La mirada socioconstruccionista en el eje agresión –

In anticipation of the increase in the older adult population as well as an increase in the needs and complex nature of the issues facing many older adults, the Older Americans Act was signed into federal law in 1965. This act led to the creation of the Administra- tion on Aging, and it funded grants to the states for various community and human service programs and provided money for age-related research and the development of human service agencies called Area Agencies on Aging (AAA) operating on the local level. The Administration on Aging also acts as a clearinghouse, disseminating

Many older people naturally begin withdrawing from the world, both physically and socially, in response to diminished capability and opportunity, and with such disengagement comes an increase in physical and emotional problems, such as depression and even alcohol abuse to combat loneliness.

information about a number of issues affecting the older adult population in the United States.

Numerous issues affect today’s older adult population, including elder abuse, age- based discrimination, housing needs, biopsychological problems (such as depression, anxiety, and alcoholism), adjustment to retirement, and grandparenting. Those in the human services field are often included in the group of professionals most likely to come into contact with the older adult population, either through direct service or through providing counseling services to a family member of an older adult, and therefore they must be familiar with these key issues, knowing how they affect older adults and their family.

Ageism

Ask some typical young Americans what they think it is like to be a man of 70, and they may well tell you that an average 70-year-old man is in poor health, drifts off to sleep at a moment’s notice, talks of nothing but the distant past, and unproductively sits in a rocker, rocking back and forth all day long. They might even throw in a comment or two about his general grouchy disposition. Ask if older adults still have the desire for sexual intimacy, and you might get a good hearty laugh in response. However, this description of older adults is a myth based on deeply entrenched negative stereotypes and can serve as a foundation of a form of prejudice and discrimination of older adults called ageism.

The term ageism was first coined by Robert Butler (1969), chairman of a congressio- nal committee on aging in 1968. He defined ageism as “a systematic stereotyping of and discrimination against people simply because they are old, just as racism and sexism ac- complish this with skin color and gender.” Butler theorized that the basis of this negative stereotype is a fear of growing old. This fear and the resultant negative stereotyping can often result in the discrimination of the older adult population in all areas of life and is the basis of many forms of elder abuse.

Ageism typically involves any attitude or behavior that negatively categorizes older adults based either on partial truth (often taken out of context) or on outright myths of the aging process. Such myths often describe old age as involving (1) poor health, illness, and disability; (2) lack of mental sharpness and acuity, senility, and dementia; (3) sadness, depression, and loneliness; (4) an irritable demeanor; (5) a sexless life; (6) routine boredom; (7) a lack of vitality and continual decline; (8) an inability to learn new things; and (9) loss of productivity (Thornton, 2002).

Gerontologists caution that the promotion of such negative stereotypes of old age and older adults not only trivializes older individuals, but also risks displacing the older adult population as communities undervalue them based on the perception that older adults are nothing more than a drain on society. A further risk of ageism is that older adults may internalize this negative stereotype, creating a self-fulfilling prophecy of sorts (Thornton, 2002). This is similar to what happens with other vulnerable populations, such as minority groups, who internalize the negative perceptions of them held by the majority population (Snyder, 2001).

Old age has not always been something those in the United States have viewed nega- tively. In fact, earlier in the 20th century, societal attitudes reflected a relatively positive

view of older adults and of the aging experience. Older adults were respected for their wisdom and valued for their experience. They were not typically perceived as being a drain on society or as a burden to the community. Yet, sometime around the mid-1900s, as life expectancy began to grow and medical technology improved dramatically, pro- fessionals such as physicians, psychologists, and gerontologists began discussing older adults in terms of the problems they posed (Hirshbein, 2001).

Many social psychologists and gerontologists cite the media as a major source of negative stereotypes of older adults. These critics claim that the consistent negative portrayal of older adults in both television shows and commercials, for example, por- traying them as dimwitted, foolish individuals living in the past, has a dehumanizing effect on the entire older adult population and has a negative effect on the self-concept of older adults. Yet, the results of a study conducted in 2004, which reviewed televi- sion commercials from the 1950s to the 1990s, did not support this critical view of the media (Miller, Leyell, & Mazacheck, 2004). In fact, Miller and his colleagues found that the media depiction of older adults has been relatively positive, particularly in the latter two decades.

It is vital that human service professionals make certain that they do not hold any of these misconceptions of old age. For instance, assuming that someone over the age of 70 is incapable of being productive and of learning something new, of gaining a new insight, whether in the counseling office or in life in general, would undoubtedly affect the dynamic between the counselor and the older adult client. In fact, research shows that negative stereotypes about aging are often internalized by older adults and can ac- tually increase feelings of loneliness and dependency (Coudin & Alexopoulos, 2010). Practitioners then must address any misconceptions they have of old age and of the older adult population in general. Practices such as talking down to older adult clients and not directly addressing difficult issues for fear that they lack the capacity to under- stand will undoubtedly affect the level of investment the client makes in the counseling relationship. This type of behavior on the part of the practitioner can also encourage a self-fulfilling prophecy within older adult clients, where they begin to act the part of the incapable, unproductive, and cognitively dull individual. Making positive assumptions about older adult clients will increase the possibility of bringing out the most authentic and dynamic aspects of older adult clients.

