Gero Exam 3

What are the ways that informal support systems often change as people age? Discuss the benefits of informal supports for physical and mental well-being in old age. The Beatles had a famous song with the line "I get by with a little help from my friends." Identify at least three ways that friendship networks can enhance well-being in old age. We often have an image that older adults live alone, are lonely, and are socially isolated. Cite evidence from the readings that is contrary to this image. List three challenges in accessing health and long-term care that LGBT elders may face compared to their heterosexual peers. What are some of the reasons that different studies and polls have varied findings regarding the number of LGBT elders in the total population? What are three of the ways that contemporary families are changing? Identify the primary reasons that there has been an increase in multigenerational families in the past decade. Discuss how living arrangements, such as whether one is living alone or with family or caring for grandchildren, may vary among older adults of color. What are two of the reasons why sibling relationships can be a powerful source of social support in old age? If you were training staff in a long-term care facility, such as a skilled nursing home, to respect older residents' privacy, what would you tell them about older adults' sexuality and desire for intimacy? Be sure to include the needs of LGBT elders in your response. What are some of the ways that the grandparenting role benefits both the grandparent and grandchild? What are some of the pros and cons of pet ownership for older adults?

Informal networks are vital to older adults' physical and mental well-being. Among these, the family is the most important source of support. Families include spouses/partners, adult children, parents, grandparents, and siblings, as well as people who may not be related to us biologically but who love and care for us—and vice versa—as loving family members do. Our definition of family is broader today than it was several generations ago, and we will continue to see more diverse and complex family structures and living arrangements in the future. Providers need to be sensitive to the wide variation of family forms that can be supportive environments, including grandparents as caregivers, LGBT partners, mothers who have delayed childbearing and are simultaneously caring for a toddler and an older parent, widowed, divorced, childless, or never-married older adults with extensive friendship networks, and elders of color with fictive kin networks. Additionally, friends and neighbors are vital sources of support for all age groups, and particularly for older adults who live alone. Another shift is the dramatic growth in multigenerational families. Health and human service providers in schools, community clinics, public child welfare, hospitals, and mental health centers, regardless of their area of expertise, will increasingly encounter three-, four-, and even five-generation families. All of these changes highlight the need for gerontological practitioners in a wide range of settings to gain skills in assessing and intervening with families, not only with the older person. Given the complexity of family forms, professionals will be challenged to think outside traditional age-based silos and models of service delivery, and develop new ways to utilize older adults as a civic resource. Some older adults are also finding support and companionship from their peers as they date, discover romance, and even marry or remarry late in life. Contrary to popular stereotypes, many older adults do desire intimacy and find enjoyment in various forms of sexual expression. Deep friendships can also be a source of comfort and support in one's later years. Creating more opportunities for reciprocal intergenerational relationships is a good way for older and younger people to enhance each other's lives and learn to value each other's contributions to society. Situating assisted living communities near preschools or elementary schools, for example, enables greater interaction between the generations. It seems inevitable that information and communication technologies will increasingly play a role in helping older adults remain connected and engaged, although they should not be a complete substitute for face-to-face human interaction. Older generations who use social media may actually learn much more about their younger family members than they would through the occasional and brief phone call or letter. To close, the majority of older persons continue to play a variety of social roles—partner, parent, grandparent, friend, and neighbor—and to derive feelings of satisfaction and self-worth from these interactions. The good news about the changing structure of families is that there are many more options, places, and relationships for elders to receive and give informal support. It could be in a traditional family environment, or it could be in an innovative living arrangement that several decades ago would not have been socially acceptable. Elders today and in the future will benefit from informal supports that come from a widening array of interpersonal relationships, including pets.

Discuss some reasons that informal and family caregiving is so essential to the American health and long-term care systems. List four of the physical, psychological, and economic costs of caregiving. Discuss at least three ways in which informal caregiving differs for women and men. What is the approximate monetary value of caregiving services provided by informal caregivers? What might be the reasons that our society does not fully value caregiving work? What is meant by subjective burden (as opposed to objective burden) as experienced by informal caregivers? What is a primary reason that feelings of subjective burden can vary among caregivers who are doing the same tasks? What are some positive aspects of being an informal caregiver? What kinds of services are funded by the National Family Caregiver Support Program (NFCSP)? Identify three types of interventions that have been found to reduce caregiver stress and enhance their well-being. Define different types of elder mistreatment: psychological abuse, financial exploitation, undue influence, and self-neglect. Describe the role that direct care workers play in our long-term care support environment. List three of the primary types of challenges that direct care workers face in the workplace.

