Final Exam Study Guide (Exam 3)
Final Exam Study Guide (Exam 3) FAD3343
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FAD3343 Final Exam Study Guide CHAPTER 11: The Oldest-Old & Caregiving - The Oldest Old o Researchers have begun separating the older population into different groups o There’s no clear cut guidelines for what constitutes the “oldest old,” but it is commonly considered 85+ o People 85 and older are the fastest growing portion of the older population o Robust aging: known as successful aging Greater social contact Better health and vision Experienced fewer life events - Physical Health of the Oldest Old o This age group is much healthier and happier than stereotypes would have us believe o Losses do not begin to take a heavy toll until after 85 years of age o Critical measure of health is daily activities: Activities of Daily Living (ADLs): bathing, eating, dressing, toileting, walking, getting around the home Instrumental activities of Daily Living (IADLs): shopping, housework, money management, meal preparation o Chronic disabling conditions: bone and joint problems; mental impairment; drug intoxication; falls; urinary incontinence. o Largest functional impairments for oldest old are physical (not mental and social) - Living Arrangements & Marital Status o Living status of oldest-old: More than 50% of oldest-old still live at home About 35% live alone (mainly women) About 25% live with relatives About 21% live in nursing homes o Marital status of oldest old: 75% are widowed Women are dramatically more likely to be widowed & living alone - Caregiving o Informal Caregiving: comes from relationships that exist naturally in a person’s environment, such as family, friends, church, and organizations that are not professional or financed by the government o Formal Care: giving by professionals & paraprofessionals, such as health care professionals, hospitals, day-care centers, and nursing homes. o Typical caregiver is a 46-year-old working woman who spends 18 hours/week caring for chronically ill 77-year-old mother who lives nearby - Obligations of Adult Children to their Parents o There are no clear cultural guidelines and no specific norms for intergenerational relationships between elderly parents and adult children, especially for caregiving. o Research has shown that adult children feel a strong moral obligation to provide care for their disabled parents. o Daughters are expected to be caregivers, and are more likely to be caregivers o Affection, gratitude, guilt, or desire for parental approval still motivates adult children to care for their aging parents o Being married & employed decreases adult child caregiving. o Geographical distance decreases caregiving - Spousal Caregiving o About 40% of all caregiving is provided by spouses; wives are more likely to be caregivers o Types of husband caregivers: o The worker: planning and educating himself; staying organized o Labor of love: provides caregiving out of a deep feeling of love and devotion, not duty o Sense of duty: caregiving stemmed from commitment, duty, and responsibility o At the cross road: a new caregiver, isn’t oriented to the role - Stress and Caregiving o Caregiver distress: negative stress associated with caretaking, including role strain, subjective burden, depression, anxiety, hostility, fear, frustration o Many adults want to care for their parents, but experience enormous financial and emotional burdens o Psychological interventions for caregivers have been shown to be moderately effective. o Respite care: time off for the caregiver, by having temporary paid help or placing the older adult in a nursing home temporarily. Chapter 11- The Oldest-Old and Caregiving Book Notes - Informal caregiving usually precedes and sometimes accompanies or replaces formal caregiving offered by hospitals and other institutional settings - No clear-cut norms or customs for caring for older family members who need help caring for themselves - Young-old (65-74), old-old (75-84), oldest-old (85+) - Robust aging- sometimes called “successful aging”, refers to aging while maintaining good mental and physical status o The most robustly aging people have certain characteristics: greater social contact, better health and vision, and have experienced fewer life events in the past 3 years o Healthier, more socially integrated people whose later lives have not been disrupted by huge personal, family, or social trauma remain strong mentally at oldest-old ages - The 75-84 age group is by and large healthier now than in any previous time in history - Generally, physical losses in old age do not begin taking a toll until after 85 - Living assistance as people become frailer is initially most often provided by family members and other help such as a housekeeper o Family members, neighbors, or church associations often help grocery shop, housekeep, and short errands like going to the bank or getting to an appointment (informal caregiving) - Informal caregiving comes from relationships that exist naturally in a person’s environment, such as family, friends, church, and organizations that are not professional or financed by the government - Formal caregiving is paid care provided by professionals and paraprofessionals, including health care professionals, hospitals, and day care centers and nursing homes - a critical measure of health is whether a person can manage daily activities alone or if they need help - functional ability is the ability to do personal activities of daily living (PADLs) without help o bathing, eating, dressing, toileting, getting in and out of bed/chairs, and walking or getting around home - a second measure of functional disability is the ability to do instrumental activities of daily living (IADLs) such as shopping, housework, money management, and meal preparation - most common chronic disabling conditions: bone and joint problems, heart disease, vision, and hearing problems, mental impairment, drug intoxication, falls, and urinary incontinence - common chronic diseases: arthritis, hypertension, cardiac problems - only a small percent of the oldest-old are institutionalized o primarily due to informal or family and friend assistance - much of the help needed for the oldest-old to live alone is not covered by Medicare - widowhood is the predominant lifestyle for women 75+, whereas men in this age group are typically married - life satisfaction is the sense of well-being that individuals experience and identify, not something recorded by measures external to the individuals o satisfaction in later life seems to depend on an elder’s sense of self efficacy —the extent to which a person is able to master the environment effectively and feel a sense of control in life - the very old are a group of people who have survived because of a combo of: their genetic makeup, the lifestyles they have both chosen and blessed with throughout their lives, and personality characteristics having to do with taking care of themselves physically, psychologically, socially, and spiritually - informal care is central to later life well-being, often the difference in being able to live at home or living in