INSTRUCTOR MANUAL for Aging and The Life Course An Introduction to Social Gerontology 6e Jill Quadag

INSTRUCTOR MANUAL for Aging and The Life Course An Introduction to Social Gerontology 6e Jill Quadagno

Aging and The Life Course An Introduction to Social Gerontology 6e Jill Quadagno (Instructor Manual All Chapters, 100% Original Verified, A+ Grade) CHAPTER 1. THE FIELD OF SOCIAL GERONTOLOGY • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking About Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. The Field of Social Gerontology a. Defining the Terms 1. Gerontology is the scientific study of the biological, psychological, and social aspects of aging.

2. Social gerontology is a subfield of gerontology and is concerned mainly with the social, as opposed to the physical or biological, aspects of aging. It draws on research from all social sciences. The research generated by social gerontologists is used in the applied disciplines of social work, public administration, urban and regional planning, and others. b. Successful Aging Several factors are associated with successful aging. Successful Aging can be achieved by setting goals, working to achieve these goals, and participating in meaningful activities. Successful aging involves both the individual and society.

II. Conceptual Issues in Research on Aging a. Defining Old Age-Old age fined using chronological age, social roles, functional age and subjective age.

1. Chronological age: Commonly used marker of old age.

2. Social Roles and Age: Defines people as old according to social roles. Social roles are expectations or guidelines for people who occupy given positions, such as widow, grandfather, or retiree.

3. Functional Age: Based on how people look and what they can do. In functional terms, a person becomes old when he or she can no longer perform the major roles of adulthood.

4. Subjective age: The most important factors in subjective age identity are activity level and health. b. Cohorts and Generations- These two terms are used interchangeably; however, generations emphasize kinship linkages. They are shaped by historical changes, compositional differences, and structural changes.

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Chapter 1 The Field of Social Gerontology

III. Ageism a. Forms of Ageism - Ageism refers to a set of beliefs about the aged. It involves discrimination, and prejudice. Stereotypes are a composite of ideas and beliefs attributed to people as a group or social category. b. Age Discrimination-when people act on the basis of negative stereotypes. c. Ageism through the Media- transmitted in a variety of ways-through the family, in the workplace, between groups of friends. But most importantly, they are perpetuated by the media, including television, the print media, and film. Recently, however, some shows depict older characters in a more positive light.

IV. Profile of Older Americans includes but is not limited to: a. Health - Older people are in good health. b. Marital Status - The chance of being widowed is much greater for women that it is for men. c. Income and Poverty - Overall improvements in the economic well-being of the elderly mask considerable differences by marital status, gender and race. d. Education - Each new generation of older people better educated though it is still stratified by race. Education benefits accrue across the life course.

V. Careers in Social Gerontology Social gerontology is an applied discipline. There are eight career categories for gerontological specialists. Expanding career opportunities with increasing older population.

CLASS DISCUSSION TOPICS 1. Successful aging: Have students describe individuals they know who aged successfully.

Highlight agreement and variation among their responses. This is an excellent way of focusing on the individualized attributes of aging.

2. Age stereotype and discrimination: Using Robert K. Merton’s paradigm to illustrate the relationship between prejudice and discrimination, have students describe one or more of these typologies that they have seen in social institutions. Merton’s typologies are: unprejudiced non-discriminator (all-weather liberal), unprejudiced discriminator (fair-weather liberal), prejudiced non-discriminator (timid bigot), and prejudiced discriminator (all-weather bigot).

Have students search the Internet for articles related to stereotypes or prejudiced views of older adults. They can use EBSCOhost or InfoTrac for this search.

3. Different cohorts: Organize the class into five cohort groups described in the chapter. Have each describe their reaction to employment for women, childrearing, premarital sex, saving money, leisure activities, and interaction with members of different ethnic groups.

4. Ageism: Have students bring media examples of ageism and/or positive representations of aging. Have each student describe their findings to class.

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Chapter 1 The Field of Social Gerontology

5. Films: Have student watch films that depict positive aging and negate traditional negative stereotypes of aging.

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Service-Learning: If service-learning is a component of your course, you might want to refer to Service-Learning and Undergraduate Sociology: Syllabi and Instructional Materials, edited

by Morten G. Ender et. al. This edition is published by the American Sociological Association Resource Center and contains articles on service-learning as well syllabi integrating servicelearning.

2. Research Project: Have students examine the aging process in another part of the world. This may be a country that the student has visited or plans to visit in the future. Key points to include in the project: types of roles performed by older adults, examples of stereotypes and discriminations encountered by older adults, and programs to address these areas.

3. Information on the Profession: For an introductory course in social gerontology or sociology of aging, it might be informative to have a student shadow a professional in the field for one day or more. The student should keep a journal of all activities performed by the professional. During the course of the shadowing, the student should ask the professional what she/he enjoys most and least about her/his position. Also, the student should ask the professional to describe opportunities in the field for the next 10-15 years.

4. Portfolios: If students are interested in a career in gerontology, they should keep a portfolio.

Items to be included in the portfolio: Resumes: A detailed resume highlighting one’s skills. A short one should be included and should target specific kinds of employment.

Courses taken, service-learning or cooperative education projects, and volunteer work: Include a detailed description of these items and transcript.

Memberships and certifications: It is good to join your professional organization while you are a student. The dues are inexpensive, and it is good information for the portfolio.

Evidence of skills and knowledge: Include evaluations provided on papers/projects, student activities, and professional events or activities in which the student is a participant.

Letters of Reference: Keep references from professors, supervisors in organizations, professional officers in organizations, and employers.

Journal of Professional Development: Keep a journal of your feelings and reactions to the development of your knowledge and professional skills.

Future Visions and Dreams: Highlight plans in five-year intervals and develop a vision for overall accomplishments.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS

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Chapter 1 The Field of Social Gerontology

1. Are the older members of your family aging successfully? In what ways do they meet or fall short of the criteria for successful aging?

Have students role-play the three criteria of successful aging for any older member of their families.

2. Pick someone in your family and define her or his age using each of the four definitions of old age.

The student should identify a member of her/his family and define the age of this member using chronological, social role, functional, and subjective definitions of aging.

3. List the generations in your family and place each in one of the five cohorts described in this chapter. Do your family members fit Torres-Gil’s description of their birth cohorts?

In what ways?

Torres-Gil notes that there are five cohorts. They are: the swing generation (born 1900-1926), the silent generation (born 1927-1945), the baby boomers (born 1946-1964), the baby bust generation (born 1965-1979), and the baby boomlet or echo boomers (born 1980-1994).

4. A survey of students on your campus shows that many of them hold ageist attitudes.

Explain why this could be a problem and suggest ways to change students’ attitudes toward the aging.

Ageist attitudes could be a problem because older adults are seen or portrayed in a negative manner. This could lead to labeling or the self-fulfilling prophecy. A way to challenge these attitudes is to have older adults attend activities on campus. Have students visit organizations or social events in which there is a large number of older adults. Finally, have students and older adults cooperate on a project together on campus.

5. Select a TV show, book, or movie you saw recently and analyze the way aging characters were portrayed.

The response should include positive and negative attributes, as well examples of the “new ageism.”

LECTURE/CLASS ACTIVITY IDEAS 1. Invite the president of the local chapter of the gerontological organization in your state. Have the person discuss with the class some of the activities or programs of the organization as well as the types of professionals who are members. This lecture will familiarize students with the professional organization in the home state.

2. Have students read the major paper in the state to determine if there is legislation related to a social policy for older adults. Some examples of social policies include elder abuse, reduced property taxes, or nursing home fraud. Have students write a letter to the committee focusing on this particular issue specifying her/his support or non-support for it.

COMMUNITY, STATE, AND NATIONAL RESOURCES Familiarize students with some of the community, state, and national resources on aging during the first couple weeks of classes.

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Chapter 1 The Field of Social Gerontology

Community Resources American Association of Retired Persons-local chapter. This organization has a diverse membership group. One can invite members to discuss policy issues with the class for which the group is currently examining.

Area Agency on Aging: Each county government has one of these agencies. Students may be introduced to it and the services offered by it.

Office on Aging: Most communities have an office or a major center which addresses issues on aging for older adults. This person can be invited to class to discuss issues/concerns of older adults in the community.

Volunteer Clearinghouses: Focus on this resource as an opportunity to find volunteer activities for students in the community.

State Resources State Network of Area Agencies on Aging: This network is a compilation of all the area agencies on aging in the state.

State Long-Term Care Ombudsman Office: This office can be contacted early in the semester for subsequent discussions related to elderly abuse or long-term care.

State Gerontological Society or Association: Inform students of the state gerontological society or agency in the state. Encourage students to join and participate in its annual meeting.

Gerontological Programs or Institutes at Other Public and Private Universities in the State: Inform students of other colleges and universities in the state with gerontological programs or institutes.

National Resources Gerontological Society of America: This is the national professional organization for those interested in the aging process. Students should be encouraged to join if they plan to continue with graduate school or pursue a career in aging. The website address is: http://www.geron.org/.

Some special units of this society include the National Academy on an Aging Society and the Association for Gerontology in Higher Education.

American Society on Aging: Its goal is to promote the knowledge and skills of those working with older adults and their families. They also provide training programs and workshops. Its web address is http://www.asaging.org.

INTERNET RESOURCES AND ACTIVITIES It might be good to introduce students to the following Internet websites during the first several weeks of class.

1. On ageism and stereotype in the media: FAIR (http://www.fair.org) 2. On Aging and Ageism: Sociosite (http://www.pscw.uva.nl/sociosite/TOPICS/Aging.html) 3. The ISLMC (Internet School Library Media Center) Ageism Page (http://falcon.jmu.edu/~ramseyil/ageism.htm) 4. Linda M. Woolf’s Gerontology Page

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Chapter 1 The Field of Social Gerontology

(http://www.websteruniv.edu/~woolfm/gero.html) 5. Sociology of Aging and the Life Course section of the American Sociological Association (http://www.asanet.org/sectionaging) 6. U.S. National Institute on Aging (http://www.nia.nih.gov) 7. Administration on Aging (http://www.aoa.dhhs.gov) 8. National Aging Information Center (http://www.ageinfo.org) 9. Centers for Medicare Services (http://www.cms.hhs.gov/) 10. Combating Ageism (http://www.van.umn.edu/advocate/3a_ageism.asp)

SUGGESTED READINGS Barrett, Anne. 2003. “Socioeconomic Status and Age Identity: The Role of Dimensions of Health in the Subjective construction of Age Identity.” Journal of Gerontology 58B(2):S101-10.

Bond Huie, Stephanie, Patrick Krueger, Richard Rogers and Robert Hummer. 2003. “Wealth, Race and Mortality.” Social Science Quarterly 84(3):667-684.

Deschamps, A, C. Onifade, A Decamp, and I. Bourdel-Marchasson 2009. “Health-related quality of life in frail institutionalized elderly: effects of a cognition-action intervention and Tai Chi.” Journal of Physical Activity 17(2):236-48.

Holahan, C. and J. chapman. 2002. “Longitudinal Predictors of Proactive Goals and Activity Participation at Age 80.” Journal of Gerontology 57B(5):P418-25.

McLaughlin, Sarah et al. 2010. Successful Aging in the United States: Prevalence Estimates From a National Sample of Older Adults.” Journal of Gerontology 65B(2):216-226.

Neumark, David. 2009. “The Age Discrimination in Employment Act and the Challenge of Population Aging.” Research on Aging 31(1):41-68.

Perry, Daniel. 2012. “Entrenched ageism in healthcare isolates, ignores and imperils elders.

Aging Today 33(2):1-10.

Strawbridge, William, Margaret Wallhagen, and Richard Cohen. 2002. “Successful Aging and Well-Being: Self-Related Compared with Rowe and Kahn.” The Gerontologist 42(6):727-33.

FILMS AND VIDEOS

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Chapter 1 The Field of Social Gerontology

Careers in Aging: Old Friends, New Faces. 1996. Association for Gerontology in Higher Education. 10 minutes.

Hill of Dreams. 2009. A short film about a small but challenging personal ambitions in later life. Available on-line at: http://www.bbc.co.uk/wales/arts/yourvideo/media/pages/alan_terrell_04.shtml.

Images of Aging. Depicts the diversity in the aging experience. Terra Nova Films, 9848 South Winchester Avenue, Chicago, Illinois 60643. 1-800-779-8491 (http://www.terranova.org).

Life is a Ball. 2012. The Assisted Living Federation of America (ALFA) Film Competition on Ageism Winner. Produced by Zac Greenbaum, Pilotfish Productions LLC. Available online at: http://www.alfa.org/alfa/2012_film_competition_on_ageism_winner.asp Myths and Realities of Aging. 1993. Good source for examining ageism and addressing common myths of aging. This is the first film of the 13 part series of Growing Old in a New Age. Produced by the University of Hawaii, Center On Aging. Distributed by Annenberg/CPS, 401 9th Street, NW, Washington, DC 20004. 1-800-532-7637; www.learner.org

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Chapter 2 Life Course Transitions

CHAPTER 2. LIFE COURSE TRANSITIONS • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking about Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Life Course Framework Approach to aging that emphasizes interaction of historical events, individual decisions, and effect of early life experiences in determining later life outcomes 1. Transitions – role changes throughout life (child, daughter, wife, grandmother) 2. Countertransitions – produced by other’s role changes 3. Trajectory – a series of transitions in the life course II. Methodological Issues in Research On the Life Course a. Age, period, and cohort effects 1. Age effect – change that occurs as a result of advancing age 2. Period effect – impact of a historical event on society 3. Cohort effect – social change occurring when cohorts replace each other b. Cross-sectional research - Asking the same info from different groups.

1. Ex. Asking 20-40-60 year olds about political affinities c. Longitudinal research - A way to sort out differences in effects. The data follows same group of people over time 1. Ex. Health and Retirement Survey (HRS) d. Qualitative Research – Qualitative research can involve Participant observation and open-ended interviews III. Identifying Life Course Events a. The Timing of Life Course Event 1. Age norms - Timing of transitions at appropriate ages 2. Social clock – a prescriptive timetable that society uses to mark timing 3. Age timetables - Moving away from idea that there are sanctions for inappropriate timing. More an average of life course event structuring than a prescription b. The Duration of Life Course Events – This is the term used to describe the number of years in each phase Quadagno: Aging and The Life Course, 6e

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Chapter 2 Life Course Transitions

1. Crowded nest – younger people staying home longer c. Sequencing of Life Course Events - Disorder can create negative consequences in later life. This can include having children too early or late. d. Effect of Early Experience on Adult Outcomes – According to a study by Elder on children of Great Depression, younger children more adversely affected than older. Also, age during historical effects can matter e. Demographic Change and Middle Age IV. Theory of Cumulative Disadvantage Being advantaged (economic, social, political, health) means more advantages later on – reverse is true too – being disadvantaged in early life means more disadvantages later on V. How Government Influences the Life Course Some of the life course uncertainties related to economic risks have been alleviated by the state. Three types of intervention can affect the individual life course: 1. Regulations and Laws 2. Social Programs 3. Services provided to people of a given age

CLASS DISCUSSION TOPICS A. Age norms and life course sequencing: How are norms changing? Do they have negative or positive effects on life course transitions?

B. Distinguishing between effects: What are examples of age, period, and cohort effects?

C. Cumulative disadvantage: What are some examples and how can individuals overcome them?

STUDENT PROJECT AND RESEARCH SUGGESTIONS A. In-depth interview: Find an older family member or friend and get their life story. In the analysis try to find themes of cumulative dis/advantage.

B. Surveying Age Norms: Have students pick 10 people. 5 older and 5 young and survey them on their attitudes about life course transitions and sequencing. See if all people are loosening their norms or if this is an age effect.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. What are the practical implications of the life course approach to social gerontology?

Have them emphasize the ability to do cross-section and longitudinal research and the detailed results it will gather about generations and cohorts from different groups in society Quadagno: Aging and The Life Course, 6e

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Chapter 2 Life Course Transitions

2. Analyze the timing, duration, and sequencing of your parents’ life course. Was it typical for their generation?

This will be based on students’ personal experiences but is a good place to draw out class discussion on age norms and sequencing 3. What was the major historical event of your life course? How did it affect your life?

Bring up the wars and recent economic crisis to give them examples.

4. If govt. officials want to promote social equality, at what stage of the life course should they intervene? Explain.

A good place to lead into discussions of altering adolescence, a place where governments can have strong positive effects.

5. If you were a government policymaker, would you use your authority to alter the course of adolescence? If so, how?

Provide examples like No Child Left Behind to stimulate discussion

LECTURE/CLASS ACTIVITY IDEAS • Compare studies discussed in chapter to break them down by type (cross sectional and longitudinal) and what they are researching (age, period, or cohort effects) •

Provide examples of different age, period, and cohort effects to help students better understand differences

•

Talk about government programs used to promote social equality in a system where cumulative disadvantage affects so many people. Use this is as a lead in for future class discussions on the role of government in aging policy

COMMUNITY, STATE, AND NATIONAL RESOURCES Community Resources American Association of Retired Persons-local chapter. This organization has a diverse membership group. One can invite members to discuss policy issues with the class for which the group is currently examining.

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Chapter 2 Life Course Transitions

Area Agency on Aging: Each county government has one of these agencies. Students may be introduced to it and the services offered by it.

Office on Aging: Most communities have an office or a major center which addresses issues on aging for older adults. This person can be invited to class to discuss issues/concerns of older adults in the community.

Volunteer Clearinghouses: Focus on this resource as an opportunity to find volunteer activities for students in the community.

State Resources State Network of Area Agencies on Aging: This network is a compilation of all the area agencies on aging in the state.

State Long-Term Care Ombudsman Office: This office can be contacted early in the semester for subsequent discussions related to elderly abuse or long-term care.

State Gerontological Society or Association: Inform students of the state gerontological society or agency in the state. Encourage students to join and participate in its annual meeting.

Gerontological Programs or Institutes at Other Public and Private Universities in the State: Inform students of other colleges and universities in the state with gerontological programs or institutes.

National Resources Gerontological Society of America: This is the national professional organization for those interested in the aging process. Students should be encouraged to join if they plan to continue with graduate school or pursue a career in aging. The website address is: http://www.geron.org/.

Some special units of this society include the National Academy on an Aging Society and the Association for Gerontology in Higher Education.

American Society on Aging: Its goal is to promote the knowledge and skills of those working with older adults and their families. They also provide training programs and workshops. Its web address is http://www.asaging.org.

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Chapter 2 Life Course Transitions

INTERNET RESOURCES AND ACTIVITIES 1. Administration on Aging: Profile of Older Americans: Shows the latest key statistics on older Americans in key subject areas including, poverty, housing, health and health care, race, and marital status. Available online at: http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/index.aspx.

2. Age Friendly Philadelphia. 2012. (PDF) Philadelphia Corporation for Aging. By Kate Clark and Allen Glicksman. Available online at: http://www.epa.gov/aging/resources/epareports.htm#presentationsatannualconferences 3. “Hispanics Living Longer than Whites, Blacks. But Why? October 14, 2010. Article from National Public Radio. Available online at: http://www.npr.org/blogs/health/2010/10/14/130567637/hispanics-living-longer-than-whitesblacks SUGGESTED READINGS Bengston, Vern, Glen Elder and Noella Putney. 2012. “The Life Course Perspective on Aging: Linked Lives, Timing and History.” Pp. 9-17 in Adult Lives, edited by Jeanne Katz, Sheila Peace and Sue Spurr. New York: Cambridge University Press.

Kohli, Martin. 2009. “The world we forgot: A historical review of the life course.” pp. 64-90 In The life course reader: Individuals and societies across time, edited by Walter R. Heinz, Johannes Huinink, and Ansgar Weymann, Frankfurt: Campus-Verlag.

Silverstein, Merril and Roseann Giarusso. 2011. Aging Individuals, Families and Societies: Micro-Meso-Macro Linkages in the Life Course. Pp. 35-49 in Handbook of the Sociology of Aging, edited by R.A. Settersten and J.L. Angel. New York, NY: Springer.

Toothman, Erica L. and Anne E. Barrett. 2011. “Mapping midlife: An examination of social factors shaping conceptions of the timing of middle age.” Advances in Life Course Research 16:99-111.

Wakabayashi, Chizuko and Katharine M. Donato. 2006. “Does Caregiving Increase Poverty among Women in Later Life? Evidence from the Health and Retirement Survey.” Journal of Health and Social Behavior 47:258-274.

FILMS AND VIDEOS Sara Lerner: Growing up during the Great Depression. 2010. 8 minutes. Available at: www.youtube.com/watch?v=xX7JlTpMf1E

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Chapter 2 Life Course Transitions

Unnatural Causes: Is Inequality Making Us Sick?. 2008. This is a seven part series bundled into four television hours. Many of the episodes discuss cumulative disadvantange because of race and wealth. Produced by California News reel with Vitial Pictures, Inc. and Presented by the National Minority Consortia of Public Television. Clips available online at: www.unnaturalcauses.org Up. 2009. Produced by Pixar Animation Studios and directed by Pete Docter. Several parts of the movie are available on youtube.

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Chapter 3 Theories Of Aging

CHAPTER 3. THEORIES OF AGING • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking About Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I.

The Origins of Social Gerontology a. Social gerontology - had its origins among developmental psychologists. Their focus included growth and maturation; however, these areas were expanded to include later maturity. During the Great Depression of the 1930s, an interest in physical decline was joined with concerns about older adults, who suffered disproportionately from poverty and unemployment. This period saw the development of research on the problems of aging.

II.

Micro Theories of Aging a. Psychosocial Theories 1. Disengagement Theory - Disengagement theory was proposed by Elaine Cumming and William Henry, two University of Chicago researchers. They noted that normal aging involves a natural and mutual withdrawal, or “disengagement,” that results in decreasing social interaction between the aging person and society. Critics of the theory, e.g., the Duke Geriatric Project, have gathered evidence to contradict its core premise.

2. Activity Theory - Activity theory was formalized by Robert Havinghurst.

According to this theory, the person who ages optimally manages to stay active and resist the shrinkage of her/his social world. Different researchers have tested the disengagement and activity theories and have reported varying results. The debate between disengagement and activity theories has left a legacy of enduring interest in measuring morale or life satisfaction.

3. Continuity Theory - Continuity theory was developed by Robert Atchley. It emphasizes that personality plays a major role in adjustment to aging and that adult development is a continuous process. One controversial aspect of continuity theory is its definition of normal aging. Also, feminist theories have argued that continuity theory defines normal aging according to a male model. b. The Individual and Social System 1. Subculture Theory - Arnold Rose applied subculture to the study of aging.

According to this theory, subcultures develop when people have longstanding friendships or share similar interests, problems, and concerns and are excluded from full participation in wider society. This theory appeared in research only

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Chapter 3 Theories Of Aging

c.

III.

recently.

2. Exchange Theory - Exchange theory had its origins in microeconomic theory.

It posits that interaction between the old and the young decreases because older people have fewer resources to bring to the exchange—lower income, poorer health, and less education. A major problem with the theory is that it ignores the value of nonrational resources, e.g., love and companionship. Another problem is that it focuses on immediate interaction between older people and other age groups.

Social Constructionism - Social constructionists focus on the individual who is capable of interpreting her/his experience. Humans are active agents who create the society in which they live. A major limitation of the theory is that it neglects the structural features of social life imposed by external forces.

Macro Theories of Aging a. Age and Social Status 1. Modernization Theory - Modernization theory evolved from the optimism which characterized the United States in the post-World War II era. The theory incorporates a model of development. Evidence offered by historians and cross-cultural studies criticized the idea of a golden age of aging.

2. Age Stratification Theory - Age stratification theory is one of the most influential and enduring gerontological theories. Matilda W. Riley proposed this theory. It notes that all societies group people into social categories, and these groupings provide us with major social identities. One major criticism of the theory is that it defines structure as relationships among positions and ignores power relationships that determine how statuses and roles are allocated. It also ignores other bases of social stratification, such as social class, gender, and race.

3. Age Integration Theory - Age integration theory draws on the core premise of the stratification theory. Society is stratified on the basis of age. Age stratification can create age-segregated and age-integrated institutions. No society is totally age-integrated or age-segregated. b. Theories of Power and Inequality 1. Political Economy Theories - Political economy theories share with modernization theories an interest in explaining the status of the aged.

This theory is a framework for examining the larger social context of problems associated with old age. In this approach, old age is socially constructed and created through power struggles. This approach has been criticized for being too negative and for viewing older people as too passive.

2. Feminist Theories - Feminist theories are more of an approach that reflects the commitment to use theory in a certain way. The feminist theories have criticized existing research on aging for the following reasons: (a) it has created separate models of aging by relating certain topics to females and others to males; (b) it employs strategies that are technically gender-neutral, but in fact dependent on a conceptual model derived from men’s experiences; and (c) social programs emphasize class effects but ignore gender effects. A feminist approach to aging does not mean ignoring older men.

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Chapter 3 Theories Of Aging

3. Critical Gerontology - The most recent approach in the study of aging is critical gerontology, which considers how the forces of globalization affect policies and programs for the aged and the daily lives of older people.

CLASS DISCUSSION TOPICS 1. Reflection Experience Referring back to class discussion of successful aging, have the students describe someone they know who has aged successfully. Have students analyze this same individual using one of the micro theories of aging.

2. Applying theories to social settings Have students describe a social setting in which there is a significant concentration of older adults. Have them apply one of the theories discussed in the chapter to the social setting. Make sure they integrate the assumptions of the theory into their analyses, and ask them to provide possible criticisms of the theory, as well.

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Research: Divide students into groups. Have each group find a journal article using one of the eight theories. Encourage students to use or InfoTrac to find the research articles. Have each group present information on: (1) when and where the research was conducted; (2) demographic data on sample--age, gender, social class, educational and income levels, and place of residence; (3) major findings; and (4) limitations of study. This is a good time to introduce students to some of the major journals in social gerontology. Also emphasize that theories help us to understand the aging process.

2. Theories underpinning programs: If class is a service-learning one, have students share experiences from their service-learning sites that illustrate one or more of the theories.

3. Political economy or feminist theories: Have students watch a feature film that addresses aging. Some possibilities are: “Going in Style,” “The Cemetery Club,” “Calendar Girls,” or “About Schmidt.” Have students analyze the film using the political economy of feminist theories.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. What is the benefit of having a theory of aging? Do gerontologists really need theories?

Emphasize that theories help us to understand social events. Refer to the aforementioned projects and indicate that if there were no theories, we would not understand the aging process. Note that gerontologists need theories because it is a multidisciplinary science.

All sciences seek to describe, explain, and predict the social world. Thus, the goal of theories is to explain social events.

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Chapter 3 Theories Of Aging

2. What type of professional might find micro theories of aging particularly useful? Who might prefer to use macro theories?

The micro theories are useful to practitioners such as geriatricians, geriatric nurses, gerontological caseworkers, social workers, care givers, and individuals experiencing the aging process. Micro theories are useful to professors, students, researchers, demographers, and policy analysts.

3. What might be the professional drawbacks of depending on a single theory of aging?

One theory may not be adequate to explain the aging process. Different theories have emerged due to the limitations of a particular theory.

4. If you were an aged person, which theories of aging would you think were most pertinent to your own life chances? Which theories might you disagree with?

Assume the role of an older adult and share which theory is more applicable to explaining your aging experiences. Keep in mind your demographic factors, such as gender, ethnicity, social class, past or current employment, and place of residence.