Most of the caregiving in the United States is provided by informal caregivers as opposed to paid care. Informal caregivers include adult children, spouses/partners, other family members, friends, grandparents, and even great-grandparents. Family and friends provide about $450 billion of financially uncompensated care. They assist older adults with ADLs and IADLs above and beyond what the formal health care system would be able to manage and thus are considered to be essential and significant contributors to enhancing the quality of life for elders. Informal caregivers experience both benefits and costs. But objective and subjective burdens tend to be greatest when caring for a relative with dementia, and women are more likely to experience high levels of stress compared to their male counterparts. Caregivers of color often have strong extended networks to help share responsibilities, but have less awareness of and access to formal services. LGBT families of choice often rely on friends for care and support. When grandparents and great-grandparents take on primary care responsibilities for their grandchildren, they experience a wide array of challenges. Financial and legal issues often complicate their ability to provide what is best for the child. Trying to navigate the legal system can be overwhelming, but there are organizations and resources to support grandparent caregivers. Service providers are increasingly aware that caregivers are "clients" whose needs should be assessed, and more communities are funding caregiver support services to support family-centered care. Information and referral services are critical for caregivers in finding out about resources available to them in their area. Where resources are available, they come in many forms, from support groups, problem-solving counseling, respite services, and home modifications, to Internet advice. There is a growing body of research to determine what interventions, such as psychoeducational programs, are effective at reducing caregiver burden and promoting their well-being. In some instances, families may not utilize services, believing that caregiving is just what they should do out of love for their relative. Continued and increased national support for caregivers is essential as the older adult population grows in the decades ahead. At times, informal care is not the best option, either because of elder mistreatment or caregiver burnout, and placement in long-term care facilities may improve the quality of care for the older care recipient. Closely related to the central role of unpaid family caregivers, underpaid direct care workers are major providers of home and community-based long-term care, and face critical needs for additional training, higher wages and benefits, and quality supervision. The needs of unpaid and underpaid caregivers are clearly a growing concern for social and health care providers and policy-makers at the national level.

How is productive aging defined? What types of activities typically characterize productive aging? What does it mean when a baby boomer says that they are spiritual, but not religious? List three benefits of religious participation/religiosity for older adults. What types of activities are included under the broad concept of civic engagement? Identify some of the benefits of volunteerism for older volunteers and for the organizations they serve. How would you respond to someone who says that older people become more politically conservative as they age? Imagine that you were the director of an agency that depends largely upon older adults as volunteers. What factors should you consider in recruiting and retaining older volunteers? What are some of the major challenges facing senior centers today? If you were the director of a senior center, what kinds of programmatic changes might you want to make? What evidence would you cite to argue that older adults today are no longer as powerful a political constituency as they were in the past? What are some limitations of age-based organizations versus intergenerational alliances to influence policies and programs? How do patterns of civic engagement often differ by race and gender? Religion, religiosity, and spirituality, volunteering and senior center engagement all have benefits for physical and mental well-being. What reasons might explain why these different types of activities have similar benefits for elders?

Older adults often experience meaningful involvement and develop new opportunities and skills through a range of productive activities: leisure pursuits, formal and informal religious involvement, and civic engagement through voluntary association membership, volunteering, education, and political involvement. Past research on religious and civic participation has pointed inaccurately to declines in old age. Although formal religious participation such as church, mosque, or synagogue attendance appears to diminish slightly among the oldest-old, other private informal activities such as reading religious texts, listening to religious broadcasts, and praying increase. Religiosity appears to be an effective way of coping, particularly among elders of color. Spirituality is differentiated from religion in that it does not imply affiliation with a specific religious group or activity. Often conceptualized as a journey, spirituality can have a positive broad impact on older people's physical and mental well-being, and can enhance active aging. Health care providers now recognize the importance of conducting a spiritual assessment to ensure that treatment and services are congruent with elders' spiritual and religious values. Civic engagement has become akin to a social change movement, with proponents advocating for elders to help solve societal problems such as climate change, while critics worry that civic engagement, particularly volunteerism, can perpetuate reductions in publicly funded services and expect older volunteers to pick up the slack. The meaning and functions of participation in these areas are obviously highly individualized. Participation may be a means to strengthen and build informal social networks, influence wider social policies, serve other persons, substitute new roles, and acquire new sources of meaning and purpose. The extent of involvement is influenced not by age alone, but also by a variety of other salient factors including gender, race, ethnicity, health, religious affiliation, marital status, social class, and educational level. Because of the number of interacting variables, age-related patterns in participation are not clearly defined. There are some general age-associated differences in types of leisure pursuits. With increasing age, the current cohort age 65 and older tends to engage in somewhat sedentary, inner-directed, and routine pursuits. But this pattern may shift with the baby boomers, who are more likely to travel extensively and seek out new learning experiences and productive roles than previous cohorts. Changes in organizational participation, such as senior centers and volunteering, are less clearly age related. Participation in voluntary associations stabilizes or diminishes only slightly with old age; declines that do occur are associated with poor health, inadequate income, and transportation problems. Volunteering, which is increasing among today's older population, tends to represent a lifelong pattern of community service that peaks in middle age and then remains relatively stable until after age 70. Voting by older people has increased since the 1980s. Declines in voting and political participation in the past may have been a function of low educational status or physical limitations, not age per se. In fact, older persons' skills and experiences may be more valued in the political arena than in other spheres. The extent to which older people form a unified political bloc that can influence politicians and public policy is debatable. Some argue that older adults are cohesive, with a strong collective consciousness; others point to their increasing diversity and differences on public policy. As a whole, it appears that older adults are not a homogeneous voting bloc and often react to policies rather than initiate them, but many politicians still court them as if they all had common objectives. Most forms of organizational involvement appear to represent stability across the life course. The knowledge and skills necessary for a varied set of activities in old age are generally developed in early or middle adulthood and maintained into later life. On the other hand, preretirement patterns of productivity are not fixed. Individuals can garner new interests and activities in later life, often with the assistance of senior centers, lifelong learning programs, and community organizations.

