Academic Geriatric Resource Center
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0. Introduction
1. Demography And Epidemiology
1.1 The Changing Face of Aging: Objectives
1.2 Local and Regional Variations Among Older Adults in the United States
1.3 Implications of an Aging Society for Health Care Needs and Resources
1.4 Common Chronic Conditions Associated with Advanced Age
1.5 Post Test
2. Biology and Physiology of Aging
2.1 Introduction and Background
2.2 Theories of Aging
2.3 Physiological Changes with Aging
2.3.1 Loss of Homeostatic Reserve--Hyperthermia
2.3.2 Loss of Homeostatic Reserve--Hypothermia
2.3.3 Vulnerability of Older Adults to Hypothermia
2.3.4 Clinical Importance of Vulnerability to Hypothermia
2.3.5 Loss of Homeostatic Reserve--Other Examples and Clinical Implications
2.3.6 Clinically Important Age-Related Changes in Organ Systems
2.3.7 Clinically Important Age-Related Changes in the Renal System
2.3.8 Clinical Significance of Age-Related Changes in Renal System
2.3.9 Clinically Important Age-Related Changes in the Cardiovascular System
2.3.10 Clinical Significance of Age-Related Changes in the Cardiovascular System
2.3.11 Clinically Important Age-Related Changes in the Pulmonary System
2.3.12 Clinical Significance of Age-Related Changes in the Pulmonary System
2.3.13 Age-Related Changes in the Neurologic System
2.3.14 Clinical Significance of Age-Related Changes in the Neurologic System (I)
2.3.15 Clinical Significance of Age-Related Changes in the Neurologic System (II)
2.3.16 Clinically Important Age-Related Changes in the Gastrointestinal System
2.3.17 Clinical Significance of Age-Related Changes in the Gastrointestinal System (I)
2.3.18 Clinical Significance of Age-Related Changes in the Gastrointestinal System (II)
2.3.19 Clinically Important Age-Related Changes in the Immune System
2.3.20 Clinical Significance of Age-Related Changes in the Immune System
2.3.21 Clinically Important Age-Related Changes in the Endocrine System (I)
2.3.22 Clinically Important Age-Related Changes in the Endocrine System (II)
2.3.23 Clinical Significance of Age-Related Changes in the Endocrine System
2.3.24 Clinically Important Age-Related Changes in the Musculoskeletal System
2.3.25 Clinical Significance of Age-Related Changes in the Musculoskeletal System (I)
2.3.26 Clinical Significance of Age-Related Changes in the Musculoskeletal System (II)
2.3.27 Clinically Important Age-Related Changes in the Genitourinary System (I)
2.3.28 Clinically Important Age-Related Changes in the Genitourinary System (II)
2.3.29 Clinical Significance of Age-Related Changes in the Genitourinary System
2.3.30 Clinically Important Age-Related Changes in the Sensory Systems
2.3.31 Clinical Significance of Age-Related Changes in the Sensory Systems (I)
2.3.32 Clinical Significance of Age-Related Changes in the Sensory Systems (II)
2.3.33 Clinically Important Age-Related Changes in the Integument
2.3.34 Clinical Significance of Age-Related Changes in the Integument
2.4 Pharmacologic Considerations
2.5 Post Test
3. Socio-cultural And Psychologicial…
3.1 Module Objectives
3.2 Social Theories of Aging
3.3 Psychological Development In Late Life
3.4 Ethno-Cultural Issues And Age-Stratified Societies
3.5 Late-Life Transitions
3.6 Dependent Elders: Special Concerns
3.7 Cultural Views of Death
3.8 References
3.9 Post Test
4. Assessment Of The Geriatric…
4.1 Module Objectives
4.2 Domains of Assessment: Functional Assessment
4.2.1 How to Use Information from a Functional Assessment
4.2.2 Vision Impairment
4.2.3 Hearing Impairment (I)
4.2.4 Hearing Impairment (II)
4.2.5 Oral and Dental Health
4.2.6 Introduction to Oral Health Assessment
4.2.7 Oral Health Assessment
4.2.8 Common Oral Conditions in Older Adults: Tooth Loss (I)
4.2.9 Common Oral Conditions in Older Adults: Tooth Loss (II)
4.2.10 Common Oral Conditions in Older Adults: Care of Dentures
4.2.11 Common Oral Conditions in Older Adults: Dental Decay
4.2.12 Common Oral Conditions in Older Adults: Periodontal Disease
4.2.13 Common Oral Conditions in Older Adults: Candidiasis Infection
4.2.14 Common Oral Conditions in Older Adults: Leukoplakia and the Risk for Oral Cancer
4.2.15 Guidelines for a Dental Referral
4.2.16 Falls and Gait Assessment
4.2.17 Assessing for Falls
4.2.18 Techniques for Gait Assessment
4.2.19 Gait Assessments and Falls Interventions
4.2.20 Risk Factors for Falls and Targeted Interventions
4.2.21 Modification of Risk Factors: Ability to Get Up After a Fall
4.2.22 Modification of Risk Factors: Fracture Risk
4.2.23 Modification of Risk Factors: Anticoagulation
4.2.24 Incontinence
4.2.25 Skin Breakdown: Pressure Ulcers
4.2.26 Cognition/Dementia
4.2.27 Benefits of Early Detection of Dementia
4.2.28 Screening Techniques for Dementia
4.2.29 Decision-Making about Dementia Screening
4.2.30 Nutrition
4.2.31 Alcohol Use and Alcoholism
4.2.32 Medication and Complementary Therapies
4.2.33 Case Example: Mr. Singh
4.2.34 Mr. Singh--Use of Herbal Medicines
4.2.35 Mr. Singh--Possible Interventions
4.2.36 Mr. Singh--Concerns about Marathon Running at 92?
4.2.37 Mr. Singh--Considerations for Patient/Family Well-Being
4.2.38 Assessing for Polypharmacy (I)
4.2.39 Assessing for Polypharmacy (II)
4.3 Domains Of Assessment: Psychosocial Health And Functioning
4.4 Special Considerations In Assessment
4.5 Post Test
5. Health Care Policies
5.1 Module Objectives
5.2 The Policy-Making Process
5.3 Financing Health & Long Term Care
5.4 Quality Of Care Issues In Long Term Care
5.5 Need And Access Across The Spectrum Of Care
5.6 References
5.7 Post Test
6. Exploring Age-Related Body…
6.1 Cardiovascular System
6.2 Endocrine System
6.3 Immune System
6.4 Musculo-Skeletal System
6.5 Neurological System
6.6 Renal System
6.7 Post Test

