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12.3: Chapter 30- Psychosocial Development in Late Adulthood

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    55319
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    Chapter 30 Learning Objectives

    • Explain the stereotypes of those in late adulthood and how it impacts their lives
    • Summarize Erikson’s eight psychosocial tasks of integrity vs. despair
    • Explain how self-concept and self-esteem affect those in late adulthood
    • Identify sources of despair and regret
    • Describe paths to integrity, including the activity, socioemotional selectivity, and convoy theories
    • Describe the continuation of generativity in late adulthood
    • Describe the relationships those in late adulthood have with their children and other family members
    • Describe singlehood, marriage, widowhood, divorce, and remarriage in late adulthood
    • Describe the different types of residential living in late adulthood
    • Describe friendships in late life
    • Explain concerns experienced by those in late adulthood, such as abuse and mental health issues
    • Explain how those in late adulthood use strategies to compensate for losses

    Ageism

    ageism or prejudice based on age. The term ageism was first used in 1969, and according to Nelson (2016), ageism remains one of the most institutionalized forms of prejudice today.

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    self-fulfilling prophecy or the belief in one’s ability results in actions that make it come true. Being the target of stereotypes can adversely affect individuals’ performance on tasks because they worry they will confirm the cultural stereotypes. This is known as stereotype threat, and it was originally used to explain race and gender differences in academic achievement (Gatz et al., 2016). Stereotype threat research has demonstrated that older adults who internalize the aging stereotypes will exhibit worse memory performance, worse physical performance, and reduced self-efficacy (Levy, 2009).

    Minority status: Older minority adults accounted for approximately 21% of the U. S. population in 2012 but are expected to reach 39% of the population in 2050 (U. S. Census Bureau, 2012). Unfortunately, racism is a further concern for minority elderly already suffering from ageism. Older adults who are African American, Mexican American, and Asian American experience psychological problems that are often associated with discrimination by the White majority (Youdin, 2016). Ethnic minorities are also more likely to become sick, but less likely to receive medical intervention. Older, minority women can face ageism, racism, and sexism often referred to as triple jeopardy (Hinze, Lin, & Andersson, 2012), which can adversely affect their life in late adulthood.

    Poverty rates: According to Quinn and Cahill (2016), the poverty rate for older adults varies based on gender, marital status, race, and age. Women aged 65 or older were 70% more likely to be poor than men, and older women aged 80 and above have higher levels of poverty than those younger. Married couples are less likely to be poor than nonmarried men and women, and poverty is more prevalent among older racial minorities. In 2012 the poverty rates for White older men (5.6%) and White older women (9.6%) were lower than for Black older men (14%), Black older women (21%), Hispanic older men (19%), and Hispanic older women (22%).

    Do those in late adulthood primarily live alone? No. In 2017, of those 65 years of age and older, approximately 72% of men and 48% of women lived with their spouse or partner (Administration on Aging, 2017). Between 1900 and 1990 the number of older adults living alone increased, most likely due to improvements in health and longevity during this time (see Figure 9.40). Since 1990 the number of older adults living alone has declined, because of older women more likely to be living with their spouse or children (Stepler, 2016c). Women continue to make up the majority of older adults living alone in the U.S., although that number has dropped from those living alone in 1990 (Stepler, 2016a). Older women are more likely to be unmarried, living with children, with other relatives or non-relatives. Older men are more likely to be living alone than they were in 1990, although older men are more likely to reside with their spouses. The rise in divorce among those in late adulthood, along with the drop-in remarriage rate, has resulted in slightly more older men living alone today than in the past (Stepler, 2016c).

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    Do those in late adulthood primarily live with family members? No, but according to the Pew Research Center, there has been an increase in the number of families living in multigenerational housing; that is three generations living together than in previous generations (Cohn & Passel, 2018). In 2016, a record 64 million Americans, or 20% of the population, lived in a house with at least two adult generations. However, ethnic differences are noted in the percentage of multigenerational households with Hispanic (27%), Black (26%), and Asian (29%) families living together in greater numbers than White families (16%). Consequently, the majority of older adults wish to live independently for as long as they are able.

    Do those in late adulthood move after retirement? No. According to Erber and Szuchman (2015), the majority of those in late adulthood remains in the same location, and often in the same house, where they lived before retiring. Although some younger late adults (65-74 years) may relocate to warmer climates, once they are older (75-84 years) they often return to their home states to be closer to adult children (Stoller & Longino, 2001). Despite the previous trends, however, the recent housing crisis has kept those in late adulthood in their current suburban locations because they are unable to sell their homes (Erber & Szuchman, 2015).