a nursing care or assisted living facility o saves the American health care system substantial dollars - families are there for their older members as the need arises, despite the preference for independence - the stress of caring for a frail, disabled person is costly in human terms among both formal and informal caregivers, but generally more so for informal family caregivers - a spouse most commonly carries out informal caregiving, and when no spouse is available, often the daughter - a caregiver is an unpaid person (spouse, partner, family member, friend, or neighbor) involved in assisting others with ADLs and/or medical tasks - formal caregivers are paid provider of those services - the modified nuclear family concept describes the typical American situation, great deal of family interaction - most elders live in separate households but are not cut off from families - no specific norms for behavior in area of intergenerational relationships between elderly parents and adult children - some older parents expect that: married children should live close to parents, children should take care of sick parents, if children live nearby should visit parents often, and children who live at a distance should write or call often - modified extended family- describes families that keep close ties even though they do not share households, norms or expectations of close relationships - adult children feel a strong moral obligation to provide care for disabled parents - intergenerational norms- the standard, expected behaviors of one generation toward another - 3 factors that contribute to the weakened family support system: demography including fewer offspring and longevity, women’s changing roles, and changing intergenerational relationships - Traditionally, providing older parents with companionship and services has produced a sexual division of labor - The presence of siblings reduces the workload on any one adult child - In the past, children had been expected to tend to aging parents in return for inhering the family farm/business- created a pattern of economic interdependence - Children are now less likely to take over parents’ farm or business, freer to take jobs elsewhere or establish careers independent of parents - The basis for helping is now less economic and more for psychological reasons - Social Security and other government programs have reduced the dependence of the old on family support systems - Changes in family, demographic shifts, and changes in the economic structure have necessitated greater levels of governmental and formal intervention in the care of older people - Spouses provide a large percent of caregiving, wives more likely to be caregivers - Husband caregivers: o The worker: models his role after the work role, plans his work schedule every day, reads everything, organizes materials o Labor of love: he provides caretaking out of deep feelings of love, caring out of devotion not duty o Sense of duty: caregiving stems from commitment, duty, and responsibility o At the crossroads: typical of a new caregiver who hasn’t oriented to the role, floundering and in crisis - Supportive intervention can work to help ease the tremendous emotional and physical burden of caring - Now is the first time in history that American couples have more parents than children - Adult sons are likely to provide instrumental support: communication with the physician, completion of insurance forms, etc. - Unmarried adult children who share a household with an ailing parent provide the most care - Being married and employed decreases the amount of help given - Family size, SES level, and ethnicity are all determinants of family caregiving patterns - Unlike caregiving for children who become more independent with age, caregiving for an impaired older parent requires more effort as the years go by - Drop in fertility rate will impact care and caregiving for adults in their later years - Childless elders follow the principle of substitution by turning to extended kin for help, but these sources are less available than are children - Childless married couples tend to rely primarily on each other and to remain otherwise independent from extended kin - Unmarried older people, having established lifetime patterns for seeking assistance, seem to be more resourceful in using a variety of people and social resources to meet their needs - The number of older parents who care for dependent adult children and grandchildren is increasing - The emotional cost of caring for a disabled child is high - A fierce tangle of emotions (anguish, frustration, inadequacy, guilt, devotion, and love) come with parenting one’s own parents - Caregiver distress indicates the negative stresses of caretaking, including role strain, subjective burden, depression, anxiety, hostility, etc. - Coping has been conceptualized as a response to the demands of specific stressful current situations o Coping techniques and abilities vary from person to person - Problems in caregiving come from: the strain of responsibility for direct personal care of the elder, the caregivers’ own current personal and health problems, role strain from the demands of other work and the need for leisure, inter-sibling problems and other strained family relationships, and arranging outside help - A social support network is very important to caregivers - Although helping parents can be rewarding for many adult children, can be financial and emotional burden - Principal caregiving adult children are “women in the middle” pulled in many directions from competing demands on their time and energy - The kinds of psychosocial interventions for caretakers were varied: individual counseling, family counseling, support groups, educational groups, problem-solving groups for the caretaker and patient, social worker visits, and family consultants - Respite care provides short-term breaks that can restore energy and help caregivers regain balance in life; found to be more effective than psychosocial interventions at alleviating stress for caregivers - home health care personnel are now the fastest-growing segment of the long-term care industry and the demand continues - home care and personal care aids help those who are disabled, chronically ill, or cognitively impaired, also help older adults who may need assistance o help with dressing and bathing, and services such as light housekeeping, washing dishes, organizing a client’s schedule, planning appointments, arranging transportation to appointments, managing food purchases and cooking, and providing companionship - home care workers are generally poorly paid and poorly trained - paraprofessional home care workers tend to be a transient work group with a high turnover rate o worker shortages, high turnover - many families do not qualify for state-funded home care workers - currently, family members provide about 80% of all in-home care that frail elders receive - the elderly are a very diverse group with widely diverse needs CHAPTER 12: Special Problems - Suicide o Suicide rate of older adults is >50% more than that of the general population o Older white men are more prone to suicide o Older