Housing

Contrary to the common belief of many in the United States, most older adults remain in their homes until death and are cared for by family members (Bergeron & Gray, 2003). But as medical technology allows people to live longer albeit not necessarily healthier lives, coupled with the fact that more women than ever are in the workforce and therefore unavailable to care for their older and chronically ill relatives, many older adults find themselves needing to move out of their homes once they reach a certain level of physical and/or cognitive decline. They might move into the home of a family member, which was far more prevalent when the United States was an agricultural soci- ety, and both men and women were home based in their work, or they might move into a retirement community, where they can still enjoy their independence while enjoying

many facility-offered services to meet their needs, such as shuttle service, handicapped- accessible facilities, and child-free living.

Government-subsidized older adult housing can make housing costs more affordable

for the older adult population, whether in the form of a subsidy provided directly to older adults in the form of tax credits, loans, or rental vouchers or subsidies provided to the housing community, which then passes on this discount to the renter. One problem with many of these programs, though, is that they require older adults to find their own housing in the community, much of which is older and not appropriate for older adult residents who often need special age-related accommodations. Another concern relates to government-subsidized communities that are designed for older adult populations but tend to be wrought with problems related to safety, including problems with poor physical upkeep of the property.

A 2003 longitudinal study that followed 1,200 older adults in their transition from independent living to age-restricted housing in 1995 found that those older adults who transitioned to more expensive communities fared the best with regard to physical health and overall life satisfaction and those who transitioned to government-subsidized housing programs fared the worse. Although the study investigators acknowledged that levels of life satisfaction might be related to a cumulative effect of a lifetime of poverty, they concluded that overall quality of housing has a direct relation- ship to life satisfaction (Krout, 2003).

Older adults needing more consistent care with their activities of daily living (ADL) sometimes enter assisted-living facilities. These facilities offer apartment-like living in a more structured environ- ment. In many respects assisted-living facilities act as a bridge be- tween independent living and nursing home care. Assisted-living facilities offer assistance with eating, bathing, dressing, housekeep- ing, and medication, and some even have fully functioning medical centers. Many assisted-living apartments have alarm systems in ev- ery unit, offer a restaurant-style cafeteria, a club for social activities, a hairdresser, a medical staff, home healthcare, and a relatively full array of human services. The services are far more intensive than in a retirement community, as residents in assisted-living facilities are there because they cannot manage their ADL without daily as- sistance. Human service professionals provide many of the same services as provided in retirement communities, but at a more com- prehensive level.

Homelessness and the Older Adult Population

One of the opening vignettes of this chapter highlighted the issue of homelessness in the older adult community. Although older adults are at a lower risk for homelessness than other age groups, homelessness in the older adult population is a growing con- cern because the percentage is expected to grow as the baby boomer generation ages (Gonyea, Mills-Dick, & Bachman, 2010). Additionally, for years the problem of home- lessness among the older population has been essentially ignored by policy makers and

Human Services Delivery Systems

Understanding and Mastery of Human Services Delivery Systems: Range of populations served and needs addressed by human services

Critical Thinking Question: Many older adults need to change their living accom- modations at some point, for a variety of reasons including affordability, physi- cal challenges, proximity to other family members, or a need for specialized care. What additional factors should a human service professional take into account while working with older adult clients who are making such a transition?

legislators, rendering this population relatively invisible (Gonyea, Mills-Dick, & Bachman, 2010).

The common causes of homelessness in the general population apply to older adult subgroups as well, such as a lack of affordable housing, too few jobs for unskilled workers, and a reduction in human services support (Hecht & Coyle, 2001; Kutza & Keigher, 1991), but the older adult population in general has additional risk factors such as being too old to sufficiently recover from a job loss, enter a new career, or reenter the workforce, as well as experiencing chronic illnesses that either are

costly or bar older adults from being self-supporting (Kutza & Keigher, 1991). For statistical purposes, individuals above the age of 50 to 55 are usually considered in the older adult category, but generally the lower threshold for what is considered “elderly” is increasing. Homeless older adults are a particularly vulnerable subgroup because of age-related physical vulnerability, which is often exacerbated by poor nutri- tion and difficult living conditions either on the streets or in a homeless shelter. They are also at a much higher risk of becoming a victim of crime while living on the streets (Hecht & Coyle, 2001).

A research study based in Los Angeles found that unlike the homeless in the general population, 85 percent of the older adult population was white (versus 61 percent in the younger homeless population) and 59 percent were veterans (versus 27 percent in the younger homeless population). Older homeless adults were far more likely to be so- cially isolated and suffer from a physical illness, but less likely to suffer from substance abuse, mental illness, or domestic violence (Linn & Mayer-Oakes, 1990). Older home- less adults between the ages of 50 and 65 are often the most vulnerable group because they are frequently the target of ageism when attempting to reenter the workforce, but too young to qualify for Medicare and Social Security benefits (Hecht & Coyle, 2001).

