Social Work With Older Adults Book

Preface

Chapter One: The Context of Social Work Practice with Older Adults

Aging in the Twenty-First Century

Diversity within the Older Adult Population

The Focus of This Chapter

The Demography of Aging

The Growth of the Older Population

Life Expectancy and Marital Status

Living Arrangements

Poverty

Employment

Health Status and Disability

The Importance of Birth Cohort

Settings for Gerontological Social Work

Geriatric Care Management

Community Social Service Agencies

Home Health Care Agencies

Adult Day Health

Independent and Assisted Living Settings

Hospitals

Nursing Homes

Developing Areas for Direct Practice

Legal Services

Pre-retirement Planning

Macro Settings for Gerontological Social Workers

Personal and Professional Issues in Work with Older Adults

Ageist Personal and Social Attitudes

The Influence of Ageism on Gerontological Social Work as a Career Choice

Ageism and Death Anxiety

Countertransference

The Independence/Dependence Struggle

Self-Awareness and Supervision

Summary

Discussion Questions/Activities

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References

Chapter Two: Biological Changes and the Physical Well-Being of Older Adults

Why Does the Body Age?

Genetic Programming

Cross-Links and Free Radicals

Deterioration of the Immune System

Biological Changes That Accompany Aging

Skin, Hair and Nails

The Neurological System

The Cardiovascular System

The Musculoskeletal System

The Gastrointestinal System

The Respiratory System

The Urinary Track System

The Endocrine and Reproductive Systems

The Sensory System

Implications of Age-Related Biological Changes for Social Work Practice with Older Adults

Older Adults’ Physical Health as a Social Barometer

Private Functions Become Public Business

Environmental Adaptation is Necessary

Incontinence

The Prevalence of Incontinence

Types of Incontinence

Treatment of Urinary Incontinence

HIV/AIDS and Older Adults

Why Older Adults May Be More Vulnerable to Contracting HIV/AIDS

The Biological Vulnerability of Older Adults to HIV/AIDS

HIV/AIDS among Older Adults of Color

Implications for Social Work Practice

What Factors Promote Healthy Aging?

The Influence of Diet

Exercise and Physical Activity

Summary

Discussion Questions/Activities

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References

Chapter Three: Psychosocial Adjustments to Aging

Psychological Changes That Accompany Aging

Intelligence

Personality

Memory

Learning

Older Adults and Sexuality

Social Theories of Aging

Prescriptive Social Theories of Aging

Descriptive Social Theories of Aging

Gender, Race and Ethnicity, Class and the Life Course

“Successful” Psychosocial Aging

Cognitive and Intellectual Functioning

The Significance of Social Support

Implications of Psychosocial Changes for Social Work Practice with Older Adults

Provide Opportunities but Respect Choice

Everything Takes More Time

Psychosocial Health is Often Contingent on Physical Health

Social Isolation Can be Deadly for Older Adults

Change is Always Possible

Summary

Discussion Questions/Activities

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References

Chapter 4: Conducting a Biopsychosocial Assessment

What is an Assessment?

What is the Purpose of a Biopsychosocial Asessment?

Evaluation of Strengths and Obstacles

Identification of Ways to Support and Maintain Existing Functioning

Identification of Interventions That Restore Lost Functioning

Identification of Supports to Replace Lost Functioning

Special Considerations in Assessing Older Adults

The Balance between Independence and Dependence

Origin of the Request for Assessment

The Heterogeneity of the Older Adult Population

Respecting Personal Privacy

Conditions for Conducting an Assessment

The Physical Environment

Optimum Functioning

Explaining the Purpose of the Assessment

The Issue of Confidentiality

Components of a Comprehensive Assessment

Basic Demographic Information

Physical Health

Psychological Functioning

Emotional Well-Being

Sexual Functioning

Social Functioning

Competencies in the Activities of Daily Living

Financial Resources

Environmental Issues

Professional Intuition

Using Collaterals to Gather Additional Information

Example of a Comprehensive Assessment

Summary

Discussion Questions/Activities

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References

Chapter Five: Differential Assessment and Diagnosis of Cognitive and Emotional Problems of Older Adults

Differential Assessment and Diagnosis

Depression in Older Adults

Risk Factors for Depression in Older Adults

The Relationship between Race, Ethnicity, Socioeconomic Class and Depression.