Module 3: Socio-cultural And Psychologicial Aspects of Aging

3.1: Module Objectives

Upon completion of this module, participants will be able to:

  1. Discuss the processes of aging in sociocultural terms.
  2. Describe three social theories of aging and explain their relevance to the interactions of health professionals with older patients.
  3. Describe the life-span developmental approach to human aging.
  4. Distinguish “normal” age-related changes in intellectual functioning from late-life cognitive disorders and mental health concerns.
  5. Discuss age as a stratifying principle in societies as it interacts with other stratifiers, e.g., gender, ethnicity, socioeconomic status.
  6. Identify the benefits and pitfalls of age-graded social organizations.
  7. Identify examples of normative and nonnormative transitions in later life.
  8. Compare and contrast characteristics of healthy, competent elders with those of elders who are frail or decrepit.
  9. Discuss special concerns relating to health care of frail elders, e.g., guardianship, abuse, caregiving, therapeutic nihilism.
  10. Describe how cultural variations in the concept of death affect end-of-life care for older adults.


3.2: Social Theories of Aging

Many theories have been developed to account for the place older people occupy in society. These all attempt to explain, either implicitly or explicitly, the connection between individual experiences and social structures. The following have been major influential theories at one point in time. Modernization theory is comparative and considers large-scale economic and macro-social structures and their impact on the status of the elderly as a distinct sub-group within various populations. Role theory takes as its focus a particular society (Western European society) and discusses how in old age individuals become unhitched from social institutions and cultural norms. The last two theories discussed here, disengagement theory and activity theory, are psycho-social in focus, elaborating on the psychological processes that lead older people to behave in particular ways.