5. What is the single most useful or important insight you have gained from reading this chapter?

Student might mention any of the theories, citing their major advantages or disadvantages, as well as the individuals responsible for first advancing them.

LECTURE/CLASS ACTIVITY IDEAS 1. Describe an aging program in the town or community in which you teach. Indicate the assumptions underlying this program. This could lead to a discussion of the micro and macro theories of aging.

2. Share with students a research article that you or a colleague has published using one of the theories discussed in the chapter.

3. Have a panel consisting of a caregiver, practitioner, and program analyst describe her/his work with older adults. Some specific examples of each person’s work role may highlight a specific theory.

4. Describe how different levels of housing can relate specifically to theories discussed.

5. Discuss the responsibility of the government in providing income security in old age.

COMMUNITY, STATE, AND NATIONAL RESOURCES Refer to Chapter 1 for a complete listing and description of resources.

Community and State Resources Area Agencies on Aging Quadagno: Aging and The Life Course, 6e

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Chapter 3 Theories Of Aging

Policy recommendations of these agencies are based on theories. Students may use these resources to analyze theoretical assumptions.

Senior Service Centers The resources and program descriptions of these centers could be used to analyze how theories and need-assessments translate into programs.

Institutes on Aging Have students check out some of the leading research and institutes that have conducted studies using various theories of aging. Some research centers are Percy Andrus Center of UCLA, Institute of Aging at Michigan and Wayne State, and Duke University.

INTERNET RESOURCES AND ACTIVITIES The University of Amsterdam website (http://www.pscw.uva.nl/sociosite/TOPCS.Aging.html) is the only accessible website that refers to social theories of aging directly. The following sites refer to other research on aging: 1. Linda M. Woolf’s Gerontology’s Page (http://www.websteruniv.edu/~woolflm/gero.html) 2. U.S. National Institute on Aging (http://www.nih.gov/nia) 3. Administration on Aging (http://www.aoa.dhhs.gov) 4. National Aging Information Center(http://www.ageinfo.org) 5. Gerontological Society of America (http://www.geron.org) SUGGESTED READINGS Adams-Price, Carolyn and Morse Linda. 2009. “Dependency Stereotypes and Aging: The Implications for Getting and Giving Help in Later Life”. Journal of Applied Social Psychology 39 (12), 2779-3043.

Bengston, Vern, Glen Elder and Noella Putney. 2012. “The Life Course Perspective on Aging: Linked Lives, Timing and History.” Pp. 9-17 in Adult Lives, edited by Jeanne Katz, Sheila Peace and Sue Spurr. New York: Cambridge University Press.

Bengtson, Vern, Norella Putney, and Malcolm Johnson. 2005. “The Problem of Theory in Gerontology Today.” Pp. 3-20 in The Cambridge Handbook of Age and Ageing, edited by Malcom Johnson. New York: Cambridge University Press.

Cummings, Elaine. 2000. “Reflections on Disengagement Theory.” Pp. 97-106 in Intersections of Aging, E. Markson, L. Hollis-Sawyer and J. Hendricks, Eds. New York: Oxford University Press.

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Delgado, Gabriel. 2012. “Stories from the Fringe: Social Isolation.” Aging Today (May-June): 8.

Hao, Yanni. 2008. “Productive Activities and Psychological Well-Being among Older Adults.”

Journal of Gerontology 63B(2):S64-72.

Marshall, Victor. 1996. “The State of Theory in Aging and the Social Sciences,” Pp. 12-30 in Handbook of Aging and the Social Sciences, edited by R. Binstock and L. George. San Diego: Academic Press.

Miller, Nancy J., Soyoung Kim, and Sherry Schofield-Tomschin. 1998. “The Effects of Activity and Aging on Rural Community Living and Consuming.”

Journal of Consumer Affairs 32(2):343.

Quinnan, Edward J. 1997. “Connection and Autonomy in the Lives of Elderly Male Celibates: Degrees of Disengagement.” Journal of Aging Studies 11(2):115-30.

FILMS AND VIDEOS One to One: The Generation Connection. (The film portrays 16-18 year olds and a group of 70-80 year olds as they explore the many issues related to their roles in society. The film illustrates age integration theory.). Terra Nova Films. 9848 South Winchester Avenue, Chicago, Il 60643. 1-800-779-8491. (http://www.terranova.org).

The Grand Generation. (This film is a portrait of six older Americans in their past or current social roles. It is good for discussion of activity theory.) Filmakers Library, 124 East 40th Street, NY, NY. 10016 (212) 804-4980

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Chapter 4 Demography of Aging

CHAPTER 4. DEMOGRAPHY OF AGING • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking About Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Sources of Population Data – The U.S. Bureau of the Census is the central clearinghouse for all national population data. It takes a national count of the population every 10 years and obtains information from each household on births, deaths, country of origin of residents, health, living arrangements, occupation, and income. The Census Bureau monitors the accuracy of the data since policy decisions are based on census numbers. The United Nations is responsible for compiling world population data.

II. Individual Aging Processes a. Life Span - The life span is one measure of individual age. It is assumed to be about 120 years. b. Life Expectancy - The life expectancy is the average number of years people in a given population can expect to live. Life expectancy is higher for females than males and is the result of the complex interaction of biological, social, and behavioral factors. c. The Sex Ratio - The sex ratio is the number of males per 100 females. After birth, death rates are persistently higher among males. In old age, females outnumber males.

III. Population Aging A population’s age structure can change through three demographic processes: fertility, mortality, and migration. The population pyramid displays the age structure. a. The Demographic Transition - This theory states that a society goes through a gradual process from high birth and death rates, to declining death rates, and finally to low birth and death rates. There are three stages in this process. b. International Variations in Population Aging - The population around the world is aging. In the future, growth in the number of older adults will take place in developing countries. The oldest old is the age category growing rapidly in developing countries.

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Chapter 4 Demography of Aging

c. Dependency Ratios – These indicate the cost of supporting an aging population. The elderly dependency ratio combined with the child dependency ratio is referred to as the total dependency ratio.

1. Elderly Dependency Ratio: The ratio of old people to adults.

2. Child Dependency Ratio: Indicates the number of persons under age 18.

3. Total Dependency Ratio: The combined ratio of children and older people to workers.

IV. Population Trends in the United States a. The Changing Age Structure -The U.S. population is aging, especially the 85 and over age group. b. Fertility - The postwar period saw an increase in the fertility rates. It produced the baby boom generation. The fertility rate peaked in 1958 at 3.17 children per woman. Subsequently, it dropped between 1971 and 1980 to a low of 1.7 children per woman. This drop was related to the birth control pill, increased educational opportunities, and female labor force participation. c. Mortality - Morality rates in the U.S. declined during the 1940s and 1970s.

The decline in the 1940s was due to medical advances reducing infant, child, and maternal mortality, whereas the decline in the 1970s was due to medical advances reducing deaths from heart disease. There are racial/ethnic differences in mortality rates, which can be explained by SES (socioeconomic status). For African Americans, after 85, the mortality rates fall below that of Caucasians. This phenomenon is termed racial crossover. d. Migration - Due to higher immigration rates for Asians, Latinos/Hispanics, and Africans, the elderly population of the future will be more ethnically and racially diverse. e. Dependency Ratio - It will rise from 20 per 100 in 1990 to 36 per 100 in 2030; however, the total dependency ratio will be no higher than in the 1970s. f. Life Expectancy - The chances of living to old age have improved. Increased life expectancy has implications for income security and health care.

Factors such as lifestyle, race and gender affect life expectancy. g. The U.S. Sex Ratio - The sex ratio declined for females 85 and older. This reduced ratio means that most older women are single, more likely to live in poverty, and to be institutionalized.

CLASS DISCUSSION TOPICS 1. Demographics - Divide the class into groups. Have them examine state and county data after discussing national aging trends from “Older Americans 2000: Key Indicators of Well-Being.” Students should be able to see similarities or differences in aging patterns for the state and counties.

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Chapter 4 Demography of Aging

2. International Focus - Ask students to select a developing country and obtain information on fertility and mortality rates, migration patterns, and the sex and aged dependency ratios. Refer students to United Nations Population data.

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Developing Policy Briefs - For item 2 of “class discussion topics,” have students identify a pattern in the data and recommend a policy appropriate to that pattern. For example, if mortality rates are high in a given country, have the students suggest a way to reduce them.

2. Debate the Implications of Health Care Rationing for Older Adults.

3. Debate the Implications of Longer Life Expectancies - Have students debate whether there should be additional funding for health care, income support programs, and housing for the 85+ population (this population has a growing number of females).

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. Social Security has been called the Third Rail of American politics, meaning that to touch it (change the program in any way) is to die (lose office). Given the rising number of retirees and the declining number of workers, do you think the program should be revised? If so, how?

Some initial focus should be given to the current funding of Social Security. Using population pyramids, a discussion should focus on the dependency Ratios (children and aged) for different time periods, e.g., 2010, 2020 or 2040. With this information, various assumptions can be made about Social Security for these different time periods. Along with the population pyramids, keep in mind the retirement and future work trends and the contribution of older adults to the national budget.

2. The proportion of working-age Americans to retired Americans has been dropping for several decades as the result of declining fertility and mortality rates.

Should the government encourage couples to have more children? Why or why not?

Think about global population, especially the aging population in developing countries. Also, think about migration patterns and the aged dependency ratio for the U.S. Furthermore, there should be an exploration of the idea that older adults should remain in the labor force as long as they are capable of performing their work responsibilities.

3. Demographers recognize the contributions immigrants make to a developed nation’s population structure. Yet many Americans feel threatened by immigrants.

What can be done to improve the immigrant’s public image?

Emphasis should be on contributions that past immigrants have made to the United States economy. Immigrants migrate to the U.S. during their younger years, so they make significant contributions to the economic system, have fewer chronic health problems, and fewer needs for income support.

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Chapter 4 Demography of Aging

4. Poverty rates among older women, especially minority women, are very high.

What kind of measures might help reduce poverty among the elderly?

An example would be intergenerational programs in which younger age groups complete chores, errands, and assist with financial planning in exchange for tuition and employment training support. Also, there is a need for educational programs to aid older women in addressing their income situations.

5. From the point of view of the elderly, what might be advantages and disadvantages of living in a state with a large elderly population? What about the point of view of the younger generations?

Advantages for the elderly include numerous services for their benefits and an extensive social network because of the homogeneous population. A disadvantage could be the population is too homogeneous. There could be a high degree of age segregation. Advantages for younger generation include intergenerational activities that would be beneficial for both groups. A disadvantages might be that older adults receive more social support programs than younger age groups.

LECTURE/CLASS ACTIVITY IDEAS 1. Invite a demographer or representative from the State Division on Aging or Area Agencies on Aging to discuss state and local population trends and social needs. The presenter(s) could introduce students to career opportunities in this area of aging.

2. Using the United Nations Population Data, share with students the developing countries with high and low fertility and mortality rates, sex ratios, and children and aged dependency ratios.

3. One of the fastest growing segments of the aging population is older women 85 and over. Focus on programs in the state or at the local level that are addressing the needs of this population.

COMMUNITY, STATE, AND NATIONAL RESOURCES Refer to Chapter 1 for a more complete listing and description of resources.

Community and State Resources Area Agency on Aging - Areas Agencies on Aging should have population data that identify trends and have policy implications. The data should be in the form of environmental scans.

Senior Service Centers - Local senior service centers that administer programs in the area of meals, transportation, and other support services should have information on the needs of older adults in the local area.

State Office on Aging - It should have data for the state on demographics and trends.

Universities with Aging Institutes or Programs - Universities or institutes in the area should have demographic and other information on the aging population.

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Chapter 4 Demography of Aging

National Resources Some good sources are the Administration on Aging, U.S. Census Bureau, and the Social Security Administration. More details are provided in the Internet section.

INTERNET RESOURCES AND ACTIVITIES 1. Administration on Aging (http://www.aoa.gov/): “Older Americans 2000: Key Indicators of Well-Being.” The report can be obtained directly from (http://www.agingstats.gov). A good exercise is to have the student read and interpret materials from the report in class.

2. United States Census Bureau (http://www.census.gov/) Poverty and Current Population Survey (CPS). The survey provides information on poverty in the U.S. as well as among the 65 and over age group. This report will provide students with more data on the current problems of an aging population.

3. The Social Security Administration (http://www.ssa.gov) includes income data and other special and working reports .

4. Red vs. Blue: Demography and Politics (2004) on a National Public Radio broadcast

by Eric Weiner that examines birth rates. Available online at: www.npr.org/templates/story/story.php?storyId=4170483 5. Fact-Checking the Future of Aging In America (2012). This is a National Public Radio broadcast that discusses some of the challenges facing the baby boom generation as they prepare for retirement. Available online at: www.npr.org/2012/08/16/158936470/factchecking-the-future-of-aging-in-america SUGGESTED READINGS Capewell, Simon et al. 2009. “Life-Years Gained Among US Adults From Modern Treatments and Changes in the Prevalence of 6 Coronary Heart Disease Risk Factors Between 1980 and 2000.” American Journal of Epidemiology 172(2):229-236.

Cohen, Joel. 2003. “Human Population; The Next Half Century.” Science 302(5648):1172-1175.

Dychtwald, Ken. 1999. Age Power: How the 21st Century Will be Ruled by the New Old. New York: Jeremy P. Tarcher/Putnam. (Explores the demographic and economic shifts caused by the aging baby boom generation.)

Himes, Christine L. 2001. “Elderly Americans.” Population Bulletin (December).

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Lesthaeghe, Ron. 2010. “The Unfolding Story of the Second Demographic Transition.”

Population and Development Review 36(2):211-251.

U.S Bureau of the Census. 2011. “More Young Adults are Living in Their Parents' Home, Census Bureau Reports.” Washington, DC: US Bureau of the Census.

U.S. Bureau of the Census. 2012. “The 2012 Statistical Abstract.” Washington, DC: US Bureau of the Census.

FILMS AND VIDEOS Living Beyond 100. (This film focuses on how to attain longevity and the implications for quality of life. It includes interviews with centenarians and doctors.) Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643. 1-800-779-8491. (http://www.teranova.org).

Centenarians Tell It Like It Is. A group of centenarians talk about all aspects of their lives. The film explores the implications of longevity through their voices. Can be obtained from Terra Nova Films. Address, telephone, and web address indicated above.

War Stories Our Mothers Never Told Us. (Focuses on the way World War II affected the lives of seven women from different social classes, races, and cultural backgrounds.)

First Run Films, 153 Waverly Place, New York, NY 10004. (www.firstrunfeatures.com).

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Chapter 5 Old Age and the Welfare State

CHAPTER 5. OLD AGE AND THE WELFARE STATE • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking About Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Social Programs of the Welfare State Before 1935 the U.S. had no national social welfare programs. The Social Security Act of 1935 was a turning point in American history. Two programs for the elderly were created: Social Security for retired workers and Old Age Assistance for the aged poor.

Later, disability insurance was created for workers who were unable to work due to illness or injury. In 1965 the Older Americans Act was enacted to offer an array of social services designed to help older people remain independent.

There are three major programs of the U.S. welfare state. a. Public Assistance - This program provides benefits for the very needy. It is based on eligibility requirements specifying who can apply for the benefits and the conditions that must be met to receive the benefits. Public assistance benefits have their origins in the sixteenth-century British system of poor relief and are paid for through income taxes. Usually paid for with progressive taxes: the higher your income, the higher your taxes. b. Social Insurance - The central principle of social insurance is that it is an earned entitlement. It promotes equality by providing economic security over the life course and preventing people from falling into destitution. Social insurance benefits are paid for through payroll taxes, which are considered contributions. c. Fiscal Welfare - This program operates through tax expenditures or tax breaks.

It consists of indirect payments to individuals through the tax system. Tax expenditures are inherently unequal in their impact because the individuals receiving the same income pay at a different rate.

II. The Organization of the American Welfare State The Social Security Act of 1935 is the cornerstone of the American welfare state. This bill created two programs for the elderly: Social Security and Old Age Assistance. Two other health insurance programs, Medicare and Medicaid, were established in 1965 with the passage of the Older Americans Act. a. Income Support - In 2005 more than 46 million Americans received Social Security benefits. It is the single most important source of income for older people.

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Chapter 5 Old Age and the Welfare State

1. Social Security System - The Social Security program evolved out of the economic conditions of the Great Depression of the 1930s. It was established to provide a minimum level of financial support to the elderly, but was not intended to be the major source of income for retirees. In 2000, more than 44 million Americans received Social Security with more than 40 percent of the income of older people coming from Social Security. Social Security has made it possible for 40 percent of the elderly to have income above the poverty level. Benefits support the disabled, widows, widowers, parents, children, and wives and husbands of retired workers. In 2001 a low earner who retired at 65 would receive $637.00 a month, while the highest earner would receive $1,538.00. In 2008 average monthly benefit was $989, with women and minorities receiving less than white males.

2. Supplemental Security Income - When this program was first created, assistance was jointly funded and administered by the state and the federal government. In 1972, SSI became a federally funded program. It is a means test Public assistance program that provides support to the aged, blind, and disabled poor. It is a myth that SSI is a program that attracts immigrants to the U.S. When Congress enacted welfare reform in 1996, it made elderly immigrants arriving in the U.S. after August 22, 1996, ineligible for SSI. 3. Tax Expenditures for Pensions - The tax code encouraged firms to introduce pension plans for their employees through tax-free accumulation beginning in the 1930s. Currently, the tax expenditures for pensions rival public spending through social security. b. Health Care 1. Medicare - There are two components to Medicare. Part A is hospital insurance paid through payroll taxes. Medicare Part A also pays for nursing home care after a hospital stay that has lasted at least 3 days, home health care, and hospice care. The first 60 days of a spell of illness are almost fully covered by Medicare. However, individuals are required to pay $952.00 of the cost themselves. If the hospitals stay last longer than 60 days, then an individual has to pay $238.00 a day. Medicare Part B is an optional program that pays for 80 percent of the cost of physician office visits. The percentage of Medicare beneficiaries with Part B is over 98 percent. In 1996 Congress added a new option, Medicare Part C, also called Medicare Advantage. Medicare Advantage plans include health maintenance organizations (HMO’s), which often provide extra benefits and lower co-payments than the traditional Medicare program. The most recent change to Medicare was the Medicare Modernization Act of 2003, which added a prescription drug benefit to Medicare. Medigap policies refer to private insurance policies that provides for expenses not covered under Medicare.

2. Medicaid - It is health insurance program for those with very low income. It pays for health services such as acute care, hospitalization, Quadagno: Aging and The Life Course, 6e

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Chapter 5 Old Age and the Welfare State

diagnostic services, testing and treatment, physician visits, and prescriptions drugs. Due to low reimbursement rates, many physicians refuse to see Medicaid patients.

3. Tax Expenditures for Health Insurance - The United States is the only Western nation without a national health insurance program. Instead it uses the tax code to encourage employers to provide health insurance. The tax expenditure for health insurance means that individuals who earn the same yearly income may pay different rates of taxes based on whether or not the employer provides health insurance. c. Support for the Disabled 1. Disability Insurance - Disability insurance is part of the Social Security system. It insures workers against the loss of income if they become physically or mentally disabled. Physicians make the determination of who is eligible for disability insurance; thus the rates of enrollment fluctuate over time. With more than 60 percent of its recipients over the age of 45, disability insurance operates as a de facto retirement system.

2. SSI Disability - If individuals have never worked or have not worked long enough to qualify for disability insurance, then they can be eligible for supplemental disability insurance.

3. Work Disincentives - The disability program discourages people from seeking work because they have a fear that they might lose their employment or insurance benefits. d. Long-Term Care 1. Medicare’s Long-Term Care Benefits - Medicare pays for home health care, but it has strict eligibility requirements.

2. Medicaid’s Long-Term-Care Benefits - Medicaid covers the costs of long-term care in nursing homes for low income elderly who have spent down their assets to qualify for a nursing home. The Medicaid system perpetuates inequality in the type of treatment received by the residents.

3. Private Long-Term Care Insurance - Private long-term care insurance is another option for older individuals. The cost varies according to the type of policy, the person’s age, and health. e. Social Services 1. The Older Americans Act (OAA) This act was passed in 1965 and provides services to enhance independent living among the elderly. Such services include congregate meals, personal care and nursing services, day care, chore services, and meals-on-wheels. OAA also provides funding for senior centers. These are community-based facilities that provide meals and social activities.

2. Housing There are three components of the housing program in the U.S. The first component is the mortgage-guarantee program. It allows home owners to deduct mortgage interest from taxable income. The second program is a modest subsidy program that encourages developers to construct low-income housing and offer subsidized rent to low-income renters. Finally, there is public housing for the poor, a disproportionate portion of which goes to the elderly.

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Chapter 5 Old Age and the Welfare State

III. The Age Versus Need Debate For the past two decades, there have been arguments favoring the elimination of age as a criterion for public policy because it perpetuates intergenerational tensions. On the other hand, those favoring age as a criterion for public policy point to the success of Social Security and Medicare.

CLASS DISCUSSION TOPICS 1. A comparative examination of program for the aged: Have students select a country outside the U.S. and gather information on the type of income support, health care, support for the disabled, long-term care, or other programs that are available for the elderly. Focus on similarities and dissimilarities between the other country and the United States.

2. Age-based versus need-based programs: Organize students into one of the following groups: income support, health care, and social services. Have each group debate the advantages and disadvantages of an age-based or need-based program for its area. In a pervious class session, students should be given materials related to the eligibility requirements for programs in these areas.

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. The American Welfare State: Have students write a news report describing one of the following types of programs in the American welfare state: Public assistance, social insurance, or fiscal welfare. This news report could be presented for a feature article in the student newspaper on campus or it could be a source of information for students enrolled in other social sciences courses.

2. Services to promote independent living: Have students select and visit one of the social services supported by the Older American Act near the campus or in their communities.

These services include: congregate meals sites, day care, meals on wheels, or senior centers. Have them assess quality and access to services, with specific emphases on class and ethnic/racial and cultural diversity. Some questions to consider: Are there special services for diverse cultures? Are all older adults being served, or is there an underserved population? What identified needs are not being met through this service, and how might the needs be addressed? This project could be presented to the class or can be used as an evaluation project.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. How would you reply to Max Cross, the conservative who benefits from government welfare programs but complains that they are wasteful? (See the opening page of this chapter.) Do you agree or disagree with him?

Max Cross needs to understand that there are different types of programs to serve various needs of the elderly and non-elderly. His tax deduction for interest on his home is one example. While he may not need this deduction, his disabled sister may

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need the benefits she is receiving. He also needs to be made aware of bureaucratic waste and fraud for these programs.

2. Should government welfare programs reinforce social class divisions, or should they serve as social equalizers? Justify your position.

For some, a democratic society means that all people should have equal access to housing, health, and education—these are rights, not privileges. Others may focus on the notion that individuals who have the skills or resources should be rewarded for them. Based on how students perceive the social world, they will support one of these viewpoints.

3. Should Americans be concerned that U.S. welfare programs give far less support to the aging than similar programs in European countries?

With an increase in the number of baby boomers expected to retire around 20122013 and the globalization of the economy, this should be a concern. Public policies will have to explore this issue immediately.

4. Should Medicare cover the cost of prescription drugs to the elderly? What about other expensive services such as home care?

In 2003, a new prescription drug benefit was added to Medicare. It will benefit low-income elderly most. In 2025 it is expected that revenues coming into the Social Security trust fund will fall below those being paid out. Measures must be taken to restore the Social Security trust fund for future retirees.

5. Should the United States have a universal system of health coverage that would treat all Americans, young or old, rich or poor, equally?

If students consider access to quality healthcare a right rather than a privilege, then there should be support for universal health care coverage. In the long run, such coverage is less expensive than providing coverage when the need arises.

6. What should be done to address high costs of Medigap policies?

Students should address access to Medigap policies for the poor. Should the government subsidize these policies for those that cannot afford them?

LECTURE/CLASS ACTIVITY IDEAS 1. Provide students with information on eligibility requirements for the three programs of the welfare state.

2. Invite three speakers, each representing one of the following areas: Public assistance, social insurance, and fiscal welfare. Have each explain how the program works, how it meets the needs of the recipients, and the problems it encounters.

3. Keep students informed of any state or federal legislation addressing any of the programs discussed in the chapter.

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Chapter 5 Old Age and the Welfare State

COMMUNITY, STATE, AND NATIONAL RESOURCES Refer to Chapter 1 for a complete listing and check Internet Resources and Activities for access to internet sites.

Local and State Resources Area Agency on Aging Local or State AARP Office Local Council or Program on Aging Local Social Security Office National Resources American Association of Retired Persons Alliance of Retired Americans Social Security Administration The Urban Institute INTERNET RESOURCES AND ACTIVITIES 1. The Social Security Administration website is http://www.ssa.gov. It provides information on Social Security, Medicare, and Supplemental Security Income (SSI) programs. Students can access program data, income and work data, and reports on such topics as widows and early retirees. Students can examine data for the state in which your college/university is located.

2. The American Association of Retired Persons (AARP) website (http://www.aarp.org) is a rich source for articles and data on Social Security, Medicare, Medigap insurance, long-term care and caregiving, and other topics discussed in the chapter. Students can also refer to AARP's Public Policy Institute, which conducts studies and analyses on a variety of health and income security issues.

3. The National Council of Senior Citizens has been assumed by the Alliance for Retired Americans. The website is http://www.retiredamericans.org. Students can obtain reports on Social Security, prescription drugs, affordable housing, long-term care, poverty, and Medicaid, and information about the organizational lobbies devoted to these issues.

4. The Urban Institute’s website is http://www.urban.org. The Institute has published extensive studies and briefs and conducted symposia on Social Security, Medicare, and Medicaid. Encourage students to examine these topics, paying close attention to the recommendations of the Institute and the basis for recommendations.

5. The Institute for Women’s Policy Research (http://www.iwpr.org) provides research and information on Social Security policy and women. The conference’s report, “Strengthening Social Security for Women: A Report from the Working Conference on Women and Social Security” (March 2000), is available online. It provides some interesting policy proposals on financing Social Security while equalizing its benefits.

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Chapter 5 Old Age and the Welfare State

6. The game “Saving Social Security” is available at www.actuary.org/content/try-yourhand-social-security-reform. This website allows students to choose what reforms they would like to make to social security in order to ensure its longevity. It can be done as a class or on their own time.

7. “Making the Rich Pay More for Medicare” by Julie Rovner is a Morning Edition broadcast about the disagreements between Republicans and Democrats on how to cut spending for Medicare. This was first broadcast on December 14th 2012. It is available online at: http://www.npr.org/blogs/health/2012/12/14/167194096/making-the-rich-paymore-for-medicare.

SUGGESTED READINGS Berlau, Daniel, Maria Corrada and Claudia Kawas. 2009. “The prevalence of disability in the oldest-old is high and continues to increase with age: findings from the 90+ Study.” International Journal of Geriatric Psychiatry 24(11):1217-1225.

Kaiser Commission on Medicaid and the Uninsured, 2011. Money Follows the Person: A 2011 Survey of Transitions, Services and Costs. Henry J. Kaiser Family Foundation.

Brown, Jeffrey R. and Amy Finkelstein. 2011. "Insuring Long-Term Care in the United States." Journal of Economic Perspectives 25(4):119-42.