    Do those in late adulthood primarily live in institutions? No. Only a small portion (3.2%) of adults older than 65 lived in an institution in 2015 (United States Department of Health and Human Services, 2015). However, as individuals increase in age the percentage of those living in institutions, such as a nursing home, also increases. Specifically: 1% of those 65-74, 3% of those 75-84, and 10% of those 85 years and older lived in an institution in 2015. Due to the increasing number of baby boomers reaching late adulthood, the number of people who will depend on long-term care is expected to rise from 12 million in 2010 to 27 million in 2050 (United States Senate Commission on Long-Term Care, 2013). To meet this higher demand for services, a focus on the least restrictive care alternatives has resulted in a shift toward home and community-based care instead of placement in a nursing home (Gatz et al., 2016).

    Erikson: Integrity vs. Despair

    Integrity vs. Despair. This stage includes, “a retrospective accounting of one’s life to date; how much one embraces life as having been well lived, as opposed to regretting missed opportunities,” (Erikson, 1982, p. 112). Those in late adulthood need to achieve both the acceptance of their life and the inevitability of their death (Barker, 2016). This stage includes finding meaning in one’s life and accepting one’s accomplishments, but also acknowledging what in life has not gone as hoped. It is also feeling a sense of contentment and accepting others’ deficiencies, including those of their parents. This acceptance will lead to integrity, but if elders are unable to achieve this acceptance, they may experience despair. Bitterness and resentment in relationships and life events can lead one to despair at the end of life. According to Erikson (1982), successful completion of this stage leads to wisdom in late life.

    Staying Active: Many older adults want to remain active and work toward replacing opportunities lost with new ones. Those who prefer to keep themselves busy demonstrate the Activity Theory, which states that greater satisfaction with one’s life occurs with those who remain active (Lemon, Bengston, & Peterson, 1972). Not surprisingly, more positive views on aging and greater health are noted with those who keep active than those who isolate themselves and disengage from others. Community, faith-based, and volunteer organizations can all provide those in late adulthood with opportunities to remain active and maintain social networks. Erikson’s concept of generativity applies to many older adults, just as it did in midlife.

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    Generativity in Late Adulthood

    Volunteering: Many older adults spend time volunteering. Hooyman and Kiyak (2011) found that religious organizations are the primary settings for encouraging and providing opportunities to volunteer. Hospitals and environmental groups also provide volunteer opportunities for older adults. While volunteering peaks in middle adulthood, it continues to remain high among adults in their 60s, with about 40% engaging in volunteerism (Hooyman & Kiyak, 2011). While the number of older adults volunteering their time does decline with age, the number of hours older adults volunteer does not show much decline until they are in their late 70s (Hendricks & Cutler, 2004). African-American older adults volunteer at higher levels than other ethnic groups (Taylor, Chatters, & Leving, 2004). Taylor and colleagues attribute this to the higher involvement in religious organizations by older African-Americans. Volunteering aids older adults as much as it does the community at large. Older adults who volunteer experience more social contact, which has been linked to higher rates of life satisfaction, and lower rates of depression and anxiety (Pilkington, Windsor, & Crisp, 2012).

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    Grandparents Raising Grandchildren: According to the 2014 American Community Survey (U.S. Census, 2014a), over 5.5 million children under the age of 18 were living in families headed by a grandparent. This was more than half a million increase from 2010. While most grandparents raising grandchildren are between the ages of 55 and 64, approximately 25% of grandparents raising their grandchildren are 65 and older (Office on Women’s Health, 2010a). For many grandparents, parenting a second time can be harder. Older adults have far less energy, and often the reason why they are now acting as parents to their grandchildren is that traumatic events. A survey by AARP (Goyer, 2010) found that grandparents were raising their grandchildren because the parents had problems with drugs and alcohol, had a mental illness, was incarcerated, had divorced, had a chronic illness, was homeless, had neglected or abused the child, were deployed in the military, or had died. While most grandparents state they gain great joy from raising their grandchildren, they also face greater financial, health, education, and housing challenges that often derail their retirement plans than do grandparents who do not have primary responsibility for raising their grandchildren.

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    Social Networks in Late Adulthood

    However, the two theories differ in explaining why this occurs.

