The Social Context of Ageing: A Textbook of Gerontology

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As you well know, life is too precious to waste time in lines at bookstores! Results 1 - 50 of for Gerontology Textbooks. Asuman, Hooyman, Dianne, Mercer, Kohn , in an overview of his research on the effect of work environments on personality and behavior, has documented that the complexity of work environments and opportunities for personal involvement and mastery not only tends to produce a sense of well-being but also enhances the prospects for subsequent personal initiative and the willingness to take on and master the challenges of environmental change with confidence.

Further, Moos and Lemke have documented that group living environments that maximize policies emphasizing personal control and involvement of residents in group decision making tend to enhance the sense of well-being of residents and reduce their inappropriate use of facility care services.

From the perspective of Bandura's theory of social cognition, care environments can be designed to maximize social support resources that, rather than encouraging behavioral dependence, produce a sense of self-efficacy and outcome expectancy of independent living among frail older adults at both the personal and the group levels. Assisted living housing has emerged as a naturally occurring strategic site in which housing becomes the reasonable counterpart of a work site whose structure is consequential for the competence and well-being of its participants.

The Social Context of Ageing

And for a subset of assisted living housing facilities in the United States, an emergent philosophy is identifiable that stresses the intention to maximize the residential quality of assisted living environments and at the same time enhance the sense of self and group efficacy among residents Kane and Wilson, ; Wilson, Regnier et al. Good theory has converged with some practical considerations to highlight assisted living housing as a strategic site for psychosocial intervention on a relatively large scale.

Historically, housing, much less housing with services, has not been considered an integral component of health and health care policy or provision in the United States.

Without much enthusiasm, nursing homes may call their inhabitants residents, but they are really patients in what operates very much like a hospital. Federal housing policy until recently has forced a separation between housing and service provision in minimally regulated and supervised settings variously known as old-age, retirement, or board-and-care homes.

For an aging population in this country that clearly has expressed its preference to age at home if possible, the prospect of a purpose-built facility that invites residents at an affordable price to buy housing and at the same time purchase levels of service appropriate to their assessed needs has been just what they wanted. Private-sector developers got the picture quickly, and by there were 28, assisted living housing facilities in the United States with provision for more than , residents, and the level of investment in this market continues to be high.

Twenty-five percent of the available places for residents are in California, Florida, and Pennsylvania alone Mollica, The potential size of this obviously attractive market is not known. A population of more than 1.

For the evidence that underlies such an estimate, see the population projections, including demographic characteristics of income, disability, and living arrangements, in Health, United States, U. DHHS, , and the multivariate analyses of how demographic and health characteristics of older adults relate to both institutionalization and management of disability in the community Manton, ; see also Wiener et al.

While special housing with services is neither a desirable nor a realistic option for all disabled older adults, it is an attractive option for many. The research of Moos and Lemke has applied a carefully evaluated methodology the Multiphasic Environmental Assessment Procedure [MEAP] for characterizing the structural and resident characteristics of group living facilities and generated normative data on how these characteristics relate to outcomes. This methodology is just what is needed to ask two really important questions about assisted living housing: 1 When a philosophy of housing is implemented to maximize autonomy, self-efficacy, social support, and participation in decisions about community, does assisted living housing achieve promised outcomes of quality residential care with economy?

Bandura has extended the personal variable self-efficacy to suggest a social and organizational variable collective efficacy in a way that is particularly relevant for understanding the potential of assisted living housing. Individuals can and do experience collectively in particular settings a shared sense of mission, cooperative behavior, and resilience in the face of challenge to one's group.

The empowerment or enablement implied in one's sense of self-efficacy is not bestowed by edict but is an observed outcome based on experience that conjoint behavior can be organized and implemented to attain group objectives. The concept of collective efficacy has been used in a variety of community research settings to explore how a neighborhood, for example, can develop a sense of social cohesion and unity of purpose that promotes not only networks of social support but also willingness to intervene in behalf of attaining some shared social good see, e.

The concept clearly has relevance to explore how, in an assisted living setting, a sense of collective efficacy in support of compensatory care role modeling could arise and be sustained. Is the theory behind a proposal sound and will theory be advanced? Is methodology available that will make what is proposed feasible? And is the proposal significant, certainly in the sense of being compatible with the priorities of the research community and, if possible, also recognizable within the priorities of the policy and attractive to programming persons responsible for advancing the public's health.

The Emergence of the Golden Age of Social Gerontology? - Jan Baars, Ph.D.

On all of these counts the recommended intervention would receive high marks. The theoretical background is very strong. The experience of Moos and Lemke has obvious applicability to assisted living housing as a tested systems analytic strategy for identifying the structuring of organizations likely to improve the functionality, sense of well-being, and adaptability of frail older adults. The population likely to benefit is large, as large—probably larger—than the current nursing home population.

And one final note: An intervention intended to benefit assisted living housing residents would necessarily deal with a key issue in the implementation of information from the initiative proposed—the intersection of public and private interests. The Moos and Lemke research that lays the groundwork for the recommended intervention has included more than group residences—congregate, residential, sheltered environments, and nursing homes. But regardless of the type of shelter, the MEAP strategy has proved to be applicable in characterizing 1 resident and staff; 2 physical and architectural features; 3 the basic objectives of institutional policy and programs; and 4 the social climate of the housing community.


