19 Older Adulthood
Alexandria Lewis
I. Human Development, Diversity, and Behavior in the Environment
IA. Human Growth and Development
KSAs:
– Theories of human development throughout the lifespan
– Gerontology
As individuals age, they may experience gradual changes in physical and cognitive functioning. These changes can vary widely from person to person, but it is common for some level of decline in areas such as mobility, stamina, or memory to become more noticeable over time. For example, the health and functional abilities of an 80-year-old may differ from those of a 65-year-old, reflecting the cumulative effects of aging and individual health factors rather than a fixed trajectory.
Older LGBTQ+ individuals may face unique challenges related to past and current stigma/discrimination, health disparities, or lack of affirming care.
Older adulthood can be divided into several age categories:
- Young-old ( 65-74)
- Oldest-old (75-84)
- Oldest-old (85 and older)
Exam Tips
When answering questions about older adults, it is important to be mindful of ageism and assumptions about aging. For instance, do not automatically attribute symptoms or concerns such as memory loss, isolation, or physical decline to the aging process without considering other possible causes or underlying issues. Carefully evaluate whether the question is testing your ability to differentiate between typical aging and signs of more serious conditions, such as depression, elder abuse, or cognitive disorders. Always consider the client’s environment, support system, and level of autonomy when selecting the best response.
 Watch for any answer choices on the exam about older adults that engage in paternalism, view older adults as stagnant, and stereotype older adults. Older adults are capable of growth, change, and the ability to adapt. Knowledge about the myths of aging will help to eliminate answers that are not correct.
Self-Check:
There are several dimensions of aging identified by Morgan and Kunkel (2016): Physical aging, psychological aging, and social aging.
Note: Click the drop down icons.
Myths of Aging:
- Older adults are not able to learn new things or adapt to change.
- All older adults have the same experiences.
- Older adults do not engage in intimate/sexual relationships.
- The majority of older adults reside in nursing homes.
- Most older adults have dementia or mild cognitive impairment.
- The majority of older adults will have arthritis.
- Depression is a normal part of aging.
- The majority of older adults have hearing loss.
- Mental health in old age cannot be treated.
physiological changes
Exam questions may require distinguishing between typical age-related changes and symptoms that warrant further medical or psychological evaluation. Being familiar with these normal physiological developments can help avoid assumptions that might be used as answer choice distractors. A physiological change refers to a natural alteration in the body’s structure or function that occurs over time, often as part of the aging process. These changes can affect systems such as the skeletal, cardiovascular, sensory, and respiratory systems, and may influence an individual’s mobility, health status, or physical capabilities.
Highlights:
- Skeletal system changes that result in height changes.
- Bone density and bone mass changes.
- Some older adults may have arthritis.
- Sensory system changes:
- Sense of smell and taste
- Balance and gait
- Degenerative changes in vision and hearing
- Changes in the cardiovascular system.
- Respiratory system changes.
- Skin changes:
- Wrinkles
- Sagging
- Skin may become thin, resulting in skin tears and bruising
- Dry skin
- Skin changes:
Neurodegenerative Diseases and the Brain
A normal part of the aging process includes the loss of some neurons and changes in the weight of the brain (Hutchison, 2017). Approximately 15-20% of persons 65 years and older have mild cognitive impairment (Alzheimer’s Association, n.d.). Dementia is best conceptualized as an umbrella term and includes the significant decline in memory, language skills, cognitive skills, problem-solving, ability to focus, etc.
Neurocognitive disorders (NCDs) are a group of conditions that primarily involve a decline in cognitive abilities. They are acquired, not developmental, meaning they represent a deterioration from a previously higher level of functioning. Cognitive issues are central to these disorders, distinguishing them from mental health conditions where cognitive deficits might be present but aren’t the main feature (like in schizophrenia or bipolar disorder). In the DSM, the category of NCDs begins with delirium and extends to two key syndromes: major neurocognitive disorder and mild neurocognitive disorder, each with several specific causes, or etiological subtypes.
There are more details available in the Neurocognitive Disorders chapter.
Quick Breakdown
Delirium:Â An acute, fluctuating disturbance in attention and awareness, often due to a medical condition, drug, or toxin. It needs urgent medical attention and can often be reversed.
Depression:Â A mood disorder causing persistent feelings of sadness, hopelessness, and cognitive slowing that may mimic dementia, but is usually treatable and reversible with therapy or medication.
Dementia:Â A chronic, progressive decline in cognitive function (especially memory) and independence, due to underlying brain disease. It is usually irreversible.
