Anthropology & Aging Quarterly  2013: 34 (3) 143

Book Reviews
Whitfield, Keith E., ed. Annual 
Review of Gerontology and Geriatrics: 
Focus on Biobehavioral Perspectives 
on Health in Late Life. Springer 
Publishing Company. Volume 30: 
2010. ISBN 978-0-8261-0613-1, pp. 
296. Price $90.00 (Hardcover)

The Annual Reviews of Gerontology 
and Geriatrics (ARGG) have been in 
existence for almost three decades. 
The focus in this volume is on how 
biobehavioral perspectives impact 
health and aging and is edited by 
Keith E. Whitfield, Ph.D. of Duke 
University who brings a wealth 
of knowledge and experience to 
the editor position. Together with 
twenty-nine interdisciplinary expert 
contributors, the authors present 
approaches and conceptualizations on 
how complex biological, behavioral, 
and social systems interact to create 
and impact aging health. Chapters 
take in to consideration the life span 
and life course approach to aging as 
a process. The content is organized 
in three distinct sections with the 
goal of “stimulating thinking about 
how biobehavioral perspectives help 
to accurately account for complex 
phenomena relative to aging” (2). 

Whitfield explains the broad 
conceptualization of biobehavioral 
as the descriptor of choice when 
referring to interdisciplinary research 
that encompasses the biological and 
social foundation of behavior. This 
approach accentuates the expanding 
interest in exploring the aging process 
by determining complex connections 
between social and behavioral factors 
that impact all other processes and 
may help to explain the etiology, 
symptomatology, and life course of 
chronic disease states in late life.

Szanton and colleagues offer a 
society-to-cells resiliency theory 

that represents theoretical synthesis 
but highlights the impact the social 
environment can have on aging 
resilience. This proposed theory 
“posits that resilience can be manifest 
in resistance, recovery, or rebound 
processes, viewing resilience as a 
process in which all individuals 
engage as they progress in life” (7). 
This approach seems logical when 
thinking about aging Baby Boomers 
and their desire to maintain physical, 
mental, and social function for as long 
as possible – their need and desire to 
be resilient. 

In chapter 3, authors present 
an overview of biobehavioral 
methodology including implications, 
strengths, and weaknesses. More 
integration of theory-driven 
explanatory models needs to occur 
in education and research training. 
Analysis of data from biobehavioral 
aging research is difficult given the 
complexity and lack of formal training 
in biobehavioral design; something 
to think about when designing 
undergraduate and graduate research 
courses for future leaders in aging 
research.

Cells to Homeostatic Systems: 
Chapters 4 through 8 cover an 
interesting range of topics: the roles of 
oxidative damage, exercise and caloric 
restriction to late life health; genetic 
and environmental contributions 
to cognitive decline in aging and 
Alzheimer’s disease; hypertension 
and neurocognitive function; vascular 
depression and the cardiovascular 
implications for mental health; and, 
stress and aging. Interesting and 
current aging topics that give the 
reader pause when thinking about 
crossing the behavioral, psychological, 
social, organ systems and molecular 
levels. Or perhaps the mind-body 
connection within a social context 
would be the take home message. The 

study of psychoneuroimmunology 
- the interactions among emotions, 
neural, endocrine, and immune 
functions - exists. What might we 
term the study of environment, 
social, behavioral, psychological, 
genetic, cellular and molecular levels? 
Optimageresilientology? Another 
point to ponder in our quest for 
understanding the process of aging so 
we can make an impact on the quality 
of aging. 

Person to Society: The final 6 chapter 
topics include: religious involvement; 
personality; an ethnographic treatise 
on poverty and health; breast 
cancer biology and behavior; the 
socioeconomic gradient in healthy life 
expectancy; and, neighborhoods and 
health in later life. In chapter 9, Hill 
presents his model of how religious 
involvement impacts health and 
longevity. Social and psychological 
resources, health behaviors and 
biological markers are identified 
from a biopsychosocial perspective. 
Generally, religious involvement 
impacts aging in a positive manner. 
However, Hill does include the “dark 
side” of religious involvement which 
was insightful as I am sure many 
clinicians working with older adults 
have witnessed the negative as well 
as positive aspect. I would have liked 
to seen an exploration of spirituality, 
especially since the importance of 
religion is currently being defined 
differently by the aging Boomers. 

Hooker and colleagues remind us of 
how important knowing the lifelong 
personality of the older adult assists 
us to understand their health issues of 
today. Gaps exist and further research 
is essential. Burton and Bromell report 
on the cumulative health disadvantage 
of being born in to poverty by using 
an ethnographic approach. The reader 
is reminded that “cancer in the older 
adult is increasing and regarded by 



Anthropology & Aging Quarterly  2013: 34 (3) 144

some as a geriatric syndrome” (295). 
The work by Harden and colleagues 
reminds us that with advancing life 
expectancy and cancer treatment 
advances, we have an obligation to 
treat older adults past the typical end 
dates of 70 years and work toward 
updating current evidence-based 
guidelines for health prevention. 
And lastly, Crimmins and Hagedorn 
tell us that “estimating healthy 
and unhealthy life is an attempt to 
estimate life of varying quality” (p. 
317). Using and understanding how 
socioeconomic factors impact aging 
can help us to change health policy 
and determine appropriate resources 
for leveling the playing field regarding 
quality.
   
This book is a relevant resource for 
researchers and educators in many 
disciplines as well as clinicians and 
health care profession students. 
Traversing levels of analysis helps 
us to think about aging as a process 
impacted from birth by external 
and internal factors that combine to 
formulate health and longevity for all 
aging individuals. Understanding the 
impact of life on living is essential in 
healthy aging. 

Linda J. Keilman, DNP, GNP-BC
Michigan State University

College of Nursing 

Peggye Dilworth-Anderson and Mary 
H. Palmer, eds. Annual Review of 
Gerontology and Geriatrics, Volume 
31, 2011: Pathways Through the 
Transitions of Care for Older Adults. 
New York: Springer Publishing 
Company. 2011. ISBN #978-0-8261-
0793-0. pp. 270, $95 (Hardcover)

This installment of the Annual Review 
of Gerontology and Geriatrics is 
organized as an answer to the complex 
question of what is needed to improve 
the quality of care adults aged 65 and 
older during their transitions from 
one health care setting to another. 
Pathways focuses on care transitions 
because this is where things are most 
likely to go horribly wrong for the 
patient, and the overarching goal is to 
improve patient outcomes, which in 
turn will reduce spending. 

The complications facing older adults 
who are experiencing care transitions 
are broadly contextualized within the 
recent public policy issue of health 
care reform, and even more broadly in 
the rapidly shifting age demographics 
of the U.S. that is slated to exacerbate 
an already strained system. While 
the many factors contributing to poor 
health outcomes during transitions 
are not unique to older adults, 
comorbidities like dementia do occur 
at higher rates in this population, 
further complicating their care. 

Pathways (and specifically “Coming 
Full Circle”) casts transitional care 
as a way of reorienting how health 
care is provided in the U.S. Because 
transitional care as the authors 
frame it focuses on the patient, with 
care providers and family members 
coordinating the patient’s care in 
symphonic harmony, transitional care 
is held up as a site for the catalysts 
that could systematically increase 
the quality of care provided while 

reducing its overall cost. 