3.3: Psychological Development In Late Life

A Model of Psychological Development

There are many theoretical perspectives on how we age psychologically, but none that covers the entire sphere of psychological aging (e.g., cognition, emotions, personality, coping/self-management, mental health/psychological disorders). However, most psychologists in the field of aging subscribe to a life-span developmental approach. In this view, the multidimensional, multidirectional, and pluralistic processes of human development are seen as continuing throughout the entire life span. The complex phenomenon of aging is considered to be part of a continuous developmental sequence which proceeds through a number of maturational phases during the entire life of the organism (Scheibel, 1996). Thus, in healthy older individuals, learning and behavior-change processes can take place at any point in the life span, including old age.

3.4: Ethno-Cultural Issues And Age-Stratified Societies

Culture And Aging

Different cultural groups organize life with respect to elders in different ways, depending on basic values and world-view, environment, societal circumstances and opportunities. In early studies of the social position of the aged, anthropologists used a macro-cultural approach, comparing the lives of older people in different cultures.

  • Simmons (1945) reported on data from 71 non-industrialized societies.
  • Clark and Anderson (1967) related culture and personality to mental health and wellness in old age for several different ethnic groups within the United States.
  • Shanas and colleagues (1968) examined the lives of old people in three European industrial societies.

Since Cowgill & Holmes’s (1972) foray into modernization theory (link to screen on Modernization Theory above), cross-cultural understanding of the elderly has shifted emphasis somewhat, from a comparative macro-cultural focus to a more micro-individual or phenomenological focus, resulting in several collections of ethnographic studies depicting aging and the role of the elderly in a wide variety of cultures or societies (Amoss & Harrel, 1981; Keith et al., 1994; Holmes & Holmes, 1995; Sokolovsky, 1997).

Other recent anthropological and sociological studies have investigated culture and its influence within diverse community settings and institutional facilities. Ethnographies have explored a wide range of sites, looking at the impact of culture on the lives of older people in living in nursing homes (Kayser-Jones, 1981; Diamond, 1992; Foner, 1994; Gubrium, 1975; Savishinsky, 1991; Shields, 1988), inner city hotels and apartments (Eckert, 1980; Stephens, 1976; Vesperi, 1985), and age-segregated residential facilities and retirement communities (Johnson, 1971; Hochschild, 1973).

3.5: Late-Life Transitions

Transitions and Ceremonies Marking Age/Stage

In every society, ceremonies mark particular life transitions and age transformations. Naming rituals that welcome and incorporate newborns into the family, initiation ceremonies noting the attainment of sexual maturity, weddings, and funerals are examples. While the move from child to young adult is usually obvious, due to physical growth and psycho-social development, the transition is often elaborately marked by ritual. The shift from mature adult to elder is often much more subtle and not demarcated by ceremony. Sometimes the only markers are increasingly gray hair, a slower pace of activity, or diminished or changed patterns of activity. The transition from healthy elder into frail older person is rarely celebrated. There are no parties when an older person can no longer leave his or her home because the stairs have become a barrier to mobility barrier; no one cheers the entry of a frail older person into a nursing home.

Would it be a good idea to have transitions in old age marked as ceremoniously as those marked at younger ages? Why or why not? Think about this. Discuss it with your friends.

3.6: Dependent Elders: Special Concerns

Competent vs. Decrepit Elders

A pervasive image of decrepitude in old age seems to form our public image of aging and being elderly, and haunts our imagination, telling us what we do not want to become when we get old. Even though this image is based on a small (probably less than 10% of all older persons at any one point in time) and vulnerable segment of the aged population, it is a powerful vision, with real and pervasive consequences.