Diagnosing Depression in Older Adults

Dementia

Alzheimer’s Disease

Diagnosing and Assessing Alzheimer’s Disease Using Biopsychosocial Indicators

Vascular Dementia

Delirium

Symptoms of Delirium

Causes of Delirium

Treatment of Delirium

Differentiating between Depression, Dementia and Delirium

Anxiety Disorders

Risk Factors for Anxiety Disorders

Types of Anxiety Disorders

Assessing Anxiety Disorders in Older Adults

Differential Diagnosis of Anxiety

Summary

Discussion Questions/Activities

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References

Chapter Six: Social Work Interventions in the Socioemptional and Cognitive Problems of Older Adults

The Intervention Process

What Happens in the Intervention Process?

Empowerment as a Goal of Intervention

Whose Goals?

Obstacles of Intervention and Treatment in Older Adults

Attitudes about Interventions

Somatization of Emotional Conflicts

Physical Barriers

Cultural Barriers

Developing a Relationship with an Older Adults

Helping Older Adults Understand the Purpose and Process of an Intervention

Developing Rapport

Cognitive-Behavioral Therapy

Older Adults Who Respond Best to Cognitive-Behavioral Therapy

The Process of Cognitive-Behavioral Therapy

Life Review

When Can Life Review be Beneficial?

The Process of Life Review

Validation Therapy

The Principles of Validation Therapy

The Pros and Cons of the Validation Approach

Advantages of the Group Work Approach

The Group Process

Specialized Groups for Older Adults

Reminiscence Groups

The Process of Therapeutic Reminiscence

Remotivation Groups

Social and Recreational Groups

Support Groups

Summary

Discussion Questions/Activities

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References

Chapter Seven: Alternative Interventions in the Socioemotional Problems of Older Adults

Traditional and Alternative Interventions

The Benefits of Creative Arts for Older Adults

The Therapeutic Use of Music

Music as Psychotherapy

Therapeutic Music with Older Adults with Alzheimer’s Disease

Receptive or Passive Use of Music

Active Participation in Making Music

Music Combined with Other Art Forms

Art as a Therapeutic Activity

Art Therapy

Art as a Therapeutic Group Activity

Art as Recreation

Recreation as Therapy

Examples of Recreation as Therapy

Animal-Assisted Therapy

The Human-Animal Bond

Animals’ Roles as Social Connections

Types of Animal-Assisted Therapy

Animal-Assisted Therapy with Older Adults with Alzheimer’s Disease

Precautions in Establishing Animal-Assisted Programs

Summary

Discussion Questions/Activities

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References

Chapter Eight: Substance Abuse and Suicide Prevention in Older Adults

Substance Abuse and Older Adults

Alcohol Use and Abuse by Older Adults

Early-Onset versus Late-Onset Alcoholism

Risk Factors Associated with Alcohol Dependence

Alcohol and Older Women

Psychological and Medical Consequences of Problem Drinking

Recognizing Alcohol Problems in Older Adults

Treatment of Alcohol Problems in Older Adults

Barriers to Treatment

Brief Treatment Approaches

Other Treatment Approaches

Drug Misuse and Dependency

The Use of Illegal Drugs

Drug Dependency and Prescription Medications

The Interaction of Alcohol and Prescription Medications

Treatment for Drug Dependency

Suicide among Older Adults

Risk Factors for Suicide Among Older Adults

Assessing Suicidal Tendencies in Older Adults

The Role of the Social Workers with High-Risk Older Adults

Long-Term Treatment for Suicidal Older Adults

Preventing Suicide among Older Adults

Summary

Discussion Questions/Activities

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References

Chapter Nine: Social Work Practice in Identifying and Preventing Abuse and Neglect of Older Adults

Growing Concern about Abuse and Neglect of Older Adults

The Incidence of Abuse and Neglect of Older Adults

Problems in Identifying the Abuse and Neglect of Older Adults

What Constitutes Abuse or Neglect of Older Adults?

Physical Abuse

Emotional or Psychological Abuse

Financial Exploitation

Neglect

Risk Factors Associated with Abuse or Neglect of Older Adults

Gender and Age

Health Status of Older Adult

Socioeconomic Class

Racial and Ethnic Group Membership

Characteristics of Abusers

Understanding the Causes of Maltreatment of Older Adults

Social Learning Theory

Social Exchange Theory

Psychopathology of the Abuser

Assessment of Abuse, Neglect or Self-Neglect

Reporting Abuse or Neglect

Asessing an Older Adult for Abuse or Neglect

Designing Interventions to Prevent Abuse or Neglect

Protecting against Financial Abuse or Exploitation

Offering Supportive Counseling

Developing Support Services

Modifying the Environment

Abuse and Neglect in Nursing Homes

When an Older Adult Refuses Protective Services

What is the Ethical Dilemma?