The health care system’s current 
state of disarray can be located in the 
five thematic “pathways” that this 
volume treats as the current health 
care system’s greatest weaknesses 
as well as its areas of greatest hope: 
family involvement, education and 
retention of the health care workforce, 
patient care quality and outcomes, 
reimbursement policies, and the 
fundamental fragmentation of the 
system. Taken together, these themes 
have the power to make or break 
continuity of care as patients transition 
from one health care setting to the 
next. 

Several solutions also recur 
thematically throughout the volume. 
Among the most popular are 
patient-centric care models, inter-
disciplinary team (IDT) coordinated 
care, multi-directional and ongoing 
communication, judicious use of 
technology, tying reimbursement 
rates to care quality, including family 
and direct care workers in decision-
making, and holding health care 
providers and institutions accountable 
via standard performance measures. 

A few chapters, notably “Public Policy 
Implications” (Reinhard and Lind) 
and “Educating Direct Care Workers 
on Transitions of Care” (Stone and 
Bryant), highlight the models and 
best practices that currently exist, 
and what promising programs the 
recently-passed Patient Protection and 
Affordable Care Act (PPACA) and 
other public policies may facilitate. 
But these same chapters also note the 
particular barriers that exist to further 
implementation of these best practices. 

All of the authors admit there are quite 
a few stakeholders who are not exactly 
eager to see things shift to a patient-
centric model. In response, “Coming 



Anthropology & Aging Quarterly  2013: 34 (3) 145

Book Reviews
Full Circle” advocates that we consider 
stakeholders “in relation to each 
other” so that common interests can 
be identified and leveraged for the 
improved health of the system and 
the people it affects (252). And the 
contributors also hold up the potential 
of PPACA as a way to implement 
systematic changes. But knowing 
what we do now about the potentially 
dire straights the PPACA is in given 
the current political climate, how do 
we read the contributors’ optimistic 
suggestion that this federal policy is 
something we will be able to leverage 
to change the system for the better?

Despite this shadow of doubt, the 
Pathways is thoughtfully written, 
its sections building easily upon one 
another. The recurring themes are 
interwoven throughout to create a 
consistent whole, allowing the volume 
to logically reach its conclusions and 
policy recommendations of the final 
chapter. The research herein has 
obvious widespread implications 
not just in the arena of public health, 
but also for our society as a whole. 
After all, as the authors point out, this 
crisis in health care is part of a larger 
socio-economic crisis. And while this 
volume focuses on the impact the 
system’s shortcomings is having and 
will continue to have on older adults, 
the authors consistently stress that it is 
not only patients who experience their 
health crises, but also their families 
and friends.

The authors employ a variety of 
research methods, statistical sources, 
and ethnography to build their 
cases. A broad spectrum of people 
contributed to the solid scholarship in 
this volume, giving Pathways a rich, 
interdisciplinary scope that bolsters 
its insightful suggestions for future 
research and policy. Many of the 
contributors hail from the medical 
field, and there is representation of 

the health policy, social work, and 
psychiatric fields, as well. These are 
researchers who may actually have 
the influence necessary to change 
the lives of the people they have so 
meticulously studied. 

Like all the volumes in this Annual 
Review series, Pathways is intended 
for students, researchers and clinicians 
in the fields of gerontology and 
geriatrics. But this volume contributes 
useful knowledge not only to the 
field of aging studies, but to multiple 
disciplines and public policy. Anyone 
interested in aging studies or health 
care would find this volume useful 
and enlightening. 

After reading this book, it seems that 
by improving care during transitions 
using the various suggestions the 
authors put forth, the impending 
health care and socio-economic crisis 
that the influx of older adults poses 
could be averted. However, the 
disconnect that all the authors identify 
as so dangerous during transitions 
of care mirrors the disconnects that 
tend to occur during the transitions 
of knowledge from research to policy 
and from policy to implementation. 
Pathways is undeniably successful in 
what it aims to do: providing tools 
to think through ways of improving 
the quality of transitional care 
for older adults in America. And 
the contributors do an admirable 
job of discussing the underlying, 
systematic barriers to the application 
of its important and well-researched 
conclusions. I simply wish its 
contributors had provided clearer 
pathways through the transition from 
research to practice.

Rachel Sona Reed
The Pasadena Village

Hayslip, Bert, Jr.; Smith, Gregory 
(eds.), Annual Review of Gerontology 
and Geriatrics, Volume 32 2012: 
Emerging Perspectives on Resilience 
in Adulthood and Later Life. Springer. 
2012. ISBN# 978-0-8261-0874-6, 299 
pp, $99 (Hardcover) 

This collection is a timely and 
excellent contribution to the study of 
resilience and the field of gerontology.  
Recognizing that resilience as a 
construct is complex and lacks a 
unified and agreed upon definition, 
the editors conceptualize resilience as 
multifaceted and multidimensional, 
while demanding “attention to a 
virtually unlimited array of interacting 
biological, psychological, and 
environmental variables that must be 
truly viewed from an interdisciplinary 
and life span perspective” (p.24).  As a 
result, the volume is organized in two 
parts: the first (chapters 1 through 7) 
addressing domains (physiological, 
biopsychosocial, and environmental 
aspects) of resilience and the second 
(chapters 8 through 14) discussing 
application (intervention and value 
of resilience in specific age-related 
contexts). Contributors to this volume 
address the multidimensional nature 
of resilience while considering 
how the research has evolved and 
developed given its historical context.  
Additionally, contributors present 
the most pertinent issues related to 
the measurement and application 
while advising and encouraging 
scholars to explore the complex 
and unanswered questions as they 
investigate and develop programs 
of resilience research. This volume 
showcases prominent scientists 
studying resilience. Additionally, 
contributors review the current state 
of the literature and articulate trends 
in the frontier of resilience research 
at large.  The content in almost every 
chapter is accessible, compelling, and 



Anthropology & Aging Quarterly  2013: 34 (3) 146

stimulating.  The collection is intended 
for both lay and expert readers 
wishing to understand the state of 
resilience research as it pertains to later 
adulthood, and would be an excellent 
text for graduate courses allied with 
aging and adult development.  

Part I of this volume details various 
domains and contexts for which 
resilience is important. Key themes 
are: defining and conceptualizing 
resilience, resilience as it pertains 
to major issues related to aging 
(immunity, cognition, stress and 
coping, environment, and spirituality), 
and the call for future research that 
better measures and models resilience 
in later life i.e., research that deals 
with the temporal nature of resilience 
as a process.  In chapter 1, Smith and 
Hayslip provide a comprehensive 
discussion of resilience as a construct 
and adequately define and situate 
resilience in relation to protective 
factors, risk and adversity.  Fagundes, 
Gillie, Derry, Bennett, and Kiecolt-
Glaser in chapter 2 examine the 
biophysiological aspects of resilience 
in the context of immunological 
functioning.  In chapter 3, Lavresky 
explores the relationship between 
stress, resilience, and mood disorders 
such as depression and anxiety. In 
chapter 4, Ryff, Freidman, Morozink, 
and Tsenkova deal with resilience in 
the context of emotional expression 
and regulation.  Stine-Morrow and 
Chui in chapter 5 explore the need 
for maintaining and coping with 
cognitive functioning in later life as a 
way to enhance resilience. Aldwin and 
Igarashi in chapter 6 treat resilience 
as the key factor enabling older adults 
to successfully manage poor person-
environment fit.  In chapter 7, Ramsey 
discusses the role resilience plays in 
promoting spirituality as a resource 
and component of successful aging. 