| Feature | Delirium | Depression | Dementia |
|---|---|---|---|
| Onset | Sudden (hours to days) | Gradual (weeks to months) | Gradual (months to years) |
| Course | Fluctuates during the day; worse at night (sundowning) | Consistent throughout the day | Steady decline, usually stable day-to-day |
| Attention | Severely impaired (easily distracted, cannot focus) | Mildly impaired (trouble concentrating) | Generally normal early on, impaired later |
| Consciousness | Altered (drowsy, hyperalert, confused) | Normal | Normal until late stages |
| Orientation | Disoriented to time, place, often person | Usually oriented | Disoriented in later stages |
| Memory | Short-term memory loss; fluctuates | May seem forgetful due to poor focus | Progressive memory loss, especially new information |
| Psychotic Features | Common (especially visual hallucinations) | Possible if severe (usually mood-congruent delusions) | Possible in later stages (delusions, hallucinations) |
| Sleep-Wake Cycle | Severely disrupted (daytime sleepiness, nighttime agitation) | Sleep problems common (insomnia, hypersomnia) | Sleep disturbances develop over time |
| Mood | Rapid mood swings | Persistent low mood | Apathy common; mood swings can occur |
| Response to Cues | May improve temporarily with redirection | Maintains engagement with encouragement | Limited improvement with cues; memory deficits persist |
| Reversibility | Often reversible if cause is treated | Reversible with treatment | Irreversible and progressive |
psychological changes
There are different perspectives about aging and personality change. Much of the literature suggests that core aspects of personality, particularly temperament, remain relatively stable throughout life. George Vaillant described personality as having two elements: character, which may evolve through experience, and temperament, which tends to be more enduring (Hutchison, 2017).
While older adults may face increased psychological stressors such as grief, loss of independence, or health challenges, many also experience emotional resilience, improved coping skills, and a deeper sense of meaning. Erikson’s theory identifies integrity versus despair as the central psychological task of this stage, where individuals reflect on their life and legacy.
Mental health conditions like depression may emerge or persist in later life, but they are not a normal part of aging and should be assessed carefully. Older adults, particularly older men, have some of the highest suicide rates of any age group. Factors such as social isolation, chronic illness, grief, and underdiagnosed depression can contribute to this risk.
| Myth | Reality |
|---|---|
| Most older adults are depressed. | While some older adults may experience depression, it is not a normal or inevitable part of aging. Many maintain emotional well-being and resilience. |
| Personality changes drastically in old age. | Research shows that personality remains relatively stable over time. Significant changes are more often linked to health conditions or major life events. |
| Older adults are no longer capable of personal growth. | Older adults can continue to learn, adapt, and experience personal growth, especially in areas of emotional insight, relationships, and meaning-making. |
| Cognitive decline is a normal part of aging. | Some cognitive slowing is common, but serious decline (e.g., dementia) is not a normal part of aging and should prompt assessment. |
| Older adults are withdrawn and uninterested in social connection. | Many older adults value and maintain strong social ties, though social losses or mobility challenges can impact opportunities for connection. |
Exam Tip: Be familiar with integrity vs. despair, which focuses on life reflection, acceptance, and unresolved regret. This developmental task may be referenced in questions about meaning-making or life review. Psychological changes do not occur in isolation. Look for questions that require you to connect emotional well-being with physical health, support systems, and life transitions (e.g., retirement, loss).
Self-Check:
health issues
Some older adults may face complex health challenges that require integrated and person-centered care. Common issues may include chronic conditions like heart disease and diabetes, risks related to falls and mobility, and cognitive changes such as dementia. Mental health concerns, including depression and social isolation, are frequently overlooked. Additional challenges include managing multiple medications (polypharmacy), nutritional deficiencies, and potential elder abuse.
sexual development
Many older adults continue to value and engage in sexual expression and intimacy. Sexuality is a lifelong aspect of human development, not limited to younger life stages. Hormonal changes, medication side effects, chronic illnesses, and changes in mobility can influence sexual function. However, these changes do not eliminate desire or the capacity for sexual relationships. For many older adults, intimacy, touch, and emotional closeness remain central to their well-being and identity. Social workers should assess and support this dimension of health as part of holistic care.
Older adults can still be at risk for sexually transmitted infections (STIs). Safe sex education and access to sexual health resources should be available regardless of age.
spiritual development
Some older adults engage in spiritual or existential reflection, seeking to make sense of their life experiences, legacy, and mortality. This aligns with Erikson’s integrity vs. despair stage. Research suggests that spirituality, for some older adults, may become more important in later life (Council on Social Work Education, n.d.). Spirituality may serve as a source of comfort, identity, resilience, and community. Spirituality may be expressed through nature, art, service, relationships, or personal philosophy.
Spiritual concerns for some older adults emerge as individuals face end-of-life issues, grief, or serious illness. Spirituality is shaped by cultural, historical, and personal contexts. Social workers must be sensitive and avoid imposing their own views or minimizing the experiences of older adults.
Some older adults use spirituality as a coping mechanism, which can provide them comfort when facing loss, illness, and the contemplation of their mortality. Engaging in spiritual practices (for some older adults) can provide a sense of purpose, hope, and connection (Lima et al., 2020).
References
Council on Social Work Education (n.d.). Integrating spirituality into social work practice: The reflections on spirituality and aging (ROSA) model
Saint Louis University, School of Social Service. https://www.cswe.org/CMSPages/GetFile.aspx?guid=13265d61-3c9f-4adb-9af0-2ada61ce5b88
Hutchison, E.D. (2017). Essentials of human behavior: Integrating person, environment, and the life course (2nd. ed.). SAGE Publications, Inc.
Lima, S., Teixeira, L., Esteves, R., Ribeiro, F., Pereira, F., Teixeira, A., & Magalhães, C. (2020). Spirituality and quality of life in older adults: A path analysis model. BMC Geriatrics, 20 (259), 1-8 https://doi.org/10.1186/s12877-020-01646-0
Morgan, L.A., & Kunkel, A. (2016). Aging, society, and life course. Springer Publishing Company, LLC.