    Convoy Model of Social Relations suggests that the social connections that people accumulate differ in levels of closeness and are held together by exchanges in social support (Antonucci, 2001; Kahn & Antonucci, 1980). According to the Convoy Model, relationships with a spouse and family members, people in the innermost circle of the convoy, should remain stable throughout the lifespan. In contrast, coworkers, neighbors, and acquaintances, people in the periphery of the convoy, should be less stable. These peripheral relationships may end due to changes in jobs, social roles, location, or other life events. These relationships are more vulnerable to changing situations than family relationships. Therefore, the frequency, type, and reciprocity of the social exchanges with peripheral relationships decrease with age.

    Socioemotional Selectivity Theory focuses on changes in motivation for actively seeking social contact with others (Carstensen, 1993; Carstensen, Isaacowitz & Charles, 1999). This theory proposes that with increasing age, our motivational goals change based on how much time one has left to live. Rather than focusing on acquiring information from many diverse social relationships, as noted with adolescents and young adults, older adults focus on the emotional aspects of relationships. To optimize the experience of positive affect, older adults actively restrict their social life to prioritize time spent with emotionally close significant others. In line with this theory, older marriages are found to be characterized by enhanced positive and reduced negative interactions and older partners show more affectionate behavior during conflict discussions than do middle-aged partners (Carstensen, Gottman, & Levenson, 1995). Research showing that older adults have smaller networks compared to young adults, and tend to avoid negative interactions, also supports this theory.

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    Relationship with Adult Children: Many older adults provide financial assistance and/or housing to adult children. There is more support going from the older parent to the younger adult children than in the other direction (Fingerman & Birditt, 2011). In addition to providing for their own children, many elders are raising their grandchildren. Consistent with socioemotional selectivity theory, older adults seek and are helped by, their adult children providing emotional support (Lang & Schütze, 2002). Lang and Schütze, as part of the Berlin Aging Study (BASE), surveyed adult children (mean age 54) and their aging parents (mean age 84). They found that the older parents of adult children who provided emotional support, such as showing tenderness toward their parent, cheering the parent up when he or she was sad, tended to report greater life satisfaction. In contrast, older adults whose children provided informational support, such as providing advice to the parent, reported less life satisfaction. Lang and Schütze found that older adults wanted their relationship with their children to be more emotionally meaningful. Daughters and adult children who were younger tended to provide such support more than sons and adult children who were older. Lang and Schütze also found that adult children who were more autonomous rather than emotionally dependent on their parents, had more emotionally meaningful relationships with their parents, from both the parents’ and adult children’s point of view.

    Friendships: Friendships are not formed in order to enhance status or careers, and may be based purely on a sense of connection or the enjoyment of being together. Most elderly people have at least one close friend. These friends may provide emotional as well as physical support. Being able to talk with friends and rely on others is very important during this stage of life. Bookwala, Marshall, and Manning (2014) found that the availability of a friend played a significant role in protecting health from the impact of widowhood. Specifically, those who became widowed and had a friend as a confidante reported significantly lower somatic depressive symptoms, better self-rated health, and fewer sick days in bed than those who reported not having a friend as a confidante. In contrast, having a family member as a confidante did not provide health protection for those recently widowed.

    Loneliness or Solitude: Loneliness is the discrepancy between the social contact a person has and the contacts a person wants (Brehm, Miller, Perlman, & Campbell, 2002). It can result from social or emotional isolation. Women tend to experience loneliness due to social isolation; men from emotional isolation. Loneliness can be accompanied by a lack of self-worth, impatience, desperation, and depression. Being alone does not always result in loneliness. For some, it means solitude. Solitude involves gaining self-awareness, taking care of the self, being comfortable alone, and pursuing one’s interests (Brehm et al., 2002). In contrast, loneliness is perceived as social isolation.

    increase in risk for dementia and a 30% increase in the risk of stroke or coronary heart disease. This was hypothesized to be due to a rise in stress hormones, depression, and anxiety, as well as the individual lacking encouragement from others to engage in healthy behaviors. In contrast, older adults who take part in social clubs and church groups have a lower risk of death. Opportunities to reside in mixed-age housing and continuing to feel like a productive member of society have also been found to decrease feelings of social isolation, and thus loneliness.

    Late Adult Lifestyles

    Marriage: As can be seen in Figure 9.45, the most common living arrangement for older adults in 2015 was marriage (AOA, 2017). Although this was more common for older men.