women have more suicide attempts, but older men are more “successful” at completing suicide. o Causes: Loss of loved ones Social isolation Aversion to bodily changes from illness Worry over medical bills - Crimes Against Older People o A majority of victimization against older people occur in their homes o A majority are property crimes, burglary, auto theft, etc. o Older, women, black, poorer, and urban people are more fearful of crime than younger, male, while, wealthier, rural people o The “fear of crime” may cause older individuals to not want to leave their homes. - Elder Abuse o Most elder abuse is done by someone with whom the elder lives, most often an adult child. o Substance abuse, cognitive impairment, economic stress, caregiver inexperience, family violence, blaming personality, unrealistic expectations, and economic dependence on the elder are all factors that increase risk of caregiver being abusive o Neglect is the most common form of abuse - Fraud o Older people are “good targets” for fraud b/c they have assets, are isolated and lonely, and may want to increase their retirement income o Types of fraud: Social referral Land and home-equity fraud Mail order fraud & phishing Telemarket/telephone fraud (top complaints filed) Credit card fraud Investment fraud Medical & healthcare fraud - Drug Abuse o Older people are vulnerable to the effects of drugs because of the changes of the mind and body with age o Multiple drug usage can cause adverse reactions and drug abuse o Aspirin is most widely used drug for older people (especially for arthritis) but can have negative side effects o Sleeping pills and laxatives are often abused Chapter 12- Special Problems Book Notes older adults are less likely to be victimized than younger adults o although less likely to be victims, older adults report a higher fear of crime than do younger adults the fear, blamed on perceived vulnerability- a belief that one is vulnerable—has psychological, physical, and lifestyle consequences for the elderly o fear can result in older adults not wanting to leave their homes, to spend money unnecessarily on security systems, and/or to generally be more vulnerable to fraudulent safety marketing among overall victims of crime, older adults are more likely than younger adults to be targeted for robbery, forgery, fraud, and intimidation older adults who are socially isolated have an increased risk of victimization because of insufficient social networks to ensure personal safety income inequality has substantial influence on crime rates o limited employment opportunities and low wage coupled with limited educational training associated with comparatively higher crime rates against elders concept of perceived vulnerability is likely a reason for attacks on older individuals o by taking stance of fear in attitudes and behaviors, become a target most crimes against older people are directed at property: burglary, auto theft, etc. o and psychological intimidation not all old people are easily intimidated dissatisfaction with neighborhood and physical vulnerability important correlates of fear of crime, but actual victimization experience was not the main determinant of fear (study) reason older people are more fearful than younger people has to do with psychological fear of crime knowing someone who was a victim of crime increased fears of crime; the more life experience one has, the more likely to have known a victim women are more fearful than men, African Americans more than whites, those with less money more afraid, and residents of larger cities are more fearful than people in smaller towns and rural areas actual crime data- women not more frequently victimized than men the more integrated one is in community activities, the less one fears crime o people feel less threatened by crime if they know and trust their neighbors o being part of a cohesive, close-knit community reduces fear of crime although older women fear crime more than older men, they are less likely to be victims o and although older people are more fearful than younger people, less likely to be victims one explanation for disproportionate fear may be that some older adults associate minor offenses with more serious ones o possible consequences of the criminal act can be as frightening as the fear of victimization itself older adults are prime targets for financial exploitation: “crime of the 21 century” in many cities, new programs aimed at preventing crimes against older citizens, helping those older people who have become victims and teaching them what they can do to help themselves are receiving priority o one common approach is the use of police units trained in the problems particular to older people inform the community of the latest trends in crime and help people be on the alert for suspicious activity o Neighborhood Watch- emphasizes crime awareness in residents of all ages, have resulted in crimes being spotted while in progress o many communities offer workshops and informational meetings to inform older adults about current scams and criminal issues targeting older adults in the area undue influence- insidious manipulation that foes undetected by a victim and often by the victim’s family o is exerted by people in a trusted position, such as a financial advisor, attorney, or family member that person is in a position to benefit at the expense of their victims often the manipulation goes unnoticed, crime not discovered or years later numerous government websites offer suggestions and assistance for older adults’ protection of themselves and their property some cities provide escort services to older people when they are most vulnerable —such as on trips to stores and banks fear often accompanies frailty because being frail means having less personal control over life’s events many states offer reimbursement programs for crime victims, and some of these programs give priority to older people most crimes committed by old people are misdemeanors—petty theft, sleeping on the sidewalk, alcohol violations, and traffic violations o shoplifting is frequent misdemeanor charge, most are white females felonies occur, most frequently in the form of grand theft and narcotic charges typically older people are caught stealing lipstick, perfume, night creams, or cigars shoplifting among elders represents the combined influence of stress, age, and merchandising; fear for the future may compel some to shoplift to conserve money for anticipated expenses o some steal to ease fear, others to get attention the criminal activities older inmates most likely engaged in were 1) violence against a family member; 2) white crimes such as fraud; 3) drug sales; and 4) alcohol-related crimes such as vehicular manslaughter professional criminals tend to remain active because crime represents their life’s work older criminals come from 2 groups: o those who started at a young age engaging in illegal activities and o those who committed offenses for the first time in their later years the older prison population is growing but adequate medical care is lacking in jails most leaders of organized crime are in the upper registers of the age