Kaiser Family Foundation. 2011. “Health Care Spending in the United States and Selected OECD Countries.” Henry J. Kaiser Family Foundation.

Kaye, H. Stephen, Charlene Harrington and Mitchell P. LaPlante. 2010. “Long-Term Care: Who Gets It, Who Provides It, Who Pays, And How Much?” Health Affairs 29(1):11-21.

The following reports and briefs from 1999-2001 are available from the Urban Institute website (http://www.urban.org) in PDF format.

Medicare: Maxwell, Stephanie, Marilyn Moon, and Misha Segal. “Growth in Medicare and Out-ofPocket Spending: Impact on Vulnerable Beneficiaries.”

Moon, Marilyn. “Growth in Medicare Spending: What will the Beneficiaries Pay?” Moon, Marilyn. “Restructuring Medicare: Impact on Beneficiaries.”

Social Security: Cordes, Joseph J. and C. Eugene Steuerle. “A Primer on Privatization.”

Steuerle, C. Eugene. Straight Talk on Social Security. (a series of 29 briefs).

Thompson, Lawrence H. “Options for Administering Individual Accounts in Social Security.”

Thompson, Lawrence H. “Sharing the Pain of Social Security and Medicare Reform.”

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Chapter 5 Old Age and the Welfare State

Institute for Women’s Policy Research. 2000. Strengthening Social Security for Women: A Report from the Working Conference on Women and Social Security.

(March, 2000). Available online at: (http://www.iwpr.org).

FILMS AND VIDEOS Both films available from Terra Nova Films, 9848 S. Winchester Avenue, Chicago, Il, 60643. 1-800-779-8491; (http://www.terranova.org).

Legacy: America’s Indian Elders. The video explores the impact of the Older Americans Act on older Indians (30 minutes).

Medicare: Take Care of It So it Can Take Care of You. This video covers Medicare benefits, resources for referral, fraud, waste, abuse, and ways to be more active consumers of Medicare (55 minutes).

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Chapter 6 Biological Perspectives on Aging

CHAPTER 6. BIOLOGICAL PERSPECTIVES ON AGING • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking about Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films And Videos

CHAPTER OUTLINE I. Theories of Biological Aging This chapter focuses on common theories of biological aging and examines some of the normal processes of biological aging for some specific systems of the body.

It makes a distinction between the process of normal aging and pathology. a. Environmental Theories of Aging 1. Wear and Tear Theory - It was proposed by German biologist August Wiesmann. The body functions like a machine, and as it ages, it loses its capability to function. It is a difficult theory to test. Also, more active organisms do not age as quickly.

2. Somatic Mutation Theory - This theory notes that insults from the external environment like air and chemical pollution, food pollution, and radiation can cause mutation. First became prominent after World War II when scientists noted the long-term damage cause to people who were exposed to radiation from bombs. It does not take exposure to something as dramatic as a bomb to cause genetic damage, however. b. Developmental/Genetic Theories of Aging 1. The Immune Function Theory - This is based on two discoveries. The first is that the immune system declines with aging. The second is that the immune system is unable to distinguish between self and nonself.

Consequently, it attacks proteins produced by the body as if they were invaders. Evidence does not support that a decline in the immune system causes normal aging.

2. Cross-Linkage Theory - It posits that the accumulation of cross-linked collagen is responsible for the loss of elasticity of the skin, hardening of the arteries of the circulatory system, and stiffness of joints throughout the body. It does focus on biochemical changes, but the accumulation of cross-linked collagen is not a major cause of aging.

3. Free Radical Theory - A popular theory of aging, it maintains that there are unstable molecules that are produced when the body transforms food into chemical energy. When they try to unite with other molecules in the area, they can damage cells or cause cell mutation. It is a great theory for

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Chapter 6 Biological Perspectives on Aging

understanding the risk factors that some individuals have for diseases, but is not a general theory of biological aging.

4. Genetic Control Theory - This theory maintains that the life span is programmed into each cell at birth. It is not a major theory to explain normal aging.

II. The Aging Body With aging, there is increased vulnerability to stress and death. Disability is a negative outcome of some aging processes. Active life expectancy is the number of years a person can expect to live without a disability. Males have a higher active life expectancy (60 years—84% of whole life expectancy) than females.

Women’s active life expectancy is 64 years or 82 % of whole life expectancy.

Active life expectancy varies from country to country.

Senescence: increased vulnerability to stress and death due to onset of agingdependent diseases like heart disease and Alzheimer’s a. Aging of the Exterior Body: Skin and Hair 1. Wrinkles and Sagging Skin - The skin changes its texture due to use (e.g., smiling) and biological changes.

2. Hair - With aging, hair becomes gray due to the decrease in the number of active pigment-producing cells.

3. Skin Discoloration - Two examples are Lengito and senile purpura.

4. Age-Related Illness: Skin Cancer - Basal cell carcinoma and malignant melanoma increase with age due to sun exposure. b. Aging of the Nervous System 1. Changes in the Brain Functioning - With aging, there is decreased flexibility, slowness of movement, and stooped, shuffling gait in many older people.

2. Balance and Falls - If the cerebellum is damaged, it can cause disruptions in balance and muscular movement increasing the risk of falls.

The term postfall syndrome is used to describe the fear of falling in the elderly who have had a prior fall. Falls are a serious and common problem that elderly face. The risk of falling increases with age. Some falls are prevented by monitoring an older person’s environment to reduce physical obstacles like poor lighting or loose carpets and by installing handrails.

3. Changes in Sleep Patterns - There is a change in the sleep pattern of older adults. They get less REM sleep. Many older people over 60 complain of insomnia. Some studies find that up to 65% of older people have trouble sleeping. Women complain of poor sleep more often than men. c. Aging of the Sensory Organs 1. Vision - With middle age, people get visual impairments. These increase with age. Specific problems are cataracts and glaucoma.

2. Hearing - Hearing loss (Presbycusis) accelerates after the age of 50 and is common in men.

3. Smell and Taste - Chronological age is associated with the inability to detect odors. This can lead to poor nutrition and reduces the quality of life.

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Chapter 6 Biological Perspectives on Aging

4. Touch and Temperature - With aging, there is an inability to regulate the heating and cooling system of the body because the sweat glands in the skin decrease or become nonfunctional. Some side effects are hypothermia and heat exhaustion or heat strokes. d. Aging of the Skeletal System: Bones, Cartilage, and Connective The period of peak bone mass is around age 30. Bone loss occurs after this age, and severe bone loss is called osteoporosis.

1. Age-Related Illness: Osteoporosis - Osteoporosis occurs when there is a thinning of the outside walls of the bones. Women are at greater risk for the disease than men. Studies have found that there are different rates of bone loss of different ethnic/racial groups. Certain factors like diet, calcium supplements, exercises, life style changes, and hormone replacement therapy are preventive measures.

2. Age-Related Illness: Rheumatism and Arthritis - Arthritis is cited as the leading cause for disability among the aged. Rheumatoid arthritis involves the inflammation of the synovial membranes. e. Aging of the Muscular System: Muscle Mass and Strength Muscle strength and aerobic capacity declines beginning at age 30, but is more evident after 50. Loss of muscle mass and strength can reduce physical activities.

It can be addressed through high-intensity resistance exercise. f. Aging of the Reproductive System 1. The Aging Female - With menopause, women cease to have a monthly menstrual cycle. Changes associated with menopause also include a decline in estrogen and progesterone. Symptoms of menopause include hot flashes, irritability, volatile mood swings, fatigue, and anxiety. These symptoms are experienced by 75-85% of women. Hormone replacement therapy was commonly prescribed to address these symptoms until 2002.

A major clinical trial revealed numerous risk factors associated with HRT—heart disease, stroke, and breast cancer.

2. The Aging Male - Males do not have a menopause, but there is decrease in the testosterone level. Also, it takes older men longer to achieve an erection than younger men.

3. Age-Related Illness: Erectile Dysfunction - Twenty-five percent of all men are impotent by 65. Impotency is caused by ordinary stress and anxiety. Viagra is a drug that is used to treat erectile dysfunction. g. Aging of the Cardiovascular System: Heart and Blood Vessels 1. The Heart - With age, there are changes in the heart. These include some muscle atrophy and reduction in the amount of blood pumped with each contraction. Irregular heartbeats caused by the increase in nonconducting cells can be treated with a pacemaker.

2. Blood Vessel Changes - With age, the blood vessels lose their elasticity and blood pressure increases.

3. Age-Related Illness: Hypertension and Heart Attacks - Over time, hypertension can cause the narrowing and loss of elasticity of the coronary arteries by plaque formation. Chest pain that precedes a heart attack (angina) in women is associated with smoking, obesity, and type-A Quadagno: Aging and The Life Course, 6e

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Chapter 6 Biological Perspectives on Aging

behavior. In men, it associated with work pressure, physically demanding work, smoking, and a low level of emotional well-being. Congestive heart failure occurs when the heart is unable to pump enough blood to meet the needs of the body. It increases with advancing age.

CLASS DISCUSSION TOPICS 1. Tithonus’ revenge or healthy aging: Have students to view the film, “Tuck Everlasting.” Raise the question if the film depicts examples of successful aging. Why or why not? Ask if they would like to live a long life or a life filled with quality?

2. Cosmetic surgery and youth enhancements: Asians are more likely than any other group to have cosmetic surgery. Why do they have the surgery? Are their reasons the same as the elderly’s reasons for having cosmetic surgery?

3. Physical decline of family member: Focus on an older family member who has experienced a physical limitation. Indicate when and where the limitation occurred and how the family member is currently addressing it.

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Geriatricians: Contact a local geriatrician in your area. Inquire about the types of diagnoses made by the geriatrician. Ask if there are variations in office visits by gender and ethnic/racial groups.

2. Biology of Aging: Check to determine if your college or university offers a course in the biology of aging. If it does not, check surrounding colleges and universities. Ask professors who teach the course to share some of the typical reactions of students to the subject matter, especially to the biological theories of aging and the aging body (decline in the five senses, skin and body, the skeletal and reproductive systems).

3. Health insurance: Compare different health insurance policies for various age-related conditions, e.g., osteoporosis, presbycusis, menopause, and erectile dysfunction. What medications or treatments are or are not covered for the conditions?

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. Some scientists believe that human life span can be extended far beyond its current limits. What do you think of this idea? Do the theories of aging you have read about in this chapter seem to support it?

The answer should focus on the distinction between the extension of life and the quality of life or active life expectancy. The issue can be explored through social exchange or modernization theories as well. For example, if individuals are able to have a long active life expectancy, what are some of the contributions that they might be able make to society (focusing on the social exchange theory)?

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Chapter 6 Biological Perspectives on Aging

2. In the United States, the cosmetic surgery business is in the midst of a boom.

Many patients who request this type of surgery are motivated by a wish to retain their youthful appearance. Why do you think Americans are so concerned with the outward signs of aging, most of which are relatively harmless? Is this a positive or a negative social trend?

The U.S. has a capitalistic economy. One aspect of the economy is materialism or conspicuous consumption. Some people may elect to have cosmetic surgery because they can afford it and they want to keep up with the latest trend or fashion in society. Others may elect to have it to conceal a disability or enhance their employment opportunities.

3. Aging can affect mental functions such as learning and memory. But is the image of the forgetful older person a reality or a false stereotype? Is there anything people can do to maintain their mental functions as they age?

All age groups are subjected to forgetfulness, but studies have found that short-term memory slows down with age. Mental function can be maintained through using techniques to compensate for the memory loss such as keeping lists and engaging the mind in problem-solving activities.

4. Doctors advise people that to reduce their risk of osteoporosis later in life, they should build up their bones as much as possible before they reach maturity. Do you and your classmates do anything special to strengthen your bones, such as exercising or eating calcium-rich foods? If not, why not?

Some students may not be aware that osteoporosis can be reduced through strength training. Their awareness may encourage them to engage in such physical training as well as encourage their friends to do so.

5. Scientists say that most cases of erectile dysfunction are psychological rather than physical in origin. Yet sales of the new drug Viagra are booming. What do these two facts suggest to you about sexuality in our society? What about attitudes toward aging? Are all people who take Viagra elderly?

Sexuality is of major interest, especially to men in our culture. Our society is youth-oriented, so there is an emphasis on being physically fit and sexually attractive and functioning. Younger males may take Viagra to enhance their sexual performance.

LECTURES/CLASS ACTIVITY IDEAS 1. Interdisciplinary Focus on the Aging Process: Invite a biologist, environmentalist, and a geneticist to talk about the main cause of aging from the perspective of their disciplines.

The specialists should focus on one or more of the theories covered in the chapter.

2. Leading Causes of Disability and Death: Provide students with data on leading causes of disability and death for persons 65 and over for the nation and for the state in which your college/university is located. Emphasize any similarities or differences in the data.

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Chapter 6 Biological Perspectives on Aging

3. Fitness Throughout the Life Cycle: Invite a fitness expert from campus or a surrounding health club to discuss the advantages of fitness routines throughout the life cycle.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources Check for state and local chapter of the national organizations listed below.

National Resources USE Arthritis Foundation (www.arthritis.org/) American Association of the Deaf-Blind (http://www.aadb.org/ American Diabetes Association (http://www.diabetes.org) American Heart Association (Stroke Connection) (http://www.anhrt.org) National Osteoporosis Foundation INTERNET RESOURCES AND ACTIVITIES 1. The National Center for Health Statistics (http://www.cdc.gov/nchs/) has information on health and aging. Data include leading causes of death, oral health, vision and hearing, and the changing profile of nursing home residents.

2. The National Institute on Aging (http://www.nih.gov/nia/) has publications, research, and fact sheets on a variety of age-related physical conditions and diseases. Some topics that students could research include: aging and your eyes, exercises, high blood pressure, menopause, prostate problems, and urinary incontinence.

3. MEDSCAPE’s Women’s Health MedPulse (http://womenshealth.medscape.com) is useful website to examine for the latest information on women’s health. This is a commercial website with most of the research being sponsored by pharmaceutical companies.

4. ABC news reports on, “More Elderly Seeking Cosmetic Surgery” on January 31, 2012.

This video discusses the trend of more elderly patients getting plastic surgery to look younger. It is available at: www.abcnews.go.com/GMA/story?id=126390&page=1 5. “Age Doesn’t Mean Heart Disease For Bolivian Tribe” is an National Public Radio clip from August 14, 2009 that examines the research being done on Bolivia’s Tsimane tribe. Gerontologist Eileen Crimmins describes a study that looked for signs of heart disease in the Tsimane, who still live a relatively traditional lifestyle. It is available online at: http://www.npr.org/templates/story/story.php?storyId=111889498. 13 minutes.

SUGGESTED READINGS

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Chapter 6 Biological Perspectives on Aging

Dietrich, Mareclo O. and Tamas L. Havrath. 2010. “The Role of Mitochondrial Uncoupling Proteins in Lifespan.” European Journal of Physiology. 459:269-275.

DiGiovanna, Augustine G., Ph.D. The McGraw-Hill Companies, New York (2000) HUMAN AGING: BIOLOGICAL PERSPECTIVES Kornadt, Anna E. and Klaus Rothermund. 2011. “Contexts of Aging: Assessing Evaluative Age Stereotypes in different Life.” Gerontology 66B(5):547-556.

Mitteldorf, Josh. 2010. “Aging in not a Process of Wear and Tear.” Rejuvenation Research 13:322-326.

Olshansky, S. Jay, and Bruce A. Carnes. 2001. The Quest for Immortality: Science at The Frontiers of Aging. New York: W.W. Norton.

Simons, Leon A., John McCallum, Yechiel Friedlander, and Judith Simons. 2000.

“Healthy Aging is Associated with Reduced and Delayed Disability,” Age and Aging 26 (2): 143-48.

FILMS AND VIDEOS The following videos are available from Terra Nova Films, 9848 S. Winchester Avenue, Chicago, Illinois 60643,1- 800-779-8491; http://www.terranova.org.

Fear of Falling: A Matter of Balance, 17 minutes.

Exercise: It’s Never Too Late, 16 minutes.

The following videos are all available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053. 1-800-257-5126; http://www.films.com.

Quality of Life, Indicators of Quality: The Important Role of the Geriatric Nursing Assistant: John Hopkins Geriatric Center Staff, 2003 The Aging Process. 19 minutes.

Living Past a Hundred. 57 minutes.

Women at Midlife: Aging in Women. 29 minutes.

BPH: Aging and the Enlarged Prostate. 24 minutes.

Brain Attack. 51 minutes.

Hypertension: The Facts. 30 minutes.

Osteoporosis: Progress and Prevention. 24 minutes.

Glaucoma: Prevention and Treatment. 20 minutes.

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Chapter 7 Psychological Perspectives on Aging

CHAPTER 7. PSYCHOLOGICAL PERSPECTIVES ON AGING • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking about Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Aging and Cognitive Change Aging can affect several psychological attributes of the individual. Cognitive psychology is the study of mental processes. Mental processes change over the life course. a. Creativity and wisdom Creativity is the production of alternative solutions to a problem or situation and is an elusive mental process to define. On the other hand, wisdom is an ability to grasp paradoxes, reconcile contradictions, and accept compromises. Wisdom is different from expert knowledge. The latter is acquired in the fundamental pragmatics of life. Wisdom consists of such traits as the ability to reason, the ability to learn from experience, and the ability to use information. b. Intelligence Creativity and wisdom are components of intelligence. Intelligence involves two types of skills.

1. Fluid Intelligence - Fluid intelligence is the capacity to process novel information. It is measured along two broad dimensions: verbal and performance intelligence. The verbal dimension focuses on learned knowledge, and the performance measures puzzle-solving ability. The Seattle Longitudinal Study reported the classic aging pattern. The study revealed a more complex picture of cognitive change. Respondents showed gains in all areas of intelligence until their late 30s or early 40s. Around age 70, measurable intelligence began to decline. The study found variation in the type and level of change between individuals and between cohorts. Individual variation can be explained by the presence or absence of cardiovascular and other chronic diseases. Socioeconomic status plays a role in the variation in intelligence change. The higher the socioeconomic status, the more likely individuals are able to maintain their intellectual abilities. A Swedish study of identical twins found that genetic factors accounted for 55% of individual differences.

2. Crystallized Intelligence - Crystallized intelligence is based on the information, skills, and strategies that people have learned through experience.

Research reveals that there is little or no decline in it with age.

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Chapter 7 Psychological Perspectives on Aging

c. Learning and Memory 1. Age-Related Changes - Studies in eye blink classical conditioning (EBCC) have been used to measure learning rates. Recent studies have revealed that there is a decline in the conditioned response with age. The decline in learning rate as one ages is associated with loss of neurons in the hippocampus. Some studies have found that older people take longer to store, research, and retrieve information. Also, studies reveal that older people are not efficient at encoding new information. Psychologists believe that there is no linear relationship between age and encoding ability.

2. Short-Term and Long-Term Memory - Short-term memory keeps information in the consciousness for only a few seconds. On the other hand, long-term memory is the permanent storage site for past experiences. Studies reveal that short-term memory slows down with age, whereas long-term memory is not affected by age. When perceptual speed is controlled, there are no differences in memory performance.

3. Learning and Information Technology - A limited number of older people use the internet (about 17 percent over age 50). Several reasons exist as to why older people use computers less. They include: less exposure to technology, less confidence about abilities to use computers, more difficulties in learning to use computers, and more problems using the touch component or mouse for the computer.

II. Mental Disorders a. Dementias 1. Alzheimer’s Disease - It is one type of dementia. There is loss of shortterm memory in the early stage. Other symptoms include repetition and confusion and dramatic personality changes. The exact cause of Alzheimer’s disease is not known; however, the numerous theories explaining it fit into the genetic disposition and environmental influences categories. There is not cure for the disease. Reality orientation (RO) is used in nursing homes. It is a process in which people are reminded of their names, the date, and current events.

Reality Orientation is a form of therapy often used in nursing homes with Alzheimer’s disease.

2. Vascular Dementia - A stroke ruptures or obstructs blood vessels to the brain. When people have numerous small strokes, there is a cumulative effect. It is called vascular dementia. Risk factors for vascular dementia are high blood pressure, diabetes, obesity, and smoking.

Aphasia- damage to the speech and language centers in the brain, often a consequence of a stroke. b. Depression Depression is diagnosed based on the presence of five of eight symptoms specified by the American Psychiatric Association. Data indicate that people 80 or older report the most depression and are followed by those 70-79. Aging may not be the cause of depression. Rather it could be related to cognitive decline or changes in social status—income and employment. Rates of depression are very Quadagno: Aging and The Life Course, 6e

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Chapter 7 Psychological Perspectives on Aging

high in nursing homes due to residents having health problems that limit their activities, death of close relatives and friends, and chronic pain. Women of all ages exhibit more depressive symptoms than men and the gender gap increase with age. The sources of this gender gap include the loss of a support network, declining health and decreased income. In addition, there are noted racial differences in the risk of depression in later life.

Diversity in the Aging Experience: Racial Differences in Depression in Later Life III. Personality and Adaptation Personality is a social construct. It defines who we are and how we react to our environment. a. Personality and Aging The Baltimore Longitudinal Study of Aging suggests stability of the personality after 30. Another cross-sectional study of men and women (between the ages of 25 and 27) suggests that the personality is constantly evolving. b. Personality and Health Personality style can have an effect on health. For example, optimism can reduce risk of death from heart disease. c. Personality and Coping There are numerous coping strategies that individuals may adopt. They may be active, confrontational, and purposeful, or passive, emphasizing avoidance, minimization of threat, or resignation. Bernice Neugarten and her associates developed a four-category typology of personality structure. They include integrated, armored or defended, passive-dependent, and unintegrated. Recent studies have identified three adaptive skills that individuals use to cope with stressful life situations. First is the ability to marshal social support. The second involves the process of compensating for losses in social roles by substituting new roles. Finally, there is the ability to modify one’s living environment.

IV. Stage Theories of Adult Development Numerous stage theories have been identified to provide understanding of adult development. a. Erikson’s Theory of Identity Development Erik Erikson was one of the first individuals to analyze adult development systematically. For Erikson, there was a pattern inherent in all human development that proceeded in stages. As each stage emerged, it included a pair of opposing dilemmas or possibilities. For example, middle adulthood’s dilemma is generativity versus stagnation. For old age, the opposing dilemma is integrity versus despair. b. Transition through Adulthood Daniel Levinson’s research has focused on three questions. First, is there a human life cycle? Second, is there an adult development process that resembles the child development process? Finally, what is the significance of gender in adult development? Levinson found that both genders shared a developmental

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pattern that could be divided into a sequence of eras, each with a distinctive biopsychosocial character, and each focused on a certain developmental task.

1. Men’s Transition through Adulthood - Levinson found that men shifted their priorities in mid-life. During this period, they are more involved in family and private concerns, whereas during the early period, they focused on work and career. The middle-adulthood period, in Levinson’s model, occurs between the ages of 40-65. The task during this period is similar to Erikson’s notion of generativity.

2. Women in Mid-Life Transition - For Levinson, both genders had similar paths of adult development; however, there are some differences. He identified three patterns of women in mid-life. For the traditional homemaker who embraces the traditional marriage enterprise, the goal is a life that promises comfort, security, and the satisfaction of being a good wife and mother. Another pattern is the pursuit competitive careers in business. And finally, another pattern is the attempt to balance homemaking with careers.

Apter, another researcher, reported findings similar to Levinson. She identified four ideal types of women in mid-life: traditional, innovative, expansive, and protestors. c. An Evaluation of Stage Theories Social gerontologists are critical of stage theories that rely on an implicit biological model of development and do not consider historical and environmental factors. Research notes that individuals do not move through a fixed linear and irreversible sequence of different stages with an ultimate end.

CLASS DISCUSSION TOPICS 1. Stage theories: Have students select one of the stage theories and apply it to an older adult they know. Discuss insights that the theories may provide for the individual.

2. Wisdom: Describe some areas in the United State in which wisdom is valued by the elderly. What about areas that value wisdom by young people? Should the country follow these examples of wisdom?

3. Gerontranscendence: The late work of Erikson and that of other theorists have posed the possibility of an additional life stage termed gerontranscendence. It is based on demographic, theoretical, and applied work with the elderly. Ask students whether they this is a genuine possibility. If so, what might be the implications for social policy?

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Memory and learning research: InfoTrac or Ebscohost are useful sites for students to search for the latest research on memory and learning. Also the website for the American Association for Geriatric Psychiatry might be useful for research briefs or reports.

2. Comparison of mental disorders: Research and compare a particular dementia, neurological disorder, or depression among the elderly in the U.S. and another country.

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Chapter 7 Psychological Perspectives on Aging

Examine causes and treatment of the disorder as well as the support network for victims, families, and caretakers.

3. Coping, adaptation, and personality: Have students describe different coping and adaptation strategies of people and older adults they have met through volunteer work in day care or assisted living facilities. They should compare their observations with some of the materials discussed in the text.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. Does our society take enough advantage of the wisdom and experience of older people? How might the aged be encouraged to share their wisdom with younger generations?

Age discrimination is one indication that the U.S. does not value the wisdom and experience of older people. We might look at ethnic and racial groups in the U.S. and other cultures who value wisdom and experience as models for the entire society.

2. Aging can affect mental functions such as learning and memory. But is the image of the forgetful older person a reality or false stereotype? Is there anything people can do to maintain their mental functions as they age?

Forgetfulness occurs among all age groups. Research has found that diet, exercises, and social activities can be effective in maintaining mental functions with age.

3. What stereotypes of the aged might be found in the symptoms of age related mental disorders? What do these stereotypes say about our society?

Stereotypes would include forgetful, impaired, deprived, and dependent. Our society values competence, independence, status, and productivity. If the elderly are subjected to stereotypes, it limits their potential to contribute to society.

4. You are a professional gerontologist who has been asked to help a local social agency address the high incidence of depression among aging women. What suggestions would you make?

Depression is higher among females because they have longer life expectancies, tend to be nursing home residents (where depression rates are higher), have lost support networks, and have declining health. Try establishing a social network, if the women do not have one, or reaffirming existing one.

5. Contrast the experiences of two older people you know, one who copes well with the challenges of aging and one who doesn’t. How might their personalities affect their ability to cope?

Social networks are important in helping older adults to cope with the challenges of aging, but personality styles may play an influential role in coping effectiveness. Studies have found three adaptive skills useful in the coping process: 1) being able to gather social support; 2) being able to replace lost Quadagno: Aging and The Life Course, 6e

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Chapter 7 Psychological Perspectives on Aging

sources of social support with new ones, and 3) being able to modify one’s living environment.

6. Could failure to resolve a conflict that is central to adult development affect a person’s ability to cope in old age? If you were a researcher in sociology of aging, how would you find out?

Focus on different stage theories, especially Erikson’s model. A sociologist would check on research conducted in this area, or if no research is available, propose a research question for investigation.

LECTURE/CLASS ACTIVITY IDEAS 1. Ask students to think about some areas of wisdom that they would like for their cohort to possess when they are the young-old. Are their responses similar to some of the current areas of wisdom among the elderly?

2. Invite a clinical psychologist to the class and have the person to discuss some of the issues involved in declining memory and learning skills. The invited speaker may test the students, with their consent, to demonstrate this decline. Also, the guest speaker might inform the students of things that can be done to improve memory and learning skills.