    Widowhood: Losing one’s spouse is one of the most difficult transitions in life. The Social Readjustment Rating Scale, commonly known as the Holmes-Rahe Stress Inventory, rates the death of a spouse as the most significant stressor (Holmes & Rahe, 1967). The loss of a spouse after many years of marriage may make an older adult feel adrift in life. They must remake their identity after years of seeing themselves as a husband or wife. Approximately, 1 in 3 women aged 65 and older are widowed, compared with about 1 in 10 men.

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    widowhood mortality effect refers to the higher risk of death after the death of a spouse (Sullivan & Fenelon, 2014). Subramanian, Elwert, and Christakis (2008) found that widowhood increases the risk of dying from almost all causes.

    Divorce: As noted in Chapter 8, older adults are divorcing at higher rates than in prior generations. However, adults age 65 and over are still less likely to divorce than middle-aged and young adults (Wu & Schimmele, 2007). Divorce poses a number of challenges for older adults, especially women, who are more likely to experience financial difficulties and are more likely to remain single than are older men (McDonald & Robb, 2004). However, in both America (Lin, 2008) and England (Glaser, Stuchbury, Tomassini, & Askham, 2008) studies have found that the adult children of divorced parents offer more support and care to their mothers than their fathers. While divorced, older men may be better off financially and are more likely to find another partner, they may receive less support from their adult children.

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    Dating: Due to changing social norms and shifting cohort demographics, it has become more common for single older adults to be involved in dating and romantic relationships (Alterovitz & Mendelsohn, 2011). An analysis of widows and widowers ages 65 and older found that 18 months after the death of a spouse, 37% of men and 15% of women were interested in dating (Carr, 2004a). Unfortunately, opportunities to develop close relationships often diminish in later life as social networks decrease because of retirement, relocation, and the death of friends and loved ones (de Vries, 1996). Consequently, older adults, much like those younger, are increasing their social networks using technologies, including e-mail, chat rooms, and online dating sites (Fox, 2004; Wright & Query, 2004; Papernow, 2018).

    wanting to lose their autonomy, care for a potentially ill partner, or merge their finances with someone (Watson & Stelle, 2011).

    Remarriage and Cohabitation: Older adults who remarry often find that their remarriages are more stable than those of younger adults. Kemp and Kemp (2002) suggest that greater emotional maturity may lead to more realistic expectations regarding marital relationships, leading to greater stability in remarriages in later life. Older adults are also more likely to be seeking companionship in their romantic relationships. Carr (2004a) found that older adults who have considerable emotional support from their friends were less likely to seek romantic relationships. In addition, older adults who have divorced often desire the companionship of intimate relationships without marriage. As a result, cohabitation is increasing among older adults, and like remarriage, cohabitation in later adulthood is often associated with more positive consequences than it is in younger age groups (King & Scott, 2005). No longer being interested in raising children, and perhaps wishing to protect family wealth, older adults may see cohabitation as a good alternative to marriage. In 2014, 2% of adults age 65 and up were cohabitating (Stepler, 2016b).

    Living Apart Together: In addition to cohabiting there has been an increase in living apart together (LAT), which is “a monogamous intimate partnership between unmarried individuals who live in separate homes but identify themselves as a committed couple” (Benson & Coleman, 2016, p. 797). This trend has been found in several nations and is motivated by:

    • A strong desire to be independent in day-to-day decisions
    • Maintaining their own home
    • Keeping boundaries around established relationships
    • Maintaining financial stability

    Gay and Lesbian Elders

    LGBT Elder Care: Approximately 7 million LGBT people over age 50 will reside in the United States by 2030, and 4.7 million of them will need elder care. Decisions regarding elder care are often left for families, and because many LGBT people are estranged from their families, they are left in a vulnerable position when seeking living arrangements (Alleccia & Bailey, 2019). A history of discriminatory policies, such as housing restricted to married individuals involving one man and one woman, and stigma associated with LGBT people make them especially vulnerable to negative housing experiences when looking for eldercare.

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    no laws to protect them from victimization. The baby boomers, who grew up in the 1960s and 1970s, began to see states repeal laws that criminalized homosexual behavior. Future lesbian and gay elders will have different experiences due to the legal right for same-sex marriage and greater societal acceptance. Consequently, just like all those in late adulthood, understanding that gay and lesbian elders are a heterogeneous population is important when understanding their overall development.

