Allison R. Heid and Steven H. Zarit
Individuals are living longer than they ever have before with average life expectancy at birth estimated at 79 years of age in the United States. A greater proportion of individuals are living to advanced ages of 85 or more and the ratio of individuals 65 and over to individuals of younger age groups is shrinking. Disparities in life expectancy across genders and races are pronounced. Financial challenges of sustaining the older population are substantial in most developed and many developing countries. In the United States in particular, employer-based pension programs are diminishing. Furthermore, Social Security will begin taking in less money than it pays out as early as 2023, and the debate over its future in part entails discussions of equitable distribution of resources for the young in need and the old. Living longer is associated with a greater number of chronic health conditions—over two-thirds of Medicare beneficiaries in the United States have two or more chronic health conditions that require complex self-management regimes partnered with informal and formal care services from family caregivers and institutional long-term services and supports. Caregiver burden and stress is high as are quality care deficiencies in residential long-term care settings. The balance of honoring individuals’ autonomous wishes and providing person-centered care that also addresses the practicalities of safety is an ever-present quandary. Furthermore, complex decisions regarding end-of-life care and treatments plague the medical and social realms, as more money is spent at the end of life than at any other point and individuals’ wishes for less invasive treatment are often not accommodated. Yet, despite these challenges of later life, a large percentage of older individuals are giving financial support, time, and energy to younger generations, who are increasingly strained by economic hardship, the pressures on dual earner parents, and the problems faced by single parenthood. Older individuals’ engagement in society and the help they provide others runs counter to stereotypes that render them helpless and lonely. Overall, the ethical challenges faced by society due to the aging of the population are considerable. Difficult decisions that must be addressed include the sustainability of programs, resources, and social justice in care, as well as how to marshal the resources, talents, and wisdom that older people provide.
Jonathan S. Gooblar and Sherry A. Beaudreau
Anxiety disorders are among the most prevalent and understudied mental health problems in late life. Specific phobia, social anxiety disorder, and generalized anxiety disorder are the most prevalent anxiety disorders in older adults among the 11 disorders identified by the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). Anxiety disorders lead to significant functional burdens and interface with physical health problems and cognitive impairment, concerns frequently experienced in adults over age 65. Additional contextual factors should be considered when assessing and treating late-life anxiety, including the effects of polypharmacy, other mental health conditions, role changes, and societal attitudes toward aging. The relationship between anxiety and physical health problems in older adults can be causal or contextual, and can involve poorer estimates of subjective health and lower ratings of functioning. These factors present unique challenges to the detection, conceptualization, and treatment of late-life anxiety, including the tendency for older adults to focus on somatic symptoms and the potential for long-term behaviors that can mask distress such as substance use. Researchers are increasingly incorporating a gerodiversity framework to understand the contributions of cultural, individual, and other group differences that may affect the presentation of anxiety symptoms and disorders. Older adults in general are less likely to be treated for anxiety disorders, and intersecting individual and group differences likely further affect how anxiety disorders are perceived by healthcare providers. Cognitive behavioral therapy and its variants have the most empirical support for treatment. Newer evidence lends support to acceptance and commitment therapy and problem-solving therapy, which tend to address some of the contextual factors that may be important in treatment.
Lizbeth Benson and Nilam Ram
In ecological sciences, biodiversity is the dispersion of organisms across species and is used to describe the complexity of systems where species interact with each other and the environment. Some argue that biodiversity is important to cultivate and maintain because higher levels are indicative of health and resilience of the ecosystem. Because each species performs functional roles, more diverse ecosystems have greater capability to respond, maintain function, resist damage, and recover quickly from perturbations or disruptions. In the behavioral sciences, diversity-type constructs and metrics are being defined and operationalized across a variety of functional domains (socioemotional, self, cognitive, activities and environment, stress, and biological). Emodiversity, for instance, is the dispersion of an individual’s emotion experiences across emotion types (e.g., happy, anger, sad). Although not always explicitly labeled as such, many core propositions in lifespan developmental theory—such as differentiation, dedifferentiation, and integration—imply intraindividual change in diversity and/or interindividual differences in diversity. For example, socioemotional theories of aging suggest that as individuals get older, they increasingly self-select into more positive valence and low arousal emotion inducing experiences, which might suggest that diversity in positive and low arousal emotion experiences increases with age. When conceptualizing and studying diversity, important considerations include that diversity (a) provides a holistic representation of human systems, (b) differs in direction, interpretation, and linkages to other constructs such as health (c) exists at multiple scales, (d) is context-specific, and (e) is flexible to many study designs and data types. Additionally, there are also a variety of methodological considerations in study of diversity-type constructs including nuances pertaining theory-driven or data-driven approaches to choosing a metric. The relevance of diversity to a broad range of phenomena and the utility of biodiversity metrics for quantifying dispersion across categories in multivariate and/or repeated measures data suggests further use of biodiversity conceptualizations and methods in studies of lifespan development.
