Adult Development and Aging: Biopsychosocial Perspectives, Fourth Edition

418 Pages·2011·15.06 MB·English

by  Susan Krauss Whitbourne

This page intentionally left blank

ADULT DEVELOPMENT
AND AGING

BIOPSYCHOSOCIAL PERSPECTIVES

Fourth Edition

Susan Krauss Whitbourne, Ph.D.

University of Massachusetts Amherst

Stacey B. Whitbourne, Ph.D.

VA Boston Healthcare System

John Wiley & Sons, Inc.

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Library of Congress Cataloging-in-Publication Data
Whitbourne, Susan Krauss.
Adult development and aging: biopsychosocial perspectives / Susan Krauss Whitbourne, Stacey B. Whitbourne. — 4th ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-470-64697-7 (hardback)
1. Gerontology. 2. Older people—Psychology. 3. Older people—Health and hygiene. 4. Older people—Social conditions. I. Whitbourne,
Stacey B. II. Whitbourne, Susan Krauss. Adult development & aging. III. Title. IV. Title: Adult development & aging.
HQ1061.W48 2011
305.26—dc22
2010037952
Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

PREFACE

E

veryone ages. This very fact should be
enough to draw you into the subject
matter of this course, whether you are
the student or the instructor. Yet, for
many people, it is difficult to imagine
the future in 50, 40, or even 10 years
from now. The goal of our book is to help you
imagine your future and the future of your family,
your friends, and your society. We have brought
together the latest scientific findings about aging with
a more personal approach to encourage you to take
this imaginative journey into your future.
The fourth edition of Adult Development and Aging:
Biopsychosocial Perspectives is significantly different
from the previous editions in that there are now
two authors. Susan invited a co-author, Stacey, who
happens to be her daughter and a professional in the
field of aging. Much of the material remains based
on the course that Susan teaches at the University of
Massachusetts Amherst on the Psychology of Aging.
She continues to incorporate her day-to-day teaching
of the course into the text. What you will read follows
very closely with the way she approaches the course
and engages her students in the learning process.
Examples, figures, and tables, as well as the words
in the text, reflect what she has found to be of most
interest to her students.
Stacey was inspired to pursue the field of aging
after taking her mother’s course in 1999. She contin-
ued her graduate work in social and developmental
psychology focusing on cognitive functioning in
later adulthood. Stacey’s contributions to the fourth
edition are based on her current research projects
on genetic epidemiology and aging. The addition
of Stacey as a co-author brings a third generation
begun by Susan’s father, who specialized in geriatric

medicine. Susan became interested in the scholarly
field of aging as an undergraduate when she decided
to write a paper on personality and adaptation in a
developmental psychology course. At the same time,
her father’s professional activities had a profound
influence and made the choice of gerontology (the
scientific study of aging) a natural one.
It is our hope and belief that you will find that
the study of aging has many fascinating aspects. Not
only is everyone around you aging, but also the
issues that are raised within this field extend from
the philosophical to the practical. Why do living
things age? Is there a way to slow down the aging
process? How will society deal with the aging of the
Baby Boomers? How will job markets be affected by
an aging society? Will you age differently than your
parents and grandparents? All of these, and more,
are questions that you will find yourself asking as
you explore the many complexities of the process
that causes people to change and grow throughout
life. At the same time, you will gain many advantages
from learning the material in this course. You will
learn the keys to healthy development in the years of
adulthood. As a result, you will learn not only how
people grow older but also how to grow older in a
way that is healthy and satisfying.

THEMES OF THE BOOK

The biopsychosocial model emphasized in our text
is intended to encourage you to think about the
multiple interactions among the domains of biology,
psychology, and sociology. According to this model,
changes in one area of life have effects on changes in
other areas. The centerpiece of this model is identity,
your self-definition. You interpret the experiences

iii

iv
Preface

you have through the framework provided by your
identity. In turn, your experiences often stimulate
you to change your self-definition.
This is an exciting time to be studying adult
development and aging. The topic is gaining increas-
ing media attention and tremendous momentum as
an academic discipline within life-span development.
The biopsychosocial model fits within the frame-
work of contemporary approaches that emphasize
the impact of social context on individuals through-
out all periods of life. Entirely new concepts, sets of
data, and practical applications of these models are
resulting in a realization of the dreams of many of
the classic developmental psychologists whose work
shaped the field in the early 20th century.

