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INTRODUCTION

We are an aging society. In 2014, 14.5% (46.3 million) of the U.S. population was 65 and over. This will increase to 23.5% (98 million) by 2060. During this same time period, the share of the older population that is non-Hispanic white is projected to drop from 78.3% to 54.6%. Those living with Alzheimer’s disease and other dementias could nearly triple from 5 million in 2013 to 14 million in 2050. The oldest of the old, those over 85, are expected to reach 19 million by 2050, and present special challenges to health care providers. Good clinical care of older adults relies on knowledge of normal aging and the common diseases of older age. This chapter focuses on these aspects of mental health and illness.

At a population level, older adults are staying in the workforce longer, having “encore” careers, contributing to our economy in a myriad of ways, and pushing the boundaries of social engagement. Eighty-seven percent of people 65+ want to stay in their own homes and communities as they age (“aging in place”). Health care and aging services providers will need to adapt to changing demographics and perceptions of aging. For example, an increased sensitivity to terminology about aging is critical. “Elderly” and “senior” can have negative implications, whereas “elder” and “older adult” are more respectful. Rather than using the term “dementia facility,” “memory care home” speaks to the fact that this setting truly is an elder’s home. Frameworks Institute, with support from AARP, the American Geriatrics Society, and others developed a model called “Reframing Aging” that offers tools and thought pieces to improve public understanding of older adults’ needs and societal contributions and is valuable for all older adult health and community providers.

NORMAL PSYCHOLOGICAL AGING

Many older adults are active, engaged, pleasure seeking, and remain curious and continue to learn throughout their lives. Temperament (i.e., energy, intensity, and reactivity) remains stable through adult life, whereas personality (learned behavior patterns) undergoes refinement and change over time in most healthy adults. Predictable changes in intellect occur in most people as they age. Changes that are normal with aging include problems with multitasking; slowed speech, word retrieval, and naming; decline in episodic memory (a conscious recollection of a person’s experienced events); and decline in motor coordination, motor response time, and balance and gait. Impairments that are not normal with aging and are associated with dementia include decline in visual-motor tasks (hand eye coordination), semantic memory (facts, meanings, concepts, and rote knowledge), physical memory (ability to knit or play the guitar), sensory perception, and written/spoken language comprehension.

Successful adaptation to growing old is difficult to define and variably expressed. Signs of successful aging include acceptance of change, affectionate relationships with family and friends, and a positive view of one’s life story. Another indicator is the ability to find new sources of self-esteem independent of raising children, career, physical ...

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