Lydia K. Manning, Lauren M. Bouchard, and James L. Flanagan
There is a great deal of concern about the increasing number of older adults who suffer from chronic disease. These conditions result in persistent health consequences and have an ongoing and long-term negative impact on people and their quality of life. Furthermore, the probability that a person will experience the onset of multiple chronic conditions, known as comorbidities, increases with age. Despite the prevalence of comorbidity in later life, scant research exists regarding specific patterns of disease and the co-occurrence and complex interactions of the chronic conditions most closely associated with aging. It is important to review the body of literature on comorbidities associated with physical and psychiatric syndromes in later life to gain an overview of some of the most commonly seen disorders in older adults: hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, arthritis, depression, and dementia. Specific patterns of disease and the co-occurrence and complex interactions of chronic conditions in later life are explored. In conclusion, we consider the need for a more informed understanding of comorbidity, as well as a related plan for addressing it.
Ideas regarding what it means to age well date back centuries. Gerontological scholarship includes countless conceptual, theoretical, and empirical contributions to how to make sense of these ideas. The construct of successful aging is therefore one of the most debated operationalizations of what it means to age well. Empirical research on successful aging taps into either understandings of successful aging or the strategies that people use to age well. The very essence of the construct of successful aging is, however, sociocultural. This is why this chapter proposes that exploring the cultural values that underpin the understandings of successful aging that inform this scholarship is a theoretically profuse approach to making sense of the controversy that surrounds this construct.
Two decades ago, a culture-relevant framework for the study of understandings of successful aging was formulated to address the disregard for cultural values that lie at the very core of this controversy. This framework proposes that there is congruence between the value orientations that people prefer and the understandings of successful aging that they hold, and that if we are to make sense of this congruence, we need to acknowledge that the foundations of value orientations (i.e., political, economic, and religious systems) shape what we deem to be necessary for aging well. From this it follows that there are bound to be more understandings of successful aging than what the scholarship in this area tends to acknowledge. After all, gerontological scholarship relies most heavily on contributions made on the basis of data from highly industrialized societies in the part of the world referred to as “the West.” In other words, gerontological scholarship on successful aging is extremely ethnocentric in its take on this construct, since only a handful of cultural understandings of what it means to age well are regarded as the norm. A failure to acknowledge this very fact leads gerontologists to disregard or downplay (often inadvertently) understandings of what it means to age well that do not resonate well with their own value paradigms or to impose (sometimes unintentionally) the Western template on findings about successful aging that do not rhyme well with what this scholarship assumes to be a given (i.e., a future, activity, independence, and mastering of nature orientation to what aging well means).
Manfred Diehl, Eden Griffin, and Allyson Brothers
Dynamic integration theory (DIT) describes emotion development across the lifespan, from childhood to old age. In doing so, DIT draws on a number of perspectives, such as equilibrium theories, theories of cognitive development, and theories of behavioral adaptation, and takes a strong cognitive-developmental view on emotion experience and emotion regulation. Two propositions are at the core of DIT. First, the development of emotion experience and emotion regulation proceeds from simple and automatic reactions to increasingly complex and integrated cognitive-affective structures (i.e., schemas). These cognitive-affective structures can be ordered in terms of increasing levels of cognitive complexity and integration, with integration referring to a person’s ability to acknowledge both positive and negative affect states and to tolerate and reconcile the contradictions and tensions that these states generate. Second, DIT also postulates that the efficiency with which cognitive-affective systems work is a result of the dynamic interplay between contextual variables and person-specific characteristics. Three key factors contribute to this dynamic interplay between person and context: (1) the strength of the affective arousal, (2) the person’s cognitive resources for dealing with different affect states, and (3) pre-existing trait-like dispositions and reaction tendencies that may either hinder or facilitate emotion regulation. Thus, a person’s emotion experience and emotion regulation in a given situation are the product of the dynamic interaction of these factors. Considerable empirical evidence supports the theoretical propositions of DIT, including findings speaking to changes in emotion experience and emotion regulation in later life when declines in cognitive functioning tend to become normative.
Philip Sayegh, David J. Moore, and Pariya Fazeli Wheeler
Since the first cluster of people with HIV was identified in 1981, significant biomedical advances, most notably the development of antiretroviral therapy (ART), have led to considerably increased life expectancy as well as a reduction in the morbidity and mortality associated with HIV/AIDS. As a result, HIV/AIDS is no longer considered a terminal illness, but rather a chronic illness, and many persons living with HIV/AIDS are beginning to enter or have already reached later life. In fact, Americans ages 50 years and older comprise approximately half of all individuals with HIV/AIDS and represent the most rapidly growing subpopulation of persons living with HIV/AIDS in the United States.