Frail or decrepit elders are not only different physically, socially and psychologically from intact ones, but they are treated differently, as Barker (1997) showed clearly for a Polynesian group. This is obvious when nursing home populations are compared with elders of the same age living at home in the community. Decrepit elders are more socially isolated, less actively involved in family or community events, less cognitively capable, and more physically impaired. Indeed, it seems that a primary distinction is made in all societies between intact and impaired elders and that the latter are subject to different responses from other (younger) people. In many societies, decrepit or frail elders are treated in a somewhat neglectful or even death-hastening manner (Glascock, 1997).

3.7: Cultural Views of Death

Cultures conceptualize death and perform ceremonials surrounding it in quite distinct ways. In Euro-American society, death is seen as an inevitable. It is an undesired but accepted natural process that arises from the cessation of biological functions and results in a departure from social life, although not necessarily from the collective or individual memory of family. Death is instantaneous and permanent and involves a radical transformation of being that largely precludes any conception of life continuing in any human-like form.

In many other societies, however, death is not a natural or single event but rather the outcome of personal or spiritual agents and deliberate acts, the result of suicide, murder, sorcery or bewitchment, or the action of malevolent spirits. Many Polynesian groups make no linguistic distinction between being unconscious, dying or being dead but rather see death as a long and partly reversible process of transition between living in this world and living in the next. Death is not so much a cessation of animation or being alive as a transformation of the locale in which living occurs.

3.8: References

Abel, E. K. (1991).  Who cares for the elderly?  Public policy and the experiences of adult daughters.  Philadelphia:  Temple University Press.

Amoss, P., & Harrel, S. (Eds. (1981).  Other ways of growing old:  Anthropological perspectives.  Stanford, CA: Stanford University Press.

Baltes, P. B. (1979).  Life-span development psychology:  Some converging observations on history and theory.  In P. B. Baltes & O. G. Brim, Jr. (Eds.), Life-span development and behavior (Vol. 2).  New York:  Academic Press.

Barker, J. C. (1997). Between humans and ghosts:  The decrepit elderly on a Polynesian island.  In J.Sokolovsky (Ed.), The cultural context of aging:  Worldwide perspectives (Revised 2nd ed., pp. 407-424).  New York:  Bergin & Garvey.

Barker, J. C. (2002).  Neighbors, friends and other non-kin caregivers of community-living dependent elders.  Journal of Gerontology: Social Sciences, 57B, S158-S167.

Barker, J. C., & Kramer, B. J. (1996). Alcohol consumption among older urban American Indians.  Journal of Studies on Alcohol, 57, 119-124.

Becker, G. (2002). Dying away from home: Quandaries of migration for elders in two ethnic groups.  Journal of Gerontology: Social Sciences, 57B, S79-S96.

Bengtson, V. L. & Schaie, K. W. (Eds.).  (1999).  Handbook of theories of aging.  New York:  Springer.

Berger, R. M.  (1996).  Gay and gray: The older homosexual man (2nd ed.).  New York: Harrington Park Press.

Bhopal, R.S. (1998).  Spectre of racism in health and health care: lessons from history and the United States. British Medical Journal, 316,1970-1973.

Burgess, E. W. (Ed.). (1960).  Aging in western societies. Chicago: University of Chicago Press.

Butler, R. N. (1963).  The life review:  An interpretation of reminiscence in the aged.  Psychiatry, 26, 65-76.

Butler, R. N. (1975). Why survive?  Being old in America. New York: Harper & Row.

Butler, R. N., Lewis, M. I., & Sunderland, T.  (1998). Aging and mental health (5th ed.).  Boston:  Allyn and Bacon.

Cancian , F. M. & Oliker, S. J. (2000).  Caring and gender.  Walnut Creek, CA; Rowan & Littlefield.

Chiriboga, D. (1987).  Personality in later life.  In P. Silverman (Ed.), The elderly as modern pioneers (pp. 133-157). Bloomington: Indiana University Press.

Clark, M. M. & Anderrson, B. (1967).  Culture and aging:  An anthropological study of older Americans.  Springfield, Ill: Chas. C. Thomas.

Cole, T. R., Achenbaum, W. A., Jakobi, P. L.,  & Kastenbaum, R. (Eds.). (1993).  Voices and visions of aging: Toward a critical gerontology.  New York: Springer.