3. Obtain resources from agencies working with Alzheimer’s, Parkinson’s, strokes and depression. Share these materials with students so that they have this information for their personal knowledge or for any volunteer work with the aged in which they are engaged.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources Area Agencies on Aging State and local support and research organizations on mental health, Alzheimer’s, Parkinson’s, strokes, and depression National Resources Administration on Aging (http://www.aoa.gov) Alzheimer’s Association (http://www.alz.org) Family Caregiver Alliance (http://www.caregiver.org) National Alliance for the Mentally Ill (800) 950-NAMI. National Family Caregivers Association (http://www.nfcacares.org) National Institute of Mental Health (http://www.nimh.nih.gov/index.shtml) Quadagno: Aging and The Life Course, 6e

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Chapter 7 Psychological Perspectives on Aging

National Institute on Aging (http://www.nia.nih.gov/)

INTERNET RESOURCES AND ACTIVITIES 1. The Alzheimer’s Association (http://www.alz.org) provides the latest statistics and demographics on the disease. Students can click on “Research” to obtain the most recent developments on the causes, treatment, and prevention of Alzheimer’s.

2. The American Association for Geriatric Psychiatry (http://www.aagponline.org/) provides information on depression. Also, information for healthcare professionals and caregivers is provided on anxiety, dementia, suicide, alcohol and other substance abuse, and the effects of divorce in later life. The “Advocacy” page may be of interest to students interested in public policy on healthcare for mental disorders.

3. The National Institute of Mental Health (http://www.nimh.nih.gov/index.shtml), the National Institute On Aging(http://www.cdc.gov), and the Centers for Disease Control (http://www.cdc.gov) also provide information on the latest research and treatment information on various mental disorders related to aging.

4. The Suicide of Older Men and Women—The website (http://www.healthyplace.com/Communities/Depression/related/suicide_3.asp) has information on how can you prevent this tragedy.

SUGGESTED READINGS Bateson, Mary Catherine. 2000. Full Circles, Overlapping Lives. New York: Random House.

Buono, Marirosa Dello, Ornella Urciuoli, and Diego DeLeo. 1998. “Quality of Life and Longevity: A Study of Centenarians.” Age and Aging (March) 27(2): 206-15.

Cohen, Gene D. 2001. The Creative Age: Awakening Human Potential in the Second Half of Life. New York: Quill.

Fridman, Ayala, Marian J. Bakermans-Kranenburg, Abraham Sagi-Schwartz, and Marinus Van Ijzendoorn. 2011. “Coping in old age with extreme childhood trauma: Aging Holocaust survivors and their offspring facing new challenges.” Aging and Mental Health 15(2): 332-342.

Hattar-Pollara, Marianne. 2010. “Developmental Transitions.” Pp. 87-94 in Transitions Theory: Middle-range and Situation Specific Theories for Nursing, edited by A. Meleis.

New York, NY: Springer Publishing Company.

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Chapter 7 Psychological Perspectives on Aging

Jeste, Dilip V., Monika Ardelt, Dan Blazer, Helena C. Kraemer, George Vaillant, Thomas W. Meeks. 2010. “Expert Consensus on Characteristics of Wisdom: A Delphi Method Study.” The Gerontologist 50(5):668-680.

Sullivan, Mark D. 1997. “Maintaining Good Morale in Old Age. Western Journal of Medicine (October) 167 (4): 276-284.

Whitfield, K. et al. 2009. “Concordance Rates for Cognitive Impairment among Older African American Twins.” Alzheimer’s Dementia. 5:276-279.

Zimprich, Daniel Mathias Allemand and Myriam Dellenbach. 2009. “Openness to Experience, fluid intelligence, and crystallized intelligence in middle-aged and old adults.” Journal of Research in Personality 43(3):444-454.

FILMS AND VIDEOS Alzheimer’s Disease: Inside Looking Out. Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643; http://www.youtube.com/watch?v=fhH_KXwehE0&list=UUGBikd1AGVMKwmVHMlrp7g&index=39 (1-800-779-8491).

The following films are available from Davidson Films, 668 Marsh Street, San Luis Obispo, CA 93401; http://www.davidsonfilms.com (800-594-0422).

Alzheimer Disease: The Patients Perspective, 100 N Greene Street, Suite 300, Baltimore, Maryland 21201-1563; (1-800-328-7450) Aging Successfully: The Psychological Aspects of Growing Old. With Paul Baltes, Ph.D. and Margaret Baltes, Ph.D. (1998) 31 minutes.

Older Brains, New Connections: A Conversation with Marian Diamond at 73.

(2000) 30 minutes.

Erik H. Erikson: A Life’s Work. (1991) 38 minutes.

The following films on depression and Alzheimer’s disease are all available from Fanlight Production, 4196 Washington St., Boston, Ma 02131 (http://www.fanlight.com) (800) 937-4113.

Depression in Older Adults. Clairborne Clark, Duke University School of Medicine, 30 minutes.

•

Alzheimer’s Care Series. The Assisted Living Federation of America. Three films of 14 minutes each: Wandering: Is It a Problem?

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• •

Resisting Care…Putting Yourself in Their Shoes Agitation…It’s a Sign Dress Him While He Walks. Alzheimer’s Association of Miami, Ohio. 20 minutes.

He’s Doing This to Spite Me. Northwest Media, Inc. 22 minutes.

The following films are all available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053 (http://www.films.com) (800) 257-5126: Parkinson’s Disease: An Update. 29 minutes.

Memory. 57 minutes.

Substance Abuse in the Elderly. 30 minutes.

When the Mind Fails: A Guide to Alzheimer’s Disease. 59 minutes.

Alzheimer’s Disease: How Families Cope. 29 minutes.

Depression and Manic Depression. 28 minutes.

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Chapter 8 Family Relationships and Social Support Systems

CHAPTER 8. FAMILY RELATIONSHIPS AND SOCIAL SUPPORT SYSTEMS • Chapter Outline • Class Discussion Topics • Student Project and Research Suggestions • Answer Guidelines for “Thinking about Aging” Questions • Lecture/Class Activity Ideas • Community, State, and National Resources • Internet Resources and Activities • Suggested Readings • Films and Videos CHAPTER OUTLINE I. The Social Support System The social support system is an extensive and reciprocal one. Social support involves friends and perhaps the organizations to which one belongs. a. Defining the concept of social support The social support system consists of family members, friends, as well as organizations to which one belongs. There is a difference between support functions and the quality of support. The convoy model of social relations describes how social support systems operate over the life course.

1. Support bank- Deposits are made early in the life course in anticipation of future needs, or withdrawals.

2. Convoy model of social relations- describes how social support systems operate over the life course. b. Gender Differences in Social Support Systems Women are more likely than men to maintain social networks. Maintaining a network can be an advantage in old age—women have more resources on which to draw. c. Changing Family Structure and Social Support Systems Due to demographic changes, people are more likely to grow older in a four or five generation family—the bean pole family structure. Smaller family size also has decreased the number of people within a given generation.

1. Nuclear family—A traditional two-parent family composed of husband, wife, and child.

2. Extended family—includes the network of familial relationships— grandparents, aunts, uncles, cousins, nieces, and nephews—outside the nuclear family.

3. Verticalization – increase in links between preceding and subsequent generations 4. Bean Pole Family Structure – 4 or 5 generation families d. Marital Status in Later Life Males are more likely to be married during later life than women because women outlive their spouses, and widowed men are seven times more likely to remarry than widowed women. Older African American women are less

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Chapter 8 Family Relationships and Social Support Systems

likely to be married than Caucasians or Latinos/Hispanics due to the higher divorce and mortality rates.

II. The Later Stages of Marriage Despite high divorce rates, most people marry at some point during the life cycle. a. Marital Satisfaction over the Life Course Marital satisfaction consistently follows a U-shaped pattern over the life course due to the arrival of children, role conflict, and restlessness in the marital relationship. The Long Island Long-Term marriage survey found that the happiest couples are those who share their lives and have compatible interests and values. b. Marital Quality and Health Marital quality has a significant effect on health. People with happy marriages have greater life satisfaction and less depression. Much of the relationship between health and marital quality is due to increased resources and control of health behaviors by spouses. c. Marital and Sexual Activity Studies have found a decline in the frequency of sexual activity for men and women with age. Among long-married couple, psychological fatigue is one cause of the decline. Some women have reported decreased interest after menopause, and erectile dysfunction may cause the decline for men. However, Viagra is used to treat erectile dysfunction of all age groups. A study of healthy 80 to 102 year-olds found that the most common sexual activity was touching and caressing with the least common being sexual intercourse. d. Gender and Marriage Studies have consistently reported that men report higher levels of marital satisfaction than women and receive more emotional support from the marital bond. Other studies have found that the division of labor that characterized the marriages in earlier years is reflected in the emotional benefits that marriage provided in the latter part of the life cycle.

III. Parent-Child Relationships The parent-child relationship is unique. It is permanent and involuntary, yet there is conflict between parents and their adult children. A major source of conflict is poor communication. a. Social Interaction and Exchange The theory of intergenerational solidarity indicates that families adjust their living arrangement over time to reflect the changing needs and resources of different generations. Living arrangements are influenced by a family’s social class. There are six components of intergenerational solidarity. They include: frequency of interaction; amount of interaction; amount of positive sentiment about family members; level of agreements about values and beliefs; degree to which services are exchanged; and amount of geographical proximity.

Sometimes when there is tension in the family, it can result in abuse of older frail family members. b. The Effect of Divorce Quadagno: Aging and The Life Course, 6e

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Chapter 8 Family Relationships and Social Support Systems

The increase in divorce rates means that many people will reach old age with no spouse for support, and the role of children will be more important for their support. Studies have documented that parental divorce changes the relationship between adult children and their parents. Findings report that children of divorced parents have less sense of obligation to parents than children from intact families. Familial tensions arise when parents and children have different expectations regarding intergenerational obligations. c. The Effect of Remarriage Remarriages are more likely to end in divorce than first marriages. They create multiple ties across households and generations. Findings suggest that ties between parents and children in stepfamilies may be weaker when parents are older, which may mean a weaker social support system.

IV. The Unmarried Elderly Approximately 5% of men and women remain single all their lives in the United States.

With increasing age, the never-married elderly may have fewer support networks from family members, as their siblings struggle with their own health issues or respond to the needs of their children and grandchildren.

V. Siblings Relationships in Later Life Sibling relationships are partly determined by the size and gender composition of the sibling group. For example, the bond between sisters is closest, followed by brother and sister, and finally those between brothers. Over the life course, sibling ties change due to marriage, employment, and parenthood.

VI. Grandparenthood Due to the increase in life expectancy, grandparenting is a relatively new phase of the life course. Currently, one-half of Americans become grandparents by age 50. a. Styles of Grandparenting Cherlin and Furstenberg have identified three styles of grandparenting. They are remote, companionate, and involved. The remote style included grandparents who had only ritualistic and symbolic relationship with grandchildren due to residential distance or divorce. Companionate style grandparents focused on emotionally satisfying leisure time activities and indicated a friendly style of interaction. Finally, the involved grandparents took an active role in rearing grandchildren, frequently behaving more like parents. b. Grandparents Raising Grandchildren There has been a small increase in the number of grandparents rearing grandchildren. Among many Native American tribes, it is the cultural norm for grandparents to rear their first and second grandchildren for several years.

Other grandparents rear grandchildren due to divorces, drug abuse, alcoholism, teenage pregnancy, parental abuse, or abandonment of the child.

Research has found that custodial grandparents experience a decline in wellbeing when they begin caring for their grandchildren. c. The Quality of the Grandparent-Grandchild Relationship Quadagno: Aging and The Life Course, 6e

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Chapter 8 Family Relationships and Social Support Systems

The relationship between grandchildren and grandparents is related to the parents’ relationship to their parents. If parents are close to their own parents, then grandchildren see their grandparents more often and have greater degree of emotional solidarity with them. d. The Grandparent Career There is a life course pattern to grandparent-grandchildren relationship.

Grandparents like to see grandchildren frequently when they are young, less frequently during the teen years, and during adulthood, more frequently as well, as the relationship becomes closer. e. Grandparenting After Divorce There is limited research on this topic. Divorce can disrupt family ties but also multiply them. Generally, relations with maternal grandparents are closer after a divorce while relationship with paternal grandparents suffer.

VII. The Families of Older Gay Men and Women Some gay men and women are alienated from their families due to sexual identity. Others are not and may be caretakers for aging parents because of geographic mobility and disposable income. a. Social Support for LGBT Individuals Nearly half of all LGBT elders do not have children. Many, therefore, plan for aging by creating a network of friends, partners, and selected biological family members.

VIII. Friends and Social Support Systems Friends provide affection and emotional and moral support in old age. a. Patterns of Friendship Life satisfaction, for both men and women, is enhanced through friendship.

One study found that men were more likely than women to share a laugh with friends, whereas women were more likely than men to confide in their friends.

Widowhood changes the composition of friendship networks. b. Dating in Later Life Older people do continue to date after divorce or widowhood. Most of them meet their dates through singles’ clubs or organizations.

CLASS DISCUSSION TOPICS 1. Social support system: Have students compare and contrast the social support networks of their families. For each generation, have them to specify the source of support, area of support, and frequency of support. Have them present this information to the class.

2. Dating among the elderly: Check out personal ads for the elderly. Bring the ads to class and share some of the characteristics that the ads indicate for prospective dates. Are there gender differences in the ads? Ethnic/racial differences?

3. Styles of grandparenting: Ask students to share the type of relationships that they have with their grandparents? Are they similar to the ones presented in the chapter?

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Chapter 8 Family Relationships and Social Support Systems

4. Intergenerational solidarity: For students living in an intergenerational relationship, ask them to describe the exchange of support between generations. Students’ descriptions should be informative, because of the ethnic/racial and cultural variations among them.

STUDENT PROJECTS AND RESEARCH SUGGESTIONS 1. Marriage and divorce among older adults: Have students use census data to examine information on marriage and divorce rates among older adults. They may want to explore these data for their own state. The Bureau of Census Website, http://www.census.gov, is a good resource for the assignment.

2. Social support systems of unmarried elderly: Investigate the social support network of older single individuals living in your community. What are some policy implications of your research? For example, if you find that the social support system for older widowed males is a limited one, what social programs or services would you recommend to address the problem?

3. Grandparents rearing grandchildren: Recent reports have documented an increase in the number of grandchildren being reared by grandparents, especially among African Americans and Hispanics/Latinos. Check current research on issues encountered by these grandparents and on how these issues are being addressed.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. On balance, should the trend toward verticalization of the family system have a positive or negative effect on the aged? Explain your reasoning.

Three or four generations are likely to be in contact with each other, so intergenerational relationships and solidarity will increase.

2. Studies have shown that men derive greater emotional support from their marriages than do women. As gender roles change over time, would you expect the gender differences in perceived emotional support to change? Why or why not?

For some ethnic groups and socioeconomic classes, there will be changes in gender roles, but not for the entire society. Some men will continue to be socialized in traditional gender roles.

3. When couples divorce, they must decide who will be responsible for the care of their children. Should they agree on who will care for their parents, if the need arises?

Children may not have the extensive network that parents have. Parents may have other daughters and sons to provide caregiving as well as siblings and friends.

However, due the smaller family size in each generation, couples may want to consider who will assume the caretaking responsibility in the event of a divorce.

Other factors to consider include that women are primary caregivers and are likely to be employed.

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Chapter 8 Family Relationships and Social Support Systems

4. Should aging grandparents who are raising their grandchildren receive some help from social welfare agencies? If so, what kind of help would be appropriate?

Some grandparents are rearing their children, are caregivers to parents, and have their grandchildren due to divorce, drug abuse, teen pregnancy, abuse or abandonment. Support services are needed for these grandparents, because they have numerous stresses as caregivers for three generations. Counseling, financial, and support groups are all services that would be useful to these grandparents.

5. What happens to the aged when the social support system breaks down?

Social isolation can lead to mental and physical problems for the aged. Social support networks provide instrumental, emotional, and moral support. Without this support, many elderly may feel that their lives are useless.

6. What can be done to strengthen the social support systems of elderly people who are slowly becoming isolated?

Keep emphasizing the need for a good social support system that may prevent illness or institutionalization. Workshops, respite programs, and community resources can assist in this area.

LECTURES/CLASS ACTIVITY IDEAS 1. Discuss support networks that exist among families in other countries. The National Council of Family Relations website might be a useful resource. (www.ncfr.org/) 2. Invite a group of grandparents rearing grandchildren to share with the class their experiences in this area. What have been some of their challenges? How have they addressed them?

3. Discuss why dating may have more significance for older adults than it does for a younger age group. It serves as a social system due to loss of spouses and other friends as one ages.

4. Have a lawyer who specializes in family law share with the class some observations of cases in this area.

5. Have an older gay or lesbian couple present their life review to the class.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources American Association of Retired Persons College and Universities Family Relations Centers Family Services Foster Grandparent Program Grandparenting Foundation Quadagno: Aging and The Life Course, 6e

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Chapter 8 Family Relationships and Social Support Systems

Office on Aging-Local and State Marriage Counselors-State and Local National Resources American Association of Retired Persons (http://www.aarp.org) has some information on grandparents.

The Bureau of the Census (http://www.census.gov has information available on household composition and marital status.

The Grandparenting Foundation (http://www.grandparenting.org/) is a nonprofit organization whose goal is to raise the consciousness of grandparents.

The National Council on Family Relations (http://www.ncfr.org/) forum for family researchers, practitioners, researchers, and educators shares the latest research and information on the family.

Elder Gay and Lesbian Housing Resources (http://www.gleh.org/)

INTERNET RESOURCES AND ACTIVITIES 1. Ameristat.org (http://www.ameristat.org/) website, developed by Population Bureau with the Social Science Data Analysis Network, has the latest statistics on marriage, family, children, and the elderly.

2. Child Trends (http://www.childtrends.org/) is nonprofit, nonpartisan research organization that has information on children, youth, and families.

3. Council on Contemporary Families (http://www.contemporaryfamilies.org/) is a nonprofit organization that disseminates information about the needs of the contemporary families and how these needs can be met.

4. Grandparenting Foundation (http://www.grandparenting.org/) is a good resource about grandparenting activities.

5. National Council on Family Relations (http://www.ncfr.org) is an excellent website for all aspects of research related to family life.

6. Gay and Lesbian Aging (http://www.webster.edu/~woolflm/oldergay.html) is a website to review issues of the older gay and lesbian.

SUGGESTED READINGS

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Chapter 8 Family Relationships and Social Support Systems

Burr, J.A. and J. E. Mutchler. 1999. “Variation in Norms of Filial Responsibility Among Older Persons.” Journal of Marriage and Family 61 (3): 674-687.

Calasanti, Toni and K. Jill Kiecolt. 2007. Diversity among late-life couples. Generations 31:10-17.

Cornwell, Benjamin. 2011. “Independence through Social Networks: Bridging Potential among Older Women and Men.” Journals of Gerontology 66B(6):782-794.

Davidson, Kate. 2001. “Late Life Widowhood, Selfishness and New Partnership Choices: A Gendered Perspective” Aging and Society 21: 297-317.

DeLamater, John and Morgan Sill. 2005. “Sexual Desire in Later Life.” Journal of Sex Research 42(2):136-149.

Fingerman, Karen L., Yen-Pi Cheng, Kira Birditt and Steven Zarit. 2012. “Only as Happy as the Least Happy Child: Multiple Grown Children’s Problems and Successes and Middle-Aged Parents Well-Being. Journal of Gerontology 67B(2):184-193.

Wilhelm, Kay et al. 2008. “Women and depression: a 30 year learning curve.”

Australian and New Zealand Journal of Psychiatry 43(1):3-12.

Films and Videos The following films are available from Fanlight Productions, 4196 Washington Street, Suite 2, Boston, Mass 02131;(www.fanlight.com) Gay and Gray in New York. 22 minutes. Gay and lesbians elders describe their lives and social network.

Grandparents Raising Grandchildren. 23 minutes.

The following films are available from Terra Nova Films,9848 S. Winchester Ave., Chicago, Illinois 60643, 1-800-779-8491; (www.terranova.org) Complaints of a Dutiful Daughter. 44 minutes. Daughter’s response to her mother as she goes through different stages of Alzheimer’s Disease.

For Better or For Worse. 55 minutes. Five diverse couples talk about conflict resolution, love and sex, and aging and the inevitability that one will die before the other.

My Mother, My Father. 33 minutes. Four families and the stresses encountered in caring for an aging parent.

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Chapter 8 Family Relationships and Social Support Systems

My Mother, My Father: Seven Years Later. 42 minutes.

The Personals. 37 minutes. Group of older adults rehearse and perform an original play about the quest for dates through personal ads.

Two Thousand. 29 minutes. Depicts the bond shared by children and older adults.

The following film is available from Annenberg/CPS, 401 9th Street, N.W., Washington, DC 20004. 1-800-532-7637; www.learner.org.

Family and Intergenerational Relationships. Vol. 8 of the 13 part series, Myths and Realities of Aging.

“Grandparents as Parents” is a news clip from The Telegraph: Middle Georgia’s News Source discussing some of the challenges faced by grandparents as they raise their grandchildren on their own. Published November 11, 2012. Online at: http://www.macon.com/2012/11/11/2245915/grandparents-as-parents.html. 3 minutes

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Chapter 9 Living Arrangements

CHAPTER 9. LIVING ARRANGEMENTS • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking About Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Household Structure There are shifting household arrangements among older adults, with differences corresponding to ethnicity/race, gender, and social class. The theory of intergenerational solidarity notes that, over time, a family will adjust its living arrangements to reflect the changing needs and resources of different generations.

II. To Move or to Stay? a. Geographic Mobility There is a movement of older adults to the Sun Belt. It is referred to as the migratory stream. Those who constitute the stream want a warm climate and reasonably priced retirement housing. Older people who move often will do so for family-related reasons.

1. The Theory of Intergenerational Solidarity- over time a family will adjust its living arrangements to reflect the changing needs and resources of different generation. b. Aging in Place Many older adults elect not to move but to remain in their own neighborhoods. This can pose a problem since houses are older and not designed to meet the needs of those with limited physical mobility. There are a substantial number of older people who live in large cities. c. Home Ownership There is a high ownership rate among the elderly. Approximately 95 percent of those over 65 reside in their own homes. Rates of home ownership are lower among single women who live alone and among certain ethnic/racial groups. Some of the disparity in home ownership for minority ethnic/racial groups is due to racial discrimination in housing. d. Housing Quality 1. Housing Problems of the Aged - Poor quality housing is concentrated among the poorest elderly. They include those who live in rural areas, belong to minority groups, or live alone. Poor quality housing is a problem for the elderly who occupy rental properties. One solution to help older people modify their homes is the reverse mortgage. Bottom of rental Quadagno: Aging and The Life Course, 6e

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market are SROs (single room occupancy hotels) with limited furniture, cooking space, and communal bathrooms.

2. The Homeless Aged - Any person 50 or older is counted among the homeless aged, due to the fact homeless people look and act 10 or 15 years older than they really are. Older homeless people are more likely than others to be alcoholics.

III. Alternative Living Arrangements There are an increasing number housing options for older adults. Supportive housing is the general term for a variety of group housing options that offer elders assistance with daily living.

1. Board and Care Homes - There has been a rapid increase in board and care homes in the last two decades due to the growing number of the oldold, the deinstitutionalization of people with mental illness, and the use of alternative housing for people with developmental disabilities. The major source of funding for board and care homes is Supplementary Security Income. Most of the board and care residents are Caucasian females.

There are no national standards for board and care homes. The first attempt to regulate them was the Keys Amendment to the Social Security Act of 1976. a. Assisted Living Aging in place is a key component of assisted living facilities (ALFs).

Most ALFs provide meals, personal care, limited medical assistance, housekeeping, utilities, social activities, transportation, and security.

Residents in ALFs consist primarily of females who are more satisfied with small facilities. A move from the general community to an assisted living residence represents a major life transition, often prompted by health problems or the loss of a spouse. b. Continuing Care Retirement Communities A typical continuing care retirement community (CCRC) provides a continuum of housing arrangement and services, from independent living to assisted living and skilled nursing care. Independent Living Community is a new type of CCRC geared toward a younger, healthier clientele.

1. The Decision to Move - People select CCRCs for different reasons.

Some do so because they know that their medical needs will be met. Others move into CCRCs to address the isolation they have experienced in their own homes. Finally, others may move due to the lack of transportation.

2. Adjustment to the Move - There is variation in adjustment by older persons moving into CCRCs. 3. Friendship Networks in CCRCs - CCRCs provide sources for structured and unstructured friendship networks. Friendships are determined frequently by marital status.

CLASS DISCUSSION TOPICS

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1. Intergenerational solidarity: Based on the assignment from Chapter 8 (Family Relationships and Social Support Systems) on the family genograms, students should add the dimension of living arrangements over time across generations. When they add this component, what are some changes seen in the living arrangements due to the changing needs and resources of different generations? What factors (social or economic) seem to have the greatest influence?

2. Aging in place: Ask students to focus on the community in which they were reared.

Ask them to think about neighbors or areas in their community in which older adults have aged in place. They should emphasize some of the support services that are available in their community to enable the elderly to age in place.

3. Assisted living facilities: Organize students into groups and have them visit an assisted living facility close to the campus or in a nearby town. Have students obtain information on the source of funding for the facility, the services offered, the monthly fee for residents, and the demographic data of the residents. Have all groups share their information. Discuss similarities and differences in the data collected by the groups.

4. Continuing care retirement communities: The previous assignment can be repeated for continuing care retirement communities. Or, a specific number of groups can visit assisted living facilities, while others visit CCRCs. STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Alternative Living Options: Have students contact a housing service or program in the community to determine what type of housing alternative is available for older adults.

One team or group may work on this project and present the findings to the class.

Students may include information related to ethnicity/race, gender, social class, and religion when presenting the information to the class.

2. Homeless aged: Have a team of students to investigate whether there are homeless aged living in any nearby communities. If so, what are some factors related to their homelessness? What are some social policies or programs that are trying to address this issue in this community?

3. Housing arrangements among immigrant families: Your community or one nearby may have a large immigrant population. Research to determine if immigrants are likely to utilize housing services in the community. If they do not use them, what are some reasons for their non-utilization? What would you recommend so that more immigrant families might use housing arrangements in the community in which they live?

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. Would families be better off if several generations lived together? List the benefits and drawbacks of such an arrangement for each generation.

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Chapter 9 Living Arrangements

Several generations might live together due to a strong cultural tradition or if family members encounter severe economic problems. The major advantage of intergenerational living is the emotional and economic support it provides. The major disadvantages are that some members of different generations might not agree on certain issues, there might be a lack of privacy, and one generation might be expected to provide more caregiving services to an older generation.

2. Is it healthy for the aged to live alone? What health problems might be exacerbated by living alone?

Older adults may live alone if they are able to complete activities of daily living, such as keeping track of money, doing light housework, taking medicine, and running errands. Health problems exacerbated by living alone include mental illness (social isolation, which can lead to a depression) and declining physical health, which can lead to falls.

3. Besides modifications to the home, what other measures might help elders who are aging in place?

The community or town can provide transportation and regular visits to check on needs or problems of the older adults. Neighborhoods with significant number of older adults aging in place can organize social activities and groups and friendship networks to address loneliness. Activities and social groups should have an intergenerational component.