Despite significant advances in HIV/AIDS treatment and prognosis, older adults living with HIV (OALH) face a number of unique challenges and circumstances that can lead to exacerbated symptoms and poorer outcomes, despite demonstrating generally better ART adherence than their younger counterparts. These detrimental outcomes are due to both chronological aging and cohort effects as well as social and behavioral factors and long-term ART use. For instance, neurocognitive deficits and neuropsychiatric symptoms, including depression, anxiety, apathy, and fatigue, are often observed among OALH, which can result in feelings of loneliness, social isolation, and reduced social support. Taken together, these factors can lead to elevated levels of problems with everyday functioning (e.g., activities of daily living) among OALH. In addition, sociocultural factors such as race/ethnicity, ageism, sexism, homophobia, transphobia, geographic region, socioeconomic status and financial well-being, systemic barriers and disparities, and cultural values and beliefs play an influential role in determining outcomes.
Notwithstanding the challenges associated with living with HIV/AIDS in later life, many persons living with HIV/AIDS are aging successfully. HIV/AIDS survivor and community mobilization efforts, as well as integrated care models, have resulted in some significant improvements in overall HIV/AIDS patient care. In addition, interventions aimed at improving successful aging outcomes among OALH are being developed in an attempt to effectively reduce the psychological and physical morbidity associated with HIV disease.
Lori E. James and Sara Anne Goring
The questions of whether and why language processes change in healthy aging require complicated answers. Although comprehension appears to be more stable across adulthood than does production, there is evidence for age-related changes and also for constancy within both input and output components of language. Further, these changes can be considered at various levels of the language hierarchy, such as sensory input, words, sentences, and discourse. As concluded in several other comprehensive reviews, older adults’ language production ability declines much more noticeably than does their comprehension, presumably because comprehension is able to benefit from contextual processing in a way that production cannot. Specifically, lexical and orthographic retrieval become more difficult during normal aging, and these changes appear to represent the most noticeable age-related declines in language production. Some theories of age-related decline focus on global deterioration of cognitive function, whereas other theories predict changes in specific processes related to language function. Both types of theories have received empirical support as applied to language performance, although additional theoretical development is still needed to capture the patterns of effects. Further, in order to truly understand how cognitive aging impacts the ability to understand and produce language, it is necessary to examine how age-related shifts in goals, expertise, and compensatory strategies influence language processes. There are important implications of research on language and cognitive aging, in that language can play a role in physical health and psychological well-being. In summary, our review of the existing literature on language and cognitive aging supports previous claims that language ability is asymmetrically impacted by age, with smaller overall effects of aging on comprehension than production processes.
Joseph A. Mikels and Nathaniel A. Young
The adult life span is characterized as a time of divergent trajectories. It is a time of compounding losses (such as physical, sensory, and cognitive declines) and is also a time of surprising growth (such as improvements in well-being and emotion regulation). These divergent trajectories present theorists with the paradox of aging: in the face of accumulating losses, how is it that as people age, they generally feel good and experience greater well-being? Theorists have grappled with this paradox and have focused on how motivational, cognitive, control, and social factors impact emotional development across the adult life span. These foundational theories have paved the way to a deeper understanding of adult life-span development, but they do not draw as deeply from theories in affective science. Some of the latest perspectives on emotion and aging offer integrative views, such as how older adults may experience different discrete emotion (i.e., anger versus sadness) from an evolutionary functional perspective. Other perspectives consider how an array of appraisal processes may change across adulthood (such as shifts in evaluations of self-control versus other-control for younger versus older adults). These newer approaches dig deeper into mechanistic explanations and underscore the need for greater theoretical integration. Later life is clearly a time of increased well-being, but the field is only on the cusp of understanding the mysteries of emotional experience in later life.
Kyungmin Kim and Yijung Kim
The parent-child relationship is one of the most significant social relations for many individuals. In particular, intergenerational ties to adult children often remain as one of the main social networks and sources of support provisions in later life. By reviewing the key literature on older parent-child relations, this article discussed the dynamics and complexity of intergenerational ties and their impact on the lives of older adults. First, we discussed theoretical perspectives that have guided recent research on intergenerational relations, including the life course perspective, and solidarity, conflict, and ambivalence models. Second, we reviewed the literature on structural aspects of the relations, including coresidence, proximity, and contact, and their implications for older adults’ health and well-being. Third, regarding a functional side of parent-child relations, we discussed the different types and implications of support exchanges between older adults and their adult children. Finally, our discussion concluded with the review of emotional qualities (i.e., positive, negative, and ambivalent) in parent-child relations and the factors that may complicate the intergenerational ties in later life. Our review revealed that the significance of parent-child ties remains with the changes in demographic, social, and cultural environments of our aging society, and the different dimensions of parent-child ties (i.e., structural, functional, and emotional) have important influences on older adults’ well-being, quality of life, and health. To better understand the implications of parent-child ties in later life, future research is needed to uncover the specific mechanisms by which different dimensions of intergenerational relations and health outcomes among family members are linked.