ORGANIZATION

There is a logical organization to the progression of
chapters in this book, essentially from the ‘‘bio’’ to
the ‘‘psycho’’ to the ‘‘social.’’ However, this is not
a strict progression. Instructors may find that they
would prefer to switch the order of certain chapters
or sections within chapters, and that will be fairly
easy to do. We have stuck to the integrative theme of
the biopsychosocial model in that many of the topics,
regardless of where they appear in the book, bring
together this multifaceted approach.
We feel strongly that the final chapter should
not be not about death and dying, as is often the
case in other books in the field, but about successful
aging. This point is reflected in our choice of a cover, a
painting of water lilies by Monet in his later years. The
painting was also a very personal choice for us; after
seeing it at an exhibit we were struck by its beauty
and relevance to our book. You will read more about
Monet in Chapter 14, where we discuss creativity and
aging. The painting is a remarkably vivid expression
of the vitality that characterizes successful aging.

FEATURES

Up-to-Date Research

The topics and features in this text are intended to
involve you in the field of aging from a scholarly and

a personal perspective. You will find that the most
current research is presented throughout the text,
with careful and detailed explanations of the studies
that highlight the most important scholarly advances.

Aging in the News

Each chapter includes one news story featuring the
accomplishments of noted older adults ranging from
Betty White (who famously hosted Saturday Night
Live at the age of 88) to Jack LaLanne, who at age 95
(in 2010) remains the most famous fitness guru in
the world.

Engaging Figures and Tables

We have given the text a new look by significantly
updating figures and tables that contain review
points and clearly show important research findings.
Our selection of these materials connects to the
PowerPoint slides that instructors can download from
the Wiley Web site.

Contemporary Approach

Wording from the previous edition was revised to
incorporate the perspective of the second author in
order to appeal to the college-aged student. We use
references to current trends (such as Facebook and
iPods) to illustrate our points. The first author now
writes a Psychology Today blog on aging, which picks
up on many of the themes of our book.

STUDENT LEARNING AIDS

Numbered Summaries

Each chapter contains a numbered summary that will
assist students in reviewing the important material
from the chapter.

Glossary Terms

Bold items in each chapter indicate glossary terms.
Because students may encounter a term more than
once after it is introduced in a particular chapter, all
the glossary items appear at the end of the book, as
do the references.

Instructor Resources
v

Ample Illustrations

Tables and figures pick up on major points in the
text. There are also photographs intended to highlight
particularly interesting or relevant issues.

CHANGES IN THE FOURTH EDITION

The first edition of Adult Development and Aging:
Biopsychosocial Perspectives was intended to provide
a fresh and engaging approach to the field of
the psychology of adult development and aging
by focusing on three themes: a multidisciplinary
approach, positive images of aging, and the newest
and most relevant research. The fourth edition
maintains the experience for students of participating
in a live classroom. We also have simplified a number
of the research presentations. This makes it possible
for students to gain a fuller appreciation of the
main points they need to know in order to master
the subject matter. We hope this approach makes
the instructor’s job easier. Students will be more
motivated to complete their readings if they like the
text and feel that they can relate to it.
We did not change the organization of chapters.
Instructors who have developed their course based
on earlier editions will not need to change the
basic structure of their lectures and assignments.
However, we condensed some sections, deleted
others, and introduced new sections to reflect
changes in the field. We also deleted the boxed
features that, in our experience, students were not
reading. Instead, we integrated such features as
critical thinking, biopsychosocial perspectives, and
self-focused exercises into the writing of the text itself.
Throughout the fourth edition, references have
been substantially updated. Approximately half of the
references are from 2008 or later, and one third are
from 2009 and 2010. To maintain the same length
of the text, outdated references were deleted and
sections were updated to reflect the newest research.
New U.S. Census data were completely integrated
into demographic material presented throughout the
text, as have special reports on older adults published
by the Administration on Aging, the U.S. Department
of Health and Human Services, and the Centers
for Disease Control and Prevention. In addition to
presenting updated information on the United States,