scale o organized crime is age-stratified, and the heads of “families” tend to be well over 50 older offenders play an important role in white collar crime more people are being sent to prison and receiving longer sentences, increasing the number of older prisoners The number of elderly prisoners is growing exponentially Although young people are most likely to commit crimes—older adults are increasingly being admitted to prison; plus, more intimates are aging in prison because of tougher sentencing laws dictating the length of time served The older population costs much more keep locked up than an average prisoner Older convicts tend to be chronic offenders who have grown old in a steady series of prison terms Age and illness are associated more strongly behind bars given lifetimes of chronic stress, smoking, depression, and substance abuse, and even head injuries from fights and other violence The costs of housing older inmates can be as much as 9x more than for younger inmates Prison costs for eyeglasses, dentures, heart surgery, emphysema, prostate problems, strokes, and other age-related needs are rapidly growing Dementia in prison is an underreported but growing phenomenon (particularly difficult to manage) o Frequently cause fights, hitting people they consider threatening or disturbing others by encroaching on their turf As the prison population has aged, so has the incidence of chronic diseases among inmates, including hypertension and diabetes Most abuse of elders is done by the person with whom he or she lives; it can affect people of all ethnic backgrounds and social status and both men and women Battered parent syndrome- parents are attacked and abused, sometimes fatally, by their adult children Factors that increase the risk of a caregiver becoming an abuser include alcohol and drug abuse, cognitive impairment, economic stress, caregiver inexperience, a history of family violence, a blaming personality, unrealistic expectations, and economic dependence on the elder Domestic elder abuse- any abusive behavior committed by someone with whom the elder has a special relationship such as a spouse, sibling, child, friend, or caregiver Institutional abuse- maltreatment occurring in residential facilities, group homes, board and care facilities, foster care homes, etc. Abuse can be intentional (ex. Withholding food or medications) or unintentional (resulting from ignorance or genuine inability to provide necessary care) Neglect is the most common form of abuse, followed by physical, then financial and material exploitation Types of abuse: o Physical abuse- willful infliction of pain or injury o Psychological abuse- includes threats, intimidation, and verbal abuse o Financial/material abuse- taking advantage of frail or ill elderly; misuse of their money or property; theft, deception, diverting income, or mismanagement of funds o Violation of rights- when all the rights of an older person are taken away o Neglect- occurs when a caregiver’s failure to provide adequate food, shelter, clothing, and medical or dental care results in significant danger to the physical or mental health of an older person in his or her care o Self-abuse and neglect- occur when old people do not adequately care for themselves; sometimes intentional, others cannot adequately provide for themselves Abandonment is an active form of neglect o Desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person Typical abused elder is a frail, widowed female who is cognitively impaired and chronically ill A common predictor of abusive behavior is economic dependence Abuse happens in nursing homes; older people are more at risk in institutions than in own homes because of their exceptional frailty and danger of retaliation by caregivers Ombudsman are professionals who advocate on behalf of residents of long-term care facilities and help resolve complaints about issues of care o Can help concerned family members understand the situation, and after visiting the facility, can advise on how and with whom a complaint is filed Fraudulent crimes differ from violent crimes in 3 primary ways: o Swindlers use no weapons, never threaten or physically harm victims, and do not rely on force o They use persuasion and emotional influence Any person with money is a potential victim of fraud Older targets make good targets because: o Many have assets, most everyone wants to increase retirement savings, and many older people live alone and are isolated or lack social stimulation; also many older people are completely dependent on one caregiver or adviser Some dating and marriage services seek out the lonely and widowed to lure them into paying big fees for introductions to new friends or possible mates o May pay hundreds of dollars for a video to be shown to prospective dates (never shown) o Or for a computerized dating service that never generates any dates Land fraud- real estate developers may offer lots for sale in a still-to-be-built retirement community, promising attractive facilities such as pools and golf courses, none of the description or promises accurate Home equity fraud- has left some elders homeless; swindlers pose as financial experts who offer help in refinancing a home, end up with cash from the home equity loan or actually gets the owner to unwittingly sign papers transferring title Mail-order catalogs and television advertising can be misleading and result in mail-order fraud Phishing is sending emails that look legitimate but are not actually from a bank or other reputable agency o Often request bank or credit card number or passwords to steal someone’s identity Online and telemarketing scams rank among the top complaints that older consumers file o Telephones are now the vehicle of choice for committing fraud Boiler rooms- offices from which telephone calls are made o Vacation scam Recommendations to older people: o Beware of requests for money to prepay taxes, beware of requests to send a check by overnight delivery or if a courier will come to collect it, beware of requests for credit card numbers to show eligibility, beware of a rush for action, and to fight back just hang up Credit card fraud- in which swindlers find ways to get card numbers and charge items on the accounts Identity theft is when criminals use personal information to access accounts or apply for credit cards in victims’ names There are many “Get-rich” schemes used to fleece older people o Older people eager to invest their savings as a hedge against inflation may become victims of numerous investment frauds involving bogus inventions or phony businesses Estate planning seminars have become common sources for marketing to people seeking high-dividend sources for their investments o Draw more regulatory attention because they target areas with high proportions of older people Medical and health care fraud is a huge issue; easier to commit against an older person who is managing multiple doctor visits, many different prescriptions, and many kinds of medications Most common types of health care fraud: o Billing for services that were never rendered o Billing for more expensive services or procedures than were actually