In the initial research, structural features such as ownership, size, and level of care required were found to be important. But more important was the factor of social climate, particularly a climate in which autonomy and choice are legitimate and promoted; residents are involved in decisions about their community; and staff are committed to a climate in which privacy, choice, and resident involvement are encouraged.

Initial research has already provided the preliminary documentation that a pro-choice, pro-involvement social climate promotes well-being, better adaptation to change, and reduction of inappropriate use of facility care resources. These are all evidence of positive outcomes for frail older adults that theory would predict.

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In their final chapter, Moos and Lemke themselves point to the next task: Now that we have identified the favorable outcomes deliverable in assisted living housing dedicated to enhancing a pro-choice and pro-involvement social climate, we should demonstrate how to promote such a social climate in assisted living facilities more widely.

This is a challenge of one significant and promising intervention in the interest of the public's health in later life likely to enhance the functioning and well-being of a large number of frail older adults while reducing unnecessary use of care resources. Assisted living housing is not the only feasible intervention to improve the public's health in our aging society. But it is an opportunity with the possibility of significant positive effect.

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Gerontology Textbooks

Search term. George L. Maddox, Ph. The expected age gradient in medical care utilization occurs, but the utilization patterns of men and women vary significantly; higher total utilization by women reflects the fact that older women are more likely to be functionally disabled than men, and they live longer. Comorbidity is a condition well known to geriatricians; the average older adult has two chronic conditions at any time of observation. For both men and women, arthritis and circulatory problems are the most totally disabling conditions.

For both conditions, women are more likely than men to be totally disabled. Depression, a common mental health problem in adulthood, has not been found to be consistently elevated in older populations. However, when present, both depression and cognitive impairment increase the risk of functional impairment from chronic conditions, complicate the management of chronic conditions, and increase the risk of extraordinary outcomes such as suicide among older males Stewart et al.

The consequences of the socioeconomic gradient of chronic conditions see, e. Active life expectancy designates disability-free years of living post-age The SES gradient of health and illness is observed worldwide, although the gradient can be affected by sociocultural factors. Ethnicity as well as socioeconomic status affects functioning and well-being in later life Clark et al. These effects are observed in distinctive patterns of disability and dependency, need for long-term care services, and cultural expectations about responsibility for providing care for family members.

Healthy life-styles are observed as frequently among older adults as among adults generally and have the expected positive effects see, e. But commitment to healthy life-styles among adults in the United States remains suboptimal. The expected age gradient of functional disability was confirmed for both men and women in the observed trajectories of functional impairment over the period of a decade; women were and remained consistently more impaired than men; and the expected socioeconomic gradient of disability was found.

But two significant surprises were revealed in the analysis. The straightforward hypothesis typically advanced is that activity is beneficial. Design Issues —Overall the studies reviewed are given low marks regarding their weak conceptualization of causation, inadequate measurement of key variables, and poor sample maintenance and motivation. Further, in many studies, favorable outcomes appeared to require a sense of social efficacy and a favorable outcome expectancy as intervening variables see Bandura, ; also Antonovsky, , for a discussion of the meaning of activities as a component of motivation.

An Educational Intervention with Osteoporotic Patients Objective —Osteoporosis, a common chronic condition among women, results in considerable pain and the possibility of significant skeletal deformity that often produces negative emotional outcomes such as depression, hostility, stress, and reduced self-esteem. To explore effective ways to counter these negative outcomes a multidisciplinary team of clinicians in a specialty clinic at Duke Medical Center created a controlled trial of education and exercise to reduce these unwanted outcomes Gold et al.

Design —Subjects in their mids, primarily women, were recruited from surrounding life care communities and offered individual evaluations by a physician; personal tutoring regarding best ways to achieve pain reduction; and group exercise regimens in structured support groups. Subjects were interviewed 6 months later and compared with controls from the same clinic.

Scope and Fields of Gerontology

Findings and Conclusion —While the intervention had no significant effect on pain reduction, psychiatric symptoms such as depression and stress were significantly reduced as were obsessive-compulsive behavior and anxiety. In subsequent research, investigators followed up what appeared to be higher levels of anxiety about self-image resulting from deformity than clinical assessment would suggest.

This finding is reminiscent of many intervention studies indicating that structured social support groups are a key variable in achieving beneficial effects from activity and that a sense of self-efficacy is a critical component of this effectiveness. Exercise Interventions with Poor and Minority Populations Objective —While the intervention was initially prompted by interest in the benefits of exercise in management of diabetes in older adults, a greater interest was found in exploring how poor and minority populations can be attracted and motivated to continue in such structured activities Clark, ; Clark and Nothwehr, Design —A large population of inner-city residents in a metropolitan area was invited to participate in a straightforward exposure to exercise as a component in managing diabetes.

From a review of literature on successful exercise interventions, investigators concentrated on the more basic question of motivating patients to participate at all.