Road Scholar

Road Scholar a program that offers adventures in learning and travel for adults age 50 and older

AGING MATTERSChapter EightProductive Aging: Leisure, Spirituality, and Civic Engagement

AGING MATTERSChapter EightProductive Aging: Leisure, Spirituality, and Civic Engagement Defining Productive Aging•Productive Aging: Thereis a much broader definition of productive aging—one that goes beyond economic terms—now includes paid and unpaid activity that produces benefits for society, e.g., caregiving, volunteerism, and contributing informally to family, friends, neighbors, and the community.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.2 Leisure•Leisure is any non-work activity characterized by the absence of obligation or what one "should" do; not having to do a leisure activity is what makes it inherently satisfying.•Can leisure replace employment roles and provide satisfaction and meaningful engagement? There are different theories and arguments on this point.•Leisure activities can have multiple benefits:•Building social support systems•Creating new sources of personal meaning and being valued•Enhancing a positive identity, self-concept, and life satisfactionCopyright (c) 2015 Pearson Education, Inc. All rights reserved.3 Religious Participation, Religiosity, and Spirituality•Of the various options for interactions with others, a religious institution is the most common choice for older people and offers both tangible and emotional support for them.•Religion refers to an organized formal system of spiritual belief, values, rituals, and practices.•Religiosity is a broader concept than religion. It assumes belief in a divine being, faith in a higher power, and it typically involves prayer. Additionally, it embraces values of hope, gratitude, and forgiveness.•Spirituality is believing in one's relationship with a higher power without being religious in the sense of organized religion.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.4 Religious Participation, Religiosity, and Spirituality: Religious Affiliation: Age, Gender, and Race•Among the current cohort of older adults, the meaning and importance of religion tend to be stronger in old age than in earlier phases of life.•Belonging to religiously affiliated groups and participating in religious activities offer a loving, supportive community.•Older women have higher rates of involvement in formal religious organizations than men.•Organized religion appears to be especially vital to the well-being of older Latinos and African Americans, enhancing their sense of meaning, life satisfaction, self-worth, and community involvement.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.5 Religious Participation, Religiosity, and Spirituality: Religiosity•Religiosity appears to be relatively stable from the late teens until age 60 and to increase thereafter.•Benefits of religious participation and religiosity for older adults:-Longer life expectancy-Later onset of disability-For those with disability, increased likelihood of improving physical functioning and better health outcomes-Better cognitive functioning-Improved immunity to disease-Lower blood pressure-Enhanced quality of life-A variety of benefits for mental well-beingCopyright (c) 2015 Pearson Education, Inc. All rights reserved.6 Religious Participation, Religiosity, and Spirituality: Religiosity•Religion has beneficial effects on health precisely because there are so many different pathways to well-being. They include:•Changes in health behaviors that reduce risk factors for poor health•A sense of belonging and social support derived from religious participation•A sense of control over unhealthy behaviors and belief systems for coping with adverse circumstances•Regular opportunities for interaction and informal support from church members as well as more formal support from religious leaders•The use of religiously based coping strategies when confronted with stressful life situations•Opportunities to care for and serve others in need, especially among women who volunteer within religious settingsCopyright (c) 2015 Pearson Education, Inc. All rights reserved.7 Religious Participation, Religiosity, and Spirituality: Spiritual Well-Being•Spirituality emphasizes an individual's subjective experience, while religiosity refers to a person's experience within the context of religion.Spirituality provides an interpretive framework for us to make sense of the world—who we are and how we should live.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.8 Religious Participation, Religiosity, and Spirituality(con't.)•Implications for healthcare providers:-There is increasing acceptance that healthcare providers should introduce questions of religion or spirituality—and be respectful of cultural and religious differences—when they treat an older adult with chronic illness or who is dying.•Stages of spiritual growth-For many older adults and their families, religiosity and spirituality are a central component of active aging, and may involve giving back to others.