4. Does the government have a moral obligation to prevent homelessness among the aged?

The government has a moral obligation to prevent homelessness among all age groups, not just the elderly. If homelessness is addressed during the early chronological years, then it does not become a problem among the middle- to oldestold. One might think of a society in which there are norms of reciprocity, intergenerational cooperation, and social credits earned over a lifetime.

5. Many older people wait too long to adjust their living arrangements to their deteriorating health. What might be done to help them plan ahead?

Preventive health care and the development of community-based home services are useful in assisting the elderly and encouraging them to plan ahead. Families and friends can also encourage family members to adjust living arrangements. If there were community organizations that can perform a living arrangement assessment, this would be useful to the elderly.

LECTURES/CLASS ACTIVITY IDEAS 1. Invite a panel of diverse housing supervisors (shared housing, board and care homes, assisted living facility, continuing care retirement community) to the class to discuss the services available for residents, the fee structure, source of funding for the type of housing, and major comments by residents of the housing type.

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Chapter 9 Living Arrangements

2. There are currently between 30,000 and 65,000 assisted living care facilities in the United States. The majority of the residents are Caucasian females. Discuss the demographic changes that will occur among residents in the assisted living facilities by 2030. By this time members of the baby boom cohort born in 1964 will be 66 year old.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources Area Agencies on Aging Community-Based Care Services, including adult day, in-home, and respite care, as well as transportation Housing Services (subsidized housing, home care, etc.)

Adult Protective Services State Directories of ALFs, CCRC, and other housing options for seniors.

Aging in Place Specialist Information, (http://www.nahb.org/page.aspx/category/sectionID=686).

National Resources The National Institute on Senior Housing (The National Council on Aging) (http://www.ncoa.org/).

Senior Housing Net (http://www.seniorhousing.net). This website provides elderly living arrangements by state and city.

American Seniors Housing Association (http://www.seniorshousing.org).

Senior Home Design, (http://www.aarp.org/families/home_design/).

INTERNET RESOURCES AND ACTIVITIES 1. The Administration on Aging (http://www.aoa.gov/): The Profile on Older Americans is updated annually and has data on the living arrangements of older adults in all settings.

2. The National Institute on Senior Housing (http://www.ncoa.org/) includes reports on research about senior living environments and alternatives.

3. The American Senior Housing Association (http://www.seniorhousing.org) provides information on various topics related to senior housing, like national data on senior housing communities, absorption trends, the Fair Housing Act, the Americans with

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Chapter 9 Living Arrangements

Disabilities Act, compliance in senior housing, the regulatory handbook for ALFs and CCRCs, and many more resources.

4. The National Coalition for the Homeless (www.nationalhomeless.org/) provides information pertaining to elderly who are experiencing home loss or homelessness. They also have resources to help find speakers or projects related to the topic.

SUGGESTED READINGS Ball, M. B., et al. 2004. “Independence in Assisted Living.” Journal of Aging Studies 18:467-73.

Blevins, Dean and James Werth. 2006. “End-of-Life Issues for LGBT Older Adults.” Pp. 206-26 in Lesbian, Gay, Bisexual and Transgender Aging, Douglas Kimmel, Tara Rose and Steven David, eds. New York: Columbia University Press.

Crary, David. 2011. “Aging in place: a little help can go a long way.” Tallahassee Democrat Nov. 21: 6.

Frenchs, Erin M., Pearl M. Moshler-Ashley. 2000. “Students’ Attitudes Toward Residential Care Facilities,” Educational Gerontology 26 (6): 583-603.

Greenfield, Emily and David Russell. 2011. “Identifying living arrangements that heighten risk for loneliness in later life: Evidence from the U.S. Social Life, Health and Aging Project.” Journal of Applied Gerontology 30(4):524-34.

Hays, Judith. 2002. “Living Arrangements and Health Status in later Life: A Review of Recent Literature.” Public Health Nursing 19 (2) : 136-151.

Hochschild, Arlie Russell. 2000. “An Old Community.” Pp. 231-254 in Gubrium, Jaber F. and James A. Holstein (eds.) Aging and Everyday Life. Malden, MA: Blackwell.

Masterson, Abigail. 2004. “Toward An Ideal Skill Mix in Nursing Homes.” Nursing Older People 16: (4) 14-16.

FILMS AND VIDEOS The following video films are all available from Terra Nova Films, 9848 South Winchester Avenue, Chicago, Il 60643 (http://www.terranova.org/) (800) 779-8491: After the Hospital: What’s Next? 14 minutes.

By Herself: Sophie. 30 minutes.

Gentle Connections. (intergenerational program). 20 minutes.

Time on Earth. (seniors traveling in motor homes). 51 minutes.

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Chapter 9 Living Arrangements

Wesley Hall: A Special Life. 28 minutes Almost Home is a feature-length, cinema verité documentary chronicling a year in the life of a retirement community in America's Midwest. It appeared on PBS just as a tidal wave of baby boomers reached their 60s. 2008. Available online: http://www.almosthomeoutreach.org/about_the_film Alive Inside. 2012. Music's therapeutic benefits have been well documented, but a new film called "Alive Inside" set out to examine just how therapeutic it can be in one community in particular -- the elderly. The film, by Michael Rossato-Bennett, and featuring commentary by social worker Dan Cohen and neurologist Oliver Sacks captures the transformation that takes place when nursing home patients are handed iPods loaded with music from their youth. Available online: http://www.huffingtonpost.com/2012/04/10/alive-inside-documentary-explores-musiceffect-on-elderly_n_1416053.html

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Chapter 10 Work and Retirement

CHAPTER 10. WORK AND RETIREMENT • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking About Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Trends in Labor Force Participation a. The Decline of Career Employment People can no longer expect to work for the same employer from middle age to retirement. b. Labor Force Participation of Men Most men are in the labor force in their thirties and forties and into their early fifties. This trend has been relatively stable for at least 50 years.

From 1994 to 2007, the percentage of men working in their early fifties and aged 60 to 64 rose, after a period of decline from 1965 to 1995. Labor force participation also increased slightly among men aged 65 to 69. Even a small increase for men over 75. c. Labor Force Participation of Women Since 1965, there has been a sharp increase in labor force participation among women aged 50 to 59, and a more modest increase among women in their sixties. The passage of the Civil Rights Act of 1965 and the expansion of service jobs are two explanations for the increased labor force participation of women. Women still have more intermittent work patterns compared to men due to family responsibilities.

1. Racial and Ethnic Differences in Labor Force Participation Unemployment rates are highest among African American men up to age 54; above that age, they are exceeded by Hispanic/Latino males. African American women have the highest unemployment rates until age 44; after that age, Hispanic/Latino women exceed them. These high unemployment rates can be explained by overt discrimination in employment by employers and trade unions and the underfunding of schools in minority neighborhoods. Among men aged 45 to 64, African American men are two and a half times as likely as Caucasians to suffer from hypertension, circulatory problems, diabetes, and nervous disorders. Some Hispanic/Latinos (Mexicans) entered the U.S. during World War II under the Braceros agreement. Under this agreement, Mexicans worked in the lowest paying jobs that were not coved by Social Security or pensions. At all ages, Hispanic/Latino females have the lowest rates of labor force Quadagno: Aging and The Life Course, 6e

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Chapter 10 Work and Retirement

participation. Caucasian females have the highest rate for women from 50 to 74 (except 55-59), but in very old age (75 or older), African American females work more because they typically do not have much retirement income. d. International Trends in Labor Force Participation Most European countries also experienced a decline in labor force participation among older men in the 1980s. This trend was a result of specific policies adopted by European countries to reduce high unemployment among younger worker by encouraging early retirement.

II. The Transition from Work to Retirement a. Bridge Jobs Bridge jobs span the period between full-time employment in a career job and permanent retirement. These jobs are clustered in smaller sets of industries and occupations. They pay significantly less than regular jobs and represent downward mobility in occupation. Distinction between voluntary and economic part-time work is necessity. b. Phased Retirement It is a process that allows employees to ease into retirement. Some options include working fewer hours each day, job sharing, or consultant work. c. Contingency Work Contingency work has increased during the last two decades of the twentieth century due to downsizing and globalization. Contingent workers are hired to complete a specific job. They do not receive pensions.

1. Social Security Benefits - The early retirement option and improvements in Social Security benefits have encouraged older workers to retire. The elimination of the earnings test for Social Security recipients aged 65 to 69 is likely to increase labor force participation among older workers.

Women’s later life employment decisions are associated with their familial responsibilities, as well as their husband’s pension income.

2. Disability Insurance - Disability insurance, a part of the Social Security system, pays a monthly benefit to disabled workers younger than 65. The program functions like a de facto pension plan. d. Age Discrimination The Age Discrimination in Employment Act of 1967 banned discrimination against workers aged 40 to 65, but there are a number of loopholes that allow companies to get rid of older workers, particularly during mergers or downsizing. Older workers generally earn higher salaries and are thought to be less productive than younger workers. Many studies, however, show that older workers often are more reliable than younger workers, call in sick less often, and display more loyalty to their employers. Older workers who lose their jobs take longer than other workers to find a new job and are more likely to take a pay cut when they do. The greatest cost of job loss in later life is the loss of health insurance, a factor that has been only partially resolved by the 1985 Consolidated Omnibus Quadagno: Aging and The Life Course, 6e

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Chapter 10 Work and Retirement

Budget Reconciliation Act (COBRA), which requires employers of 20 or more workers to provide the opportunity for departing employees to purchase insurance for 18 months. Cobra policies are often expensive, since the employer is no longer paying part of the premium. To resolve these problems, Congress enacted the Health Insurance Portability and Accountability Act of 1996. HIPPAA gave workers who had exhausted their COBRA eligibility the right to convert these policies to individual coverage.

III. Factors Affecting Labor Force Withdrawal a. Economic Incentives Historically, low economic growth and high unemployment have meant fewer job opportunities for older Americans. During the 1980s, many firms encouraged older workers to retire by offering them early retirement incentive programs (ERIPs). In the early 1990s, the combined effects of a recession and a wave of mergers forced many older white-collar workers out of the labor market.

1. The Shift from Defined Benefit to Defined Contribution Plans - The defined benefit plan pays a certain income once the worker reaches a certain age. There is no incentive to continue to work beyond a certain age because there will not be an increase in benefits. The defined contribution plan came into effect during the 1970s. It is essentially a saving plan with some tax advantages. There has been a decrease in the number of defined benefit plans, while the defined contribution plans have increased between 1981 and 2001. b. Retiree Health Benefits with no lifetime health benefit guarantees post-retirement, many are returning to work c. Retirement as an Individual Choice Retirement is not always determined solely by external forces. Within the constraints imposed by the labor market and the welfare state, people time their retirement on the basis of their own desire to trade work for leisure.

1. Joint retirement - couples retiring at same time 2. Sequential retirement - one partner retiring before the other d. Future Trends in Retirement Future trends suggest that people will continue to retire at older ages than previous generations.

IV. Being Retired a. Satisfaction with Retirement The crisis and continuity theories have been used to explain how well people adjust to retirement. The crisis theory views the loss of the work role as a drastic one for males that deprives them of their jobs, status, and meaningful roles in a society. The continuity theory notes that retirees are likely to experience retirement in a positive manner if they substitute new roles to fill the void created by retirement. Recent research supports the continuity theory. One of the most consistent findings of retirement Quadagno: Aging and The Life Course, 6e

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Chapter 10 Work and Retirement

literature is that happiness in retirement is associated with good health.

Studies indicate that men and women who have adequate income and good health, reside in a suitable living environment, and have access to a satisfactory social support system are more satisfied with retirement than those who do not have these things. b. Daily Activities and Health Activity level depends on health. As old age disabilities decline, level of activity will stay higher. Most elderly find a way to cope with tasks that may seem daunting c. Volunteering Large society increase in volunteering attributed mostly to people over 60.

Factors: Older people in better health, more free time, pre-WWII cohort effect, improves life satisfaction, positive effects on personal health d. Religious Participation More prominent among women and increases with age Older African Americans more likely than whites Improves health, reduces disability, increases self-esteem, reduces depression CLASS DISCUSSION TOPICS 1. Retirement plans and satisfaction: Have students share the age at which they plan to retire. Also, ask them to indicate the activities in which they will be engaged once they retire and to list some factors likely to influence their own satisfaction with retirement.

2. Volunteerism: If students are volunteering with the elderly, what patterns have they experienced with volunteerism by and for the elderly? What community opportunities and coordinating bodies exist? What role does volunteerism play in the lives of the elderly they have interviewed or know?

3. Religious participation and spirituality: Have students share their experiences—from their families or their work/volunteer sites—about the role of religious participation and spirituality in the lives of elderly. Do the patterns they see confirm the research cited in the chapter? Do patterns of religious participation they observe in the elderly correspond to or diverge from patterns in the same cohort’s earlier years? Have students share conversations or observations concerning spirituality among the elderly they know.

4. Income security and sources of support: Have students share what they know about their parents’ and their grandparents’ planning for income security in their retirement years. So far, have their plans worked out? What factors have influenced income security? Could better planning alone have addressed obstacles or shortfalls? How are issues of financial support, inheritance, and income security addressed or not addressed in various families? Ask the students if they plan to use their parents or grandparents as role models in planning their retirement security.

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Chapter 10 Work and Retirement

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Retirement and health care issues for older immigrants: New immigrants to the U.S. who are at or near retirement age often face daunting challenges in securing necessary services and sufficient income. Immigrant and refugee centers offer English-language and job training services, but are often unable to secure necessary services for the older immigrant. Similar problems confront people with insufficient work history to qualify for Social Security, or downsized workers in their late fifties and early sixties. Students could research the particular problems that confront these groups by visiting the Social Security website or by consulting with local Social Security, Medicaid, Adult Services, and immigrant services offices. The issues could be highlighted through interviews with immigrants or caseworkers with relevant agencies. The real needs of these constituencies are often overlooked in the political rhetoric about immigration. The project presents a genuine challenge for students to design ways in which public policy could address the needs.

2. Community resources and volunteer opportunities for retirees: Successful retirement entails maintaining social connections and meaningful activity that uses the skills and knowledge of the retiree. Have students investigate community resources and volunteer opportunities for retirees in your area. Area agencies on aging, senior centers, and other private initiatives should provide an overview of resources and opportunities. Students could interview seniors working in those agencies or get referrals to agencies and facilities that use senior volunteers. (See State and Community Resources below).

Student projects could focus either on the significance of these resources and opportunities for retirement satisfaction, or on the contribution seniors with such opportunities can make to the community.

2. The wisdom of elders: Have students reflect on what wisdom today’s elders have to offer society. They may want to interview others in preparation for a brainstorming session on ways to design opportunities and contexts for elders to share that wisdom.

Native American communities often have established programs for transmitting language and traditions and preserving heritage. Do other communities have such mechanisms?

What could be done to identify and value such wisdom, and to create contexts within which elders can share it?

3. Contingency work, bridge jobs, and early retirement: The chapter talks about the growth of contingency work, bridge jobs, and forced early retirement. A useful student project would be either to interview elders who have confronted these realities or to work with case studies illustrating various scenarios of these work-related challenges. Have students identify the major social and economic issues involved, discuss how these challenges affect older workers and their families, and design programs or policies that would alleviate the impact of this trend.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS

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Chapter 10 Work and Retirement

1. Many older women drop out of the labor force to care for ill or aging relatives. In doing so, they forgo Social Security benefits later in life. Should the government give these women credit for the unpaid work they do? What might be the practical problems in doing so?

Women who drop out of the labor force to provide caregiving to an ill or aging relative perform an extremely significant service to society. Their service reduces the cost that the public has to pay for the caregiving; it should be rewarded as paid work, and women should receive Social Security credit for it.

2. What can government do to help older workers who have lost their jobs and health insurance, but are not yet old enough to retire?

Downsizing and a trend of earlier involuntary retirement have created a gap of 5 to 10 years for workers who face age discrimination, unemployment, and contingency jobs without benefits. Some recent legislation has attempted to fill this gap, but much more should be done. The extension of Medicare benefits to early retirees or the expansion of Medicaid to cover unemployed or uninsured workers could alleviate the major problems facing older workers.

3. What do you think of the trend toward hiring contingency workers who do not receive the same benefits as permanent employees? Does it provide employment opportunities that older workers would not otherwise have, or does it undermine their well-being?

One problem with contingency work is that the worker receives a wage that makes them ineligible for state healthcare benefits, but provides insufficient resources for privately purchased coverage. Contingency work also fails to utilize the full potential and experience of older workers and can present serious threats to physical and emotional well-being.

4. Should government be in the business of moving older workers out of the workforce to make room for younger workers? Explain your position.

Government policy influences labor force patterns on a number of levels, but the negative implications of moving experienced workers out of the workforce calls for serious reconsideration. Current incentives, such as the lifting of the earnings cap for Social Security recipients, offer more retirees the opportunity to continue satisfying or work conducive to their well-being. It also reduces the burden on the families who would otherwise need to contribute more for their care. The salaries of older workers also contribute to the economy.

5. How soon do you yourself hope to retire? Why? Students’ responses will depend upon many factors: rules of their employment, the meaning of work to them, health, income, and family responsibilities.

LECTURE/CLASS ACTIVITY IDEAS 1. Invite guest speakers from foster grandparents, RSVP, and other prominent organizations of senior volunteers in the community. Students are often quite impressed Quadagno: Aging and The Life Course, 6e

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Chapter 10 Work and Retirement

with the energy and imagination of such seniors, and they often discover volunteer opportunities through them.

2. Invite a senior fitness, educational travel (Elderhostel), or other leisure-activities professional to describe innovative programs as well as professional opportunities for gerontology students.

3. If you can, find a financial counselor or retirement specialist not interested in selling plans to your students. Such a person could be useful in providing an overview of the current issues confronting retirees and worker, even young people, planning their retirement.

3. Invite the local or state labor and industry or human rights commissioner to class. She or he should be experienced in dealing with age discrimination and the remedies available. Hearing how cases are handled and gaining some understanding of the challenges in age discrimination cases could generate an interesting discussion on effective policy to address such discrimination.

4. Invite local volunteers over age 60 to discuss why they do it and what they get from it.

Hearing older people do these things may inspire students to get involved and discuss volunteer opportunities throughout the life course instead of just older age.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources Area Agencies on Aging College and university senior and retirement learning centers Elder Hostel, and other elder leisure and continuing learning efforts Older American Act Programs (through local Senior Centers) National Senior Service Corps (Senior Corps) local programs: • Foster Grandparent Program • Senior Companion Program • Retired and Senior Volunteer Program (RSVP) • Service Corps of Retired Executives (SCORE) • Volunteers in Parks (VIP) National Resources The Active Retirement Center (http://www.yourretirement.com/). This site is oriented as a guide for retirees.

Administration on Aging (http://www.aoa.gov/). It has resources of the Administration on Aging related to retirement.

American Association of Retired Persons (http://www.aarp.org). It has extensive resources on work and retirement issues.

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Chapter 10 Work and Retirement

Center for Retirement Research, Boston College (http://www.bc.edu/crr). It publishes extensive issues in briefs, working papers, and other research online.

Elder Web (http://www.elderweb.com). It has resources on housing, finance, healthcare, and other retirement issues.

Families USA (http://www.familiesusa.org). It focuses primarily on healthcare, including Medicare issues.

FirstGov for Seniors (http://www.seniors.gov/retirement.html) It has links to all government resources related to seniors and retirement and is organized as a retirement planner.

Institute for Women’s Policy Research (http://www.iwpr.org). This is a published report on Women and Social Security Conference (March 2000) and other resources.

National Center for Women and Retirement Research (http://www.agingfocus.com). This includes extensive research and publications.

National Commission on Retirement Policy, Center for Strategic and International Studies (http://csis.org/). This bipartisan commission focuses on all aspects of retirement policy from a national perspective.

Retirement Research Foundation (http://www.rrf.org). This has extensive resources, publications, and fact sheets.

Setting Priorities for Retirement Years (http://www.spry.org). Resources on all aspects of retirement.

The Urban Institute (http://www.urban.org). Its Retirement Project includes several publications.

INTERNET RESOURCES AND ACTIVITIES 1. The Administration on Aging (http://www.aoa.gov). In addition to the fact sheet on work and age discrimination discussed in the text, students will find the Retirement and Financial Planning section of interest (see National Resources, above).

2. The National Council on Aging (http://www.ncoa.org) provides many news and research links and resources. Maturity Works provides fact sheets on trends related to work and retirement. Research and Demonstration provides several surveys and studies on aging, work, retirement, and other issues confronting the elderly.

3. Depending on the focus on the course, students will find the websites referenced under National Resources of interest for research projects, or for quick facts on particular issues related to work and retirement.

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Chapter 10 Work and Retirement

4. “Working Past Retirement Age, Meaningfully” - As baby boomers begin to turn 65, many expect to keep working well past retirement age. Nearly one in five working Americans tapped into retirement accounts in the past year, and some now worry they will outlive their savings. Others may not need to work, but choose a so-called "encore" career. This National Public Radio clip discusses encore careers. Face the Nation. 2011.

30 minutes. Available online: http://www.npr.org/2011/05/09/136144264/working-pastretirement-age-meaningfully 5. “US Pensions in Crisis, but not in Rohde Island” - States and cities across the country face a trillion-dollar pension crisis that threatens to reduce local services, raise taxes and trim pension benefits for public employees. But sweeping reforms in Rhode Island have alleviated the state's unfunded pension liability. Face the Nation. 2012. 30 minutes.

Available online: http://www.npr.org/2012/09/24/161696119/u-s-pensions-in-crisis-butnot-in-rhode-island

SUGGESTED READINGS Cheung, Chau-kiu, Ping Kwong Kam and Raymond Man-hung Ngan. 2011. “Age discrimination in the labour market from the perspectives of employers and older workers.” International Social Work 54(1):118-136.

Esping-Andersen, Gosta. 2009. The Incomplete Revolution: Adapting to Women’s New Roles. Cambridge: Polity Press.

Feldman, Daniel C. and Seongsu Kim. 2000. “Bridge Employment During Retirement: A Field Study of Individual and Organizational Experiences with Post-Retirement Employment.” Human Resource Planning (March) 23 (1): 14f.

Goldberg, Beverly. 2000. Age Works: What Corporate America Must Do to Survive the Graying of the Workforce. New York: The Free Press.

Johnson, Richard. 2012. “The Growing Importance of Older Workers.” Public Policy and Aging Report 21 (4): 26-30.

Kajakazi, Kilolo. 2002. “Impact of unreported social security earnings on people of color and women.” Public Policy and Aging Report, 12 (3): 121-127.

Markson, Elizabeth W. and Lisa Ann Hollis-Sawyer (eds.). 2000. Intersections of Aging: Readings in Social Gerontology. Los Angeles: Roxbury. [Chapters 17-24 include several articles on work, retirement, and income security.]

Price, Christine A. 2000. “Women and Retirement: Relinquishing Professional Identity.”

Journal of Aging Studies (March) 14 (1): 81f.

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Chapter 10 Work and Retirement

Putnam, Robert D. 2000. Bowling Alone: The Collapse and Revival of American Community. New York: Simon and Schuster.

Robertson, Ann. 2000. “‘I Saw the Handwriting on the Wall’: Shades of Meaning in Reasons for Early Retirement.” Journal of Aging Studies (March) 14 (1): 63f.

Savishinsky, Joel S. 2000. Breaking the Watch: The Meanings of Retirement in America.

New York: Cornell University Press.

Taylor, Philip. 2005. The Ageing European Workforce. London: International Longevity Center.

FILMS AND VIDEOS Aging and Saging. Films for the Humanities & Sciences (http://www.films.com) 800257-5126. 24 minutes.

The following films are available from Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643 (http://www.terranova.org) 800-779-8491: Aging with Grace. 20 minutes.

The Challenge of Aging: Retrieving Spiritual Traditions. 2 videos, 22 minutes Downsizing in an Aging Work Force—The Law, the Limits and the Lessons. 25 minutes.

Forever Young. 58 minutes.

Maximizing Retirement Supports for Persons Who Are Aging and Developmentally Disabled. 15 minutes.

Time on Earth. 51 minutes.

You Won’t Need Running Shoes, Darling. 53 minutes.

Work, Retirement and Economic Status. 1993. This is film 9 of the 13-part series of “Growing Old in a New Age.” Distributed by Annenberg/CPS, 401 9th Street, NW, Washington, D.C. 20004. 1-800-532-7637: www.learner.org.

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Chapter 11 Health and Health Care

CHAPTER 11. HEALTH AND HEALTH CARE • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking About Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Adding Years to Life or Life to Years?

There is an increase in chronic illness as one ages chronologically. Should poor health, then, be associated with old age? a. Stages of the Epidemiologic Transition The demographic transition is accompanied by the epidemiologic transition, which refers to change in the leading cause of death from infectious diseases to chronic diseases. There are three distinct stages of the epidemiologic transition. In the first stage, there are high death rates from chronic malnutrition and periods of epidemics of infectious disease and famine. The second stage is characterized by a decline in deaths from epidemics and famine. In the third stage, there is a shift in the leading cause of death from infectious disease to chronic disease. The most common chronic disease affecting 45.3 percent of people aged 65 to 74 in 1999 was arthritis. The next most common diseases were hypertension, hearing impairment, and heart disease. b. The Compression of Morbidity Thesis This theory was suggested by James Fries in 1980. It assumes that the maximum number of years a human has to live is fixed and finite, and improvements in health care and prevention will compress the number of years that a person will be disabled in the last few years of the life span. Older people are more likely to suffer from chronic disease, which have no cure. People are more likely to view personal health favorably is no loss of daily activities.

II. Social Determinants of Health One’s health lifestyle is a factor in whether or not one develops a chronic disease that produces a disability. a. Health Lifestyles 1. The Effect of Smoking - Around 400,000 deaths from cancer and heart diseases are attributed to smoking each year. Smokers 65 or older have probably been smokers all their lives. Asians have the lowest smoking rates of any ethnic/racial group, while Native Americans have the highest.

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Chapter 11 Health and Health Care

2. The Effect of Exercise - Regular exercises improve cardiovascular function, long and short-term memory, and decreases disability. Older people often use shopping malls to do “power walking.”

3. The Effect of Alcohol Consumption - Alcohol can have positive or negative effects on health and longevity. An occasional glass of wine with dinner has been linked to linked to diminished mortality risk.

4. The Effect of Diet - Obesity is a risk factor for heart disease, diabetes, and joint problems. Women may experience weight gain during menopause. b. Social Support Systems A strong social support system can improve morale, reduce depression, and enhance recovery from depression. Also, it has an impact on the cardiovascular, endocrine, and immune systems. c. Socioeconomic Status 1. Measuring SES - Socioeconomic status consists of occupation, income, and education. These indicators are problematic when examining the aged.

Occupation has some problems as a key status indicator because older people are less likely to be in the labor force.

2. Theory of Cumulative Disadvantage Versus Convergence Theory One theory, cumulative disadvantage, notes that people who begin life with greater resources continue to have them throughout life. The convergence theory, on the other hand, contends that old age is a great leveler—it reduces inequality evident at earlier stages of the life course. d. Gender Women have poorer health and higher levels of disability than men. This is true for women in developed and developing countries. The gender differences in active life expectancy can be attributed to women having more frequent contact with health providers, thus reporting ailments. e. Race and Ethnicity The health differences between Caucasians and African Americans, Asians, or Hispanics/Latinos can largely be explained by the theory of cumulative disadvantage. Racial discrimination in education, employment, and housing has life course consequences reflected in poor health and ultimately lower life expectancy.