substantial information was added from international
statistics, particularly in the area of health.
We revamped our approach to presenting biologi-
cal, physiological, and cognitive approaches to aging.
The incorporation of new figures and tables will
appeal visually to students and guide them through
their reading of the text. As in previous editions, we
aimed to provide studies that were as interesting as
possible to illustrate major points. We continued to
expand the treatment of brain imaging studies, an
area that has grown tremendously in the past three
to four years. New data on genetics and aging were
included in relevant sections. We have also drawn
heavily from studies such as Whitehall II that show
the importance of social class as an influence on health
and aging. These exciting changes in the field con-
tinue to illustrate the importance of a biopsychosocial
perspective.

Supplements

Wiley is pleased to offer an online resource containing
a wealth of teaching and learning material at http://
www.wiley.com/college/whitbourne.

Web Site Links

References in this edition show the Web sites
that students and instructors can consult to gather
updated information on changes in the field.

INSTRUCTOR RESOURCES

Instructor’s Manual

The content in the Instructor’s Manual reflects over
30 years of experience in teaching this course.
You will find chapter outlines, key terms, learning
objectives, and lecture suggestions. Video suggestions
are also provided as well as resources for finding
documentaries, movies, and even pop music.

PowerPoint Slides

Prepared for use in lectures, a complete set of
PowerPoint slides tailored to the book are available for
download. Contained on the slides are highlights of

vi
Preface

chapters and extensive visual illustrations of chapter
concepts and key terms.

Test Bank

A complete downloadable test bank includes 50 to
70 questions in each chapter that follow along with
the order that the concepts are presented in the text.
Each multiple-choice question is labeled according
to which concept it tests, along with its difficulty
level. Included are short answer and essay questions
corresponding to each section of the chapter.

ACKNOWLEDGMENTS

Our first set of acknowledgments go to our families.
Husbands Richard O’Brien and Erik Gleason have
graciously provided important support that allowed
us to spend the many hours required over the period
of a year in revising the book. Jennifer O’Brien,
daughter and sister, is a wonderful sounding board
for our ideas and as she continues her career in

clinical psychology, we look forward to continued
‘‘collaboration’’ with her.
Throughout the writing of this book, students
in the Psychology of Aging class at the University
of Massachusetts Amherst provided valuable insights
and observations. As we were revising the book and
preparing the lectures, they continued to provide us
with fresh perspectives. Their good humor, patience,
and willingness to experiment with some new ideas
makes it possible to add the all-important student
viewpoint to the finished product.
We feel extremely fortunate to have had the
guidance of the editor at John Wiley & Sons,
Chris Johnson, who helped us prepare this and the
previous edition. His insights, support, and friendly
advice have been central to our ability to maintain
the book’s strength while widening its appeal. We
would also like to give special thanks to our associate
editor, Eileen McKeever. She maintains the tradition
of Wiley’s efficiency and helpful attention that we
have had the good fortune to receive throughout the
revision process. Hilary Newman, Photo Manager,
and Teri Stratford, Photo Researcher, have helped