Part II of this volume “focuses on the 

application and value of resilience to 
a variety of issues key to successful 
development” (p.151). Key themes 
are: translating resilience into the lives 
of older adults and best practices for 
doing intervention based work in 
the context of resilience. In chapter 
8, Walsh applies key components of 
resilience to later life families using a 
family systems perspective. In chapter 
9, Rybarcyzk, Emery, Guequierre, 
Sharmaskin, and Bethel look at 
indicators of resilience of individuals 
in rehabilitation following a stroke, 
fall, or onset of a chronic condition.  
Bonanno, Westphal, and Mancini in 
chapter 10 discuss resilience in the 
context of individual differences in 
adaptive coping. In chapter 11, Sterns 
and Dawson consider resilience in 
the workplace and how it relates to 
the older worker.  Coon in chapter 12 
explores the resilience of caregivers.  
In chapter 13, Diehl, Hay, and Chui 
discuss the role stress plays in the 
process of recovery and resilience in 
the everyday lives older adults. Lerner, 
Schmid, Weiner, Arbeit, Chase, Agans, 
and Warren in chapter 14, using 
person-environment interactions, 
consider the constructs of biological 
and psychological resilience in the 
context of a lifespan developmental 
perspective. 

Traversing the life course promises 
that individuals will encounter a 
multitude of life events, and for 
some these events will be sources 
of hardship, adversity, and trauma.  
What determines whether people 
thrive or survive when encountering 
these events? What circumstances 
increase the likelihood of having 
resilience, or the capacity to 
maneuver through adversity in a 
manner that protects health and well-
being?  Is it simply inner strength, 
self-regulation, or innate human 
capacity? Why is it important that 
we investigate resilience in the later 

decades of life? How do we translate 
the underpinnings of resilience into 
interventions and policies that benefit 
older adults and society at large?  If 
you are a looking for a volume that 
addresses these questions and more 
while offering new and exciting 
ways to fill existing gaps in resilience 
research, reading this volume is a 
worthy investment of your time and 
energy. 

Lydia K. Manning, PhD 
Associate Professor of Gerontology

Concordia University Chicago 

Jean-Marie Robine, Carol Jagger, and 
Eileen M. Crimmins, eds.,  Review 
of Annual Review of Gerontology 
and Geriatrics. v 33, 2013. Healthy 
Longevity: A Global Approach.  
Springer Publications. New York: 
2013.  ISBN-10: 0826109942  $95.49 
(Hardcopy)

This volume is part of the series of 
reviews of research in aging.  As the 
subtitle specifies, it addresses research 
on living longer.  The sixteen chapters, 
each by different sets of authors, 
included have a consistent conclusion:  
with appropriate medical care, older 
people will live longer with less 
destructive effects from debilitating 
conditions.  More people will live to 
be the older elderly and men will live 
longer than before.  The effect of this 
older elderly aging has significant 
policy and fiscal implications, because 
appropriate treatment and monies will 
need to be applied to them.

The chapters address different issues 
that are of interest to students of 
gerontology, geriatrics, and especially 
the members of AAG.  Chapter 2, 

Book Reviews



Anthropology & Aging Quarterly  2013: 34 (3) 147

Book Reviews
for example, by Mikael Thinggard, 
Matt  McGue,  and Kaare Christensen,  
“Age Trajectory  of High Cognitive 
Functioning,” notes that: “It is 
reassuring that exceptional longevity 
does not necessarily lead to high levels 
of cognitive disability in the 1905 
cohort. (p.45.)”  The authors ask that 
this finding be tested in later born 
Danish cohorts as well as cohorts in 
other countries. They go on to suggest 
appropriate statistical methodologies 
be used to make certain any missing 
data be addressed 

These findings are further 
confirmation of earlier results.  
Zarit and Zarit, in their review of 
aging disorders, explore cognitive 
functioning longitudinally and across 
cohorts.  They note data drawn from 
the Seattle Longitudinal Study that 
show stability in most areas as people 
reach older ages (2011:25.)  Of course, 
both medical and psychological factors 
can detrimentally affect cognitive 
skills. This is reassuring as we find 
ways to diagnose both sets of factors.  

From this example, and others to 
follow, it is clear that except for Japan, 
the volume focuses on European 
and North American studies.  The 
editors and chapter writers note that 
comparable studies should be done 
elsewhere and continue to be done 
throughout the First World, with 
particular reference to appropriate 
statistical methods that connect both 
longitudinal and cohort studies.  

Several of the chapters focus on 
biological factors in health aging.  
In Chapter 7, “Optimizing Human 
Health Span and Life Span,” Bradley 
J. Wilcox et al. look at the phenotypes 
that define human aging.   They 
conclude from a number of studies: 
“…the phenotypes of ‘healthy’ or 
“successful’ aging or ‘health span’ are 
complex and ill defined. It is difficult 

to assess predictors or correlates of 
these phenotypes and even more 
difficult to replicate findings if the 
phenotypes are unclear and differ 
from study to study. (p.156.)”  They 
suggest continued use of autopsy 
studies, especially given the advances 
in micro-technology that allow more 
accurate study of organs to determine 
aging issues.

Others focus on medical service, 
education, and self-care factors.  
Chapter 13, for example, in Karine 
Peres, et al., “Recent Trends in 
Disability Free Life Expectancy in the 
French Elderly,” follows the general 
theme of the chapter reviews and 
studies in this book.   The authors 
suggest that “…the health of older 
people has significantly improved 
over the last two decades concurrent 
with a rise in LE [Life Expectancy]…”  
They go on to note that healthier life 
styles—e.g., better diets, more exercise, 
decreased consumption of nicotine—
have helped as well.  Furthermore, 
they note that some of the gender 
differences of the past seem to be 
changing outcomes: “Men and women 
may have developed some competency 
in areas traditionally dominated by the 
other gender in previous cohorts, such 
as doing the shopping or preparing 
meals among men and driving a 
car or handling finances among 
women. (p.306.)”  Some alternative 
research suggests that women may 
report more disability than men: 
http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC1448463/  Consequently, 
in this reviewer’s experience as an 
anthropologist and psychologist 
treating the elderly, researchers and 
therapists should be sensitive when 
doing assessments and treatment to 
this possibility when working with the 
elderly.

As this chapter and other chapters 
throughout the volume suggest, 

there are policy implications for 
this healthier aging.  In simple 
terms, as the later chapters portray, 
more elderly are living longer.  The 
readings suggest that appropriate 
medical and psychological care, 
with suitable funding, can help the 
elderly achieve a more successful 
and fruitful experience during these 
years.  The various authors do note 
the limitations in the research they 
do and suggest further research in 
the First World should be done to 
address uncertainties in their findings.  
Meanwhile, those of us concerned with 
issues of aging will find this collection 
welcome in terms of enhancing 
positive outcomes for the elderly.  