provided “upgrading” o Performing medically unnecessary services for the purpose of generating insurance payments o Misrepresenting non-covered treatments as medically necessary to gain insurance payments o Falsifying a patient’s diagnosis to justify tests or other procedures o Unbundling-- billing each step of a procedure as if it were a separate procedure o Billing a patient more than the co-pay amount for services paid in full by the benefit plan o Accepting kickbacks for patient referrals o Waiving patient co-pays or deductibles and overbilling the insurance carrier or benefit plan Medical quackery- misrepresentation of either health or cosmetic benefits through devices or drugs that are presumably therapeutic, can victimize both young and old; older people more prone to this o Top 5: ineffective arthritis products, spurious cancer clinics (many located in Mexico), bogus AIDS cures, instant weight-loss schemes, and fraudulent sexual aids Miracle drugs- cancer cures and arthritis cures Many older Americans who need medical devices such as eyeglasses, hearing aids, and dentures frequently are victims of overpricing, misrepresentation, and high- pressure sales tactics Elders are likely targets for products that promise to restore the appearance of youth—cosmetics, skin treatments, hair restorers, male potency pills, wrinkle and “age spot” removers, etc. o In a society like ours, which glamorizes youth, the desire to remain young is strong o Even products that have been FDA approved tend to be advertised with exaggerated claims Fraudulent cancer cures rob the sick of their money and of their time for proper treatment Arthritis is the most common chronic condition of elders; an inflammation that makes joints stiff and painful to move o Because no one knows exactly what causes it, doctors can do little more than prescribe pain relievers o Fake cures Older people are particularly vulnerable to the mental and physical effects of drugs because of changes in minds and bodies with age Though people of all ages need prescription drugs for various health problems, elders need them in much greater proportions because they are more likely to suffer chronic illnesses or pain Older Americans take more prescription medicines than any other age group Age slows the liver’s ability to filter medicines out of the body o Older adults may have side effects or become addicted from a drug at a lower dose than younger adults Adverse drug reactions occur more frequently in old age, and multiple drug use should be closely monitored Elders do not have higher rates of alcoholism than younger adults Risk factors for alcoholism in later life: o Family history of alcoholism o Personal history of excessive alcohol consumption o Discretionary time, money, and/or opportunity to drink o Age-related volume of alcohol distribution in the body o Increased central nervous system sensitivity to alcohol o Pain or insomnia secondary to chronic medical disorders o Other psychiatric disorders such as schizophrenia and depression Consumer education is vital in helping individuals to avoid fraud, medical quackery, and drug abuse Adult education programs are one way of reaching the public Education, self-help groups, and professional help should be available to assist elders with their special problems Consumer education is useful in learning to detect frauds and gaining knowledge about over-the-counter and prescription drugs CHAPTER 13: Women & Ethnic Groups - Minority Population o Minorities: ethnic elders who have experienced unequal treatment in certain segments of society based upon their physical/cultural characteristics. o By 2030, about 70 million people will be over 65 years old in the U.S. 25% will be minority populations This will increase to 33% by 2050, which 40% will be White. Asian & Hispanic populations will have the most dramatic increase - Women as Minorities o Women are considered minorities b/c of the sexism that is part of society o Older women are among the most poor in the U.S. o Double Standard of Aging: the standard of aging for women progressively destroys her sense of her beauty and self-worth, while it is less wounding on men o Age Terrorism: the exploitation of women’s fears of growing older - African Americans o Largest minority group in the U.S. o Compared to Whites, African Americans: Have shorter life expectancy Have lower retirement incomes and more largely based on S.S. Are in nursing homes less (more likely to be cared for by family) Are in lower quality housing - Hispanic Americans o Hispanic elders are 2x as likely (compared to total population) to live with other relatives o Likely to be poor, less educated, have inadequate healthcare, and have increased illiteracy rates o Tend to live in urban areas o Tend to underutilize services that could be helpful to them b/c of lack of education, money, and suspicion o Adult children provide a great deal of support to their aging parents - Asian Americans o Large amounts of diversity between different Asian ethnic groups o Filial piety: eldest son assumes responsibility for his parents. o Have a tradition of respect and care for elders o Value of education and hard work ethic provides higher family incomes and wealth being passed down from older generations. - Native Americans o Most deprived of all ethnic groups o Lower employment rates, lower literacy rates, and substandard housing o Strong beliefs in attaining harmony between human beings and nature o Decreased life expectancy than Whites o Increased rates of alcoholism, suffer from alcohol-related health problems Chapter 13- Women and Ethnic Groups Book Notes Increases in all the groups are related to past fertility patterns, immigration patterns, and to increasing life expectancy Ethnicity involves a culture and an internalized heritage not shared by outsiders, social status, and the composition and function of support systems Discrimination is not necessarily associated with ethnicity Minorities in this context are ethnic elders identified by language, physical or cultural characteristics, and based on those characteristics have experience unequal treatment in certain segments of society Traditional considerations for longevity have been an issue of minorities and the poor, with a focus on good medical care Perhaps longevity is related to health care options and availability, lifelong poverty and discrimination, and the culture in which one lives 5 groups: women of any ethnicity, African Americans, Hispanics, Asians, and Native Americans Women, although not an ethnic minority group, hold a lower status in our culture than men o Therefore, women have been judged a minority group not in terms of numbers but in terms of status The minority status of women is based on the sexism that pervades US society o For older women, sexism is compounded by ageism Older women have trouble finding acceptance and equality in the work world, in politics, and in romance One advantage for women is their willingness to reach out and get help: from each other, from books and seminars, from reentry programs at colleges, and from various counseling services o Women look to each other for examples