About the Authors
vii

us tremendously in meeting our requests for great
illustrative material. Yee Lyn Song, the production
editor, provided helpful and friendly feedback. The
marketing team, Danielle Torio and Melissa Kleckner,
ensure that you and your colleagues know all about
the book. Finally, the work of Seng Ping Ngieng, the
designer, has ensured that the book is attractively
presented. These individuals provide behind-the-
scenes help that every author knows is invaluable
to the creation of an excellent text.
Our final thanks go to the reviewers who provided
helpful comments and suggestions throughout the
revision process. Their insightful observations and
thoughtful proposals for changes helped us tighten
and focus the manuscript and enhance the discussion
of several key areas of interest in the field. Thank
you to Gary Creasey (Illinois State University), Carrie
Andreoletti, (Central Connecticut State University),
Richard Tucker (University of Central Florida),
Renee Babcock (Central Michigan University), Susan
Bell (Georgetown College), Susan H. Mcfadden
(University of Wisconsin, Oshkosh), Katie E. Cherry
(Louisiana State University), Joseph E. Gaugler
(University of Minnesota), and Victoria Hilkevitch
Bedford (University of Indianapolis). We have also
benefited from informal reviews provided by our
colleagues who use the book in their teaching and we
greatly appreciate their helpful suggestions.
In conclusion, we hope that we have given you
something to look forward to as you venture into
the fascinating field of adult development and aging,
and that the subsequent pages of this book will
fulfill these expectations. We have tried to present
a comprehensive but clear picture of the area and
hope that you will be able to apply this knowledge
to improving your own life and the lives of the older
adults with whom you may be preparing to work.
We hope you will come away from the course with a
positive feeling about what you can do to ‘‘age better’’
and with a positive feeling about the potentialities of
later life. And maybe, just maybe, as has happened
on many past occasions with people who have read
this book, you will decide to pursue this field and we
can welcome you as colleagues in the coming years.
Finally, we would like to comment on the process
of working together as a mother–daughter team. The
first author was pregnant with the second author
when she embarked on her first textbook in the field,

the precursor to the present volume. Little did she
know that the child she was about to have would
become a psychologist, much less a specialist in
aging. We have had an enjoyable time working on
the revision and are proud and happy to be able to
share our perspectives with you, the reader.

Susan Krauss Whitbourne, Ph.D.
Stacey B. Whitbourne, Ph.D.
June 2010

ABOUT THE AUTHORS

Susan Krauss Whitbourne, Ph.D., Professor of Psy-
chology at the University of Massachusetts Amherst,
received her Ph.D. in Developmental Psychology from
Columbia University in 1974 and completed a post-
doctoral training program in Clinical Psychology at
the University of Massachusetts at Amherst, hav-
ing joined the faculty there in 1984. Her previous
positions were as Associate Professor of Educa-
tion and Psychology at the University of Rochester
(1975–84) and Assistant Professor of Psychology at
SUNY College at Geneseo. Formerly the Psychology
Departmental Honors Coordinator at the Univer-
sity of Massachusetts Amherst, she is Director of
the Office of National Scholarship Advisement. In
addition, she is Faculty Advisor to the University
of Massachusetts Chapter of Psi Chi, a position for
which she was recognized as the Eastern Regional
Outstanding Advisor for the year 2001 and as the
Florence Denmark National Faculty Advisor in 2002.
She served as Eastern Region Vice President of
Psi Chi in 2006–07 and as Chair of the Program
Committee for the National Leadership Conference
in 2009. Her teaching has been recognized with
the College Outstanding Teacher Award in 1995
and the University Distinguished Teaching Award
in 2001. Her work as an advisor was recognized
with the Outstanding Academic Advisor Award in
2006. In 2003, she received the American Psy-
chological Association (APA) Division 20 (Adult
Development and Aging) Master Mentor Award and
the Gerontological Society of America (GSA) Behav-
ioral and Social Sciences Distinguished Mentorship
award.

viii
Preface

Over the past 20 years, Dr. Whitbourne has held
a variety of elected and appointed positions in APA
Division 20 including President (1995–96), Treasurer
(1986–89), Secretary (1981–84), Program Chair
(1997–98), Education Committee Chair (1979–80),
Student Awards Committee Chair (1993–94), Con-
tinuing Education Committee Chair (1981–82), and
Elections Committee Chair (1992–93). She has
chaired the Fellowship Committee and serves as
the Division 20 Representative to the APA Coun-
cil (2000–2006 and 2009–present). She is a Fellow
of Divisions 1 (General Psychology), 2 (Teaching of
Psychology), 12 (Clinical Psychology), and 20. She
has served on the APA Committee on Structure and
Function of Council and chaired the Policy and Plan-
ning Board in 2007. She currently serves on the APA
Membership Board.
Dr. Whitbourne is also a Fellow of the American
Psychological Society and the Eastern Psychological
Association, for which she serves on the Executive
Board. She is a Fellow of the Gerontological Society of
America, and currently serves on the Behavioral and
Social Sciences Executive Board. She is Chair-Elect of
the Council of Professional Geropsychology Training
Programs. A founding member of the Society for the
Study of Human Development, she was its President
from 2005 to 2007. She also serves on the Board of
Directors of the National Association of Fellowship
Advisors. In her home of Amherst, Massachusetts,
she has served on the Council on Aging (2004–07)
and was the President of the Friends of the Amherst
Senior Center (2007–09).