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.9 Civic Engagement•Civic Engagement is a process in which people actively participate in the life of their communities through individual and collective activities associated with civic life, such as voting, being a political activist, joining community groups, and volunteering.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.10 Civic Engagement: Toward What End?•Conservatives frequently favor volunteerism as a way to address social problems rather than turning to governmental solutions. Progressives advocate for elders to be politically active and to promote social justice to ensure that public policies, such as Social Security, safeguard the rights of vulnerable elders.•Others argue that the concept of civic engagement itself may overlook less visible ways of attaining meaning and fulfillment in later life.•Regardless, our society needs to create purposeful roles for elders.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.11 Civic Engagement: Membership in Voluntary Associations•Voluntary association membership is presumed to be a "good" leisure activity.•Patterns of membership: Overall, older people tend to be more involved in voluntary organizations than younger adults. Membership, however, is tied most closely to social class, not age, and varies among cultures.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.12 Civic Engagement: Volunteering•Volunteering is defined as choosing to serve or help others and can be formal or informal. •About 25% of all adults age 65 and older volunteer.•When volunteering is redefined to include informal contributions, an additional 50% volunteer informally.•Volunteerism rates climb slightly among those 65-74.•Women and professionals in the age range of 55-64 express the most interest in volunteering.•Socio-emotional selectivity is the process whereby older adults tend to be more selective about how—and with whom—they spend their time.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.13 Civic Engagement: Volunteering (con't.)•Benefits of volunteerism:-Greater life satisfaction-Positive self-efficacy-Lower rates of depression-Higher levels of cognitive functioning-Better physical well-being-Improved social well-beingCopyright (c) 2015 Pearson Education, Inc. All rights reserved.14 Civic Engagement: Volunteering (con't.)•Race, social class, and volunteering•When informal volunteering is included in definitions, African American elders report slightly more hours of volunteering than whites.•The Latino community has the lowest rates of formal volunteering, but informal volunteering is rooted in Latino culture.•Mutual aid is frequent in American Indian communities.•Volunteer activities among Asian and Pacific Islander elders reinforce the continuation of their value systems•Experience corps is one example of a highly successful intergenerational project involving lower-income, less-educated elders of color, many of whom had mobility problems.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.15 Civic Engagement: Lifelong Learning Programs•Another important source of social and civic engagement for older adults is lifelong learning.•Since 1975, the Rhodes Scholar program has involved over 150,000 adults age 50 and older in over 8,000 programs at over 1,500 different academic institutions.•The Osher Lifelong Learning Institutes (LLIs) are based on a financial model that requires participants to provide labor and leadership to pay for their own continuing education.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.16 Civic Engagement: Political Participation•Political acts range from voting to participation in a political party or political action group, to grassroots campaign work, to running for or holding elective office.-Do older adults become more politically conservative with age?-Older voters are highly heterogeneous, with voting differences greater within than between age groups.-Voting behavior-Regardless of how they vote, older Americans are more likely to go to the polls than younger adults.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.17 Civic Engagement: Political Participation (con't.)-Are older adults a powerful political constituency?•There are arguments on both sides of this debate.-AARP•The largest membership organization in the country•One reason older adults are perceived as politically powerful is the dramatic influence of AARP.-Sample services offered by AARP include tax preparation, peer grief and loss counseling, driver safety courses, mobile home insurance, etc.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.18 Civic Engagement: Political Participation (con't.)•Other organizations:-Gerontological Society of America (GSA)-The National Council on Aging (NCOA)-Older Women's League (OWL)-Gray Panthers Copyright (c) 2015 Pearson Education, Inc. All rights reserved.19