of how to grow old with grace Not all aging is necessarily grown into with grace; but role models of activist agers as well as the maintenance of extraordinary beauty in maturity are good role examples for many women Work and community roles for older women, formerly narrowly constructed in the US are broadening Increasingly, older women have more options to experience a rewarding and fulfilling later life Poverty among older people is unevenly distributed, with women being among the most poor in the US Poverty among married women is fairly low o Poverty among unmarried women is 3-4x that of married women More than 50% of women 65+ would live in poverty if not for Social Security o Women receive more than 48% of retired worker benefits and almost 46% of disabled worker benefits Among unmarried older women, SS is 48% of their total income, whereas it is only 37% of unmarried elderly men’s income and only 30% of couples’ income Major ways women’s lives are compromised in later life: o Lower wage histories- women on average earn only about 76% of what men earn—less $ to invest o Low retirement income— women more likely than men to leave jobs before becoming vested in retirement plans; low wages mean many women can’t save for retirement o Divorced women are particularly vulnerable o Lack of financial planning skills o Women live longer than men o Need for public benefits o Caregiving responsibilities o Inadequate housing Financial problems for women frequently originate in middle age or even earlier: sporadic lifetime work histories at lower wages than men’s’; greater chance of work in a business not providing a pension; and less information and sophistication about investment and retirement planning than male counterparts For both men and women, being single in later life is associated with greater poverty, and for the boomer generation, divorce has been very common Since women are less likely to remarry, a cohort is formed of divorced women entering later life o Women more likely to spend old age in poverty The middle-aged women who can save some money—or at least pay into SS— improve their chances for a fulfilling old age Single women have historically been seen as piteous, tragic, and lonely people with a meaningless life More than 25% of women 65+ who live alone or with nonrelatives live below poverty level Ever single women (never married) tend to have greater retirement incomes than do divorced or widowed single women Lifetime income impacts the quality of life in many aspects, from health care to living arrangements to opportunities for socialization Many older widowed women depended entirely on their husband’s incomes and when retired, on their husband’s private pension plans or SS o More often than not, private pension plans fall sharply when a retired spouse dies The death of a spouse lowers the amount of SS benefits o If this is the case, widows’ low incomes expose them to greater social and economic risks than other segments of the older population The opportunity for older widows to remarry is limited, due primarily to the relatively small number of eligible males in their age group o Older females who are eligible for marriage outnumber males by a ratio of more than 3 to 1 o Additionally, males who marry after age 65 tend to marry women from younger age groups Divorce is one of the top 2 most stressful events an individual can experience in a lifetime, second only to death Divorce has long-term postretirement consequences for women Divorce affects women’s labor force participation, pension income, savings, and health In our society, in spite of positive steps toward equality, women remain disadvantaged in the workplace Inequalities in income for older women will not totally disappear until women achieve equality in the workplace from the beginning of their careers If women are homemakers or caregivers of children or older parents during all or part of their working years, they suffer financially in later life o Being removed from the paid labor market reduces their SS benefits, pensions, and life savings Double standard of aging- standard of aging for a woman progressively destroys her sense of beauty and self-worth, whereas the standard of aging for a man is much less wounding o Girls learn from an early age to care about their physical beauty o The youth culture in our society exerts an intense social pressure for women to remain young Self-neglect in old age may come about because of negative self-concept resulting in part from comparing one’s physical condition and personal competence to a standard that in unattainable at all cycles of life The successful exploitation of women’s fears of growing older has been called age terrorism Late midlife astonishment- a developmental crisis in which women aged 50-60 become aware of and begin to work through society’s devaluation of their physical appearance o Women unable to make a transition from young to middle-aged to old may suffer loss of self-esteem, depression, and have feelings of shame and self- consciousness One dangerous outcome of negative shifts in self-image can be neglect o Women’s fear of age-related physical change can take on a pathological flavor because personal changes can cause a woman to doubt her social capability, which leads to low self-assessment, leading to low self-esteem, leading to self-neglect The key to successful aging appears to be that women develop adequate strategies to maintain their self-identities even as key aspects of their bodies, their minds, and their health, change Miscegenation- discredits the abolitionist movement; the objective was to create fear and debate over intermarriage between blacks and whites Anti-miscegenation is the illegal status of sexual relations, marriage, cohabitation, or interbreeding of people of different races, more commonly called miscegenation It was not until 1967 that anti-miscegenation laws were ruled unconstitutional 1967: baby boomers were protesting a war, and they and their parents and children were marching for racial equality in rallies and protests throughout the country The election of 2008 of an African American president—a man of multiracial background—has shifted current perceptions of black Americans by much of the American and world population o Symbol of progress and possibility for people of color and a symbol to the world of America’s ability to embrace cultural and racial differences The trend for declaring multi-ethnicity, as well as the legal and social freedom for interracial relationships, is in no small part due to the demise of anti- miscegenation laws The African American older population is the largest minority group among older Americans Economic security of people 65+ has improved over the last 30+ years For most older African Americans, SS benefits provide the foundation for their retirement income security African Americans as a group differ widely in socioeconomic factors o As a result of the civil rights movement, have gained a large middle class (a class having grown to roughly the same size group as the African American poor or marginally poor) Elders in inner cities are often left to cope with