Cowgill, D. & Holmes, L. D. (1972).  Aging and modernization. New York: Appleton-Century-Crofts.

Crews, D. E., & Bindon, J. R. (1991).  Ethnicity as a taxonomic tool in biomedical and biosocial research. Ethnicity and Disease, 1, 42-49.

Cumming, E., & Henry, W.  (1961).  Growing old:  The process of disengagement. New York: Basic Books.

Diamond, T. (1992). Making gray gold. Chicago: University of Chicago Press.

DiSorbo, A. (1995, Fall-Winter). Equity: liberty and justice for all?  Harvard Journal of Minority Public Health, 16-19.

Eckert, J. K. (1980).  The unseen elderly: A study of marginally subsistent hotel dwellers.  San Diego: Campanile Press.

Erikson, E. H. (1963).  Childhood and society (2nd ed.).  New York:  Norton.

Erikson, E. H. (1984).  Reflections on the last stage—and the first.  Psychoanalytic Study of the Child, 39, 155-165.

Ferraro, K. F.  (1987). Double jeopardy to health for Black older adults?  Journal of Gerontology, 42, 528-533.

Foner, N. (1994). The caregiving dilemma. Berkeley, CA: University of California Press.

Geiger, J. H. (1996). Race and health care—an American dilemma. New England Journal of Medicine, 335, 815-816.

Glascock, A. P. (1997).  When killing is acceptable: The moral dilemma surrounding assisted suicide in America and other societies.  In J. Sokolovsky (Ed.), The cultural context of aging:  Worldwide perspectives (Revised 2nd ed., pp. 56-70). Westport, CT: Bergin & Garvey.

Gubrium, J. F. (1975). Living and dying at Murray Manor. New York: St. Martin’s Press.

Hahn, R. A. (1992). The state of federal health statistics on racial and ethnic groups.  Journal of the American Medical Association (JAMA), 267, 268-271.

Herskovits, E. J. (1995).  Struggling over subjectivity: Debates about the "self" and Alzheimer’s disease.  Medical Anthropology Quarterly, 9, 146-164.

Herskovits, E. J. & Mitteness, L. S. (1994).  Transgressions and sickness in old age. Journal of Aging Studies, 8, 327-340.

Holmes, E. R. & Holmes, L. D. (1995).  Other cultures, elder years (2nd ed.).  Thousand Oaks, CA: Sage Publishers.

Hochschild, A. (1973). The unexpected community. Englewood Cliffs, N.J.: Prentice-Hall.

Iris, M. A. (1988). Guardianship and the elderly: A multi-perspective view of the decision-making process. The Gerontologist, 28, 39-45.

Johnson, S. K. (1971).  Idle haven: Community building among the working-class retired

Berkeley, CA; University of California Press.

Kayser-Jones, J. S.  (1981). Old, alone and neglected:  Care of the aged in Scotland and the U. S.  Berkeley, CA: University of California Press.

Kehoe, M. (1989). Lesbians over 60 speak for themselves. New York: Haworth Press.

Keith, J., Fry, C. L., Glascock, A., Ikels, C., Dickerson-Putman, J., Harpending, H.C. &  Draper, P.  (1994).  The aging experience: Diversity and commonality across cultures.  Thousand Oaks, CA; Sage Publishers.

Keith, P. M. & Wacker, R. R. (1994). Older wards and their guardians. Westport, CT: Praeger.

Kelly, J.J.  (1977). The aging male homosexual: Myth and reality.  The Gerontologist, 17, 328-332.

Kelly, J. J. (1980).  Homosexuality and aging.  In J. Marmour (Ed.), Homosexual behavior: A Modern Reappraisal, pp. 176-193.  New York: Basic Books.

Kertzer, D. I., & Keith, J. (1984).  Age and anthropological theory.  Ithaca: Cornell University Press.

Kramer, B. J., & Barker, J. C.  (1994). Ethnicity in the elderly. Journal of Cross-Cultural Gerontology, 9, 403-417.

Morgan, D. L. (Ed.). (1998, Spring).  The Baby Boom at midlife and beyond.  [Special issue]. Generations.

