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"Do not deprive me of my age. I have earned it."

—May Sarton, The Poet and the Donkey: A Novel


By the end of this chapter, readers will be able to:

  1. Identify demographic developments that will affect aging in the future.

  2. Describe trends in social, cultural, and personal characteristics that describe expectations for aging in the coming decades.

  3. Discuss emerging trends in creating meaning in later life.

  4. Describe ways in which changing social and physical environments may change the experience of later life.

  5. Discuss emerging factors in health care that will alter strategies for working with older adults in the future.

  6. Identify the ways in which these various trends interact to affect older adults.

  7. Describe the implications of these trends for delivery of physical therapy and occupational therapy services.

Clinical Vignette

Harriet Smythe is a 78-year-old widow who lives in a small Iowa town. Her husband, who had been a farmer, died 12 years ago, at which point Mrs. Smythe moved from the farm into the nearby town. She was increasingly uncomfortable with driving and felt she would be closer to help if she lived in town.

Mrs. Smythe retired 2 years ago from her position as bookkeeper for a local business, a job she held for 30 years. She has no pension and a very modest income from social security. She also has a small income from investments made after the sale of the farm. She now lives in a compact two-story cottage that has not been updated recently. The town is rapidly losing population as young people move to urban areas. In addition, only one of five health clinics remains open; the three physicians there are all over age 70 and talking about retiring. A hospital 100 miles away offers weekly telehealth appointments.

Before her bookkeeping job, she was a stay-at-home mother for her two daughters. One daughter has moved to a city in the same state, at a distance of 300 miles from her mother. She and her husband and three children visit twice a year. Mrs. Smythe used to visit them but no longer feels comfortable making the drive. The other daughter lives in New York City where she manages a dance troupe. This daughter never married.

Mrs. Smythe has lost muscle mass, which makes it difficult for her to carry groceries and other moderately heavy items. She has slightly elevated blood pressure but is otherwise healthy. She is an active and enthusiastic gardener, although joint pain has begun to limit her ability to work in the garden for sustained periods. She belongs to four book clubs (three of them online) and stays in close touch with her former coworkers. She indicates that she worries about her daughter in New York and that she wishes she saw her grandchildren more often. She does communicate regularly with them using Skype and Facebook and has ...

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