The Very Late Old: Sociologist Daniel Levinson described eight stages of adulthood (e.g., Levinson, 1986). The last stage of adulthood, late adulthood, occurs at age 65 and beyond. Levinson’s theory was originally described many years ago and as medical advances continue the late adulthood stage of Levinson’s been expanded considerably (Hutchinson, 2011). The oldest of the old or very late adulthood describes individuals 85 years old or older. This is the fastest growing segment of the population in the United States, women in this segment outnumber men by ratio of 3 to 2, men in this age group tend to be married whereas women are more likely to be single, and this particular age group represents a challenge for family, healthcare professionals, and others who have to work with them and see to their needs (Hutchinson, 2011). With respect to housing for this group there are several very important concerns to consider.

Physical Changes: There are a number of physical changes that occur in the very late stage of adulthood that can have an impact on housing decisions for these people. Hutchinson (2011) documents many of these changes. In many people of this age group the hearing and eyesight have become compromised. Their heart muscles become thicker and the amount of oxygen delivered to tissues declines. There arteries stiffen and this places a greater strain on their hearts and can result in high blood pressure. Tasks that normally wouldn’t be physically demanding can be very demanding for individuals in this age. Breathing capacity decreases by an average of 40% in this age group. Therefore, housing decisions require the consideration of diminished cardiac and respiratory functioning that will naturally occur in this age group.

There are other considerations as well. For example bladder capacity diminishes and the kiddies are less able to remove waste materials. Elderly people need to use the restroom more frequently than younger people and accessibility to bathrooms, especially at night, is important. Bones thin and become more brittle. Falls can be quite devastating to people in this age group and can result in serious complications such as a broken hip. When the long bones of the hip or femur are fractured in an elderly person due to a fall this can lead to severe complications including dementia and even death in these individuals (Marks, Allegrante, Ronald MacKenzie, & Lane, 2003). Most of the people in this group have one or more chronic conditions which impacts their functioning on a daily basis.

There can be quite a bit of variance in the physical functioning of people within this age group depending on how well they take care of themselves, their physical histories, and other factors. All of these physical variables need to be taken into consideration when making housing decisions for these people. Housing considerations should include such things as maintenance and upkeep, elimination of the need for going up and down stairs frequently, and ease of access to bathrooms, kitchen, etc.

Cognitive Changes: Individuals in the oldest of the old group typically undergo some significant cognitive changes that can also be a consideration for housing. Even those people at this stage who have no frank cognitive impairment still have reduced mental processing speed, poorer working memory capacity (or short-term memory), and poorer fluid intelligence (the ability to approach novel learning situations) compared to their younger days (Christensen, 2001). These individuals often do not adapt well to new technology and are more comfortable with landline phones and cell phones, simple electronic devices, and other familiar components. These issues should be taken into consideration when housing individuals of this age. Again issues such as maintenance and upkeep, a simple layout of the housing structure (e.g., stairways with doors), and other issues that will not tax the fluid learning abilities or the mental processing speed of the individual should be considered.

Of course this group is at the highest risk for the development of dementia and other neurological disorders such as Parkinson’s disease. The individual’s level of cognitive impairment is a big consideration when considering housing.

Social Considerations: The particular individual’s social status should also be considered. As mentioned above, women more likely to be single than men at this stage. It is important not to isolate an individual from their peers. Individuals at this stage often do not make new friends is readily as to younger individuals. Research also indicates that this group tends to prefer to socialize with individuals in their own age group (Escobar-Bravo, Puga-Gonzalez, & Martin-Baranera, 2012). Neighborhoods or apartment complexes where the inhabitants are younger may not be suitable for individuals in this age group. Many of these individuals often have children or other relatives with whom they are close and who may attend to their affairs. It is important when considering housing alternatives for these individuals to also consider their access to friends and relatives. These individuals also suffer frequent and significant losses of friends and relatives and there may be issues surrounding, depression, and feelings of loneliness. An individual in this age group who wants to live alone should be thoroughly examined for their capacity to do so.

Spiritual Concerns: Many of these individuals have strong spiritual beliefs and it is important when considering housing alternatives for them to consider how far they will need to travel to places like church, meetings, friends, etc. Spirituality is not the same thing as religion although certainly a person’s religious beliefs contribute to spiritual issues. Nine of ten people in this age group consider religion to be extremely important in their life (Hodge, Horvath, Larkin, & Curl, 2012). Things to consider with this age group regarding spirituality include their capacity to engage in creative and fulfilling activities, will they be able to remain in contact with relatives and their children (which helps fulfill them and contributes to their spiritual well-being calls parent, their religious beliefs and access to institutions/events that are consistent with their beliefs, and the domicile’s capacity to make them feel at one with themselves and with others.