    Type Description
    Physical Abuse Physical force resulting in injury, pain, or impairment
    Sexual Abuse Nonconsensual sexual contact
    Psychological and Emotional Abuse Infliction of distress through verbal or nonverbal acts such as yelling, threatening, or isolating
    Financial Abuse and Exploitation Improper use of an elder’s finances, property, or assets
    Neglect and Abandonment Intentional or unintentional refusal or failure to fulfill caregiving duties to an elder

    did not consider verbal abuse as elder abuse, and higher socioeconomic status African American and White women did not consider financial abuse as a form of elder abuse (as cited in Roberto, 2016, p. 304).

    Substance Abuse and the Elderly

    • There are 2.5 million older adults with an alcohol or drug problem.
    • Six to eleven percent of elderly hospital admissions, 14 percent of elderly emergency room admissions, and 20 percent of elderly psychiatric hospital admissions are a result of alcohol or drug problems.
    • Widowers over the age of 75 have the highest rate of alcoholism in the U.S.
    • Nearly 50 percent of nursing home residents have alcohol-related problems.
    • Older adults are hospitalized as often for alcoholic related problems as for heart attacks.
    • Nearly 17 million prescriptions for tranquilizers are prescribed for older adults each year. Benzodiazepines, a type of tranquilizing drug, are the most commonly misused and abused prescription medications.

    Diagnosis Difficulties: Using criteria from the Diagnostic and Statistical Manual of Disorder-5th Edition (American Psychiatric Association, 2013), diagnosing older adults with a substance use disorder can be difficult (Youdin, 2016). For example, compared to adolescents and younger adults, older adults are not looking to get high, but rather become dependent by accident.

    of a substance use disorder. Further, a diagnosis of a substance use disorder involves impairment in work, school, or home obligations, and because older adults are not typically working, in school or caring for children, these impairments would not be exhibited. Stigma and shame about use, as well as the belief that one’s use is a private matter, may keep older adults from seeking assistance. Lastly, physicians may be biased against asking those in late adulthood if they have a problem with drugs or alcohol (NCADD, 2015).

    Abused Substances: Drugs of choice for older adults include alcohol, benzodiazepines, opioid prescription medications, and marijuana. The abuse of prescription medications is expected to increase significantly. Siriwardena, Qureshi, Gibson, Collier, and Lathamn (2006) found that family physicians prescribe benzodiazepines and opioids to older adults to deal with psychosocial and pain problems rather than prescribe alternatives to medication such as therapy. Those in late adulthood are also more sensitive to the effects of alcohol than those younger because of an age-related decrease in the ratio between lean body mass and fat (Erber & Szuchman, 2015).

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    Cannabis Use: Blazer and Wu (2009) found that adults aged 50-64 were more likely to use cannabis than older adults. These “baby boomers” with the highest cannabis use included men, those unmarried/unpartnered, and those with depression. In contrast to the negative effects of cannabis, which include panic reactions, anxiety, perceptual distortions and exacerbation of mood and psychotic disorders, cannabis can provide benefits to an older adults with medical conditions (Youdin, 2016). For example, cannabis can be used in the treatment of multiple sclerosis, Parkinson’s disease, chronic pain, and fatigue and nausea from the effects of chemotherapy (Williamson & Evans, 2000).

    Future Substance Abuse Concerns: There will be an increase in the number of seniors abusing substances in the future because the baby boomer generation has a history of having been exposed to, and having experienced, psychoactive substance use over their adult life. This is a significant difference between the current and previous generations of older adults (National Institutes of Health, 2014c). Efforts will be needed to adequately address these future substance abuse issues for the elderly due to both the health risks for them and the expected burden on the health care system.

    Successful Aging

    • Relative avoidance of disease, disability, and risk factors, like high blood pressure, smoking, or obesity
    • Maintenance of high physical and cognitive functioning
    • Active engagement in social and productive activities

    selective optimization with compensation is used when the elder makes adjustments, as needed, in order to continue living as independently and actively as possible (Baltes & Dickson, 2001). When older adults lose functioning, referred to as loss-based selection, they may first use new resources/technologies or continually practice tasks to maintain their skills. However, when tasks become too difficult, they may compensate by choosing other ways to achieve their goals. For example, a person who can no longer drive needs to find alternative transportation, or a person who is compensating for having less energy learns how to reorganize the daily routine to avoid over-exertion.

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