III. The Elderly in the Health Care System The treatment of the elderly in the health care system is affected by their interactions with physicians and other health care providers as well as access to health care. In the past minority elderly received poorer health care than white elderly. a. Health Care Providers and the Elderly Due to stereotypes that doctors have of the elderly and communication problems, illnesses in older people sometimes are under-treated. Often an elderly person communicates with a physician through an intermediary. b. The Organization of Health Care 1. Changing Incentives in Medicare Due to a shift from fee-for-service to the Medicare and Medicaid programs in 1965, efforts have been made to control Medicare spending. Since 1983, the prospective payment system (PPS) was Quadagno: Aging and The Life Course, 6e

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Chapter 11 Health and Health Care

introduced to pay the hospital bills of Medicare recipients, and DRGs (diagnosticrelated groups) categorized the various diagnoses.The Medicare Modernization Act of 2003 has been called the biggest overhaul of Medicare since its inception.

Many older people needed help paying for prescriptions; yet many older people failed to sign up by the enrollment date because they found the rules governing the new drug benefit too confusing.

2. The Role of the Private Sector - Many elderly individuals supplement their Medicare policy with Medigap policies. Half of Medigap policies are paid for by former employers of retirees and the other half by the retirees (people who have the policy). There is variation in having Medigap policies by ethnicity/race.

CLASS DISCUSSION TOPICS 1. Trends in chronic diseases: Have students watch ads on TV or in magazines for health remedies for chronic diseases for older adults. Ask them to share the chronic illnesses indicated by gender and social class, if possible, in these ads.

2. Newspaper obituaries to examine the cumulative disadvantage theory: Have students examine for several days the obituary page of the local newspaper. What examples of cumulative disadvantage are evident in the obituaries? Did the deceased start with numerous resources in early life and continue to accumulate throughout life?

3. The importance of social support systems to health: Ask students to share with class members the things that they do to assist older family members or relatives who have been hospitalized or have chronic illnesses.

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Health lifestyle: Have students organize into groups and conduct interviews with older persons at shopping malls (power walkers), restaurants, movies, or theatres, about some of the things that they do to maintain good health. The results should be diverse and could lead to a discussion of variations of health lifestyle by gender, ethnicity/race, religion, and other social variables.

2. Healthcare: Search the internet for one example of a good health care system for the elderly in the U.S. and one in a foreign country.

3. Medicare reform: Currently, there are concerns about the increase in health care costs for Medicare recipients. Reforms have been introduced to reduce cost, such as the drug prescription plan. Assume that you are a policy analyst and you have developed a proposal to reduce Medicare’s cost. Briefly highlight the measures in your proposal to reduce cost.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS

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Chapter 11 Health and Health Care

1. A great deal of money has been spent in recent years on antismoking campaigns aimed at persuading young people not to start smoking. Do you think these campaigns are an effective way to prevent health problems in old age? If not, can you think of a better approach?

Research has shown that most smokers 65 and older have been smoking most of their lives, so this may not be effective for older adults. Obtaining an understanding of health behavior of older adults and using this information in health ads may be effective for them.

2. State officials have successfully sued tobacco companies on behalf of consumers whose health was damaged by cigarette smoking. Why not take the same approach to manufacturers of alcoholic beverages?

To continue to sue companies for undesirable health habits of consumers will not change these behaviors but lead to continuous lawsuits. With respect to alcohol, evidence has indicated that there are positive as well as negative health effects related to it, whereas this is not true for tobacco consumption.

3. Describe some government programs that promote a healthy lifestyle. Is the government doing enough to encourage people to live healthy lives? What else could be done?

There are ads promoting healthy eating habits and exercise, but many people may not be able to afford healthy food or have access to recreational facilities. If encouragement of a healthy lifestyle is a major goal of the government, then it must encourage the private sector to advocate for this cause as well.

4. If a person’s socioeconomic status is a good predictor of health, should the government attempt to promote health through educational assistance programs?

Research has documented that educational programs can be effective at conveying health messages if presented in culturally appropriate media outlets. Higher education is correlated with better health, so investing in the equalization of educational opportunity should have a positive impact on health.

5. Medicare pays an older person’s medical bills regardless of that person’s lifestyle.

Should people who choose to live an unhealthy lifestyle (who smoke or drink too much, for example) pay higher Medicare premiums than those who don’t?

Medicare is not a private insurance program that utilizes risk-ranking items. It is a universal program and to which all contribute and from which all benefit.

Furthermore, it would be difficult to monitor and enforce a health lifestyle check throughout the lifespan. And finally, if the government does not provide resources for a healthy lifestyle in earlier years, it cannot refuse to pay the medical bill in later years.

LECTURE/CLASS ACTIVITY IDEAS

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Chapter 11 Health and Health Care

1. Invite a diverse panel of older individuals to share with students some things that they are doing to lead a healthy life style. Be sure to have them share the age at which they began to live this healthy life style.

2. Invite a health advocate or ombudsman to share with the class the issues or challenges confronting older adults in obtaining adequate and affordable healthcare.

3. Share with students recent information related to the cumulative disadvantage and the convergence theory on some specific health issues as arthritis, hypertension, hearing impairments, heart disease, and vision disease in the context of gender and ethnicity/race.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources Area Agencies on Aging State and County Departments of Health Healthcare Providers who Conduct Workshops and Services on Lifestyle and Health Issues Private and University Health Research Institutes National Resources Administration on Aging (http://www.aoa.gov/) Agency for Health Care Policy and Research (http://www.ahrq.gov/) Health and Human Services Resource Center for Women with Disabilities (http://www.hhs.gov/od/women-with-disabilites-violencecounseling/index.html) National Center for Health Statistics (http://www.cdc.gov/nchs) Aging Activities National Institute on Health and Aging (http://www.nih.gov/nia/) National Mental Health Association (http://www.nmha.org)

INTERNET RESOURCES AND ACTIVITIES 1. The Centers for Disease Control and the National Center for Health Statistics (http://www.cdc.gov/nchs/) has an area called “Aging Activities.” It has longitudinal studies, fact sheets on trends in health and aging, and other resources.

2. The Agency for Health Care Policy and Research (http://www.ahrq.gov/) has full research reports on various health conditions and reports on healthcare provision for the aging.

3. The World Health Organization (http://www.who.int/ageing/) has extensive resources on aging, including fact sheets, demographic and epidemiological studies, and links to international health and aging sites. Of major interest may be the information about preparations for the Second World Assembly on Ageing in 2002 and the link to the UN program Toward a Society for All Ages.”

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Chapter 11 Health and Health Care

SUGGESTED READINGS Dawson, Joel. 2011. “Traveling with Gusto.” Pp. 55-68 in Real Gusto Comes Later: How Professional Women Experience Retirement, edited by Freddie GroomesMcLendon. United States: SokheChapke Publishing Inc. Ferraro, Kenneth F., Tetyana Pylypiv Shippee and Marcus Schafer. 2009. “Cumulative Inequality Theory for Research on Aging and the Life Course.” Chap. 22 in the Handbook of the Sociology of Aging, edited by R.A. Settersten and J.L. Angel. Springer.

Kahana, Eva, Boaz Kahana and Kyle Kercher. 2003. “Emerging Lifestyles and Proactive Options for Successful Ageing.” Ageing International 28 (2): 155-180 May, Carl et. al. 2004. “Framing the Doctor-Patient Relationship in Chronic Illness: A Comparative Study of General Practitioners’ Accounts.” Sociology of Health and Illness 26(2) :135-158.

Markson, Elizabeth W., and Lisa Ann Hollis-Sawyer, eds. 2000. Intersections of Aging: Readings in Social Gerontology. Los Angeles: Roxbury. [Chapters 35–44 include several articles on health and illness in later life.]

McMurdo, Marion E.T. 2000. “A Healthy Old Age: Realistic or Futile Goal?” British Medical Journal 321 (7269): 1149f.

National Center for Health Statistics. 2011. “Death in the United States.” NCHS Issue Brief 64. July.

National Center for Health Statistics. 2010. “National Health Interview Survey 2009.”

US Department of Health and Human Services, Center for Disease Control and Prevention.

Omran, Abdel. 2005. “The Epidemiologic Transition: A Theory of the Epidemiology of Population Change.” The Milbank Quarterly 83(4):731-57.

Villa, Valentine M., Steven P. Wallace, Sofya Bagdasaryan and Maria P. Aranda. 2012.

“Hispanic Baby Boomers: Health Inequities Likely to Persist in Old Age.” The Gerontologist 52(2):166-176.

FILMS AND VIDEOS

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Chapter 11 Health and Health Care

The Chronically Ill: Pain, Profit, and Managed Care. Films for the Humanities & Sciences; http://www.films.com (1-800-257-5126). 48 minutes.

The following videos are available from Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643; http://www.terranova.org (1-800-779-8491).

Break the Chain. 26 minutes.

Ethnic Diversity: Barrier or Benefit in Health Care of the Elderly? 120 minutes.

Importing Drugs: The Canadian Connection. 22minutes Living Longer at What Cost? 26 minutes Mrs. Dorothy Peterson: A Case Study. 13 minutes.

THE OPEN ROAD: AMERICA LOOKS AT AGING (2012) is an hour-long documentary that examines the impending retirement of America's baby boomers on both society as a whole and on individual choices for the future. The film explores the work and lifestyle options of a host of individuals, at various representative stages of retirement, and reveals the manner in which they have shaped - and continue to shape - the critical "third stage" of life. http://www.snagfilms.com/films/title/the_open_road_america_looks_at_aging Aging in America. (2008) This short documentary (5 minutes) follows volunteers from the Meals on Wheels organization as they explain the sometimes devastating effects of aging in America. Available online: http://www.snagfilms.com/films/title/aging_in_america1 Living Old. (2006) For the first time in American history, "the old old" -- those over 85 -are now the fastest growing segment of the U.S. population. Medical advances have enabled an unprecedented number of Americans to live longer, healthier lives. But for millions of elderly, living longer can also mean a debilitating physical decline that often requires an immense amount of care. And just as more care is needed, fewer caregivers are available to provide it. In "Living Old," FRONTLINE investigates this national crisis and explores the new realities of aging in America. Available online: http://www.pbs.org/wgbh/pages/frontline/livingold/view/

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Chapter 12 Caring for the Frail Elderly

CHAPTER 12. CARING FOR THE FRAIL ELDERLY • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking about Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Family Care The major source of care for the frail elderly is provided by family members. a. A Profile of Caregiving According to the General Accounting Office, approximately 12 million people needed some assistance with daily living in 1995. Only 9 percent of people aged 65 to 69 need help with activities of daily living (ADLs), while 43 percent of those older than 85 needed help. Children are most likely to provide care to aging parents, followed by a spouse. Caregiving generally lasts from five to seven years.

1. Activities of Daily Living—Ability to eat, bathe, dress, and transferring from one’s bed.

2. Instrumental Activities of Daily Living—Activities that include keeping tack of money, doing light housework, taking medicine, and running errands.

3. Long-Term Care—Refers to a variety of services designed to help people with chronic conditions and to compensate for limitations in their abilities to function independently. b. Gender Differences in Caregiving Research has found women to be the primary caregivers of ill and disabled family members. Among children who care for elderly parents, 80 to 90 percent are daughters.

1. Primary Caregivers—Most studies have found that women are primary caregivers of ill/or disabled family members. Gap disappears for husbands and wives caring for each other. c. The Caregiver Burden A distinction is made between caregiver burden and caregiver stress by researchers. Women who are not employed outside of the home report the greatest level of stress. Caregiver stress can lead to abuse of the care recipient. Support groups have been effective in reducing stress among caregivers. d. Work and Caregiving About one-third of caregivers are employed full-time or part-time. Caregivers experience greater stress on the job and more work-family conflicts than noncaregivers. Recognizing the stress and turnover among employees, some employers have introduced special programs like flexible working hours, Quadagno: Aging and The Life Course, 6e

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Chapter 12 Caring for the Frail Elderly

information and referral services, lunch time seminars, special insurance programs that cover older care costs, and counselors who lead weekly support groups. Individuals actively caring for children and aging parents are referred to as the “sandwich generation.” e. Caregiving and Family Relationships Recent research has documented that caregiving not only poses a problem for the caregiver, but extends to other family members.

1. The Effect on Parent-Child Relationships - Adult daughters are most likely to feel stress when the parent is demanding, critical, and unappreciative of their efforts. If there is role reversal, the parent becomes the dependent one and stress increases.

2. The Effect on Sibling Relationships - Sibling disagreements occur over how to care for parents. Disagreement over whether siblings are sharing fairly in caregiving responsibility often generates anger.

3. The Effect on Marital Relationships - There are positive and negative aspects of caregiving on marriages. The most stressful situation occurs when one spouse has Alzheimer’s disease.

4. The Effect on Grandchildren - Caregiving by parents may be resented by grandchildren. Some reasons include having to compete with grandparents for their parents’ attention, making financial sacrifices, or enduring a crowded living space.

II. Home Care Many older adults are able to remain in their homes because they have access to home and community-based services (HCBs). a. Home and Community-Based Services These services include: personal care, housekeeping, case management, respite care, adult daycare, and home health care. Research reveals that families do not withdraw support when home and community-based services are provided. In fact, the disabled elderly receive more care. Most home care workers are middle aged women. Studies find that quality of care often not adequate, and there is very little regulation of the industry. b. Race, Ethnicity, and Long-Term Care Minority ethnic and racial groups are less likely to receive home and communitybased services or to enter nursing homes, even though their health tends to be poorer than that of Caucasian elderly. Some reasons for these differences include cultural preferences and lack of access to nursing homes. c. Private Long-Term Care Insurance Long-term-care insurance is an alternative because it pays for nursing care and alternative services in the home. Private policies pose several problems. Older people wait until they are in their 70s and 80s to purchase them, so people with health problems are turned down by insurers. In addition, a high proportion of policy holders let their policies lapse. Long-term care insurance has grown considerably since it began in the mid-1980s. Most people begin to thing about coverage only after dealing with an elderly parent’s long-term care needs.

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III. Institutional Care The long-term care option of last resort is the nursing home. Approximately 7 percent of older people living in a community enter a nursing home in any two-year period. a. The Nursing Home Industry The demand for nursing home care has increased since the mid-1950s. This increase is due in part to the growth of the aged populations, especially those over 85 with multiple chronic ailments. There are numerous problems in many nursing homes, including untrained staff, poor health care, unsanitary conditions, poor food, and unenforced safety regulations. b. Staff Turnover in Long-Term Care High turnover can be attributed to low salaries, few fringe benefits, long hours, and injuries caused by lifting patients. Studies have shown the highest quality of care to be provided in homes operated by nonprofit organizations. c. Access to Nursing Home Care Medicare pays a small portion of nursing home car, which, according to 2003 data, can exceed $56,000 a year. Ethnic and racial minorities are more readily accepted for Medicaid when entering to nursing homes. On the other hand, Caucasian men and women are likely to enter nursing homes as private paying patients and then convert to Medicaid when they have spent down their assets.

Ninety-one percent of nursing home aides are women. d. The Nursing Home as Total Institution There are five categories of total institutions. Nursing homes are total institutions established to care for people who are both incapable and harmless.

1. Adjusting to a Nursing Home - There are major adjustments to be made when a person moves into a nursing home. A major issue is the loss of independence.

Ethnic and immigrant groups must adjust to cultural and language differences.

2. Daily Life in a Nursing Home - Nursing homes are bureaucratic organizations that maintain efficiency and effectiveness as a total institution. The main spheres of life—sleep, work, and play—are routinized.

3. Patient Abuse - Due to high turnover and absenteeism, there is often verbal and physical abuse in nursing homes. Ombudsmen serve as watch dogs and monitor the quality of care in nursing homes.

4. Families of the Institutionalized Elderly - Caregiving stress does not end when an aging parent or spouse is admitted to a nursing home; it increases. The highest levels of stress and depression occur among caregivers of patients with severe behavioral problems and memory loss. One research project conducted by Cornell University found that family members who participated in workshops focusing on improving listening skills and enhancing communication had greater empathy with the staff.

CLASS DISCUSSION TOPICS 1. Family care: Have students of diverse ethnic/racial and cultural backgrounds share information on the major caregiver and type of caregiving provided to a frail elderly in the family.

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2. Long-term care insurance: Have students debate the advantages and disadvantages of long-term care insurance.

3. Ask students if they have experienced a sickness. If so, ask them to respond to the ADL (activities in daily living items) and four response categories. This activity sensitizes students to problems elderly people have in performing ADL. STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Elder abuse by family caregivers: After class discussion of elder abuse, have students conduct research on it and present their findings in a workshop format to the class. If the course is a service-learning one, then organizations or program directors might be invited, as well as caregivers associated with these organizations or programs.

2. Nursing homes as total institutions: Students may want to refer to Jaber Gubrium’s or Timothy Diamond’s sociological work on nursing homes. Those students working on a service-learning project in a nursing home or those who have family members or relatives in one may want to observe and complete a report on the home functions of a total institution.

3. Support for family caregivers: The Administration on Aging has launched a National Family Caregivers Support Program. Using this program as a model, research what your community is doing to address the needs of caregivers.

4. Institutional versus home care: Have students meet and talk with older adults who have been cared for in the home and in an institution for a chronic disease. Ask the older adults about some advantages and disadvantages of the care provided in each setting.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. What kind of social support would be helpful to stressed-out sandwich-generation caregivers?

Caregivers are primarily women and about one third are employed full-time or part-time. Programs such as intergenerational day care, home health care, and social service groups can help provide respite for the caregiver. The Family and Medical Leave Act should be strengthened to extend more time and benefits to all workers.

2. As a concerned citizen or social worker, how would you argue for greater government support of home-based services for the elderly?

Present data on caregiving needs for an area or community who is in need, services that should be provided, and the cost effectiveness of these services.

3. Should long-term care be available to everyone, regardless of his or her health?

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If provided by the government, there should be educational programs promoting and encouraging a healthy life style. Some incentives should be provided for those who maintain their health.

4. Federal standards for nursing home care often conflict with federal reimbursement limits. What is the source of this conflict, and how might it be resolved?

The origin of the conflict is the bureaucratic gap between federal regulations and reimbursement through Medicaid. An oversight commission is needed to monitor staffing and funding to resolve the conflict.

5. Many people fear ending their lives in a nursing home. In your view, what is the worst aspect of life in a total institution? If you were a nursing home operator, how would you address it?

There is a lack of independent decision making. All decisions are made to increase efficiency of the home. Permitting residents to make some decisions regarding meals, social activities, and health care visits can help, especially in larger facilities. Smaller facilities should include residents in decision making as well reduce the routinization of the home.

LECTURE/CLASS ACTIVITY IDEAS 1. Invite a nursing home administrator or head of nursing, a health care provider, a program/social activity director from a for-profit and one from a public nursing home to share with the class things that they do to keep residents engaged in the daily activities of the home.

2. Check out and share with the class the services that are provided in the community to assist caregivers of the frail elderly.

3. Every state has a Long-Term Care Ombudsman Program—an advocacy program for older adults in long-term care. These are volunteers who monitor and report on situations at the facility. Invite a person who volunteers as an ombudsperson to the class. Students may gain an interest in volunteering for this program after the visit of the ombudsperson.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources Adult Care Home Programs Administration on Aging Adult Protective Services Area Agencies on Aging Assisted Living Facilities Caregiver Support Networks and Organizations Continuous Care Retirement Communities

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Home Health Care Facilities and Services National Council on Elder Abuse Nursing Homes and Facilities State Long-Term Care Ombudsman Office National Resources Administration on Aging (http://www.aoa.gov/) Agency for Health Care Policy and Research (http://www.ahcpr.gov) The Eden Alternative (http://www.edenalternative.com) National Family Caregivers Association (http://www.nfcacares.org) National Institute on Health and Aging (http://www.nih.gov/nia/) Caregiver Alliance (http://www.caregiver.org/caregiver/jsp/home.jsp) Caregiver Support (http://www.alz.org/Care/overview.asp) INTERNET RESOURCES AND ACTIVITIES 1. The Administration on Aging (http://www.aoa.gov/) has extensive resources on care for the frail elderly in homes and long-term care facilities. The National Family Caregiver Support Program was launched in September 2001, provides fact sheets, locators, research, and numerous other resources of interest to students and caregivers.

2. The Health Care Financing Administration provides information on Medicare and Medicaid programs for elders. Students researching Medicare and Medicaid coverage or regulations will find this a useful site.

3. “Amid Budget Squeeze, N.Y. Sells Nursing Homes” (2012) The national recession may be over, but local governments around the country are still hurting. Core services and programs are being scaled back, cut or privatized. In Upstate New York, county officials are scrambling to sell off nursing homes that have been taxpayer-funded for generations. Story available online at: http://www.npr.org/2012/08/16/158868363/amidbudget-squeeze-n-y-sells-nursing-homes

SUGGESTED READINGS Albert, Steven M. 2000. “The Dependent Elderly, Home Health Care, and Strategies of Household Adaptation.” In Aging and Everyday Life, edited by Jaber F. Gubrium and James A. Holstein, 373–85. Malden, MA: Blackwell.

Bookwala, Jamila. 2009. “The Impact of Parent Care on Marital Quality and Well-being in Adult Daughters and Sons.” Journal of Gerontology 64B:339–347.

Calasanti, Toni and Neal King. 2007. “Taking 'Women's Work'' Like a Man': Husbands' Experiences of Care Work.” The Gerontologist 47(4):516-527.

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Diamond, Timothy. 2000. “Nursing Homes as Trouble.” In Aging and Everyday Life, edited by Jaber F. Gubrium and James A. Holstein, 401–12. Malden, MA: Blackwell.

Garner, J, Dianne, and Susan O. Mercer. 2000. Women As They Age. Second edition.

New York: Haworth Press. (Covers full range of topics relevant to other chapters.)

Kirkland, Kevin. 2000. Full Circle: Spiritual Therapy for the Elderly. New York: Haworth Press. (Focuses on therapy for cognitively impaired elders.)

Lovell, B. and M. Wetherell. 2011. “The Cost of Caregiving: Endocrine and Immune Implications in Elderly and Non-elderly Caregivers.” Neuroscience and Biobehavioral Reviews 35 (6):1342-1352.

Loverde, Joy. 2000. The Complete Eldercare Planner. New York: Time Books.

Pinquart, Martin and Silvia Sorensen. 2007. “Correlates of physical health of informal caregivers: A meta-analysis.” Journal of Gerontology 62P:126-137.

Pipher, Mary Bray. 2000. Another Country: Navigating the Emotional Terrain of Our Elders. Riverhead Books.

Savundranayagam, Marie, Rhonda Montgonery and Karl Kosloski. 2011. “A dimensional analysis of caregiver burden among spouses and adult children.” The Gerontologist 51(3):321-331.

Wakabayashi, Chizuko and Katharine M. Donato. 2006. “Does Caregiving Increase Poverty among Women in Later Life? Evidence from the Health and Retirement Survey.” Journal of Health and Social Behavior 47:258-274.

FILMS AND VIDEOS Almost Home. PBS documentary that takes you inside a year-in-the-life of a nursing home trying to implement culture change. (http://www.uwm.edu/Dept/ageandcommunity/Resources/products.html) The following videos are available from Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643; http://www.terranova.org (1-800-779-8491).

On elder abuse and prevention: Breaking Point. 20 minutes.

Close to Home. 18 minutes.

Elder Abuse: Five Case Studies. 40 minutes.

Elder Abuse: The Real Definition (3 tape Series) Financial Exploitation of the Elderly. 25 minutes.

I Grow Old. 30 minutes.

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I’d Rather Be Home. 30 minutes.

Institutional Abuse: Everyone’s Responsibility. 17 minutes.

Just to Have a Peaceful Life. 10 minutes.

A Safer Place. 20 minutes.

Serving the Victim of Elder Abuse. 21 minutes.

Abuse: The Resident’s Perspective. 20 minutes When Help Was There: Four Stories of Elder Abuse. 19 minutes.

Care and caregivers: Aging Parents: The Family Survival Guide. With 192 page print guide. 3.5 hours.

The Caregivers’ Journey: The Journey Begins – Part 1. 30 minutes.

The Caregivers’ Journey: The Toll – Part 2. 30 minutes.

The Caregivers’ Journey: Surviving – Part 3. 30 minutes.

The Caregivers’ Journey: Healing – Part 4. 30 minutes.

The Caregivers’ Journey: Quiet Triumphs – Part 5. 30 minutes.

Caring for the Alzheimer’s Resident: A Day in the Life of Nancy Moore. 28 minutes.

Coming Home: Basic Information for the Home Caregiver. 51 minutes.

Complaints of a Dutiful Daughter. 37 minutes.

Curtain Call. 52 minutes.

Dealing with Alzheimer’s: Facing Difficult Decisions. 23 minutes.

Elder Parent Care: The Family Meeting. 30 minutes.

A Family Decision. 25 minutes.

Full Circle. 29 minutes.

He’s Doing this to Spite Me: Emotional Conflicts in Dementia Care. 22 minutes.

The Healing Influence. 43 minutes.

How to Choose a Nursing Home. 31 minutes.

Labor of Love: Five Stories of Caregiving. 45 minutes.

94 Years and One Nursing Home Later. 33 minutes.

No Easy Answer: Moving Beyond Guilt. 23 minutes.

What Shall We Do about Mom and Dad? 22 minutes.

Not My Home. Fanlight Productions, http://www.fanlight.com (1-800-937-4113). 45 minutes.

Almost Home is a feature-length, cinema verité documentary chronicling a year in the life of a retirement community in America's Midwest. It appeared on PBS just as a tidal wave of baby boomers reached their 60s. 2008. Available online: http://www.almosthomeoutreach.org/about_the_film Alive Inside. 2012. Music's therapeutic benefits have been well documented, but a new film called "Alive Inside" set out to examine just how therapeutic it can be in one community in particular -- the elderly. The film, by Michael Rossato-Bennett, and featuring commentary by social worker Dan Cohen and neurologist Oliver Sacks captures the transformation that takes place when nursing home patients are handed iPods loaded Quadagno: Aging and The Life Course, 6e

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with music from their youth. Available online: http://www.huffingtonpost.com/2012/04/10/alive-inside-documentary-explores-musiceffect-on-elderly_n_1416053.html

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Chapter 13 Dying, Death, and Bereavement

CHAPTER 13. DYING, DEATH, AND BEREAVEMENT • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking about Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Cross-Cultural and Historical Perspectives on Death The experience of death varies from culture to culture. a. Death in Preliterate Societies In many preliterate societies, the dead are endowed with special powers and considered potentially harmful to the living. In other societies, the dead are considered members of the community. For example, they may be valuable allies, perform services for the living, or serve as intermediaries between the worlds of the living and the dead. b. Death in Non-Western Cultures In some Eastern religions, such as Hinduism, there is a belief that at death the soul passes from one body to another. Death, then is a reminder that there is no permanent self.

1. The Transformation of Death in the United States There has been a radical transformation of the perception of death in the United States, due to changing demographics. Death is seen as a taboo subject rendered largely invisible.