Her publications include 15 published books,
many in multiple editions, and more than 140 journal
articles and chapters, including articles in Psychology
and Aging, Psychotherapy, Developmental Psychology,
Journal of Gerontology, Journal of Personality and Social
Psychology, and Teaching of Psychology, and chapters
in the Handbook of the Psychology of Aging, Clini-
cal Geropsychology, Comprehensive Clinical Psychology
(Geropsychology), the Encyclopedia of Psychology, and
the International Encyclopedia of the Social and Behav-
ioral Sciences. She has been a Consulting Editor for
Psychology and Aging and serves on the Editorial Board
of the Journal of Gerontology and is a Consulting Edi-
tor for Developmental Psychology. Her presentations
at professional conferences number over 200, and
include several invited addresses, among them the
APA G. Stanley Hall Lecture in 1995, the EPA Psi Chi
Distinguished Lecture in 2001, and the SEPA Invited
Lecture in 2002.
Stacey B. Whitbourne, Ph.D., received her Ph.D.
in Social and Developmental Psychology from Bran-
deis University in 2005 where she was funded
by a National Institute on Aging Training Fellow-
ship. She completed her post-doctoral fellowship
at the Boston University School of Public Health,
Department of Epidemiology, funded by a National
Institute on Aging Grant and a Department of Veter-
ans Affairs Rehabilitation Research and Development
Service Grant. Currently, she is a Research Health
Scientist at the Massachusetts Veterans Epidemiol-
ogy and Research Information Center (MAVERIC),
an independent research center housed within the
V.A. Boston Healthcare System. The author of sev-
eral published articles, she is also a co-author on a
chapter for the Sage Series on Aging in America. She
is a member of the American Psychological Associ-
ation Division 20 and the Gerontological Society of
America. A member of the Membership Committee
of Division 20, she has also given more than 30
presentations at national conferences. As an under-
graduate, she received the Psi Chi National Student
Research Award. In graduate school, she was awarded
the Verna Regan Teaching Award and an APA Stu-
dent Travel Award. She has taught courses on adult
development and aging at Brandeis University and
the University of Massachusetts Boston.

CONTENTS

Preface iii

CHAPTER 1

Themes and Issues in Adult
Development and Aging
2

The Biopsychosocial Perspective 3

Four Principles of Adult Development and
Aging 4

1. Changes Are Continuous Over the Life Span 4
2. Only the Survivors Grow Old 4
3. Individuality Matters 5
4. ‘‘Normal’’ Aging Is Different From Disease 6

The Meaning of Age 7
Using Age to Define ‘‘Adult’’ 8
Divisions by Age of the Over-65 Population 9
Personal Versus Social Aging 10

Social Factors in Adult Development and
Aging 12
Sex and Gender 13
Race 13
Ethnicity 14
Socioeconomic Status 14
Religion 14

The Baby Boomers Grow Up: Changes in The
Middle-Aged and Older Populations in The United
States and The World 15
United States 15
Aging Around the World 17

Summary 19

CHAPTER 2

Models of Development: Nature and
Nurture in Adulthood
20

Models of Individual–Environment
Interactions 21
Reciprocity in Development 24

Sociocultural Models of Development 25
Ecological Perspective 25
The Life Course Perspective 26
Ageism as a Social Factor in the Aging Process 27

Psychological Models of Development in
Adulthood 29
Erikson’s Psychosocial Theory 29
Piaget’s Cognitive-Developmental Theory 32
Identity Process Theory 33