deteriorating neighborhoods, high crime rates, and the threat of violence, or they are left in rural areas to struggle with poverty and lack of medical and social services, and often more limited social support networks Compared with Caucasian elders, older African Americans have less adequate income and poorer-quality housing o Serious social problem, older people cannot easily move elsewhere due to those limited incomes and because of likelihood or fear of housing and/or neighborhood discrimination Unemployment rates for African Americans of all ages are far higher than for whites A small % of retired African Americans are from upper class, having owned large businesses or real estate, headed large corporations, or worked in the highest levels of industry Overall, older blacks continue to have high levels of poverty, and have not paid as much into SS as white Americans; they have worked predominantly and historically in jobs with no pensions Old African Americans are slightly more likely than older than whites to be looking for work after 65 o Lifetimes of higher unemployment rates than older whites Older people in lower SES groups regardless of race have a different understanding of retirement o Health permitting, they often work at lower-paying jobs well beyond retirement age to meet basic expenses for food, medical care, and housing African American elders are more likely than older whites to reside in decaying central cities and to live in substandard housing o Also more likely to live in public housing Although black elders’ physical health has at least the same proportion of chronic physical illnesses as white elders’ health, low use of long-term care cannot be explained only with the statement that African Americans prefer to care for elders within their families o Having the economic option to make long-term care a choice is not available to many black American families Low-income African American elders have health care problems o Many poor elders have lacked the resources for adequate health care throughout their lives, resulting in a life expectancy rate that is much lower than for whites The age at which max SS benefits begin is scheduled to gradually increase; as such many boomer-generation African American men, whose benefits begin at 66, will not live to be recipients o African American life expectancy= 70.2 yrs, Whites=76.5 yrs Black men= 66.1 yrs (all men= 73.6) The differences in life expectancy between black and white Americans fade away if social variable held constant, including marital status, income, education, and family size o Marriage, high income and education, and small family size are correlated with longevity Life expectancy trend reversed in 80s—decreased o AIDS o Thousands died from illnesses that could be cured by routine medical care (appendicitis, pneumonia, hypertension, etc.) o Inadequate health care, could have been cured by early detection Physical and mental illness can result from the chronic stress of prejudicial attitudes and behavior of others o Combined with the possibility of genetic predisposition for hypertension, health of older African Americans is precarious for tragically unjust reasons For whatever reason, incidence of high blood pressure among blacks is nearly 2 1/2 x more than whites and mortality from high blood pressure is also higher The different outcomes of a lifetime of good health and self-care, and the accumulative disadvantage of poverty and lack of access become striking in later life 3 most frequently occurring conditions among African American elderly: hypertension, diagnosed arthritis, and all types of heart disease o Roughly parallel with conditions among all the population Most older African Americans self-report to be in good or excellent health o Cultural differences in self-acceptance help explain the lower report of good health for older African Americans o Who we anticipate being in old age impacts our sense of self o The standard for what is good health is culturally mediated The provision of health care through Medicare radically changed the proportion of older African Americans who have a usual source of care Though yoga, aerobics, and biofeedback programs reduce blood pressure have typically been attended by white, middle-class people, African Americans are beginning to join programs focused on prevention of disability Exercise continuing throughout old age is an example of good self-care that helps ameliorate physical as well as mental issues in later life More than 40% of African American women 65+ live in poverty Traditional African American culture incorporates a resolve to persevere Solid family ties, which are one source of strength, are indicated in the concept of familism- a notion of family extending beyond the immediate household Families tend to value their older members because they have survived in the face of hardship and they play important roles within the family Religion has long been a resource of support in African American fmailies The black American church has been a source of strength for coping with racial oppression and has played a vital role in the survival and advancement of African Americans o Place of importance, belonging, and values o Within the church, older people are valued as members, choir members, deacons, and trasureers A spirit of survival has seen older African Americans through hard times Multi-generational gatherings of celebration are important for family and cultural bonds Studies of fear of crime and victimization- much higher rates of fear for African Americans than whites Rates of victimization much higher than for whites o Major reason is thought to be geographic: more black elders than white elders live in high-crime areas such as inner city and in or near public housing Feelings of alienation and mistrust of police o Older African Americans less likely to reach out for help o Family ties and community strengths are critical Value of family and church community are integral parts of African American culture HISPANICS Older Hispanics (ancianos) are not a homogenous group One of the many obstacles preventing Hispanic elders from being understood and serve is the lack of a clear-cut definition of who they are o Two inclusive terms that increase the problem: Spanish heritage (having Spanish blood or antecedents) and Spanish origin (having been born in a Spanish-speaking country or having antecedents who were) All Americans are living longer, same is true for Hispanics 14 categories of Hispanic: Mexico, Cuba, Puerto Rico, Dominican Republic, Central America, El Salvador, Guatemala, Nicaragua, Ecuador, Honduras, Panama, Other Central Americans, South America, Peru, Colombia, and other South Americans Strongly valued la familia- family is foremost o This cultural value explains some of the lower utilization of social services and community resources for older adults among Hispanics The Hispanic population, one of the fastest-growing ethnic groups, became the largest US minority group in 2000 Census Several social factors indicate the minority status of Hispanic elders: o High % that lives below the poverty level o Inadequate health care