The Need to Remain Current: Is important for the social worker to keep up with innovations in technology, social trends, population shifts, etc. when working with the very old population.

Physical Well-Being: When considering housing for the very late adult the social worker should be up-to-date on technological and medical innovations/changes that are appropriate to this age group. For instance, many physically compromised elderly people use mechanical wheelchairs or other mechanical devices to navigate their environment with. A social worker placing an individual with an amigo on the seventh floor of an apartment building with a small elevator may be creating more problems for the person. Social workers should immediately recognize any mechanical devices, new technological aids, etc. that these individuals use and be able to adjust placement in the housing accordingly. Keeping up with the latest medical advances, technological advances, and the latest assistive devices commonly used by individuals in this age group is a must for the social worker was involved in helping these people make housing decisions (Wilhelmson et al., 2011). Other considerations are the potential access to caregivers, drug stores, and assisted living for needy individuals.

Cognitive Issues: Obviously the social worker would need to thoroughly understand the difference between normal cognition in this age group and impaired cognition in this age group. Dementia or senility are not aspects of normal aging (Christensen, 2001). Housing decisions for people of advanced age are greatly influenced by their cognitive abilities. The understanding of what constitutes normal aging and normal cognitive changes for this group and what constitutes cognitive impairment is rapidly being updated. Social workers who are involved in the care of elderly individuals should make sure to keep up with any new innovations and changes the conceptualization of cognitive impairment in this group. For instance, the new DSM is due out in May of 2013 and there will be changes to some of the criteria for diagnosing cognitive issues (Snelgrove & Hasnain, 2012). It is important for social workers to understand these new criteria for diagnosing mild cognitive impairment and how this impacts housing for select individuals.

Understanding Social Trends: Social workers should pay particular attention to understanding several levels of social trends when working with the very old. For example, when considering housing for elderly individuals it is important to understand the changing populations of the areas under consideration (Hutchinson, 2012). One would not want to place an elderly couple in an area with high crime. As mentioned above one would not want to place an 85-year-old man apartment complex for the average age is 23. It would also be important to understand the attitudes of landlords, homeowners associations, etc. towards elderly people when considering placing them in a particular environment (Escobar-Bravo et al., 2012). Keeping up with the literature on the social needs of the very old is also important and making sure that housing considerations are in line with the needs of the particular individual(s) being placed.

Spiritual Considerations: An interesting recent finding has been that people who are 80 years and older prefer to socialize with individuals/groups that share the same faith as they do (Hodge et al., 2012). When considering housing for this group it is important to make sure that you do not isolate someone sharing their spiritual or religious beliefs. A social worker who does not keep up with the understanding of the individuals with whom they work could be inadvertently setting up a disaster for such an elderly individual. It is always important to discover, praise, and attend to new developments and changes regarding all aspects of the clients with which the social worker involved.

References

Christensen, H. (2001). What cognitive changes can be expected with normal ageing?

Australian and New Zealand Journal of Psychiatry, 35, 768 — 775.

Escobar-Bravo, M.A., Puga-Gonzalez, D., & Martin-Baranera, M. (2012). Protective effects of social networks on disability among older adults in Spain. Archives of Gerontology and Geriatrics, 54(1), 109-116.

Hodge, D.R., Horvath, V.E., Larkin, H., & Curl, a.L. (2012). Older adults’ spiritual needs in health care settings: A qualitative meta-synthesis. Research on Aging, 34(2), 131-155.

Hutchinson, E.D. (2011). Dimensions of human behavior: The changing life course (4th ed.).

London: Sage.

Levinson, D.J. (1986). A conception of adult development. American Psychologist, 41, 3-13.

Marks, R., Allegrante, J.P., Ronald MacKenzie, C., & Lane, J.M. (2003). Hip fractures among the elderly: causes, consequences and control. Ageing Research Reviews, 2, 57-93.

Snelgrove, T.A., & Hasnain, M. (2012). A concern about the proposed DSM-V criteria reclassifying cognitive disorders. American Journal of Geriatric Psychiatry, 20(6), 543.

Wilhelmson, K., Duner, a., Eklund, K., Gosman-Hedstrom, G., Blomberg, H., Gustafsson, H.,

Dahlin-Ivanoff, S. (2011). Continuum of care for frail elderly people: Design of a randomized controlled study of a multi-professional and multi-dimensional intervention targeting frail elderly people. BMC Geriatrics, 11(24), 1-20.

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