AGING MATTERS Chapter Seven Informal and Family Caregiving

Chapter SevenInformal and Family Caregiving What Is Informal Caregiving?•Caregiving is the act of assisting people with personal care, household chores, transportation, and other tasks associated with daily living provided either by family members without compensation or by professionals.•Informal caregiving isused interchangeably with "family" but that type of care can be performed by friends and neighbors.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.2 What Is Informal Caregiving: What Kind of Informal Care Do Some Older Adults Need?•The kind of informal care that we might need as we age is wide ranging and differs in intensity from person to person.•The primary forms of care provided by informal caregivers:•Emotional support•Help with instrumental activities•Personal care or direct assistance with ADLs•Financial help•Contacting service providers and advocating for and coordinating servicesCopyright (c) 2015 Pearson Education, Inc. All rights reserved.3 What Is Informal Caregiving: Who Are Informal Caregivers?•Family members, neighbors, or "family of choice" among LGBT populations•Nearly 66 million or almost 29% of all adults in the U.S. provide care to someone who is ill, disabled, or elderly.•44 million are caring for someone 50 years of age or older and 15 million are caring for someone with dementia.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.4 What Is Informal Caregiving: Losses and Gains of Informal CareCopyright (c) 2015 Pearson Education, Inc. All rights reserved.5 What Is Informal Caregiving: Costs of Informal Caregiving•Primary stressors are events that directly derive from an elder's illness.•Secondary stressors are not secondary in terms of their importance, but so called because they do not arise directly from the older person's illness; they occur when primary stressors spill over into other aspects of the caregivers' life.•Caregiver burden is the physical, emotional, and financial costs associated with care.•Objective burden refers to daily physical tasks, e.g., handling legal, employment, and financial problems of elders.•Subjective burden encompasses the caregivers' emotions or feelings, e.g., grief, anger, etc.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.6 What Is Informal Caregiving: Benefits of Informal Caregiving•Although research has typically focused on the burdens or negative aspects of informal caregiving, it encompasses positive experiences as well, such as:•Confidence•Self-affirmation•Pride•Greater closeness with care recipientCopyright (c) 2015 Pearson Education, Inc. All rights reserved.7 What Is Informal Caregiving: Adult Children as Caregivers•The gendered nature of caregiving: Women are still the primary nurturers and kin keepers; women form about 66% of all primary family caregivers.-Caring for refers to help with daily personal care tasks that entail intimate contact-Caring about means relational aspects of care that involve a sense of psychological responsibility or nearly constant worryCopyright (c) 2015 Pearson Education, Inc. All rights reserved.8 What Is Informal Caregiving: Spouses as Caregivers•Of all family caregivers of older adults, it is usually the spouse or partner age 75 and older who performs up to 80% of care tasks.•When men are primarily caregivers, it is typically as husbands; they comprise nearly 40% of spousal caregivers.•Men and women spouses/partners experience care responsibilities differently.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.9 What Is Informal Caregiving: Family Caregivers of Color•As compared to white caregivers, African-American caregivers tend to:-Provide higher levels of care-Have higher levels of self-efficacy-Be more economically disadvantaged-Be less likely to have alternative caregivers-Be less likely to use formal supportsCopyright (c) 2015 Pearson Education, Inc. All rights reserved.10 What Is Informal Caregiving: Friends as Caregivers•Family members are sometimes unavailable or unwilling to provide care.•Many older adults—especially LGBT elders—turn to friends and neighbors to provide some support.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.11 What Is Informal Caregiving: Caregiving for Persons with Dementia•Caregivers for persons with dementia provide the most difficult kinds of personal care, spend more hours per week giving care ("constant care") and do so for longer periods of time without any break.•Caregivers of persons with dementia are at a higher risk of emotional stress, mental and physical health problems, and family conflicts.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.12 What Is Informal Caregiving: Grandparents as Primary Caregivers•The number of grandparents who are primary or sole caregivers to their grandchildren has grown dramatically in the past three decades.•Skipped-generation households are composed of grandparents and grandchildren, which are the fastest-growing type of family in the U.S.•There are rewards and challenges for both the grandparent and grandchild living in this type of family.