The differences between younger homeless and older homeless populations become important when considering programs designed to assist the older adult homeless pop- ulation. Many human services’ homeless assistance programs focus on root causes of homelessness more common in younger populations, such as providing assistance with substance abuse and domestic violence. Any human services programs designed to as- sist the older adult subgroups with housing issues need to focus more on issues related to insufficient income, health concerns, and low-income housing, offering supportive services to the older adult population with declining health.

Adjustment to Retirement

The concept of retirement is so common to the 21st century that it rarely needs explana- tion. When an individual comments on his or her upcoming retirement, others seem to instinctually understand that what is being discussed is the practice of leaving one’s

An aged homeless woman with all of her belongings in two gar- bage bags.

Joseph Sohm/Visions of America/Corbis

employment to permanently enter a phase of chosen nonemployment, and even though some might choose to dabble in part-time employment from time to time, the most common conceptualization of retirement involves an employee permanently surrender- ing his or her position, at approximately age 65, and drawing on a pension or retirement account that has likely been accruing for years. Of course, there are numerous variations on this theme—some people don’t ever formally retire, and some people work in fields that have mandatory retirement ages, such as the airline industry, which requires that all pilots retire at the age of 60, and for some, retirement is a luxury they cannot afford. Also, it would be incorrect to assume that everyone in the workforce has accrued a pen- sion sizeable enough to permit them to live on for years. But despite the range of retire- ment experiences, certain generalizations can be made about the retirement experience for the majority of those living in the United States during the 21st century.

Robert Atchley (1976) was one of the first researchers who attempted to describe the retirement experience for men and women. He identified five distinct, yet overlapping, stages that most retirees progress through on formal retirement. These stages are as follows:

1. The Honeymoon Phase: Retirees embrace retirement and all their newfound free- dom in an optimistic but unrealistic manner.

2. Disenchantment: Retirees become disillusioned with what they thought retirement was going to be like and get discouraged with what often feels as though is too much time on their hands.

3. Reorientation: Retirees develop a more realistic view of retirement, with regard to both increased opportunities and increased constraints.

4. Stability: Retirees adjust to retirement.

5. Termination: Retirees eventually lose independence due to physical and cognitive decline.

There has been some controversy about whether retirees actually progress through such distinct phases or whether there is just too much of a range of experiences among retirees in the United States to categorize experiences in a stage theory. A study by Reitzes and Mutran (2004) appears to support Atchley’s stage theory, finding that retirees experience a temporary lift right after retiring (for about 6 months), but then develop an increasingly negative attitude after about the 12-month mark, with some retirees start- ing to experience increased optimism after about two years. The study also found that an individual’s level of self-esteem preretirement seemed to have an effect on their over- all mental health after retirement, with those who had higher levels of self-esteem far- ing better. A more recent study on postretirement dynamics seems to support some of Atchley, and Reitzes and Mutran’s findings, while refuting others. The study, which was funded by the National Institute on Aging, found that men and women who continued to work for a period of time after retirement, on a part-time or temporary basis (called “bridge employment”) had much better physical and psychological quality during their elder years, indicating that sudden and complete retirement, without any transition, may have negative side effects for an older adult’s physical and mental health. Interestingly, the positive effects gained from bridge employment existed regardless of the retiree’s preretirement mental and physical health (Zhan, Wang, Liu, & Shultz, 2009).

Because nearly 50 percent of the U.S. population is now over the age of 50, the implications of retirement preparation and adjustment to retirement for the human services field obviously cannot be ignored. Human service professionals will likely come into contact with retired or retiring adults in many different settings, thus it is important to real- ize that impending retirement can become an issue for someone even in middle adulthood.

Finally, race and gender have a significant effect on retirement experiences. Re- search has shown that women and minority workers often have different attitudes and experiences surrounding retirement issues due to disparity in income and education levels (McNamara & Williamson, 2004). Thus, the human service professional must un- derstand that most factors affecting a client’s retirement experience are going to be in- fluenced by the client’s gender and racial background.

Grandparents Parenting

The practice of grandparents raising grandchildren has increased dramatically over the past several years, signaling many problems within U.S. society that have emerged since the 1970s. The U.S. Congress became interested in this issue in the mid-1990s, and in 1996, it passed legislation that required the 2000 U.S. Census to include questions re- garding whether grandparents were residing with grandchildren, whether they had pri- mary responsibility for them, and what length of time they had acted in a parental role (i.e., revealing whether the situation was temporary or permanent).

Current (as of 2009, the most recent statistics available) figures estimate that ap- proximately 6.6 million U.S. households (about 5 percent of the population) are com- prised of grandparents coresiding with grandchildren under the age of 18; 64 percent of these are female grandparent-headed households. Approximately 2.7 million of these families involved grandparents who were primarily responsible for their grand- children (U.S. Census Bureau, 2012). This represents a significant increase over past years, and means that 28 percent of grandparents in the United States are responsible for raising their grandchildren. About two-thirds of these grandparents are between the ages of 50 and 59, and about a third are over 60. Some of these households included at least one of the parents, but many of them included one or both grandparents acting in the role of surrogate parent(s).

Although the demographics of grandparent-headed households var y considerably, such households are far likelier to be an ethnic minority, suffer from poverty, and have low education levels. Households led by only a grandmother