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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #1, #6, #23, and #24

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LEARNING OBJECTIVES

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Learning Objectives

  • Apply the life course perspective to the aging process to show how the experience of aging depends on cultural factors, such as the conceptualization of the lifespan, as well as lifespan changes in affective experience.

  • Identify core psychosocial factors and the mechanisms by which they affect health and well-being in older adults.

  • Examine the significance of resilience, the process by which older individuals adapt to challenges associated with disability and declining health.

  • Recognize current trends in common old-age transitions such as retirement, widowhood, and caregiving.

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Key Clinical Points

  1. Lack of support (social isolation and loneliness) has a negative effect, and social engagement (volunteering, lifelong learning, and involvement in intergenerational programs) has a positive effect, on health and well-being in old age.

  2. Social environments that promote aging in place support psychosocial health.

  3. The aging services network is important in promoting engagement across diverse domains.

  4. Hospice supports the psychosocial health of caregivers who provide end-of-life care.

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OVERVIEW

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As people age they experience changes in physical and cognitive capacities, such as gait speed and reaction time, and also changes in emotional experience and social interests. Cultures impose an order on this continuum of change in widely shared understandings of the life course, which partition the lifespan into different stages. One of the most famous is Shakespeare’s seven ages of man (As You Like It, II, 7). The Elizabethan stages of life include infancy, “whining school boy … creeping unwillingly to school,” lover, soldier (“seeking the bubble reputation even in the cannon’s mouth”), judge, and then two stages of decline: initial loss of capacities (“big manly voice, turning again toward childish treble”) and finally “second childishness and mere oblivion … sans teeth, sans eyes, sans taste, sans everything.” Other cultures are more charitable in their ideas about advanced age. The Samia people of Kenya describe old age as a pleasant time to sit before the fire and be fed. Such differences in thinking about the life course remind us that psychosocial aging is governed both by biological and sociocultural elements. A major focus of developmental approaches to psychosocial aging is to distinguish between invariant biological change and cultural constructions that selectively emphasize particular transitions in this continuum of change.

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Life Course Developmental Perspective

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There is no single age at which we can say that people cross the threshold into “old age.” People age at different rates; hence, for any given age, there will be great variation in all proposed biomarkers of aging or phenotypes of healthy aging. For example, in the United States, establishment of the Social Security system linked old age to age 65. This definition of old age is more a product of social perceptions and economic necessity than anything else.

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