2011 Zarit, Steven H. and Judy M. Zarit. 
Mental Disorders in Older Adults: 
Fundamentals of Assessment and 
Treatment.  2nd. edition.  The Guilford 
Press.  New York.

2004 http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC1448463/

Richard Zimmer 
Sonoma State University



Anthropology & Aging Quarterly  2013: 34 (3) 148

Levine Madori, Linda. Transcending 
Dementia through the TTAP Method:  
A New Psychology of Art, Brain, and 
Cognition. Baltimore, MD: Health 
Professions Press. 2012. ISBN 978-
1-932529-72-2, 243 pp. Price $42.95 
(Paper)

Dr. Linda Levine Madori has 
developed an approach to enhance 
the quality of life for people 
with dementia.  The twelve-step 
Therapeutic Thematic Arts Programing 
(TTAP) offers a way for administrators 
to implement person-centered 
dementia care for residents of nursing 
homes and assisted living facilities.  
The TTAP embraces finding out what 
animates a person and taps into what 
Levine Madori refers to as the mind’s 
eye throughout the book.  TTAP 
allows the individual to reminisce, 
reflect, and share with others in a 
group setting by utilizing a variety of 
communication and self-expression 
forms.  TTAP focuses on the arts 
which include painting, music, dance, 
sculpture, and writing.  The resident is 
empowered by their ability to choose 
colors, media, word choices, and 
music styles.  The resident is further 
empowered to plan social events 
celebrating their accomplishments 
by planning events such as themed 
meals for other residents, staff or 
family members.  Finally, the most 
important opportunity to engage in 
empowerment and self-advocacy 
is when the individual is asked to 
evaluate their experiences and offer 
suggestions for improvement and 
options for future TTAP experiences.

Upon first impression, I felt that 
this book was directed towards 
Therapeutic Recreation and Activities 
professionals. The text provides an 
overview of Alzheimer’s disease and 
dementia, an overview of the TTAP, 

basic brain anatomy and physiology, 
and details of neurophysiological 
responses in clients engaging in the 
TTAP. Upon further reflection, this 
book is meant for everyone.  Culture 
change within a care center, regardless 
of the method chosen, can only happen 
with support from administration.  
Once administration has chosen the 
method of culture change there must 
be education and acceptance by all 
stakeholders, particularly the nursing 
assistants.  In the final chapters there 
is discussion about the replication of 
Levine Madori’s TTAP at multiple 
care facilities.  As an administrator, 
the part that caught my attention was 
that one facility claimed an estimated 
cost savings of over $160,000 in one 
year (170).  As an educator, I could see 
this text being utilized in gerontology, 
activities, and recreation courses. Of 
further interest to the academicians 
is the chapter that highlights how the 
TTAP is grounded in interdisciplinary 
research with foundations from 
theories in developmental, life span, 
recreation, psychology, life review, 
neurodevelopmental, object relations, 
and gerotranscendance.

I found the appendixes to be a great 
strength of the book and helpful to 
me as an administrator.  In Appendix 
A, Levine Madori provides sample 
protocols for the TTAP which details 
the treatment protocol, the materials 
needed for the session, the rationale 
for the session, how clients are referred 
to the sessions, risk management, 
the structure of the session, time 
allotment, outcome and evaluation 
gathering as well as personnel needed 
for implementation.  Appendix B 
provides sample assessment tools.  
Appendix C provides ideas for 
programming using affordable, 
everyday supplies that are budget 
friendly.  Appendix D provides 
samples of graphic visual organizing 
tools to help clients to develop themes 

for the session.  Appendix E provides 
a list of suggested themes to initiate 
the session.  A weakness for me is 
that I personally would have liked to 
have seen more detail in Appendix 
A as well as more information on 
actual implementation.  However, 
upon further research at www.
levinemadoripdd.com I found that the 
author has written other companion 
books that may provide the additional 
information I am seeking.  As my 
interest was piqued by the cost savings 
at one facility, I would have like more 
information in this area.

 As facilities and those who regulate 
them struggle to meet the changing 
demands of the industry and their 
clients, I find this book to provide 
an excellent opportunity to begin 
or advance current progress on 
implementing person-centered care.  
Finding the method that meets your 
facilities personality and culture can 
be a challenge.  Whether the TTAP is 
the right one for a particular facility, 
only the staff and residents can tell.  
Regardless of the method adopted, 
there are definitely lessons to be 
learned and incorporated into any 
activity or recreational program.

Jennifer A. Wagner, MPH, LNHA 
Bowling Green State University 

Instructor, Gerontology Program

Karen L. Fingerman, Cynthia A. Berg, 
Jacqui Smith & Toni C. Antonucci, 
Eds. Handbook of Life-Span 
Development. Springer Publishing 
Company, New York, 2011. ISBN 978-
0-8261-1079-4. pp881. E-book ISBN: 
978-0-8261-1080-0. Price $125.00  
(Hardcover)

Book Reviews



Anthropology & Aging Quarterly  2013: 34 (3) 149

Book Reviews
(Karen L. Fingerman et al. continued) 

Karen Fingerman, PhD is Professor 
of Developmental and Family Studies 
at Purdue University; Cynthia Berg, 
PhD is Professor of Psychology at 
the University of Utah; Jacqui Smith, 
PhD is Professor of Psychology at 
the University of Michigan; Toni 
Antonucci, PhD is Professor of 
Psychology and Research Professor of 
the Institute of Social Research at the 
University of Michigan.

The handbook is an impressive 
collection of research studies and 
theories provided by knowledgeable 
contributors on life-span development 
from conception to old age.  The 32 
chapters are organized within four 
major thematic sections: 1) Theory and 
Overviews; 2) Physical and Cognitive; 
3) Socio-emotional; and 4) Contexts of 
Development.  Exemplars from each 
section are selected to demonstrate 
related content.  Relationships, the 
environment and socialization threads 
are interwoven throughout the text.  
Study findings of population and 
generational groups are discussed; 
however, the uniqueness of the 
individual is addressed.

Theory and Overviews (8 chapters)-
Several theories and models used by 
scientists and their study approaches 
are included in this first section of the 
book.  Attention is given to biological 
and cultural processes involved in the 
human complex development system.  
Heredity accounts for only a portion 
of variance in human development, 
for from the moment of birth, a 
child’s experiences and behaviors are 
shaped by the culture and customs of 
the environment.  The parent-child 
attachment has a great influence—
whether positive or negative—on 
the child’s socialization processes.  
Socialization continues through 
interaction with important others that 

make up the immediate and social 
environments.  The environment 
shapes a person’s interpretation of 
self, relationships with others, social 
networks, and aids the individual in 
finding a sense of meaning in the past, 
present, and future life. Socialization 
represents stability and is composed of 
many discrete and related acts over an 
extended period of time.  