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.13 What Is Informal Caregiving: Legal Issues Related to Grandparent Caregiving•Grandparent or great-grandparent caregivers typically face legal challenges that add to their burden or stress.•The best option for most grandparents is to obtain legal custody, whereby the grandparents assume legal authority to make decisions, but birth parents remain financially responsible for the children and the right to visitation.•Websites can provide an overview of legal issues and kinship care navigators (an advocacy program) can also help sort through legal issues.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.14 What Is Informal Caregiving: Legislation and Policies to Support Family Caregivers•Family and Medical Leave Act: Businesses with 50 or more employees are required to grant up to 12 weeks of unpaid level annually when a child is born or adopted; when a child, a spouse, or parent with a serious condition needs care; or when the employee is unable to work because of a serious health condition.•National Family Caregiver Support Program: The law requires that the Aging Network, which is funded by the Administration on Aging, must serve not only older adults but also family caregivers age 18 and older who are caring for an adult age 60 and older and older-kin caregivers of grandchildren.•Family-centered care is an approach to caregivers that views them as clients in need of services and support to address their own needs and as partners in decision making.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.15 Services and Support for Caregivers•Interventions are things that can be done to support family caregivers, such as providing information or linking them to services. An assessment of caregivers' needs is the first step toward identifying services that caregivers will perceive as supportive and will reduce their burden.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.16 Services and Support for Caregivers: Why Don't Caregivers Use Services?•They are unaware of services.•They cannot afford them.•They resist accepting help, thinking they can "do it on their own."•They do not identify themselves as caregivers needing support.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.17 Services and Support for Caregivers: Effective Evidence-Based Interventions•Psychoeducational groups, skills training, and treatments•Support groups•Modifying the home environment•Respite care•Electronic supportsCopyright (c) 2015 Pearson Education, Inc. All rights reserved.18 Services and Support for Caregivers: Future Service Directions•Support services should be culturally competent and accessible, such as in primary care clinics, the workplace, senior and community centers, faith-based institutions, and schools.•Self-care for caregivers is an essential component in reducing stress and preventing out-of-home placement.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.19 When Caregiving Becomes Too Much•Placement in long-term care facilities: The move to a long-term care facility is often the result of a breakdown in the balance between the older person's care needs, the primary caregiver's resources, and the larger support network.•Elder mistreatment encompasses any knowing, intentional, or negligent act by a caregiver or other person that harms or causes risk of harm to a vulnerable adult.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.20 When Caregiving Becomes Too Much•Financial abuse and exploitation•Reporting and other legal requirements: All 50 states have procedures for reporting domestic abuse and nearly all states have made such reporting mandatory for healthcare providers.-Adult protective services is the state or county system that investigates reported cases, evaluates risk, assesses the elder's capacity to agree to services, develops and implements care plans, and monitors ongoing service delivery.-Elder Justice Act 2010-The National Committee for the Prevention of Elder Abuse (NCPEA)Copyright (c) 2015 Pearson Education, Inc. All rights reserved.21 Underpaid Caregivers: Direct Care Workers•Direct-care workers are the nurse aides, personal assistants, and home care staff who provide hands-on care in both home and long-term care settings; also referred to as "chronic care workers."•Defining characteristics of direct care workers:-90% are women, often single mothers responsible for dependent children-51% are African American, Asian and Latina women-20-25% are foreign-born women-Many are low-income younger womenCopyright (c) 2015 Pearson Education, Inc. All rights reserved.22 Unpaid Caregivers: Economic and Health Disparities Faced by Direct Care Workers•Direct care workers make an average income of $17,000 a year, well below the median wage for all U.S. workers.•Additional problems faced by healthcare workers include:•Unpredictable hours•Lack of full-time work•Limited or nonexistent health and other types of benefitsCopyright (c) 2015 Pearson Education, Inc. All rights reserved.23