Biological Approaches to Aging in Adulthood 35
Genes and DNA 36
Programmed Aging Theories 37
Random Error Theories 40

Summary 42

CHAPTER 3

The Study of Adult Development and
Aging: Research Methods
44

Variables in Developmental Research 44

Descriptive Research Designs 46
Age, Cohort, and Time of Measurement 46
Longitudinal Designs 47
Cross-Sectional Designs 51

ix

x
Contents

Sequential Research Designs 53
The Most Efficient Design 53

Correlational Designs 55
Simple Correlational Designs 55
Multivariate Correlational Designs 56

Types of Research Methods 57
Laboratory Studies 57
Qualitative Studies 58
Archival Research 58
Surveys 58
Case Reports 59
Focus Groups 59
Observational Methods 60

Measurement Issues in Adult Development and
Aging 60

Ethical Issues in Research 61

Summary 63

CHAPTER 4

Physical Changes
64

Appearance 64
Skin 65
Hair 68

Body Build 69

Mobility 72
Muscles 72
Bones 73
Joints 74

Vital Bodily Functions 75
Cardiovascular System 76
Respiratory System 78
Urinary System 78
Digestive System 80

Bodily Control Systems 80
Endocrine System 81
Immune System 85

Nervous System 86
Central Nervous System 86

Sleep 88
Temperature Control 89

Sensation and Perception 90
Vision 90
Hearing 92
Balance 93
Smell and Taste 94
Somatosensory System 95

Summary 96

CHAPTER 5

Health and Prevention
98

Diseases of the Cardiovascular System 98
Cardiac and Cerebrovascular Conditions 98
Incidence Rates 100
Behavioral Risk Factors 100
Prevention of Heart Disease and Stroke 103

Cancer 104
Risk Factors and Preventions 104
Treatments 106

Disorders of the Musculoskeletal System 107
Osteoarthritis 107
Osteoporosis 108

Diabetes 109
Characteristics of Diabetes 109
Incidence and Risk Factors 109
Prevention and Treatment 110

Respiratory Diseases 110

Dementia and Related Neurological Disorders 111
Alzheimer’s Disease 112
Prevalence 112
Psychological Symptoms 112
Biological Changes 113
Proposed Causes of Alzheimer’s Disease 114
Diagnosis 116
Medical Treatments 117
Psychosocial Treatments 117
Other Neurological Diseases That Can Cause
Dementia 119

Summary 121

Contents
xi

CHAPTER 6

Basic Cognitive Functions: Information
Processing, Attention, and Memory
124

Information Processing 124
Psychomotor Speed 125
Attention 126

Driving and Aging 130

Memory 132
Working Memory 133
Effects of Aging on Long-Term Memory in
Adulthood 134
Identity, Self-Efficacy, Stereotype Threat, and
Control Beliefs 137
Memory and Health-Related Behaviors 139
Memory Training Studies 141

Summary 142

CHAPTER 7

Language, Problem Solving, and
Intelligence
144

Language 144
Cognitive Aspects of Language 144
Social Aspects of Language 147

Everyday Problem Solving 148
Characteristics of Problem Solving 149
Problem Solving in Adulthood 149
Adult Learners 153

Intelligence 154
Adult Intelligence: Historical Background 155
Theoretical Perspectives on Adult Intelligence 155
Primary Mental Abilities 156
Alternative Views of Intelligence 158
Empirical Evidence on Adult Intelligence 158
Training Studies 162

The Psychology of Wisdom 163

Summary 165

CHAPTER 8

Personality
166

Psychodynamic Perspective 166
Ego Psychology 168
Vaillant’s Theory of Defense Mechanisms 171
Adult Attachment Theory 172

Trait Approaches 173
The Five Factor Model 174
Research on Aging and the Five Factor Model 174
Health and Personality Traits 175

Social Cognitive Approaches 177

Cognitive Perspective 179
Possible Selves Theory 180
Coping and Control 180
Identity Process Theory 181

Midlife Crisis Theories and Findings 183
Theory of the Midlife Crisis 183
Critiques and Research on the Midlife Crisis 186