The authors present an overview 
of the early research that influences 
the current work about human 
development.  Erik Erikson (1950/1963 
and 1968) based his psychosocial 
theory of task development on 
the work of the early 19th century 
scientists, Charles Darwin and 
Sigmund Freud.  According to Erikson 
the success of completing an age 
specific task before moving to the next 
task, or failure to do so, is measured 
by sociocultural expectations.   Robert 
Havinghurst, whose work was 
influenced by Erikson, stated that task 
development is accomplished through 
biological maturation, sociocultural 
pressures, and the values and goals of 
the individual.  Many theorists have 
selected these theories as the basis 
for cross-sectional and longitudinal 
studies in education, sociology, 
anthropology, psychology and other 
sciences.  Life-span developmental 
theory emphasizes that human 
development continues from birth to 
death; therefore, this theory can open 
new paths for examining the tasks of 
adulthood that have not been fully 
explored.  

The Convoys of Social Relationships: 
Past, Present and Future model can 
be an excellent tool for an individual 
as the central person to identify 
the people that make up a support 
system in three concentric circles in 
the order of most importance.  The 
scientist and the individual can, then, 
explore the type of support these 

people provide, and how the circles 
constrict and expand throughout the 
individual’s life span.  Each life cycle 
has its own challenges and rewards. 
The model can, also, help to explain 
how the individual adapts to these 
gains and losses.  To date there is scant 
research on the transitional phases 
of life.  Recommendations for future 
research include frequent observations 
of a cohort group and individuals to 
discover the subtle changes that occur 
over a life time.

Physical and Cognitive (9 chapters)-The 
authors in this section provide an 
overview of neurological anatomy 
and the structural changes in the 
developing brain.  Study findings 
revealed that neurogenesis occurs 
prenatally and that the majority of 
brain growth volume occurs in infancy 
and the toddler years. Axons and new 
synapses are formed throughout life, 
yet some are eliminated as the person 
becomes more efficient in processing 
information.  Additional studies were 
conducted to understand individual 
differences in behavior and cognition.  
Other research designs were used 
to study the effects of maturation on 
sensory, motor, cognitive, linguistic 
and social processing through 
childhood and adolescence.  Magnetic 
Resonance Imaging (MRI), Positive 
Emission Tomography (PET) scans 
and other technologies have permitted 
scientists to begin mapping the brain 
structures.

Technological advances have also 
assisted neuroscience researchers 
in examining and identifying the 
changes in the aging mind and brain.  
Researchers have learned that long 
term memory in older adults varies, 
and some people use different brain 
areas to preserve their cognitive 
abilities.  Research on these areas is 
relatively new.  There is evidence that 
the brain is particularly sensitive to 



Anthropology & Aging Quarterly  2013: 34 (3) 150

Book Reviews
social stimuli. Theories derived from 
these studies may provide key insights 
in ways to combat adverse effects of 
aging on cognition such as perception 
attention, working memory, executive 
control functions and long-term 
memory.  The aging population is 
ripe for studying brain disorders like 
dementia which is not part of normal 
aging; however, the risk increases 
with age and the etiology is still not 
understood.

Socio-emotional (8 chapters)- The control 
of emotions is not an easy task for 
the very young.  Researchers usually 
observe the mother as the principal 
care provider who serves as the 
external regulator of the behavior 
of the infant and young child.  
Personality and temperament are, also, 
frequently associated with emotional 
responses to environmental stimuli.  
Emotion control is particularly difficult 
for teenagers due to the changes in 
hormone levels and the effects on 
rapid changes in moods.  Studies have 
found that the most dramatic increase 
in clinical depression rates peak 
during the ages of 15 and 18 years.  
However, maturity and the pressure 
of social behavior expectations have a 
great impact on the person’s control 
over emotional responses and coping 
mechanisms. 

Narratives have been important 
methods for centuries to convey 
historical facts to generations of 
people. Children enjoy listening to 
stories, and frequently create their 
own life stories about their identity 
and who they want to be.  During 
the middle years, individuals focus 
their narratives on their memories 
of a specific life event or happenings 
over an extended time frame.  Their 
accounts depict the “high and low 
points, turning points, and other 
emotionally charged events” (p. 
596).  Reflecting on these events 

may build social relationships, 
strengthen connections with family, 
and can substantiate the person’s 
identity.  Story telling can, also, be 
therapeutic in coping with losses and 
other negative life events.  Research 
with older adults has revealed that 
narratives are a means for discovering 
the various strengths as survivors 
over their personal life challenges.  
Researchers have discovered that 
intergenerational story telling can 
affect the development of people of all 
ages.  The narrative can be a legacy to 
leave for the next generation.
 
Contexts of Development (7 chapters)-
The authors comment that research on 
cognition, emotions, and motivation 
development can be dependent upon 
the changes or consistency of social 
environments for individuals and 
groups.  The context should be used 
to develop the research questions.  
Researchers are concerned about the 
inequalities that include race, ethnicity, 
gender, sexual orientation, class, age, 
and geographic location.  Additional 
factors include citizenship, and the 
concentration of living in affluent or in 
high poverty neighborhoods. 

The neighborhood environment is 
of particular interest to researchers 
in public health, sociology, 
developmental psychology, economics, 
and epidemiology.  Residents often 
describe their neighborhood as an 
expansion of the family.  Socialization 
that begins in the home moves on to 
the schools and into the neighborhood.  
Many researchers have examined 
neighborhoods from ecological and 
sociological perspectives.  Several 
theories are needed to adequately 
explore the many variables 
involved.  However, due to the 
inevitable changes and instability 
in neighborhood environments, 
researchers have difficulty in 
conducting longitudinal studies.  The 

authors suggest that interdisciplinary 
collaboration and different methods 
of inquiry including inter- and intra-
generational studies are required in 
order to capture all concepts that are 
involved.   

There is a need for additional 
theoretical guided empirical studies 
related to racial and ethnic inequalities 
associated with neighborhoods 
where there is disproportionate 
allocation of economic and social 
services.  Poverty neighborhoods can 
be dangerous living environments.  
Research has revealed that infant and 
pregnancy mortality rates are greater, 
unemployment is prevalent, and poor 
healthy lifestyles contribute to poorer 
outcomes including acute and chronic 
illnesses. 

Reflecting back and Looking Forward 
to the Future- Our world is changing 
rapidly.  The turbulent nature of 
post-modern society has resulted in 
many social roles that did not exist for 
older adults when they were young. 
Today’s family roles have different 
responsibilities and realignment of 
activities than a few decades ago.  
Technology has a major impact on the 
lives of everyone, and will continue to 
do so.  One often wonders what our 
world will be like in 2025, 2050 and 
beyond.  My review was conducted 
within the health care perspective.  I 
can envision many possibilities for 
research in the future.  Perhaps a 
legacy for this book is being the first 
edition of handbooks that will follow.  