II. Facing Death Studies suggest that attitudes toward death vary over the life course. a. Preparing for Death For the young, death may be viewed as inevitable and distant. Young people tend to romanticize death. Around middle age, there is much more awareness of death. People have increased self-reflections and reminiscence about the past. Older people tend to think and talk more about death, and it is less frightening. Older individuals are likely to engage in the life review—a process that allows the aged to integrate their experiences and images of self into a whole. b. A Stage Theory of Dying Elizabeth Kubler-Ross, in her work as a physician, identified five stages of dying: denial, anger, bargaining, depression, and acceptance. These stages have been criticized because they do not occur in a fixed sequence. It is

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thought that individuals will respond to death in the same manner in which they have handled other stressors in their lives.

III. Managing Death Modern medical technologies raise ethical questions related to lengthening the dying process and the preservation of human dignity. a. The Right to Die The Hippocratic Oath mandates that physicians should not harm any patient. However, in practice, many physicians have permitted terminally ill patients to die peacefully. Due to modern medicine’s ability to prolong life, the nature of public discussion about euthanasia has changed. Whites are more likely than African Americans to discuss treatment preferences before death.

African Americans are more likely to request all possible life-prolonging care.

This is due to possible mistrust of blacks of medical system (justified).

1. Passive Euthanasia - It involves withholding or withdrawing medical treatment from the terminally ill. It has been recognized for decades. The courts have been involved with two issues centered on a physician’s right to withhold treatment from the terminally ill. Based on these issues, the courts have given physicians the right to honor living wills.

2. Active Euthanasia - Active euthanasia is also known as assisted suicide. It occurs when a physician, close friend, or relative helps a terminally ill or disabled person to commit suicide. According to surveys, public opinion favors physician-assisted suicide; however, it remains in legal limbo.

3. Suicide among the Aged - Suicides rates are especially high among men eighty-five and older. Caucasian males are the only group more likely to commit suicide than to die in an automobile accident. Suicide rates increase with chronological age due to social isolation, boredom, a sense of uselessness, financial hardship, the multiple losses of loved ones, or chronic illness and pain. The most frequent psychiatric disorder among the elderly is depression, and it is the reason for most suicides in this age group. b. Hospice Care 1. The Hospice Movement - The hospice movement originated in medieval Europe. The first modern hospice was located in London. In the United States, the first hospice opened in 1974 in Branford, Connecticut.

2. The Structure of Hospice Care - There are five models of hospice in the U.S.: home-based care provided by professionals and volunteers, homebased care provided by health care agencies or visiting nurses associations, freestanding hospice facilities, special units of hospitals (the most common), and nursing home hospices. There may be variation in the model followed by a specific hospice, but all provide a medically directed continuum of care and support for terminally ill patients.

3. Paying for Hospice Care - Hospice care can be paid through five means: Medicare, Medicaid, private insurance, private pay, and charitable donations. Policymakers believed that hospice care would be much less

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costly than hospital based care. This has not been supported. Overall, hospice care just saves just over 3 percent of Medicare costs.

IV. Bereavement Among those 65 years and older, almost half of the women and one-fifth of the men have lost their marital partners. a. Widowhood 1. Women as Widows - Research documents that women go through three stages: preparation, grief and mourning, and adaptation. Preparation for widowhood varies. Also, a widow’s grief may be compounded by financial problems—rights to spouse’s pension may be lost and social security benefits reduced. Research indicates that those widows with intimate ties with an adult child tend to survive longer. Widowhood alters the social support network and the friendship patterns.

2. Men as Widowers - Men have greater problems adjusting to widowhood than women because they do not expect their wives to die first. Also, because their wives have cared for them, they may find it difficult to adjust to the daily demands of life. Finally, the traditional male role emphasizes independence, and this can pose a problem for widowers.

Older men are more likely than older women to have a partner who can care for them if they become physically disabled. Research has shown that positive relations with one’s spouse before death increased the bereaved survivors’ yearning but reduced the anger at their loss. b. The Death of a Parent Grief over the loss of a parent is linked to the quality of the parent-child relationship. Some research suggests that the loss of a mother is much more disturbing than the loss of a father. Sons and daughters have different reactions to a parent’s death. One study found that anticipatory grief was a common experience among daughters whose mothers had been ill for a period of time before death. Another type of grief was selfish grief in which the daughter wished that the mother was still alive. In this type of grief, the daughter felt that she should suppress it because it would be selfish to extend to the mother’s suffering.

CLASS DISCUSSION TOPICS 1. Grief Process: Kubler-Ross’s stages of the grief process have become a part of popular culture. Examine a popular film which addresses dying and identify the stages of dying depicted in the film. Do these stages occur in sequence?

2. The Right to Die: States vary in laws related to passive or assisted suicide. What are the laws on this issue in your state? Share information about any recent legislation related to it.

3. Death and the Family: Some students may have experienced a death in their family.

Have students share how death has affected their family and particular family members,

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Chapter 13 Dying, Death, and Bereavement

and compare student experiences with the research on widows and widowers, and the death of a parent or sibling.

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Life Review: Research whether facilities in your town or city utilize the life review process. Try to gather information on the length of time the process has been in existence and some of the pros and cons of using this process.

2. Physician-Assisted Suicide: Researching the first years of the implementation of the Oregon Death with Dignity Act legalizing physician-assisted suicide would enable students to examine various aspects of the impact of such a program. What have been some of the consequences of this law? Also, what are some ethical issues confronting doctors, caregivers, and pharmacists?

3. Hospice Care and Death at Home: The development of hospice care facilities and services is part of a shift toward a higher percentage of deaths at home with family members. Some medical facilities offer home-like hospice care facilities for patients and their families when home-care is not an option. Students could examine these programs to determine the impact on patients and family members, to identify any changes in attitudes toward death, and to understand the social and ethical issues and opportunities raised by this growing trend.

4. Comparative Suicide Rates among the Aged: The high suicide rate and the high incidence of depression among the elderly raise serious issues beyond the “right to die debate.” Examine suicide rates in several other countries to determine if the same pattern prevails as in the United States. Address the following questions: What are the risk factors for elder suicide in these countries? What treatments and care approaches are best designed to address the issue of suicide? What effect does elderly suicide have on the family?

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. Which is better, the traditional way of dying at home or the modern way of dying in a medical institution? What does your answer say about the culture you live in?

Student responses will vary based on value system and religious orientation to death.

2. Many people say they would rather die young than waste away in old age from a degenerative disease. What might be the drawbacks of dying young?

Wanting to die young means that the person has not been socialized to experience the rich content of the life cycle. One contemporary book, Tuesdays with Morrie, and other accounts of people who have experienced degenerative disease demonstrate that such experiences are not entirely negative and can have a tremendously positive impact on younger people. Wanting to die young also reflects cultural biases toward youth.

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Chapter 13 Dying, Death, and Bereavement

3. What would you say to a terminally ill person who wants to end his or her life?

Student discussion of this question should include a consideration of the social factors in the terminally ill person’s life and the possibility of clinical depression. Also, a guided life review might indicate the underlying reasons for the desire to die. Pain management is another factor, as would be the implicit or explicit pressures from family members. If the person is responsive to counseling, this may be a way to help the person to see that her/his life is meaningful and that there are people who care about her/him.

4. Life-extending medical technology is extremely expensive. Should it be rationed depending on a person’s age? Why or why not?

Any discussion of the rationing of life-extending medical measures on any basis, whether age, productivity, responsibility for one’s condition, or future potential, poses serious ethical dilemmas. Of significance is whether students focus on individual ethics or societal ethics in their calculation. The costs of life-extending measures depend upon how health care in general is structured in a society. For example, the U.S. health care system insures that only some people in society will have the means to decide on use of expensive medical technologies. This means that most of the members in the U.S. do not have the means for such a service, and this is an issue of public policy.

5. If you were dying, what kind of care would you prefer to receive and where?

Would you refuse life-prolonging treatments? Would you want help in ending your life?

Again, attitudes on this issue will depend on awareness of options and ethical choices. Students need to conduct a realistic assessment of the effects of many life-prolonging treatments that may result in a severely reduced quality of life (in contrast to miraculous recoveries in TV medical dramas). The extent to which one is in prolonged pain or has limited support networks are factors to consider.

LECTURE/CLASS ACTIVITY IDEAS 1. Organize a class debate on the issue of physician-assisted suicide. What issues do students consider relevant to the debate? These include: the rising costs of healthcare; whether elder patients should be allowed to make the decision to use physician-assisted suicide alone; whether family members should be involved; and the impact family members.

2. Invite a hospice care provider to speak to the class about the daily tasks and decisions that confront hospice workers. Some students may be interested in getting hospice volunteer training either as a volunteer or hospice care provider.

3. Invite a legal professional to discuss the various options available in your state for advance directives and powers of attorney. Students may want to discuss the social and ethical issues involved in advance directives and other decisions regarding the giving or withholding of treatment.

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4. Invite a representative from a widow or widower support group to discuss the activities and services of the group. Have the class compare the offerings and perspective of the support group with the research on the needs and concerns of widows and widowers.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources State hospice associations Local hospice providers State or local funeral directors Elder law professionals and services Widow/widower support groups Support groups for survivors National Resources Agency for Health Care Policy and Research (http://www.ahcpr.gov) American Academy of Hospice and Palliative Medicine (http://www.aahpm.org) American Hospice Foundation (http://www.americanhospice.org) Hospice Foundation of America (http://www.hospicefoundation.org/) HospiceNet (http://www.hospicenet.org) The National Hospice and Palliative Care Organization (http://www.nhpco.org) Project on Death in America (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282198/) INTERNET RESOURCES AND ACTIVITIES 1. The National Institute of Health Research (http://www.nihr.org) focuses on the link between spirituality and health care. Of interest are articles on death anxiety and religiosity, physician attitudes toward assisted suicide, and the impact of religiosity on health and morbidity.

2. The American Association of Retired Persons (http://www.aarp.org) has research and fact sheets on a number of issues related to death and dying, including ways of paying for hospice care, assisted suicide, funeral arrangements, widowhood, and so on.

3. The Center for Ethics in Health Care of the Oregon Health Sciences University (http://www.ohsu.edu/ethics) conducts research on the Oregon Death with Dignity Act legalizing doctor-assisted suicide. A recent publication available through the website, “The Oregon Report Card: Improving Care of the Dying,” will be of particular interest to students concerned about pain management and ethical issues in the care of the dying.

4. Supportive Care Coaltion (http://www.supportivecarecoalition.org/) provides information about pain relief and symptom management.

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Chapter 13 Dying, Death, and Bereavement

SUGGESTED READINGS Curlin, Farr A. et al. 2008. “To Die, to Sleep: US Physicians' Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support.” American Journal of Hospice and Palliative Care 25(2):112-120.

Doka, Kenneth J., and Joyce D. Davidson, eds. 2001. Caregiving and Loss: Family Needs, Professional Responses. Washington, DC: Hospice Foundation of America.

Donnelly, Edward, Field Nigel, and Mardi J. Horowitz. 2001.”Expectancy of Spousal Death and Adjustment to Conjugal Bereavement.” Omega 42(3): 195-208.

Goodman et al. 2011. “Trends and Variation in End of Life Care for Medicare Beneficiaries with Severe Chronic Illness.” Report of the Dartmouth Atlas Project.

Dartmouth Institute for Health Policy and Clinical Practice. Lebanon, New Hampshire.

Kubler-Ross, Elisabeth, and David Kessler. 2000. Life Lessons: Two Experts on Death and Dying Teaching Us about the Mysteries of Life and Living. New York: Scribner.

Miller, Susan, et al. 2010. “The Growth of Hospice Care in U.S. Nursing Homes.”

Journal of the American Geriatrics Society 58(8):1481-88.

National Center for Health Statistics. 2011. “Death in the United States.” NCHS Issue Brief 64. July.

Rawls, John et al. 2009. “Assisted Suicide: A Philosophers Brief.” Pp. 312-330 in Philosophy and Death, edited by S. Brennan and R. Stainton: Broadview Press.

Touyz, L. and G. Dent. 2011. “An appraisal of life’s Terminal Phases and Euthanasia and the Right to Die.” Current Oncology 18:65-69.

Van den Hoonaard, Deborah K. 2010. By Himself: The Older Man’s Experience of Widowhood. Toronto: University of Toronto Press.

FILMS AND VIDEOS Please note that several films also available from Terra Nova and Films for the Humanities & Sciences are not included in the following lists.

The following videos are available from Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643; http://www.terranova.org (1-800-779-8491): Are You Listening – Widows. 28 minutes.

Final Chapter. 26 minutes.

By Herself: Dear Papa. 30 minutes.

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Death on My Own Terms: Right or Privilege. 57 minutes.

Full Circle. 29 minutes.

Grief, Loss and Older Adults. 20 minutes.

Grieving: Suddenly Alone. 26 minutes.

In Your Hands. 19 minutes.

A Late Frost. 55 minutes.

Understanding Advance Directives. 8 minutes.

The following videos are available from Films for the Humanities & Sciences, http://www.films.com (1-800-257-5126): Before I Die: Medical Care and Personal Choices. 60 minutes.

Death: An Overview. 50 minutes.

Death: What Does It Mean to Die? 52 minutes.

A Desperate Act: Suicide and the Elderly. 23 minutes.

Dying with Dignity: The Sun City Choice. 12 minutes.

Grief: The Courageous Journey. 7 videos. 24 minutes each.

Loss of a Family Loss of a Daughter Loss of a Son Loss of a Spouse Facing death Understanding Grief Portraits of Grief I’m Really Going to Miss Me: Coping with Terminal Illness. 59 minutes.

Letting Go: A Hospice Journey. 90 minutes.

Managing Care, Managing Death: Disguised Euthanasia. 29 minutes.

On Our Own Terms: Moyers on Dying in America. 4 part series. 90 minutes each.

The Physical Aspects of Death: The Death Knell of Old Age. 25 minutes.

With Eyes Open: Coping with Death. 4 part series. 30 minutes each.

Grief and Healing Difficult Decisions: When a Loved One Approaches Death Caregiving Beyond Life and Death Who Plays God? Medicine, Money, and Ethics in American Health Care. 2 hours.

The following videos are available from Fanlight Productions, http://www.fanlight.com (800-937-4113): How I Coped When Mommy Died. 26 minutes.

Grief in America. 55 minutes.

The Right to Decide. 43 minutes.

Surviving Death: Stories of Grief. 47 minutes.

The Way We Die: Listening to the Terminally Ill. 25 minutes.

Those Who Stay Behind: When a Family Member Is Dying. 31 minutes.

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Chapter 14 The Economics of Aging

CHAPTER 14. THE ECONOMICS OF AGING • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking about Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Aging Policy and the Economy Economics is the science examining production, distribution, and consumption.

Economic problems arise because of the scarcity of resources. Because resources are limited, a society must decide what to produce and how to divide the goods and services among its members. Current economic debates focus on how best to distribute societal resources across generations.

II. The Changing Economic Status of the Aged Older people have experienced an increase in income of more than 95 percent in the past few decades regardless of marital status. Compared to the aged of the 1960s, the aged today have more diverse sources of income. Median net worth rises steadily over the life course, and begins to decline again after age 70. a. Today’s Older Generation Thirty years ago, the elderly were the least privileged group in the U.S. Since the 1960s there has been a great improvement in the economic position of the aged. b. Income Inequality in Later Life People that are poor younger tend to be poor older. Biggest stratifying characteristic are assets: savings accounts, 401k, rental properties etc… Some people are lucky because they inherit assets, others have to build them over time c. The Aging of the Baby Boomers The baby boomers have not had the economic security that their parents have had due to the sheer size of the cohort. However, baby boomers have married later, waited longer to have children, have had fewer children, and have benefited from intergenerational sharing. These factors have minimized the negative impact of the competition among the baby boom cohort.

III. Public Income Sources The current debate about social security is actually about the distribution of benefits among social assistance, social insurance, and fiscal welfare programs.

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a. The Status of Social Security The Social Security system has worked well to date in reducing poverty and delivering benefits at low administrative cost, but confidence in the system has been declining.

1. Social Security and the Federal Budget - Payroll taxes are deposited into the government’s general treasury, and a corresponding amount in special Treasury bonds are issued to the trust funds. Consequently, benefits are then paid out of general treasury with corresponding reductions made in the securities held by the trust fund.

2. The Future of the Trust Fund - Currently, there is more credit in the trust funds than is required to pay Social Security benefits, but various estimates project a depletion of the fund by 2037. The crisis results from the aging of the baby boom generation, the slowing of population growth, and increased longevity. b. Restoring the Trust Fund 1. Raising the Retirement Age - One of the proposed solutions to address the Social Security problem is to raise the normal retirement age to 70, and another is to link it to life expectancy. The latter proposal is problematic since ethical and racial groups have lower life expectancies than Caucasians. When the Social Security Act was passed in 1935, the average life expectancy was 61 years. Another problem with raising the retirement age is the competition for employment among all age groups.

2. Reducing Benefits - Benefits can be reduced by tinkering with the formula for calculating what people receive by lengthening the years of work needed for full benefits or by decreasing what high earners receive. Also, benefits can also be decoupled from cost-of-living increases.

3. Increasing Revenues Increasing the payroll tax rate would increase revenues; however, the burden would fall most heavily on young workers who already pay more in payroll taxes than they do in income taxes. c. Means Testing The affluence test is another proposal to address the Social Security crisis. This test would reduce benefits to higher-income individuals and would be administered through the tax system. A means test would discourage savings and undermine the political support for the program. d. Privatization Privatization has numerous problems. First, the stock market could plunge, leaving retirees with little money. Second, the system does not have income redistribution built into it. Finally, there is a risk of life crisis.

IV. Private Sources of Income in Old Age Most people have diverse sources of income in old age. a. Employer Pensions 1. Defined Benefits - Defined benefits (DB) plans provide a guaranteed monthly benefit based on the company’s vesting rules (years of service) and prior earnings. Access to such plans is limited, vesting rules exclude many workers, and many DB plans are not indexed to inflation. Bad planning, Quadagno: Aging and The Life Course, 6e

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Chapter 14 The Economics of Aging

poor investments, fraud, or embezzlement have often left insufficient funds to cover promised benefits. The Employee Retirement Income Security Act (ERISA) of 1974 and the Pension Benefit Guaranty Corporation (PBGC) partly address these problems, but the high costs to companies and taxpayers have led to a decline in such plans.

2. Defined Contributions - Defined contribution plans are contractual arrangements between worker and employer. Participation is voluntary.

One problem with the plan is workers may have to withdraw funds before retirement. Another problem is that workers are sometimes required to allocate their contributions to company stocks. b. Personal Savings The last part of the three-legged stool of retirement income is private savings. The Individual Retirement Account (IRA) allows certain groups of workers and their spouses to contribute a yearly amount without paying taxes on income or the earnings. There are numerous benefits to saving; however, one problem in planning for retirement saving is that the future cannot be predicted.

CLASS DISCUSSION TOPICS 1. Income and Wealth Trends: Engage students in a discussion of income and wealth trends. Ask them to compare their projected lives with their parents in the areas of housing, employment, income, savings, and leisure time activities. What are some differences?

2. Poverty in Old Age: Role play different categories of social class among the elderly.

Be sure to integrate materials related to cumulative effects of employment, housing, savings and investment over the life course.

3. Social Security: What are student attitudes toward the Social Security system, and what do they think should be done to ensure its survival? You might administer one of the attitude tests on Social Security, available on a number of websites. How do their attitudes compare with the major Social Security reform proposals? Also, have students visit the Social Security Administration website to calculate their projected Social Security benefits.

4. Retirement Planning: Ask students when they plan to retire. What will they do when they retire, and what will be their sources of income during retirement?

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Social Security Reform: Organize students into groups to address the major proposals for Social Security reform (raising the retirement age, reducing benefits, or reducing revenues). Have students share their research in a public forum that ends with an attempt to gain consensus on directions for reform. Compare the results of the student forum to national attitudes toward Social Security reform.

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Chapter 14 The Economics of Aging

2. Privatization: Privatization would shift responsibility for old age security from the Social Security Administration to individual Americans. Develop case studies representing different sectors of American society—corporate class, upper middle class, middle class, working men and women, homemakers and caregivers, the chronically unemployed, working-class poor, and immigrants. Have each team or individual student explore the potential impact of privatization on their “case.” Share the results and explore public policy options to enhance retirement investment return while providing a safety net.

3.Old Age Income Security: Assign students to research various aspects of income security and insecurity in old age. One group could research the potential impact of intergenerational sharing and inheritance across generations. Another could examine access to private pensions and assets beyond Social Security. Home equity and access to home ownership could be the focus of a third group. Each group should focus on an ethnic/racial group, a specific household structure, and the impact of a catastrophic illness for the family. Each group should examine the impact of current and proposed policies related to old-age security on their group. Have students share the results of their research in a class discussion focused on policy responses.

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. Social Security obviously benefits the aged; how might it benefit younger groups?

Social Security can be seen as an intergenerational income transfer program.

Younger working members are pooling their resources to provide fiscal and health insurance to older members of their family.

2. Of the three ways to restore solvency to the Social Security trust fund—raising the retirement age, reducing benefits, and increasing revenues—which would you favor? Why? Pros and cons of the three ways to restore the fund should be a part of the discussion. During this discussion, students’ value systems will be explicitly or implicitly described.

3. Would you favor means-testing of Social Security beneficiaries? Why or why not?

Means-testing undermines the universal support for such programs, and thus their long-term viability. Means-testing also stigmatizes recipients. An affluence test, on the other hand, does not carry a stigma, although it might undermine support from those sectors of society that pay the most into the system.

4. Aside from the need to find a solution to the looming Social Security crisis, what other benefits might privatization of the federal pension program bring?

In shifting the burden to individuals, privatization might increase personal and familial responsibility for intergenerational care and support. Workers could receive a better rate of return on their investments, and it could create a stimulus for the economy.

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Chapter 14 The Economics of Aging

5. Could the federal government do more to encourage people to save for their retirement? Be specific.

The government could expand the percentage of income that could be invested in tax-exempt accounts. Guaranteed living wages would also enable a greater portion of the society to invest in retirement savings. Furthermore, tax or incentive policies could encourage employers to contribute to employee savings plans.

6. Could the federal government do more to encourage and help people build asset portfolios throughout the life course? What other ways can society help encourage asset development?

The government could offer subsidies for people wanting to invest their money in long-term vehicles by reducing taxes on interest earned.

LECTURE/CLASS ACTIVITY IDEAS 1. Invite an economist to come and speak with the class about income security and insecurity during the later years.

2. Examine the local or national newspaper for recent articles or debates on Social Security reform. How do these reforms compare with those discussed in the text?

3. Organize a debate or invite speakers from AARP or the Social Security office to share the pros and cons of privatizing Social Security.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources Area Agencies on Aging State or local AARP office Local Social Security Administration office National Resources American Association of Retired People (http://www.aarp.org) National Bureau of Economic Research (http://www.nber.org) National Committee to Preserve Social Security and Medicare (www.ncpssm.org) National Council on Aging (http://www.ncoa.org) Pension Research Council (http://www.pensionresearchcouncil.org/boettner/) Social Security Administration (http://www.ssa.gov) The Social Security Network (http://www.ssa.gov) United for a Fair Economy (http://www.ufenet.org)

INTERNET RESOURCES AND ACTIVITIES

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Chapter 14 The Economics of Aging

1. The AARP website (http://www.aarp.org) has extensive resources and links on economic and income issues related to aging.

2. The Employee Benefit Research Institute(http://www.ebri.org/) has several research studies (ongoing) that may be of interest to students. They include Social Security Reform Evaluation Research Program, Retirement Confidence Research, Small Employers Retirement Survey and the Defined Contribution Participant Research Program.

3. The Federal Intra-Agency Forum on Age-Related Statistics (http://www.agingstats.gov). Go to “Older Americans 2000: Key Indicators of WellBeing,” then to “Economics.” In addition to the investigation of poverty suggested in the text, there are several other economic indicators that could be explored on this site.

4. The Health and Retirement Study (http://hrsonline.isr.umich.edu/)is a rich source of cross-sectional and longitudinal data for policymakers and researchers on issues related to health and retirement.

SUGGESTED READINGS Attar-Schwartz, Shelhevet, Jo-Pei Tan, Ann Buchanan, Eirini Flouri and Julia Griggs.

2009. Grandparenting and adolescent adjustment in two-parent biological, lone-parent, and step-families. Journal of Family Psychology 23(1):67-75.

Garfinkel, Irwin, Lee Rainwater and Timothy Smeeding. 2010. Wealth and Welfare States: Is America a Laggard or Leader? New York: Oxford University Press.

Kail, Ben Lennox, Jill Quadagno and Jennifer Reid Keene. 2009. "The Political Economy Perspective in Aging." Pp. 555-571 in Handbook of Theories of Aging, edited

by Vern Bengtson, Merril Silverstein and Norella Putney. New York, NY: Springer.

Quadagno, Jill and JoEllen Pederson. 2012. “Attitudes toward Social Security in the United States, 2000 and 2010: Self-Interest or Political Ideology?” International Journal of Social Welfare.

Schulz, James and Robert Binstock. 2006. Aging Nation: The Economics and Politics of Growing Older in America. Baltimore, MD: Praeger.

Skocpol, Theda. 2000. The Missing Middle: Working Families and the Future of American Social Policy. New York: W. W. Norton. (Includes a discussion of the Social Security system.)

Smith, Spencer. 2011. “The Effect of Mortgage Distress on Retirement Savings: Evidence from the PSID.” Ann Arbor: University of Michigan. Retrieved from: http://deepblue.lib.umich.edu/bitstream/2027.42/.../spenceds-revised.pdf Quadagno: Aging and The Life Course, 6e

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FILMS AND VIDEOS Watch for documentaries or news analyses on Social Security and retirement economics.

The following videos are available from Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643; http://www.terranova.org (1-800-779-8491): When She Gets Old. 28 minutes.

The Living Trust Video. 55 minutes.

Social Insecurity: Work, Family, and Retirement, 60 minutes. Available from PBS at (http://www.pbs.org).

Pension Shock: The Future Is Now (2012) George Lee returns with a special one hour documentary - Pensions Shock: The Future is Now - that looks at the looming pensions crisis in Ireland. From the top down pensions are fast becoming unaffordable and everyone faces a more difficult retirement than the one they imagined. Online: http://www.rte.ie/tv/programmes/pensionshock.html Historic Social Security Films DVD: 1935 - 1962 US Social Security Administration & Retirement System History & Social Security Act Speech Films - Social Security has long been debated in American politics. This compilation includes (3) three vintage films about the controversial social security system spanning over 25 years. Table Of Contents: (1) FDR Social Security Act Speech (1935) - Our Thirty-Second President, Franklin D. Roosevelt, sign the Social Security and then speaks about its importance to the American people - 2 Minutes (2) Your Social Security (1940s) - Social security promotional and information film designed to educate the public about how the social security systems works, who can benefit from its service, and how money is collected and distributed - 17 Minutes (3) The Social Security Story (1962) - An interesting tour of the Social Security building and operations center in Baltimore, Maryland - 13 Minutes. Available on Amazon for $13.00.