Summary 188

CHAPTER 9

Relationships
190

Marriage and Intimate Relationships 190
Marriage 191
Cohabitation 193
Same-Sex Couples 194
Divorce and Remarriage 195
Widowhood 196
Psychological Perspectives on Long-Term
Relationships 197

Families 201
Family Living Situations 201
The Transition to Parenthood 201
The Empty Nest 203
Adult Parent–Child Relationships 204

Siblings 208

xii
Contents

Grandparents 209
Grandparents Raising Grandchildren 209
Patterns of Grandparenting 209

Friendships 210
Theoretical Perspectives 210
Patterns of Friendships 210

Summary 212

CHAPTER 10

Work, Retirement, and Leisure Patterns
214

Work Patterns in Adulthood 214

Vocational Development 217
Holland’s Vocational Development Theory 217
Super’s Self-Concept Theory 220
Variations in Vocational Development 220

Vocational Satisfaction 222
Intrinsic and Extrinsic Factors 222
Positive and Negative Moods 224
Occupational Reinforcement Patterns 225
Work Stress 225
Conflict Between Work and Family 226
Age and Vocational Satisfaction 227

Age and Vocational Performance 228

Retirement 230
Definitions of Retirement 231
Facts About Retirement 231
The Effects of Retirement on the Individual 232
Retirement and Health 234
Factors That Influence Adjustment to
Retirement 234

Leisure Pursuits in Later Adulthood 235

Summary 237

CHAPTER 11

Mental Health Issues and Treatment
238

Psychological Disorders in Adulthood 238
Major Axis I Disorders in Adulthood 240
Axis II Disorders in Adulthood 248

Elder Abuse 249

Suicide 250

Treatment Issues in Mental Health Care 250
Assessment 251
Treatment 253

Serious Psychological Distress 257

Summary 258

CHAPTER 12

Long-Term Care
260

Institutional Facilities For Long-Term Care 261
Nursing Homes 261
Residential Care Facilities 262

Community-Based Facilities 263
Home Health Services 263
Geriatric Partial Hospital 263
Accessory Dwelling Units 264
Subsidized Housing 264
Continuing Care Retirement Community
(CCRC) 264

The Financing of Long-Term Care 265
Medicare 265
Medicaid 268

Legislative Issues in Care of Older Adults 268
1987 Omnibus Budget Reconciliation Act of 1987
(OBRA 1987) 268
1997 Balanced Budget Act 270
1998 Nursing Home Initiative 270
Congressional Hearings on Nursing Home
Abuse 270
2002 Nursing Home Quality Initiative 271
2007 GAO Report 271

Characteristics and Needs of Nursing Homes and
Their Residents 272
Characteristics of Residents 273
Nursing Home Deficiencies 273

Psychological Issues in Long-Term Care 274
Models of Adaptation 275
Suggestions for Improving Institutional Care 276

Summary 278

Contents
xiii

CHAPTER 13

Death and Dying
280

Technical Perspectives on Death 280
Medical Aspects of Death 281
Mortality Facts and Figures 281

Cultural Perspectives 286
Beliefs About Death 286
The Role of Religion 288

The Dying Process 288
Stages of Dying 290
Psychological Perspectives on the Dying Process 290

Issues in End-of-Life Care 291
Advance Directives and the Patient
Self-Determination Act 291
Research on the End of Life 292
Physician-Assisted Suicide and Euthanasia 295
Suggestions for End-of-Life Care 297

Bereavement 298
Death of a Spouse 298
Death of Other Family Members 299
Theories of Bereavement 300

Summary 302

CHAPTER 14

Successful Aging
304

Theoretical Perspectives on Successful Aging 304

Subjective Well-Being 306

Productivity and Creativity 310
The Relationship Between Age and Creativity: Early
Studies 310
Simonton’s Model of Age and Creative
Productivity 312
The Neuroscience of Creativity 314
Characteristics of Last Works 315
Sociocultural Variations 318

Successful Aging: Final Perspectives 318

Summary 319

Glossary 321

References 333

Photo Credits 379

Name Index 381

Subject Index 394