Ruth N. Grendell, DNSc, R.N.
Certified Advanced Facilitator

University of Phoenix.
Professor of Nursing, Emeritus

Point Loma Nazarene University



Anthropology & Aging Quarterly  2013: 34 (3) 151

Book Reviews
Aldwin, Caolyn M. and Gilmer Fox, 
Diane. Health, Illness, and Optimal 
Aging: Biological and Psychosocial 
Perspectives Second Edition. New 
York, NY: Springer Publishing 
Company.  2013. ISBN 978-0-8261-
9346-9, 416 pp. e-book ISBN 978-0-
8261-9347-6 Price $90 (Soft cover)

The rising number of aging adults 
has increased exponentially both 
within the United States and abroad. 
This increase warrants a critical 
examination of the ways in which 
these adults can obtain and maintain 
optimal health and address illnesses 
throughout the aging process. Drs. 
Carolyn Aldwin and Diane Gilmer 
explore, address, and articulate ways 
in which optimal aging is understood. 
They revisit their earlier work with 
regards to optimal aging in the second 
edition of Health, Illness, and Optimal 
Aging: Biological Psychosocial 
Perspectives with the intent of 
expanding their current arguments, 
providing a useful toolkit for 
researchers, scholars, caregivers and 
health providers, to use in continued 
gerontological studies. 

Aldwin and Gilmer have written a 
text that is accessible to senior level 
and honors undergraduates as well as 
graduate students across disciplines 
and orientations. This book also 
will appeal to researchers across the 
social, biological, and psychological 
sciences. It serves as an excellent 
medium for fostering and engaging in 
interdisciplinary research. Clinicians 
and care providers will find this text to 
be a useful tool in exploring integrated 
health care of the aging.

The authors are very explicit in stating 
that one of the primary goals of this 
expanded text is to advance and be a 
facilitator of knowledge as it relates 
to optimal aging. Throughout the 

text the authors intricately weave a 
multi-dimensional tapestry for late 
life studies.  Each chapter critically 
examines emergent gerontological 
themes across disciplines. They posit 
that late life research and scholarship 
cannot be understood through a 
singular theoretical model; however, 
these areas of study would greatly 
benefit from an integrated and holistic 
approach. Aldwin and Gilmer argue 
that “gerontology is not yet at a stage 
in which a unified theory can be 
proposed.  The book is organized so 
that it illustrates the various ways in 
which multiple theories can be used 
to advance research and scholarship. 
The authors indicate that their overall 
goal in this edition was “to examine 
the biological and psychosocial aging 
literatures to determine whether they 
can be organized using the aging 
accelerators and decelerators model, in 
order to enhance understanding of the 
many facets of aging and to promote 
optimal aging and to create a bridge 
for understanding across disciplinary 
boundaries (3,6).”

The book is organized into four very 
distinct sections: 1) Demographic, 
Theoretical, and Methodological 
Issues; 2) Aging of Biological Systems; 
3) Psychosocial Factors Affecting 
Physical Health; and 4) Practical 
and Clinical Aspects of Aging. Each 
section is underpinned with the 
theme of accelerators and decelerators 
that factor into the ways in which 
individuals participate in aging. These 
sections serve as a backdrop for the 
anthropologist, psychologist, medical 
practitioner, and lay person to glean 
important interrelated components of 
aging. 

Like the ways in which an individual 
progresses through various life 
stages, the strengths of the sections 
and chapters in this text follow 
similar trajectory. One of the many 

strengths of this book begins in the 
introduction, is followed by chapter 
4, and concludes with chapter 14. 
In the introduction, Aldwin and 
Gilmer carefully outline the basic 
concepts in aging. They provide the 
reader with a set of definitions that 
puts aging and identity into context 
as well as delineates the notions of 
health and illness. In chapter four 
they walk the reader through the 
processes of aging research. This is 
a particularly useful section for the 
senior level or honors undergraduate 
student that desires to engage in aging 
research. Chapter fourteen defines 
and articulates the notion of optimal 
aging. Of interest in this chapter, are 
the sections on wisdom and optimal 
aging, religiousness, spirituality, and 
optimal aging, and ars moriendi-the 
art of dying.  These sections portend 
a literary artful finality to the text. 
Finally, the primary strength of this 
book is the implicit optimistic tone of 
the text. Aldwin and Gilmer illustrate 
that an individual has the ability to age 
gracefully they need not take “the lay 
down and die approach” to aging. The 
aging adult is equipped with different 
ways of aging well (6). They are able to 
live sustainable healthy physical and 
mental lives.  

Aldwin and Gilmer have supplied 
an interesting textual model for 
examining health, illness, and aging. 
Their homogenized approach to aging 
research is refreshing and insightful. 

Elisha R. Oliver, MA
PhD Student in Anthropology

University of Oklahoma



Anthropology & Aging Quarterly  2013: 34 (3) 152

Book Reviews
Van den Hoonaard, Deborah K. By 
Himself: The Older Man’s Experience 
of Widowhood.  University of Toronto 
Press.  2010.  ISBN #978-1-4426-
4109-9.  198 pp.  $45.00 (Hardcover)

Deborah K. van den Hoonaard is a 
sociologist, professor and qualitative 
Research Chair at St. Thomas 
University in Canada.  Her recent 
book, By Himself, provides a revealing 
look at the lived experience of 
widowhood for older adult men.  The 
book is divided into four parts.  Part 
One introduces the conceptual basis 
for van den Hoonaard’s research, with 
Parts Two, Three and Four containing 
in-depth chapters that explore various 
aspects of widowhood for these men.  

Part One orients the reader by 
describing the theoretical and 
methodological issues of van den 
Hoonaard’s study.  Chapter 1 situates 
her research within the wider body of 
literature on widowhood that is often 
based on the perspectives of women 
or younger widowed men.  Van den 
Hoonaard’s work is distinct in this 
area of research given its focus on 
older adult male widowers, a group 
that is relatively unknown in the 
literature.  Grounding her study in a 
symbolic interactionism framework, 
van den Hoonaard interviewed older 
adult men living in rural Atlantic 
Canada and Florida retirement 
communities to explore how 
widowhood is conceptualized from 
their perspective.  The author began 
recruiting for her study exclusively 
in rural Atlantic Canada.  Yet she 
notes that “widowers were not easy 
to find” (van den Hoonaard 2010: 
13), and expanded her recruitment to 
include widowers living in Florida.  
Although this geographic expansion of 
her research was not anticipated, the 
author felt the more diverse sample 
provided deeper analytical insights.  In 
chapter 2, van den Hoonaard discusses 

how widowhood is inherently a 
gendered experience and consequently 
emerged as a key theoretical issue that 
she effectively integrates throughout 
subsequent chapters.  She notes how 
the men never considered widowhood 
a possibility in their lives, operating 
under the assumption that their 
spouses would outlive them.  When 
the men became widowers, they felt 
disoriented and “did not know where 
they belonged in the foreign country 
which they had entered when their 
wives died” (van den Hoonaard 
2010: 21).  Their sense of masculinity, 
already threatened by age, also became 
threatened by widowhood, a status 
that deprived these men of “visible 
heterosexuality” (van den Hoonaard 
2010: 20). 