Myerhoff,  B. (1984).  Rites and signs of ripening: The intertwining of ritual, time, and growing older.  In D. I. Kertzer & J. Keith (Eds.), Age and anthropological Theory (pp.305-330). Ithaca: Cornell University Press.

National Urban League. (1964). Double jeopardy: The older Negro in America today.  New York: National Urban League.

Quinn, M. J., & Tomita, S. K. (1986). Elder abuse and neglect: Causes, diagnosis, and intervention strategies. New York: Springer.

Rosow, I. (1974).  Socialization to old age.  New York: Free Press.

Rosow, I. (1976).  Status and role change through the life span. In R. H. Binstock & E. Shanas (Eds.), Handbook of aging and the social sciences (pp. 457-482). New York: Van Nostrand Reinhold Co.

Rowe, J. L., & Kahn, R. L. (1998).  Successful Aging.  New York:  Pantheon Press.

Savishinsky, J. S. (1991).  The ends of time: Life and work an a nursing home.  New York: Bergin & Garvey.

Schaie, K. W. (1996).  Intellectual development in adulthood.  In J. E. Birren & K. W. Schaie (Eds.), Handbook of the Psychology of Aging (4th ed., pp. 266-286).  San Diego:  Academic Press.

Scheibel, A. B.  (1996). Structural and functional changes in the aging brain.  In J. E. Birren & K. W. Schaie (Eds.), Handbook of the Psychology of Aging (4th ed., pp.105-128).  San Diego:  Academic Press.

Shanas, E., Townsend, P., Wedderburn, D., Friis, H., Milhoj, P. &  Stehouwer, J.

(1968). Old people in three industrial societies. New York: Atherton Press.

Shields, R.R. (1988).  Uneasy endings: Daily life in an American nursing home.  Ithaca: Cornell University Press.

Silverman, P. (Ed.).  (1987).  The elderly as modern pioneers. Bloomington: Indiana University Press.

Simmons, L. (1945).  The role of the aged in primitive society.  New Haven, CT: Yale University Press.

Sokolovsky, J. (Ed.). (1997). The cultural context of aging: Worldwide perspectives (Revised 2nd ed.). Westport, CT: Bergin & Garvey.

Stephens, J. (1976). Loners, losers, and lovers: Elderly tenants in a slum hotel.  Seattle:

University of Washington Press.

Tanjasiri, S.P., Wallace, S. P.,  & Shibata, K. (1995). Picture imperfect: Hidden problems among Asian Pacific Islander elderly. The Gerontologist, 35, 753-760.

Thomson, G.E. (1997). Discrimination in health care. Annals of Internal Medicine, 126, 910-911.

Turner, B. F., & Troll, L. E. Eds.).  (1994).  Women growing older: Psychological perspectives.  Thousand Oaks, CA: Sage Publications.

U.S. Department of Health and Human Services.  (1999). Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

Uehara, E. S., Takeuchi, D.T., & Smukler, M. (1994).  Effects of combining disparate groups in the analysis of ethnic differences: Variations among Asian American mental health service consumers in level of community functioning. American Journal of Community Psychology, 22, 83-99.

Vesperi, M. D. (1985).  City of green benches: Growing old in a new downtown. Ithaca: Cornell University Press.

Wade, N. (2002, July 30).  Race is seen as real guide to trace roots of disease. New York Times.

Williams, D. R.  (1990).  Socioeconomic differentials in health: A review and redirection. Social Psychology Quarterly, 53(2), 81-89.

Williams, D. R. (Ed.). (1999). Racism and health. [Special issue.]. Ethnicity and Disease, 5.

Williams, D. R., & Collins, C. (1995). U. S. socioeconomic and racial differences in health: patterns and explanations.  Annual Review of Sociology, 21, 349-386.

Zinny, G.H., & Grossberg, G. T.  (1998). Guardianship of the elderly: Psychiatric and judicial aspects. New York: Springer.


Module 3: Socio-cultural And Psychologicial Aspects of Aging
2.5 Post Test
3.1 Module Objectives