brought about by poverty and other cultural contingencies o High illiteracy rates (second only to Native American elders) o Lower occupational levels Many traditional job categories of Hispanics have had no benefits, including health, retirement, and pension o Some entered the country illegally Fear of detection and expulsion limits mobility in work-related fields SS plays a pivotal role in keeping older Americans from poverty, accounting for more than 80% of total family income for older Americans in the lowest income quintile Cumulative disadvantage for Hispanics, culminating in more limited resources in later life The two largest Hispanic subgroups are Mexican and Puerto Rican Foreign born people of any ethnicity are not as acculturated as native-born citizens: need more help to understand and utilized services Because so many Mexican Americans are born in the US, they are not as extensively urbanized as other Hispanics o Occupational histories have been more agricultural and less industrial in nature, prompting residence in smaller rural towns across the US Immigrants from 6 of the 12 Hispanic nations identified in the 1990 census have more than 80% of their populations in the nation’s largest cities (NY, LA, Chicago, Miami, Washington DC, Boston, Philadelphia, and San Diego) Most older Hispanic people who immigrate tend to locate in urban areas o In TX, older urban immigrants outnumber rural counterparts 5:1 Hispanic elders are often somewhat suspicious of governmental institutions and of service workers and researchers not of their culture o This discomfort, along with avg. levels of education and income, can result in isolation and a low utilization of available services Traditional cultural values of family support across the life course are critical for sustaining quality of life in later life lack of adequate medical and health care reflect the result of poverty and the perception and experience of systematic bias toward Hispanic elders in the medical system Hispanic families tend to be larger than white non-Hispanic families in the US Both cultural values (need of the larger family go above one’s individual needs) and economic need dictate close family ties Patterns of intergenerational assistance are strong compared to white Americans Though minority elders tend to underutilize government and health services, high ethnic population density seems to correlate with higher rates of utilization ASIAN AMERICANS Asian American refers in the broadest sense to people of Chinese, Korean, Japanese, Filipino, East Indian, Thai, Vietnamese, Burmese, Indonesian, Laotian, Malayan, and Cambodian descent who live in the US Most Asian American elders are concentrated in California, Hawaii, NY, Illinois, Washington, and Massachusetts A single description cannot encompass the Asian communities in the US o Differences of cultures, language, and religion make each group unique o Chinese Americans are the largest Asian group, followed by Filipinos, Asian Indians, Vietnamese, Koreans, and Japanese American laws historically discriminated against Asians o Chinese Exclusion Act of 1982 o Anti-Japanese Alien Land Law of 1913 o Executive Order of 1942 Such legislation, combined with a history of prejudice and discrimination, has contributed to feelings of mistrust, injustice, and fear of government among many Pacific Asian elders o This, along with cultural patterns of pride and family obligation, contributes to a reluctance to utilize services The current generation of Asian Americans, conditioned to traditional American social and cultural folkways, may be just as likely to regard elders as unwelcome burden as some middle-class whites According to traditional culture, the eldest son assumes responsibility of his elder parents Filial piety is a custom demanding that family members respect and care for elders Older family members hold on to traditions, especially concerning moral propriety, while the young move away from them o Reluctance to continue with traditional cultural customs can be interpreted by an elder as disrespectful JAPANESE AMERICANS o Bulk of Japanese immigration, men wanted traditional families; many waited until they could afford a wife and paid for one to come from japan Reinforced traditional values of high status for men and elders o First generation worked primarily on farms or as unskilled laborers or service workers o Economic mobility o Older Japs have adequate savings or family support in their retirement years o Largely replicated traditional pattern of family care for elders CHINESE AMEICANS o Because past restrictive immigration laws denied entry to wives or children, a disproportionate share of Chinese and Filipino American elders are men Outnumber women 3:1 o Valuable as cheap labor in US mines, canneries, farms, and railroads— wives/children unneed/unwanted o Tradition of respect for elders o Second generation are more educated, more acculturated, and more comfortable financially o Despite discrimination, high rate of occupational mobility SOUTHEAST ASIAN AMERICANS o Vietnamese, Cambodians, and Laotians o Strong family ties o Traditionally, extended families are standard o Special respect for elders, especially fathers and grandfathers o California has largest number o Older people are highly valued, children expected to be well behaved and obey, value intelligence o Because of the language barrier and lack of communication with larger society, displacement is more difficult for the elderly than for the young NATIVE AMERICANS o Native Americans- small % of American Society Possibly the most deprived of all ethnic groups o Many of the problems of these elders are due to minority status rather than age o Reservations and in rural areas- extremely high unemployment rates Few jobs on reservations o Many houses on rez are substandard o Substantial improvements in health, disparities in sanitation and nutrition though o Systematic government efforts to separate from cultural roots- generally disorganized poverty-stricken communities o Alcohol and drug abuse is prevalent o High suicide rates Fractured sense of community and lack of feelings of belonging o Bad treatment of Native Americans o Diverse group differing in customs, language, and family structure o Share some cultural beliefs: lifestyle and spirituality- deep reverence for the land, animals, and nature o Believe in attaining harmony between humans and nature o Relationships are key aspect of life, particularly family o Patriarchal, largest tribe is the Navajo o Most older Native Americans live on reservations, young seek work in the city Most return to retire o Most rural of any ethnic group o Life expectancy is substantially lower than whites o Low education levels o Unemployment is a problem, retirement limited (few pay into SS) o More likely to suffer from illnesses and disabilities than any other ethnic aged group o Lack of income leads to poor nutrition and health care, associated with lower education Differences in life expectancy are due in large part to risks associated with lifestyle among different groups in different geograph
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