Part Two focuses on the men’s 
experiences coping with their wives’ 
illnesses and deaths.  In chapter 
3, van den Hoonaard provides 
a compassionate account of the 
widowers’ experiences interacting 
with and caring for their wives 
once they became ill.  The author 
analyzed the widowers’ discourse, 
which revealed speech patterns that 
“emphasize their masculinity” (van 
den Hoonaard 2010: 31).  For example, 
when describing their caring presence 
at their wives bedside, the men’s 
discourse revealed how they embodied 
the gendered role of the committed 
husband.  The period immediately 
after their wives’ deaths, the subject of 
chapter 4, brought a range of emotions 
from “shock” to stoicism (van den 
Hoonaard 2010: 49) for the widowers.  
The men described various forms of 
social support from friends, family 
and religious affiliations that provided 
a needed sense of comfort during 
this difficult time.  The men also took 
comfort in how well their wives were 
thought of, symbolically represented 
in high number of funeral attendees.  
Yet the harsh realities of widowhood 

existed beyond these comforting 
social networks as some men had to 
settle financial affairs that included 
continuously furnishing death 
certificates, which acted as a stark 
reminder of their profound loss.          

Part Three describes the widowers’ 
various social relationships.  Chapter 5 
focuses on how the widowers interact 
with their children, and provides 
numerous ethnographic examples 
illustrating the multidimensionality 
of these relationships as well as 
boundary issues.  Some of van den 
Hoonaard’s findings about these 
relationships are not unexpected, 
such as daughters fulfilling some of 
their mother’s gendered roles like 
cooking or maintaining traditional 
family events.  Interestingly though, 
the author also discovered that some 
of the widowers used the interview 
as an opportunity to openly discuss 
their children’s “flaws” and that “the 
men tended to blame their wives” 
for these issues (van den Hoonaard 
2010: 76).  Chapter 6 focuses on 
female companionship and begins 
with the author acknowledging that 
her data “reinforced the commonly 
held belief that finding a new woman 
is an intrinsic part of widowhood 
for men” (van den Hoonaard 2010: 
84).  Van den Hoonaard draws 
cultural contrasts between the men in 
Atlantic Canada and those in Florida 
regarding how each interprets their 
relationships with women.  For 
instance, the Atlantic Canadian men 
describe a great sense of discomfort if 
women are too forceful when vying 
for their attention.  Chapter 7 provides 
another viewpoint into the men’s 
social networks through examining 
their friendships.  The closing of 
one’s social network after the death 
of a spouse is a common experience 
of many widowers, both male and 
female, according to the author.  The 
men in van den Hoonaard’s study 



Anthropology & Aging Quarterly  2013: 34 (3) 153

Book Reviews
are no exception.  For example, some 
of the men found that their widower 
status made them “the odd man out” 
(van den Hoonaard 2010: 109) when 
socializing with their married friends.  
Yet van den Hoonaard’s method of 
qualitative inquiry reveals that the 
closing of one’s social network is not 
experienced by all widowers.  One 
of her participants, a widower living 
in a Florida retirement community, 
discussed how his friends rallied to 
his side after his wife’s death and 
continued their friendships with him 
thereafter.    

Part Four describes how the widowers 
conceptualize “everyday life” (van den 
Hoonaard 2010: 121), which includes 
“keeping busy” (van den Hoonaard 
2010: 123), the focus of chapter 
8.  To stay busy, the men describe 
volunteering, doing “odd jobs” 
(van den Hoonaard 2010: 133) and 
informal socializing as opportunities 
for them to leave their home and 
engage in activities that reinforce their 
masculinity (such as fishing).  Leaving 
the home is highly important for these 
men, as an empty home is a significant 
symbolic reminder of the loneliness 
associated with widowhood.  
Interestingly, van den Hoonaard notes 
that the men preferred spur-of-the-
moment over pre-planned activities 
as it asserted their independence.  
Cleaning the home and cooking is 
the subject of chapter 9, and the men 
perceived these tasks traditionally 
female oriented.  As a result, they 
had no desire to “to master” (van den 
Hoonaard 2010: 159) this domain; 
rather they preferred doing just 
enough cooking and cleaning to get by 
on a daily basis.  When the widowers 
did clean or cook, they spoke about 
their experiences using very masculine 
language to justify engaging in these 
feminine tasks.  In the following 
chapter, chapter 10, Van den Hoonaard 
concludes her book with an overview 

of key themes, and provides some 
insights for future inquiry.                      

Overall I found myself immediately 
engaged by van den Hoonaard’s book 
that paints a poignant ethnographic 
picture of these men’s lives as 
widowers.  What makes this book 
so engaging is her ability to iterate 
detailed ethnographic examples with 
theory to provide a robust analysis of 
this experience, yet one that is firmly 
grounded in the men’s experiences.  
This book showcases her skill as a 
qualitative researcher and storyteller, 
and provides a significant contribution 
to the gerontological theory on 
widowhood.  This is a highly readable 
text that would be appropriate for 
both undergraduate and graduate 
courses in gerontology, sociology, 
anthropology and aging studies.  
Researchers interested in conducting 
qualitative studies with populations 
that are more difficult to access will 
also find this book a valuable resource.  
Van den Hoonaard includes her 
interview guide at the end of the text.  

The views expressed in this review are 
those of the author and do not necessarily 
represent the views of the Department of 
Veterans Affairs.

Lindsey Ann Martin, Ph.D.
Michael E. DeBakey VA Medical 

Center
Houston HSR&D Center of Excellence

Feil, Naomi and de Klerk-Rubin, Vicki. 
The Validation Breakthrough: Simple 
Techniques for Communicating with 
People with Alzheimer’s and Other 
Dementias. 3rd edition. Baltimore, 
MD: Health Profession Press. 2012. 
ISBN 978-1-932529-93-7, 304pp. 
$34.95 (paper).

Nearly five decades have passed 
since Naomi Feil originally developed 
Validation as a therapeutic tool 
and in this time, organizations 
and families throughout the world 
have experienced and attested to its 
benefits.  In this most recent edition of 
The Validation Breakthrough (3rd ed.), 
Ms. Feil, along with co-author and 
master-teacher Vicki de Klerk-Rubin, 
continue to refine the terminology, 
concepts, theoretical underpinnings, 
and techniques of Validation.  The 
authors have expanded the number 
of case studies and testimonials 
from certified Validation teachers, 
and updated resources for readers 
who seek additional training and 
information.

Stated simply, Validation is a method 
of empathetically communicating with 
and caring for disoriented older adults 
who have Alzheimer’s disease or 
other types of dementia.  It is intended 
to benefit very old persons who are 
disoriented and who frequently 
exhibit challenging behaviors, as well 
as the persons caring for them.  The 
authors contend that challenging 
behaviors often arise from a person’s 
struggle to resolve unfinished business 
during their last stage of life.  As the 
disoriented person progresses through 
phases of resolution, caregivers can 
employ the Validation techniques to 
connect with the person and assist 
them with expressing repressed 
emotions.