AGING MATTERS Chapter SixFamily, Friends, and Other Informal Supports

Chapter SixFamily, Friends, and Other Informal Supports We All Need Informal Social Support•Social support is informational, emotional, or instrumental assistance from your social networks.•The benefits of social support:•Improved health status, increased morale and self-confidence, reduced depression and anxiety•Reduced risk of disability and even death•Increased feelings of personal control, autonomy, and sense of being competent, including when dealing with stress•Improved cognitive abilities (memory and learning) •Diminished negative effects of adverse and stressful life eventsCopyright (c) 2015 Pearson Education, Inc. All rights reserved.2 We All Need Informal Social Support (con't.)•Do social supports change as we age?-Reciprocal exchanges means being able to help others who assist them.•What factors affect our social relationships?-Health status-Gender-Race-Social classCopyright (c) 2015 Pearson Education, Inc. All rights reserved.3 The Centrality of Family Supports•The family is older adults' most important source of informal support and encompasses a diverse array of relationships. Fictive kin provide the kind of love and support that healthy family members do for each other.•Families are changing:•More couples living together but choosing not to marry•More couples choosing not to have children•A decline in the percent of children in the total population•More unmarried couples raising children•More single women having children without a male partner to help raise them•More gay and lesbian couples raising children•More mothers of young children working outside the home•More interracial marriagesCopyright (c) 2015 Pearson Education, Inc. All rights reserved.4 The Centrality of Family Supports: The Growth of the Multigenerational Family•Multigenerational families is defined by at least two adult generations and one other generation older or younger.•Skipped-generation households are those in which a parent is not present in the household. This type of household has increased dramatically.•20% of adults 25-34 and 20% of adults age 65 and older now live in multigenerational households, frequently for financial reasons.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.5 Older Partners as Social Support•Older adults and marriage:•Nearly 55% of older adults are married and live with a spouse.•42% of women and 72% of men age 65 and older are married and living with a spouse.•About 11% of women and 9% of men are divorced or separated.•Only 15% of women and 60% of men age 85 and older are married.•LGBT older adults are less likely to be partnered.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.6 Older Partners as Social Support (con't.)•Empty nest is when children leave home for college or a job, leaving the home "empty."•Marital satisfaction: The physical and emotional benefits from having a spouse or a partner are related to the quality of their relationship.•Divorce in old age: The pattern of long-term marriages and lower divorce rates for adults over age 65 is declining and more elders in future cohorts will be divorced and single.•Remarriage and other late-life romantic relationships: Separation, divorce, or the death of a spouse does not have to be the end of an older adult's romantic life.•Dating in old age: Single older people got on dates just like younger people who are single do.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.7 Older Partners as Social Support: Never-Married Older People•Approximately 4% of the older population has never married.•The majority of never-married older persons typically develops reciprocal relationships with other kind, especially siblings, and with friends and neighbors; they may not feel lonely or isolated.•Never-married adults who have had lifelong employment tend to enjoy greater financial security in old age.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.8 Older Partners as Social Support: Childless Older Adults•Approximately 20% of those age 85 and older are childless.•The growing number of childless and unmarried younger adults may affect the proportion of older people who will seek formal supports and develop alternative living arrangements, such as cohousing, in the future.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.9 Older Partners as Social Support: Lesbian, Gay, Bisexual, and Transgender (LGBT) Partners•A major social trend that differs from previous generations is the greater openness related to sexual identity; gerontological family research has expanded to include LGBT individuals. There are obstacles to obtaining data, however.•What we now know about older LGBT families: They are as diverse as families headed by heterosexual adults.•Effects of race, class, and cohort with sexual identity: Some studies suggest that the aging experience of gays and lesbians is qualitatively different.•Barriers to supports for LGBT elders: LGBT adults face disparities and legal and policy barriers that can affect their well-being in old age.•Working with LGBT elders: In a study, 21% of LGBT older adults had not revealed their sexual orientation to their primary physician, interfering with adequate diagnosis and prevention.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.10 Sexuality, Intimacy, and Emotional Support•Intimate bonds are a vital source of emotional support, no matter what one's age.Copyright (c) 2015 Pearson Education, Inc. All rights reserved.11 Other Types of Family Supports•Relationships with adult children•Sibling relationships-Blended families are those families structured through remarriage.•Grandparenthood and great-grandparenthood-Intimacy at a distance: strong emotional ties among family member even though they do not live near each other•Friends and neighbors as social support-Programs to strengthen or build neighborhood and community supports•Natural helpers: nonfamily members that others can turn to •Gatekeepers: people in service positions who can fulfill natural helping functions•Neighborhood and community buildingCopyright (c) 2015 Pearson Education, Inc. All rights reserved.12

multigenerational family

a family with three or more generations alive at the same time; considers the needs of middle generation, not just young and old as with intergenerational

financial abuse

a form of mistreatment in which a person's finances are wrongly exploited

Older Women's League (OWL)

a national advocacy organization concerned about issues affecting older women

Generations United

a national intergenerational coalition of over 30 organizations, including AARP, the Child Welfare League, and the Children's Defense Fund

Gray Panthers

a national organization founded by Maggie Kuhn, which encourages intergenerational alliances around social and environmental issues

civic engagement

a process in which people actively participate in the life of their communities through individual and collective activities, such as volunteering

hoarding

a type of self-neglect in which the person excessively saves things, often putting themselves or others at risk

Senior Companion Program

a volunteer program in which seniors receive a stipend to assist homebound elders

spiritual reminiscence

a way of telling a life story by emphasizing what gives meaning to life and what has given joy or brought sadness

undue influence

abusive behavior when a person uses role and power to exploit the trust, dependency, and fear of another, often around financial matters

neighborhood and community-building

an approach that strengthens a community's self-help and problem-solving capabilities

family-centered care

an approach to caregivers that views them as clients in need of services and supports to address their own needs and as partners in decision-making

Gerontological Society of America (GSA)

an association of researchers, educators, and practitioners interested in gerontology and geriatrics

Civic Ventures

an organization that provides resources for civic engagement and awards to innovators and agencies working for the common good

religion

an organized formal system of spiritual beliefs, values, and behaviors shared by a community (a denomination), not an individual behavior

leisure

any activity characterized by the absence of obligation, which in itself is inherently satisfying

social networks of choice

are mutually helpful social relationships consisting of friends, relatives, and members from the community at large

Osher Lifelong Learning Institutes (OLLIs)

associated with colleges and universities, older participants make decisions about course offerings and may volunteer to teach courses

socio-emotional selectivity theory (SST)

aware of limited time, older adults are more selective about how and with whom they spend their time, and are more likely to pursue emotional satisfaction rather than acquiring information

spirituality

believing in one's relationship with a higher power without being religious in the sense of organized religion

family of choice

consists of people who are like family members to someone but may not be formally related to that person

elder neglect

deprivation of care necessary to maintain elders' health by those trusted to provide the care (e.g., neglect by others) or by older persons themselves (self-neglect)

secondary stressors

do not arise directly from the older person's illness but result when primary stressors affect other areas of the caregiver's life, such as work or friendships; but not secondary in terms of importance.