Determining Legal Competence

Summary

Discussion Questions/Activities

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References

Chapter Ten: Spirituality and Social Work with Older Adults

Spirituality and Religion in Social Work Practice

Defining Spirituality and Religion

The Social work Profession’s Approach-Avoidance Relationship with Spirituality

Early Ties to Charitable Organizations

The Influences of Empiricism and Freud

Social Work’s Renewed Focus on Spirituality

The Relevance of Spirituality to Social Work with Older Adults

Naming Psychosocial Tasks as Spiritual

The Common Ground between Social Work and Spirituality

Themes and Contexts of Spirituality in Older Adults

The Effect of Religion and Spirituality on Older Adults

Spirituality in the Lives of Older women and Older Adults of Color

Women’s Religiosity and Spirituality

Older Adults of Color

Incorporating Spirituality into Social Work Practice with Older Adults

Precautions before Pursuing Spirituality

Self-Awareness and Spirituality

Learning about Religious Traditions and Practices

Spirituality as an Element in the Assessment Process

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Assessment Requirements

Spirituality and Social Work Intervention Techniques

How These Efforts Differ from Pastoral Counseling or Spiritual Direction

Summary

Discussion Questions/Activities

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References

Chapter Eleven: End-of-Life Care for Older Adults

End-of-Life Care as Part of Gerontological Social Work

The Process of Dying

The Meaning of Death to Older Adults

Physical and Psychological Manifestations of Dying

The Needs of Dying Older Adults

The Role of the Social Worker in the Dying Process

Providing Emotional Support

Advocating on Behalf of the Older Adult and the Family

Providing Information

Self-Care for the Social Worker

Bereavement and Grief

Manifestations of Grief

Stage Theories of Grief

Factors Affecting the Grieving Process

Complicated Grief

Hospice Care

The Philosophy of Hospice Care

Hospice Care Services

Accessing Support Groups

Advance Directives

Instructional Directives

The Durable Power of Attorney for Health Care

The Social Worker’s Role in Advance Directives

Barriers to Completing an Advance Directive

Ethical Dilemmas in Death and Dying

The Allocation of Scarce Resources to Frail Older Adults

Physician-Assisted Suicide

Summary

Discussion Questions/Activities

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References

Chapter Twelve: Working with Older Adults’ Support Systems: Spouses, Partners, Families and Caregivers

Older Adults; Support Systems

Spouses and Partners

Gay and Lesbian Couples

Changing Marital Roles

The Goals of Supportive Interventions with Older Couples

The Context of Couples’ Work

Helping Older Couples Manage Loss

Creating Opportunities for Mastery and Control

Maintaining Identify

Therapeutic Interventions with Older Couples

Resource Mobilization

Marital Life Review and Reminiscence

Communication Skills Training

The Family Meeting

Planning a Family Meeting

Grandparents Raising Grandchildren

Challenges to Grandparents

Challenges to Grandchildren

Social Work Roles in Supporting Grandfamilies

Caregivers as Support Systems for Older Adults

Gender as a Factor in Caregiving and Care Receiving

Caregiving among Racial and Ethnic Groups

The Stresses of Caregiving

Sources of Stress in Caregiving

Depression among Caregivers

Moderators of Caregiver Stress

Social Work Interventions with Caregivers

Caregiver Support Groups

Improving the Caregiver-Care-Receiver Relationship

Promoting Self-Care for the Caregiver

Summary

Discussion Questions/Activities

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References

Chapter Thirteen: “Aging in Place”: Income Programs, Health Insurance and Support Services for Older Adults

“Aging in Place”

Income Support Programs for Older Adults

Social Security Retirement and Survivors’ Benefits

The Future of Social Security

Supplemental Security Income (SSI)

Health Insurance Programs for Older Adults

Medicare: Parts A, B, and C

Medicare Part D: Prescription Drug Coverage

Medicaid

Support Services to Older Adults

Support Programs Authorized by The Older Americans Act of 1965

Choices for Independence

Finding Services for Older Adults: The Eldercare Locator

Home Equity Conversion Mortgages (Reverse Mortgages)

Accessing the Value of One’s Home

Limitations of the Reverse Mortgage Concept

Continuing Care Retirement Communities (CCRC)

What Challenges Lie Ahead?

Generational Differences

Transportation

Health Care in the Future

Quality vs. Quantity of Life

Discussion Questions/Activities

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References

Index