As with previous editions, the book 



Anthropology & Aging Quarterly  2013: 34 (3) 154

Book Reviews
is organized into three parts.  Part 
one begins with descriptions of the 
theoretical underpinnings, concepts, 
assumptions, benefits, limitations, 
target populations, and techniques 
of Validation.  A substantive chapter 
is then devoted to each of the four 
phases of resolution (i.e., maloriented, 
time confused, repetitive movers, 
vegetation) and one brief chapter is 
devoted to people with early-onset 
Alzheimer’s disease.  Although the 
authors attempt to review some of 
the literature about the efficacy of 
Validation (Ch. 8), this is by far one of 
the weakest chapters in the book.  The 
authors conclude this section with a 
useful albeit brief discussion of how 
Validation compares to other therapies 
commonly used with disoriented 
older adults who have dementia (Ch. 
9).  Part two of the book focuses on 
case studies and testimonials from 
certified Validation teachers.  It 
features stories of older adults in each 
of the four phases of resolution and 
how Validation benefited them and 
their caregivers.  Part three provides 
a detailed description of how an 
organization can set up a Validation 
group.

Unquestionably, the greatest strength 
of this publication is the large number 
of real-life examples that portray the 
challenging behaviors commonly 
exhibited by the target population 
and how Validation techniques were, 
or could be, applied to the situations.  
These cases make the book easy and 
enjoyable to read, while also providing 
an accurate portrayal of challenges 
constantly faced by professional and 
informal caregivers.  Testimonials from 
Validation teachers and authorized 
organizations throughout the world 
appear at the end of each chapter 
and also in the appendix, providing 
compelling stories about how 
Validation has helped their residents 
and staff.  

This book has broad appeal to a 
variety of audiences, but is especially 
appropriate for health professionals 
and other caregivers who interact 
frequently with the Alzheimer’s 
and dementia population.  It is a 
useful guide for activity directors 
and nurses working in long-term 
care facilities and adult day centers.  
Students seeking an introduction 
to this particular method of care or 
seeking insight into the disoriented, 
dementia population will also 
benefit.  The content is particularly 
germane to the fields of interpersonal 
communication, nursing, gerontology, 
rehabilitation therapies, psychology, 
and anthropology.  Professional 
caregivers who are already familiar 
with Validation and researchers 
seeking a thorough discussion of 
the scientific merits of this method, 
may not gain much additional 
insight from this new edition.  It is an 
essential read, however, for persons 
considering Validation certification as 
well as facilities that are considering 
becoming an Authorized Validation 
Organization.  Family members and 
other informal caregivers struggling 
to understand and communicate 
with a disoriented older adult may 
experience greater empathy and may 
be able to more frequently connect 
with the person after reading this book 
and implementing the recommended 
techniques.  Students, health 
professionals, and family members 
alike will most likely enjoy reading 
this book due to the numerous cases 
and examples of application.  While 
Validation is not intended for all 
disoriented elderly populations, it 
is an important therapeutic tool for 
caregivers to have in their tool box.
 

Stacy L. Barnes, MGS
Director, Wisconsin Geriatric 

Education Center
Marquette University

Film Review

Grandma, a Thousand Times (Teta, 
Alf Marra). 48 minutes. 2010. 
UAE/Qatar/Lebanon: Veritas Film. 
(Mahmoud Kaabour).

‘Grandma, a Thousand Times’ is a 
sweet and poignant documentary 
about an aging and spirited Lebanese 
matriarch in a memory-inducing 
neighbourhood of Beirut.  Writer and 
director, Mahmoud Kaabour, pours 
his heart out in this measured yet 
never over-sentimentalized film about 
his grandmother Teta Kaabour (a.k.a. 
Hajjieh Fatima).  Mahmoud, who has 
been living abroad, is haunted by an 
audiotape of his grandfather’s violin 
playing.  The seven taqsims (melodic 
improvisations) on the tape bring the 
filmmaker back to his home, to the 
house of Teta.  There, we are treated to 
acts of love; love of a supra-motherly 
kind that only a grandmother knows 
how to impart.  Mahmoud and Teta 
reconnect on the screen, and we are 
witnesses to acts of intimate kinship. 
We see Teta peeling an orange with a 
small knife expertly, and then feeding 
Mahmoud with her clean bare hands.  

Part of the charm in this documentary 
rests with the fact that Mahmoud 
not only looks like his grandfather, 
but also bears his first name.  In an 
intricate weaving of intergenerational 
ties and the annoyances for Teta 
surrounding Mahmoud’s uncanny 
resemblance to his grandfather, 
grandma is once again ignited in her 
anguish and longing for her deceased 
husband.  This is compounded when 
Mahmoud takes Teta down the street 
in the morning dressed up in fine 
clothes, donning a red fez hat before 
he gets married to Eva Star Sayre.

For most moviegoers, this short 



Anthropology & Aging Quarterly  2013: 34 (3) 155

Book Reviews
film will function as a window into 
a family, largely kept together by 
Teta, and what she means to them 
and their memories of Beirut.   They 
may also empathize with Mahmoud 
and his siblings’ desires to keep their 
snapshot of Beirut and Teta alive and 
unchanged for as long as possible, 
even if that means turning a blind eye 
to Teta’s hobby of Arguileh smoking.

What I came away with, however, 
were some other aspects that captured 
my attention.  To begin with, the 
documentary showcases a very 
ethnographic account of what old 
age is like.  Grandma realizes that she 
needs to exert herself intermittently, 
probably because of her lack of regular 
exercise and stamina. This amounts 
to getting out of the chair and taking 
a few more steps to fetch something 
instead relying on Hasna the hired 
caregiver to do so, and haggling on the 
phone with a desirous feistiness for the 
freshest and leanest cuts of meat from 
the butcher. 

Her feet are old and swollen, and we 
see them juxtaposed against the newly 
laid out winter Ajami rugs. Teta tells 
her grandson, that she also likes gum, 
but she only puts it in her mouth; she 
is unable to chew it fully. We see how 
she moves, and waves deliberately and 
methodically without wasting energy 
or flexing unnecessary muscles. She 
inhabits her empty house, but for her 
children (and their children) she is the 
warden of their ‘home’.  Furthermore, 
Teta is not a boastful matriarch. She 
is a survivor thrust into her position 
by the people around her who invest 
their memories with and in her.  Teta 
inherits and negotiates this role with 
a mixture of good humor and good 
politics.  

We are often told that the elderly need 
to tell their stories, that reaching back 

is a way of providing continuity and 
narrative therapy.  In this film, it is 
apparent that it is Mahmoud and his 
siblings that need the narrative as a 
reminder and a lodestone for their 
own history making and ontologies.  
We may need narratives of our elders, 
but for the aging, they need real time 
commentary, commentary on their 
lives as things change around and 
with them.   Teta has perfected her 
daily rituals of smoking Arguileh, of 
sitting outside on the balcony, and of 
providing her own life commentary.  
It is this subtle and dual commentary: 
of us talking about our elders and our 
elders reflecting on themselves that 
merges the past, present and future.

Even though this documentary is all 
too brief, there are beautiful images 
that lace seamlessly with spiritual 
solo violin, lingering on well after the 
film’s ending.  In one gorgeous scene, 
a marble gravestone is being cut with a 
wet saw, and we can’t help but feel the 
intensity and sorrow associated with 
the bleeding white tears of the marble 
slab.  Teta is called upon by her family 
a thousand times, and Insha’Allāh she 
will remain Teta for thousand and one 
more nights.
 

Philip Kao
Postdoctoral Fellow

University of Pittsburgh

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