1. “Becoming old has been one of the most unexpected events of my life”

2. Older Adults What issues of poverty, health care? What does NASW say about working with Older Adults? What elder rights are outlined by the UN Principles for Older Adults?  Can you identify whether any of these principles are reflected in policies or programs aimed at this group?

3. How Do We Define Old? According to Erikson, the period of life from age 60 until death is the eighth stage or old age. The crisis of this age is: Integrity versus despair  The ability to integrate or satisfactorily blend one’s history and experience with the task of evaluating and accepting one’s life – success=wisdom.  Erikson and Jung suggest people at this stage are more reflective and introspective:  Has life been meaningful and rewarding?  Regrets and disappointment due to missed opportunity and unresolved conflicts leaves people vulnerable to despair. Newman and Newman revised Erikson’s stages arguing that one stage is not enough to encompass all of life from 60 to death

4. Characteristics of older adults by sub periods Young old (65-74):  Remain active in community with strong family/friend ties  Employed, volunteering  Phenomenon of women outliving partners  Caregiver roles to grandchildren, elderly relative or partner  Retirement can mean new freedom for some, loss of status and income/of being needed/of meaning if much of personal identity is attached to work role.  Beginnings of chronic illnesses; friends and family in age group begin passing on. Middle-old (75-84):  Increased chronic disease and stress of losing loved ones, sometimes including adult children.  More physiological changes experienced  For some loss of mobility and freedom (driving); slowing of response time  However, many in this age group remain very active, in relatively good health and function independently (obviously depending on where they stand in the world). Old-old (85+)  Mobility likely limited although some in this age group still working, living independently. Greater risk of social isolation due to decreased mobility and freedom (driving); greater reliance on helpers.  The prevalence of dementia, such as Alzheimer’s disease, increases with age – up to 50% of the 85+ group show evidence of brain disorders or some form of dementia.

5. Living Longer As people live longer, with better access to health and personal care, what we think of as old keeps getting older – with the stage of old age lasting longer and expanding. The graying of America and many other nations in the world will require an overhaul in medical and social services. In 2010, there were 40 million people in the United States over the age of 65, 13%of the population In 203o, persons over the age of 65 will be 20% of the population By 2050, there will be 20.8 million Americans 85 years or older. What does this mean for social work practitioners?

6. Trauma (across the life span) Heart Disease Alzheimer’s Disease:  Approximately 5.2 million individuals in the United States; 13% of people over 65 have Alzheimer's jumps to 40% over the age of 85 (Soniat & Micklos, 2010). 63% of all dementias Depression:  Anhedonia – loss of pleasure in things that used to bring pleasure.  Increased somaticization-express psychological distress through concerns with physical symptoms. Suicide:  Increased risk for those who are socially isolated Poverty Loneliness, bereavement/loss, grief Alcohol and other drug use in late adulthood  More difficult to detect since can masquerade as depression, dementia, or other problems associated with aging. Elder Abuse and Neglect:  Most abuse perpetrated by adult child or other family member Care-giver stress Role loss/change Sexually transmitted infections

7. Quality of Life What factors contribute to quality of life in late adulthood?  Health  Economic and social status  Racial, cultural background  Love  Social/family supports  Gender  Sexual orientation  Economic and social status  Level of education and employment  Activity levels, involvement in community  Physical impairments/strengths  Genetic strengths and vulnerabilities  Graduating from college  Effective stress management techniques  Ability to perform ADLs (personal care, food prep)  Psychological strengths (mental flexibility)  Attitude: You are as young as you feel/you are as young as you can function

8. End of Life Average life expectancy for women in the United States is 81, for men 76 (Hispanic women: 83)  Death of a partner  Moving to a nursing home Elisabeth Kubler-Ross  Five stages in the dying process:  Denial and isolation  Anger  Bargaining  Depression  Acceptance Hospice  Palliative care – comfort, not cure Advanced Directives  Technological advances in medical care have complicated the dying process in the last several decades, quality of life at the end of life is an issue that will affect many older adults. What roles for social workers in assisting and advocating persons at the end of life and their families?

9. What is your earliest memory of experiencing or observing any of the following: Someone made decisions for you because of your age. Someone assumed that you could not understand because of your age. You were ignored or left on your own because of your age. Your personal privacy was invaded because of your age. Someone withheld affection, closeness, and approval to secure your compliance with their wishes. Someone assumed that you were incompetent because of your age. You were teased, yelled at or touched against your will because of your age. How do these early experiences affect how you think about and treat young people in the present time? How do these early experiences affect how you think about and treat elders in the present time? How do you describe your age-based social identity?

10. What is Ageism? “A process of systematic stereotyping of and discrimination against people because they are old…old people are categorized as senile, rigid in thought and manner, old fashioned in morality and skills” (Butler, 1975). How are ageism and adultism related?

11. Life review or reminiscence:  helps the older adult orient to the present by getting a good grip on the past, resolve earlier conflicts and achieve closure through scrapbooks, writing memoirs, constructing family trees, telling their story  Oral History Project and Person-Centered Care Ecomap and genogram

12. Services of Older Adults Jewish Family Services  Winter Park Office  2100 Lee Road, Winter Park, Florida 32789  Phone: 407-644-7593 Fax: 407-628-0773 Senior Resource Alliance at  http://sraflorida.org/ http://sraflorida.org/ Low Income Energy Programs  http://www.liheap.org/