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Chapter 15 Poverty and Inequality

CHAPTER 15. POVERTY AND INEQUALITY • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking about Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Aging and Social Stratification Age is a form of social stratification. All human societies use it, as well as gender and kinship, to assign people to social roles and rank individuals in a hierarchy. a. The Theory of Cumulative Disadvantage The theory of cumulative disadvantage integrates a life course framework for analyzing stratification among the aged. It states that although people may move up or down the social ladder, generally those who begin life with greater resources have more opportunities to acquire additional resources, and those who begin life with little resources fall further and further behind. b. Income and Poverty Older people have lower poverty rates than people of other age groups. However, women of all ethnic/racial groups have higher poverty rates than men. The income differential by ethnicity/race can be attributed to sources of income.

Social Security constitutes a larger share of income for older ethnic/racial subordinate groups than it does for older Caucasians. The largest source of income disparity is from assets. Women are less likely than men to receive income from private pensions, and for those women who do, as for pensioners from subordinate ethnic/racial groups, the amount of pension is likely to be small.

II. Gender Inequality in Old Age Gender inequality in old age is a consequence of the division of labor and women’s commitment to familial responsibilities over careers. a. Patterns of Gender Inequality Most older women 65 and over have moved in and out of the labor force to care for children and aging parents. Women who move in and out of the labor force are penalized by Social Security and pension benefit rules that favor an orderly work history. b. Inequality in Social Security Income 1. Paid Work and Eligibility for Social Security - Social Security rewards high earners and people with stable work histories. One recommendation to the Social Security rule for women is to base benefits on gender recognition.

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Chapter 15 Poverty and Inequality

women have been caregivers for their children. There is a possibility that gender differences in Social Security benefits may disappear due women working more continuously and the increase in job instability among men.

2. Unpaid Work and Eligibility for Social Security - Women also obtain access to Social Security benefits through their unpaid labor as dependents of male breadwinners, through spouse and widow benefits amendments passed in 1939. Social Security is important for women. Of Social Security beneficiaries age 62 or older, 58 percent are women; 71 percent of beneficiaries 85 or older are women. Recent reforms in Social Security have emphasized gender neutrality. A man or woman married to a worker who retires at 65 can receive a spouse benefit equal to 50% of the worker’s benefit. Those who have worked and are eligible for spouse benefits are dually entitled. Under this entitlement, an individual receives a benefit as a worker plus an additional amount of the worker benefit if the benefit is less than that of the spouse. A survivor’s benefit is equal to 100 percent of the worker benefit. Because of the way spousal and survivor benefits are calculated, a two-earner couple pays more in taxes and receives lower benefits. There are different opinions on how to correct the inequity. Several anomalies in divorce, spousal, and survivor benefits might be eliminated through a universal minimum benefit. c. Inequality in Supplemental Security Income Supplemental Security Income (SSI) provides income for the aged, blind, and disabled poor; nearly 74 percent of the aged who receive SSI are women. The average monthly SSI payment was $646.00 in 2003. The safety net of SSI, Social Security, and Food Stamps in the U.S. explains why so many older women live in poverty, in contrast to older women in countries with a universal basic pension. d. Inequality in Employer Pension Coverage 1. Pension Benefits - Women who have worked in jobs that lack pension coverage, or worked in small firms, or who have interrupted work histories may fail to have a pension or have reduced pension benefits.

2. Survivor’s Benefits - Under the Retirement Equity Act of 1984 (REA), spouses were protected in the event of death or divorce by requiring that pensions for married employees be joint and survivor annuities. The REA also allowed pension-splitting to become part of a divorce decree. One major problem with REA is that it only applies to private sector workers.

III. Race, Ethnicity, and Inequality Race/ethnicity is another form of social stratification that impacts on life chances. Racial disparities in income still exist. In 2004 the median income for non-Hispanic whites was $49,019 compared to $30,288 for blacks. a. The Social Construction of Race and Ethnicity Most of the information on ethnic/racial subordinate groups comes from the Census Bureau, which has relied on self-reporting since 1970. b. Racial and Ethnic Variations among the Aged 1. The African American Elderly - The economic position of some older African Americans can only be understood from a life course perspective of Quadagno: Aging and The Life Course, 6e

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cumulative disadvantage. Due to higher rates of unemployment, more sporadic employment, and lower wages, African Americans have had fewer opportunities to become vested in private pension plans or to accumulate savings. Racial discrimination has also impeded the accumulation of wealth by African Americans, primarily through racial discrimination by realtors, Caucasian neighborhoods, and the federal government as a grantor of housing and housing loans.

2. The Hispanic Elderly - Hispanics constitute the largest ethnic/racial minority group in the U.S. The three largest groups of Hispanics are Cubans, Mexicans, and Puerto Ricans. Of all Hispanic groups, Puerto Rican families are the most disadvantaged. Poverty rates are highest for Puerto Ricans (31.7%), followed by Mexicans (23.1%), and then Cubans (12.1%). Many older Hispanics have no health insurance coverage, work in seasonal or sporadic jobs or occupations not covered by Social Security, or have worked for long periods as illegal aliens.

3. The Asian Elderly - Older Asians constitute a diverse population. Some, like Chinese men, migrated to the West Coast in the twentieth century to build the railroads. Others, like the Vietnamese and Cambodians, came to the U.S. in the 1970s as political refugees. Asians, as a whole, have the lowest poverty rate of any ethnic/racial minority group, and older Asian women have lower poverty rates than Caucasian women.

4. The Native American Elderly - The U.S. has nearly 500 federally recognized tribes and more than 300 languages among the indigenous Indians. They have the highest unemployment and mortality rates of any subordinate ethnic/racial group due to federal policy created in the nineteenth century.

The general health of the majority of Indians has improved, thus increasing the life expectancy due to the Indian Health Service (HIS), which stipulates that health care must be provided at no cost as reparation for land taken from them.

5. Minorities in Canada and Europe - Like the U. S., Canada and Great Britain are struggling with some of the same problems of cumulative disadvantage among their ethnic groups.

CLASS DISCUSSION TOPICS 1. Gender and Race in Old Age: Assign students to a specific gender and ethnic/racial identity for the class session. Present a scenario (inadequate housing, or not enough money to cover medical bills) that students will need to address with this identity. How do students react to their assigned identity? How do they imagine addressing the problems of old age typical of this group?

2. Social Security Inequalities: Discuss the basis for inequalities in Social Security benefits and the various proposals for correcting the inequalities.

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3. Survivor Benefits: Discuss current laws and regulations protecting surviving spouses for Social Security and pension benefits. Can other things be done to insure equity and income security of survivors?

4. Strengths of Ethnic Communities: Describe some examples that older subordinate ethnic/racial group members use to address cumulative disadvantage. Do you think that you might integrate some of these examples in your life during this same chronological time?

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Ethnic Diversity in Aging: Assign teams of students to research the social construction of aging among four minority groups: African American, Hispanic, Asian, and Native American. What characteristics do aging members of these groups share? What accounts for the economic situation of the various groups? What changes in Social Security and other public policy might better serve the needs of a diverse and aging population?

2. Work Histories and Aging: Assign groups of students focus on typical work histories of women and racial/ethnic minorities in the U.S. to determine differences in earnings, Social Security benefits, wealth and assets, and work-related pensions. Share the results of the teams’ research in class, with a view toward formulating policy directions to address the disparities.

3. Gender and Marriage Penalties in Old Age: Students can research the various penalties and obstacles confronted by women (especially married women who devoted years to caregiving) in Social Security and pension benefits. A useful resource is the conference proceedings on women and social security published by the Institute for Women’s Policy Research (http://www.iwpr.org).

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. Which do you think has a more powerful effect on an aged person’s economic well-being: gender or race and ethnicity?

For older ethnic/racial groups, it may be impossible to distinguish one from the other.

However, due to social changes in employment opportunities as well as changes made about by the Retirement Equity Act, it may be possible to designate one of these forms of stratification as being the most powerful. One must take into consideration historical events, and longitudinal data would be effective to address the question completely.

2. From a purely economic point of view, would a young woman be better off in old age by marrying or by staying single and working?

It could vary. A woman could marry and her spouse might become disabled, or he might die prior to middle age. On the other hand, a single working woman could encounter health issues, an accident, or a major health tragedy in her family. If one

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Chapter 15 Poverty and Inequality

could predict (with certainty) certain life course events, a definitive answer would be available.

3. Why haven’t women’s organizations or retired people’s associations made the problem of poverty among elderly women a priority? Should they be doing more to solve it?

The focus of women’s organizations on improving women’s occupational opportunities and wages, together with the promotion of public policies that allow women to fulfill family obligations without leaving the labor force, ultimately contributes to eliminating the problem of poverty among elderly women. Both women’s organizations and retired people’s associations tend to represent the interests of Caucasians and the middle to upper class, and thus are less likely to focus on the poverty of elderly women that is concentrated among ethnically/racially subordinate women. This raises the question of what interests the retired people’s organizations, like the AARP, represent.

4. What can government do to increase the economic security of minority group members in their old age?

Address some of the inequities currently in the system and consider the possibility of a universal social insurance/pension plan like many European countries have.

5. Can you think of a way to increase the well-being of minority groups in their old age that does not involve the government?

Even employment and retirement policies of private companies ultimately depend upon governmental fiscal welfare. The argument that faith-based organizations and “communities” can support elders and other groups is gaining attention, but this calls for serious scrutiny. Largely segregated communities and churches in the U.S. undermine serious efforts to address inequities on a private basis since they do not have the resources, and wealthy Caucasian communities often lack awareness or motivation.

LECTURE/CLASS ACTIVITY IDEAS 1. Invite representatives of women’s or retirement organizations to address the problem posed in question 3 of “Thinking About Aging.” This should generate lively discussion.

What are some similarities or differences in their response to the question?

2. Invite advocates and caregivers who work with ethnic/racial minority communities to address the particular strengths and problems encountered by aging ethnic/racial subordinate groups.

COMMUNITY, STATE, AND NATIONAL RESOURCES Community and State Resources Area Agencies on Aging Local AARP office Quadagno: Aging and The Life Course, 6e

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Chapter 15 Poverty and Inequality

Senior Centers and Advocacy Groups for Women and Minorities National Resources Administration on Aging (http://www.aoa.gov/) AARP (http://www.aarp.org) National Caucus and Center for the Black Aged (http://www.ncba-blackaged.org) National Hispanic Council on Aging (http://www.nhcoa.org) Older Women’s League (OWL) (http://www.owl-national.org) Social Security Administration (http://www.ssa.gov) U.S. Bureau of the Census (http://www.census.gov): See latest reports on poverty and income.

INTERNET RESOURCES AND ACTIVITIES 1. The AARP (http://www.aarp.org/work/social-security/info-11-2012/social-securityolder-minorities.html) has published a special report on Older Minorities and has resources related to specific minority groups, including women. In addition, it has the article, “A Portrait of Older Americans.”

2. The National Academy of Social Insurance (http://www.nasi.org/) publishes regular working papers on various topics related to income security, including the impact of health issues, attitudes toward Social Security, proposals for Social Security reform, and so on.

3. The Older Women’s League (http://www.owl-national.org/) has numerous articles and reports related to older women. There is a section on current initiatives and OWL Reports.

4. The Social Security Administration (http://www.socialsecurity.gov/) has articles and reports related to older people living in poverty.

SUGGESTED READINGS Bond Huie, Stephanie, Patrick Krueger, Richard Rogers and Robert Hummer. 2003.

“Wealth, Race and Mortality.” Social Science Quarterly 84(3):667-684.

Calasanti, Toni and K. Jill Kiecolt. 2007. Diversity among late-life couples. Generations 31:10-17.

Glynn, Sarah, and Audrey Powers. 2012. “The Top 10 Facts about the Wage Gap.” Center for American Progress; http://www.americanprogress.org/issues/2012/04/wage_gap_facts.html Harrington Meyer, Madonna and Pamela Herd. 2007. Market Friendly or Family Friendly? The State and Gender Inequality in Old Age. New York: Russell Sage.

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Johnson, Colleen L. 2000. “Adaptation of Oldest Old Black Americans.” In Intersections of Aging: Readings in Social Gerontology, edited by Elizabeth W. Markson and Lisa Ann Hollis-Sawyer, 133–41. Los Angeles: Roxbury.

Wilmoth, Janet. 2012. “A Demographic Profile of Older Immigrants in the United States.” Public Policy and Aging Report 22(2):8-11.

Wright, Rosemary. 2012. “Paying for Retirement: Sex Differences in Inclusion in Employer-Provided Retirement Plans.” The Gerontologist 52(2):231-244.

Wu, Ke Bin. 2009. “Family Income Sources for Older Persons, 2009.” AARP Fact Sheet.

FILMS AND VIDEOS The following videos are available from Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643; http://www.terranova.org (1-800-779-8491): Ethnic Diversity: Barrier or Benefit in Health Care of the Elderly? 120 minutes.

Images of Aging. 21 minutes.

Legacy. 30 minutes. (On Native Americans.)

When Help Was There: Four Stories of Elder Abuse. 19 minutes.

When She Gets Old. 28 minutes.

UNNATURAL CAUSES (2008) is the acclaimed documentary series broadcast by PBS and now used by thousands of organizations around the country to tackle the root causes of our alarming socio-economic and racial inequities in health. Available online: http://www.unnaturalcauses.org/about_the_series.php

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Chapter 16 The Politics of Aging

CHAPTER 16. THE POLITICS OF AGING • • • • • • • • •

Chapter Outline Class Discussion Topics Student Project and Research Suggestions Answer Guidelines for “Thinking about Aging” Questions Lecture/Class Activity Ideas Community, State, and National Resources Internet Resources and Activities Suggested Readings Films and Videos

CHAPTER OUTLINE I. Political Activism Among the Elderly Older adults tend to exercise their political preferences, and these preferences have an impact on programs and social policies. a. Voting 1. Age and Cohort Differences in Voter Turnout. Age has been a consistent predictor of voter registration. Older people are more likely to register and vote. The voting patterns by age represent the classic problem of separating age, cohort, and period effects. In 2008, voter turnout among younger people rose to 54%, which was even greater among college students. Health disabilities negative affect voter turnout among disabled old.

2. Age and Voting Preferences. Older Americans do not engage in bloc voting.

Symbolic politics theory, which states that behavior and attitudes are more strongly linked to personal beliefs than to material interests, applies to older voters. Gender, race, income, and educational levels are much more important in predicting support for Social Security and Welfare. Women, African Americans, and Hispanics, low-income people, and people with less than a high school education are most likely to say the government does not spend enough on the elderly because they depend most on government programs. Despite the lack of evidence that people vote their age, politicians still believe that older people carry clout at the ballot box, a perception that allows old-age advocacy groups to employ the “electoral bluff,” which says that politicians ignore the interests of the elderly at their own peril. 2008 shows that voting preferences differ by age. Younger more likely to vote Obama, because older white men less likely to choose him. Gender, race, income, and education better predictors of support for Social Security and Medicare b. Interest Group Politics 1. The Rise of Interest Group Politics - Interest groups assumed a central role in the twentieth century due to a decline in political parties, the emergence of powerful large corporations, and the civil rights and anti-Vietnam War movements of the 1960s. Legislation proposed by interest groups is not Quadagno: Aging and The Life Course, 6e

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Chapter 16 The Politics of Aging

automatically enacted, nor are interest groups always able to block legislation contrary to the interest of members.

2. The Growth of the Gray Lobby - The growth of the gray lobby in the 1960s, 70s and 80s can be explained by the battle over health insurance for the aged, the convening of the White House Conference on Aging, and threats to the Social Security system during the Carter and Reagan administrations.

3. The Major Senior Organizations - AARP is the largest voluntary organization in the US, with some 35 million members, a paid staff of 1,300, and an annual budget of a quarter of a billion dollars. It was founded in 1958.

Because of its broad-based constituency, AARP tends to take middle-ofthe-road positions. Other organizations, including the National Council of Senior Citizens, the National Committee to Preserve Social Security and Medicare, and the National Association of Retired Federal Employees represent the more specialized interests of their membership. There have been some exceptional cases in which age-interest groups have been very effective, but most legislation for older people has been proposed by other age groups. c. Social Movement Politics 1. The Townsend Movement. Older people are least likely of all age groups to be adherents to a social movement operating through noninstitutional methods. The first major social movement, the Townsend Movement, was founded by the physician, Dr. Francis Townsend in 1933. Its goal was to give every person over the age of 65 a pension of $150 a month. The Townsend Movement was the forerunner of the Social Security Program.

2. Medicare Catastrophic Coverage Act of 1988 - The next major elder social movement organized in response to the Medicare Catastrophic Coverage Act of 1988, which would have been financed with a surtax to be paid by middle- and upper-income aged. Congressional offices were inundated with mail opposing this legislation, so it was repealed in October 1989. d. The Aged as Political Office Holders Generally, the higher the office, the older the age of the officeholder. Age sometimes arises as an issue when someone of advanced age runs for political office, although interests and positions seem to be more important to most voters.

McCain’s age worked against him with younger voters. e. Other Forms of Political Involvement Older people are more likely than younger people to follow primary contests, to watch party conventions on television, and to become involved in political party activities. For example, they work in voter registration drives, help recruit local candidates to run for office, and remain involved in party organizations.

II. Political Debates about the Aged There is debate about entitlement programs such as Social Security and Medicare.

However, much of this debate is really about the future of these two programs, not about whether they should continue to exist.

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Chapter 16 The Politics of Aging

a. The Deserving Elderly Poverty among the elderly declined significantly with the passage of Medicare and Medicaid, substantial increases in Social Security benefits, and automatic cost-of-living increases added to Social Security. The increase in economic security for the aged has not translated in the same increase for children. b. The Generational Equity Debate The generational equity debate notes that the elderly have been the beneficiaries of the unfair distribution of public resources that have left them better off, financially, than younger groups. The central question is whether there is a tradeoff in spending on the elderly instead of on children.

1. Generational Equity in Comparative Perspective. Other countries like Great Britain and New Zealand have focused on this issue. Canada, however, does not perceive it as an issue, because it has a national health insurance program for all people, regardless of age and income, it does not have a gray lobby that has been visible like in the U.S., and the poverty levels of children and he elderly have converged in Canada, while this has not been true for the U.S. 2. Is Generational Conflict Likely in the Future? Despite the media fixation with impending generational warfare, most Americans have not bought the scenario, perhaps because the aged are visible and present in all American families. c. The Entitlement Crisis The notion of an entitlement crisis is centered on two areas: First, about one-third of the federal budget is devoted to programs for older people; second, spending on the elderly will increase as the baby boom generation reaches retirement age. The core thesis of the entitlement crisis is that entitlement spending is consuming a disproportionate share of the federal budget, crowding out other social needs.

Spending on the three largest programs—Social Security, Medicare, and Medicaid—has been stable for more than a decade, and by the late 1990s, the budget deficit had disappeared. The long-term problem of financing the Social Security program needs to be resolved. d. The Ownership Society Recent efforts to dramatically change the nature of Social Security have focused on creating what is called an “ownership society.” This would occur through privatization, where workers would be allowed to divert a portion of their share of payroll taxes into private accounts.

CLASS DISCUSSION TOPICS 1. The Gray Lobby: Check out any issues in which the Gray Panthers have been involved recently. How successful was the organization in addressing the issue?

2. Generational Conflict: Ask students to share their thoughts regarding the generational war. For example, can they observe this issue in their own family? Will this issue become a prevalent one in 20 to 25 years?

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Chapter 16 The Politics of Aging

3. Entitlement Crisis: Is there an entitlement crisis? What factors will influence spending on Social Security, Medicare, and Medicaid?

STUDENT PROJECT AND RESEARCH SUGGESTIONS 1. Age and Politics: Research on interest group politics and age suggests that seniors do not constitute a monolithic group, and that groups other than the aged have proposed most legislation benefiting older people, although elder lobbies have worked to preserve existing benefits. Have students choose particular issues, like Social Security, prescription drug benefits, Medicare, and long-term care to see what initiatives and positions have been taken by senior organizations, and what other groups are currently doing in response to these issues. The website (http://www.opensecrets.org) has extensive information on funding, and students should be able to find more specifics on organizational activity through major organizations. Theda Skocpol’s The Missing Middle also has extensive documentation on historical support for Social Security, Medicare, and other programs. An alternative project is to have several older adults from different ethnic/racial groups to share their political experiences on certain issues or their participation in political activities. Are their experiences illustrative of rational choice theory or symbolic politics theory?

2. Senior Organizational Politics: Ken Dychtwald and others have criticized AARP and other senior organizations that advocate for senior interests to the extent that they may be creating generational conflict over limited resources. Assign teams of students to investigate the positions and activities of major senior organizations with local offices in your town or city. Students should investigate the national politics of these organizations as well, but it would be useful for them to visit local offices and interview representatives and members. Besides sharing the results of their research, students could develop criteria by which to assess the extent to which senior organizations take positions that are generationally inclusive.

3. Entitlement Crisis: Assign students to prepare for a class debate with a group of older adults on whether or not there is an entitlement crisis? If there is one ,what solutions can the two groups offer to address it?

ANSWER GUIDELINES FOR “THINKING ABOUT AGING” QUESTIONS 1. What do you think is the single most pressing political issue for older Americans?

Students may give varying responses. One issue is whether programs like Social Security and Medicare should be available based on entitlement or some other criteria. A second is the issue of generational equity. Will it be a pressing concern in 15 or 20 years?

2. The “gray lobby” has been advocating prescription drug coverage for the aged for some time. What interest groups might oppose such legislation? Would some older Americans belong to those interest groups?

Some older Americans identify with prescription drug companies because of their employment history, their general identification with business interests, or their stock portfolios. As the debate is currently framed, the dividing issue is whether Quadagno: Aging and The Life Course, 6e

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Chapter 16 The Politics of Aging

prescription drugs will be financed through private insurance or governmentsubsidized programs.

3. Today’s older Americans tend to engage in the same kind of political activity they did when they were younger. When the baby boom generation retires, what kind of political activity can we expect to see from them? Be specific.

Putnam’s Bowling Alone is a good resource on this. Baby boomers are more likely to engage in social and protest movements. For example, there may be widespread protest by baby boomers if there are major changes, even necessary ones, in entitlement programs like Social Security and Medicare.

4. Now that Americans are living longer, should there be an upper limit on the age of candidates for high public office? Why or why not?

Studies indicate that older individuals have the capability to retain information placed in long term-storage. Because there are complex and extensive social issues occurring in a society, it is ideal to have older adults serving in public office. Also, the wisdom and experience older adults have can be essential in addressing social issues.

5. Do you think children in the United States deserve the same degree of support from their government as the aged? Explain your reasoning in sociological terms.

Children represent the future generation. If there is not significant investment in children, who will support older adults in the future? For example, the generational equity debate is nonexistent in Canada, where there is a national health insurance program for all people, regardless of age and income LECTURE/CLASS ACTIVITY IDEAS 1. Present examples of European systems that manage to provide for the needs of children and the aged. How do these systems differ from the U.S. system? Do students feel that such programs could work in the U.S.? How might such programs be “sold” to the American public?

2. Present Putnam’s data on the political and community involvement of today’s elders, the baby boom generation, and younger generations. Discussion of these trends should be especially interesting if different generations are represented in your class. What influences the extent of involvement in the baby boom generation and in younger generations? How involved are the students now? If they are not involved, what reasons do they give? Do they believe their involvement will change as they age?

3. Present data on voting preference by age for 2008 presidential candidates. What are the reasons for differences by age? What other factors count in affinity with social issues like Social Security and Medicare? What historical trends in voting are apparent among older white men?

COMMUNITY, STATE, AND NATIONAL RESOURCES

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Chapter 16 The Politics of Aging

Community and State Resources Area Agencies on Aging Senior Centers Political parties AARP and other senior organizations National Resources Major senior organizations cited in previous chapters, in addition to the two organizations listed in Internet Resources, below.

INTERNET RESOURCES AND ACTIVITIES 1. In January 2001, the National Council of Senior Citizens (http://www.ncscinc.org/) ceased operations and endorsed a new organization, the Alliance for Retired Americans (http://www.retiredamericans.org), an AFL-CIO-affiliated organization that has adopted many of the positions the National Council of Senior Citizens advocated for 39 years.

The website of the Alliance has positions on several issues, including Social Security, prescription drug benefits, Medicare, affordable housing, long-term care, poverty, and Medicaid. News items posted regularly follow the ongoing debates and legislative developments.

2. The Gray Panthers (http://www.graypanthers.org) organizes around social and economic interests on an intergenerational basis. After the death of its founder Maggie Kuhn in 1995, the organization went through a bit of a slump, but seems to be revitalizing itself. Students can access positions on a number of issues and link to other advocacy groups. Students can also search by state for local chapters.

3. “Latino Vote Marked by ‘Generation Gap’” - Education and conservative views of family values are among the leading concerns of Latino voters, while immigration issues fall well down the list. But young Latinos may be reshaping overall voting tendencies.

Available online from NPR: http://www.npr.org/templates/story/story.php?storyId=18468236

SUGGESTED READINGS Amenta, Edwin, Neal Caren, Elizabeth Chiarello and Yang Su. 2010. “The Political Consequences of Social Movements.” Annual Review of Sociology 36:287-307.

Freedman, Marc. 2000. Prime Time: How Baby-Boomers Will Revolutionize Retirement and Transform America. Public Affairs.

Lynch, Fredrick. 2011. One Nation Under AARP. Berkeley: University of California Press.

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Chapter 16 The Politics of Aging

McCall Leslie and Lane Kenworthy. 2009. “Americans’ Social Policy Preferences in the Era of Rising Inequality.” Perspectives on Politics 7(3):459-484.

Pederson, JoEllen and Jill Quadagno. 2012. “The Three Pillar Approach to Pension Reform: Pathways to Welfare State Restructuring.” In Global Dynamics of Aging, edited

by Sheying Chen and Jason Powell. Hauppauge, NY: Nova Science Publishers.

Putnam, Robert D. 2000. Bowling Alone: The Collapse and Revival of American Community. New York: Simon & Schuster.

Quadagno, Jill. 2005. One Nation, Uninsured: Why the US Has No National Health Insurance. New York, NY: Oxford University Press.

Skocpol, Theda. 2000. The Missing Middle: Working Families and the Future of American Social Policy. New York: W.W. Norton.

FILMS AND VIDEOS The following videos are available from Terra Nova Films, 9848 South Winchester Avenue, Chicago, IL 60643; http://www.terranova.org (1-800-779-8491): Charting New Waters: Responding to Violence against Women with Disabilities.

35 minutes.

Maggie. 21 minutes.

Medicare and Medicaid at 40 (2005) The Kaiser Family Foundation has produced three documentaries to mark the 40th anniversary of Medicare and Medicaid. The documentaries examine the social needs that led policymakers to create these programs, the expectations of what they would achieve and the reality of these programs today. Key policymakers, staff officials and members of Congress involved in the creation and implementation of Medicare and Medicaid are interviewed. Extensive use of historic video helps tell the story of these landmark social programs. There are three documentaries; one about Medicare only, one about Medicaid only and one that tells the story of both programs. All three are included in a single DVD. Free and available online: http://www.kff.org/medicaid/40yearsvideo.cfm US Health Care: The Good News (2012) The United States is the only industrialized democracy that doesn’t provide health care for all its citizens. Of course, we’d like to cover all of the 50 million uninsured, but how would you pay for it? In fact, we could.

The consensus view among health policy experts is that Americans pour enough money into health care — a $2.6 trillion industry — to have universal coverage. Available from PBS: http://www.pbs.org/programs/us-health-care-good-news/

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