mental disorders in late life, with minor depression estimated to be as high as 10 to 30% among community-dwelling elders (Gellis, 2006). This is of concern since depression often coexists with medical conditions such as heart disease, stroke, arthritis, cancer, diabetes, chronic lung disease, and Alzheimer’s disease, compounding dysfunction and delaying a recovery process. Detecting depression is challenging, since older people often mask or hide symptoms; it is most frequently misdiagnosed among elders of color. Rates of depression are highest among women, those lacking social supports, and low-income elders (Blazer, 2003; Mitchell & Subramaniam, 2005).
Most older adults with chronic mental disorders live in the community, but fewer than 25% of those who need mental health services ever receive treatment, a pattern across all service areas (Gellis, 2006; Kaskie & Estes, 2001). The likelihood of irreversible dementia increases with advancing age, with some estimates as high as 50% for those age 85 and older and over 80% for those age 90 and older. Alzheimer’s disease (AD), the most common dementia in late life, accounts for 60 to 80% of all dementias, and 13% of adults age 65 and older are diagnosed with AD. By 2050, 11 to 16 million people age 65 and older are projected to have AD, compared with 5.2 million currently, unless there are medical breakthroughs in its prevention and treatment (Alzheimer’s Association of America, 2012; Alzheimer’s Disease International, 2009).
Although the majority of elderly people live with others, about 19% of men and 37% of women age 65 and older live alone; after age 75, these rates increase. Those living alone are most likely to be women, elders of color, the oldest-old, low-income, and in rural areas (AOA, 2012). Among those living alone, the most vulnerable are the homeless. Homeless elders (defined as age 55 and older because they are often 10 to 20 years older physiologically than their chronological age) comprise 8 to 10% of the homeless population (Sermons & Henry, 2010). Those living alone and the oldest-old are most vulnerable to being placed in nursing homes, assisted living, adult family homes, and hospitals. Among older age 95 and older, 25 percent are skilled nursing facilities, for example, (U.S. Census Bureau, 2011c).
Opportunities, Resources, and Incentives for Productive Aging
With the aging of the baby boomers, who may live a third of their lives in a healthier and more financially secure retirement than previous cohorts, increasing attention is given to concepts of productive aging and civic engagement. These concepts recognize that elders are our society’s most underutilized asset, with wisdom, skills, and life experience to contribute to addressing social problems. This has translated into growing numbers of civic engagement initiatives, such as voluntarism, intergenerational programs, and cross-generational political advocacy, which are typically associated with higher life satisfaction (Freedman, 2011; Metlife, 2008).
Another widely used concept is successful aging, defined as a combination of physical and functional health, high cognitive functioning, and active involvement with society. However, this concept is critiqued for conveying a middle-age, middle-class norm of remaining active as a way to show that one is an exception to their age peers, that is, “not really old, not aging.” Strategies to avoid being seen as old are put forth by the mass marketing of exceptionally fit and physically attractive older adults and the growth of “lifestyle industries” to preserve “youthfulness.” The concepts of productivity, civic engagement, and successful aging can implicitly assume that all elders have resources to age successfully and be productive, such as volunteering. They may overlook structural constraints, such as unhealthy communities, limited employment options, and daily preoccupation with economic survival, that prevent choosing healthy lifestyles. Both policies and social environments need to be modified so that all adults have opportunities to be productive in the broadest sense of the term (Hendricks & Hatch, 2006; Kahn, 2003; Martinson & Minkler, 2006; Wray, 2003).
An emphasis on activity characteristic of mainstream Western culture may also overlook elders—often from other cultures—who are spiritual and contemplative, and experience a high degree of subjective well-being. A narrow definition of successful aging can be stigmatizing to older adults with chronic illness who develop strategies to compensate for their functional disabilities and experience quality of life. Instead, models of successful aging need to recognize that older adults may experience subjective well-being, engage in personally meaningful activities, and “age well,” even though they may not be classified as successful in terms of external factors (George, 2006).
Because of class, race, and gender biases implicit within successful aging, the concepts of active aging and resilience may be more useful for conceptualizing elders’ strengths (for example, internal, family, social, community, and cultural capacities) when faced with adversity. In fact, many older adults find meaning in their lives because of adversity, not despite it. Even when impaired, they may contribute to society in diverse ways (Fredriksen-Goldsen, 2006; Zarit, 2009).
The concept of “active aging” is relevant to culturally and economically diverse populations since it focuses on improving quality of life for all people, including those who are frail, disabled, or require assistance. It is consistent with the growing emphasis on autonomy and choice with aging, regardless of physical and mental decline, that benefits both the individual and society. The determinants of active aging include individual behaviors, personal characteristics, the physical and social environment, structural variables such as gender and race, economic security, and access to and use of health and social services across the life course (WHO, 2002).
Role of Social Workers
Social workers are well positioned to promote active aging and well-being for all older adults. The opportunity and challenge for social work, with its social justice mission, is to address both increased longevity along with life course inequities for women, persons of color, and GLBT individuals. As a first step, social workers must be prepared to meet the geriatric workforce challenge, since the need for gerontologically competent social workers far exceeds the supply. With its person-in-environment perspective and strengths-based values, social work is pivotally placed to advocate for structural and policy changes to reduce lifetime inequities (for example, dependent care credits in Social Security) and to enhance the well-being of adults and their families as they age.
As the primary providers of mental health services, social workers are also central to addressing growing rates of depression, substance abuse, and mistreatment among elders. They are often the lead professionals supporting multigenerational families, particularly related to psychosocial interventions to reduce the stress of cross-generational caregiving across the life course. Social work assessments are strengths-based and take account of the needs of the total caregiving system, not just the elder person. Similarly, social workers can provide leadership in developing and testing innovative models of integrated care or service delivery and interventions with caregiving dyads. As more adults live longer with disability, social workers are central to community-based models for chronic disease management, rather than cure, and to fostering the social supports essential to health-promoting behaviors. Similarly, social workers, with their value of self-determination and dignity, play vital roles in changing the culture of care of institutional settings to be resident-centered and to empower the direct care staff. Social workers also can facilitate the use of assistive technology, including computer-based options, along with informal social networks to enable elders to remain in their homes. In times of shrinking public resources and increasing societal and moral issues affecting all ages, social workers can foster intergenerational alliances that crosscut traditional age-based approaches to services. And most important, social workers, by building on the strengths of all elders, even those with limited functional disability, will reaffirm older adults’ dignity and worth.
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