intimate partner violence

domestic violence between partners/spouses

fictive kin

families of choice, not relatives in the formal sense, whose members provide the kind of love and support that caring family members do for each other

blended families

families whose memberships comprise blood and non-blood relationships through divorce or remarriage

Family and Medical Leave Act (FMLA)

federal legislation passed in 1993 that provides job protection to workers requiring short-term leaves from their jobs for the care of a dependent parent, spouse or child or due to the employee's serious health condition

Retired and Senior Volunteer Program (RSVP)

federally sponsored program that places older adult volunteers in a wide range of service settings

AARP

formerly known as the American Association of Retired Persons, a national organization open to all adults age 50 and over, offering a wide range of informational materials, discounted services and products, and a powerful political lobby

skipped-generation household

grandparent-and-grandchild households where the middle or parental generation is absent

caring for

help with daily personal care tasks that are physically draining, such as bathing, dressing, and eating, involve daily interruptions, and entail intimate contact

productive aging

includes both paid and unpaid activity that produces benefits for society, such as caregiving, volunteerism, and contributing informally to family, friends, neighbors, and the community

religiosity

individual's personal experience in the context of organized religion, but does not necessarily require participation in a formal organized setting with others

social support

informational, emotional, or instrumental (e.g., help with tasks of daily living) assistance from social networks

elder mistreatment

maltreatment of older adults, including physical, sexual, and psychological abuse, and financial exploitation and neglect

American Society on Aging (ASA)

national association of primarily practitioners interested in gerontology

National Council on the Aging (NCOA)

national organization of over 2,000 social welfare agencies concerned with aging that provides technical consultation and is involved in federal legislative activities

encore careers

new careers after retirement that may be paid or volunteer

empty nest

normative for middle-aged parents when adult children leave home for college or employment

direct care workers

nurse aides, personal assistants, and home care staff who provide hands-on care in both home and long-term care settings

gatekeepers

people in formal (e.g., postal carriers, beauticians) or informal (e.g., friends and neighbors) roles who regularly interact with older adults and can watch for signs indicating a need for assistance

natural helpers

people who assist others because of their concern, interest, and innate understanding

care recipient

person receiving paid or unpaid assistance

caregiver burden

physical, emotional, and financial costs associated with assisting persons with long-term care needs

Senior Community Service Employment Program (SCSEP)

program sponsored by the federal government that provides subsidies for nonprofit groups and businesses to employ older workers

interventions

programs, services, counseling, or other systematic strategies to support family caregivers and/or older persons

lifelong learning

pursuing both formal and informal paths to enhancing one's knowledge and understanding about various subjects across the life course

objective burden

reality demands that caregivers face (income loss, job disruption, poor health)

National Family Caregiver Support Program (NFCSP)

requires state and area agencies on aging to provide services to support family caregivers

intergenerational programs

services that facilitate the interaction of people across generations, typically young and old

respite care

short-term relief for caregivers; may be provided in the home or out of the home (e.g., adult day health centers)

Adult Protective Services

social services provided to older adults or adults with disabilities, typically administered by a state or local government agency charged to investigate complaints of abuse, neglect, or exploitation

Experience Corps

sponsors school-based programs where older adults work one-on-one with children, create before- and after-school programs, and receive a modest stipend for their service

Third Age

stage in life after middle age but before the final stage, and is conceptualized as a time of continued involvement and growth in areas of life beyond employment and family

primary stressors

stress-inducing events that derive directly from an elder's illness, such as memory loss or wandering

intimacy at a distance

strong emotional ties among family members even though they do not live near each other

caregiving

the act of assisting people with personal care, household chores, transportation, and other tasks associated with daily living; provided primarily by families without compensation or by direct care workers

subjective burden

the caregiver's experience of caregiver burden; differential appraisal of stress (e.g., worry, anxiety)

self-neglect

the older adult engages in behavior that threatens their own safety, even if mentally competent

Association for Gerontology in Higher Education (AGHE)

the only national membership organization of colleges and other academic groups devoted primarily to gerontological education

caring about

the relational aspects of care that involve trust, rapport, compassion, comfort, communication, and a sense of psychological responsibility or nearly constant worry

family caregiving

unpaid assistance provided by family members for persons requiring help with ADLs and IADLs

informal caregiving

unpaid assistance provided by family, friends, and neighbors for persons requiring help with ADLs and IADLs

Foster Grandparents Program

volunteer program pairing elders with children with special needs

women in the middle

women who have competing demands from older parents, partners, children, or employment