Clinical Gerontological Social Work Practice

Robert Youdin, PhD, LCSW, LLC, has been Adjunct Associate Professor at the Fordham University Graduate School of Social Service in New York City for over 20 years. He was a Project Director for a Gero Innovations Grant for the Master's Advanced Curriculum Project funded by the John A. Hartford Foundation and Council on Social Work Education. Dr. Youdin was a participant in the Curriculum Development Institute (Gero-Ed) sponsored by John A. Hartford Foundation and Council on Social Work Education. He is a past assistant research scientist of the Biometrics Unit of the New York State Psychiatric Institute in New York City. In 1977 he was elected as member of Sigma Xi - the Scientific Research Society of North America Dr. Youdin has been a private practitioner for the past 28 years and currently practises in Princeton, New Jersey. He has an existential humanistic orientation and is trained in Eriksonian hypnosis. Dr. Youdin is coauthor (with Tina Maschi) of Social Worker as Researcher: Integrating Research with Advocacy (2012). In addition, he has appeared on numerous public service radio programmes discussing substance abuse problems.

Foreword
Patricia Brownell, PhD xiii




Preface xvii




Acknowledgments xxiii




PART I: OVERVIEW OF THEORIES, ASSESSMENT TECHNIQUES,




AND TREATMENT APPROACHES TO THE OLDER ADULT CLIENT




1. Theories to Inform the Social Worker Practicing With Older Adults
3




The Need for a Unifying Gerontological Social Work Theoretical Orientation
4




Theory Circle
5




Suggested Theories to Inform the Social Worker Treating Older Adults
6




Age Stages 6




Psychological and Social Aging Theories
8




Erikson’s Stages Theory 8




The Medical Model 9




Person-in-Environment Theory and Resilience: A Good Partnership 10




Person-in-Environment Theory: The Beginning 12




Perception of Control 13




The Case of Georgina
14




Summary
17




Discussion Topics
17




2. Assessing an Older Adult
19




Part 1: Environmental and Communication Challenges to Be Overcome by the




Social Worker and Older Client
20




Offi ce Assessment Setting 20




A Matter of Speaking 20




Home, Nursing Home, Assisted Care Facility, or Hospital Assessment




Setting 21




Working the Clock 21




To Take or Not Take Notes 22




Part 2: Assessment Categories
22




Gender, Age, Ethnicity, Sexual Orientation 22




Presenting Problem 23




Environmental and Demographic Information 24




Developmental History 24




Medical Status 25




Sexual Assault History 26




Sexual History 26




Substance Use 26




Psychiatric History 27




Appearance 27




Attitude 27




Motor Status 27




Speech Quality 28




Thought Process 28




Mood/Affect 28




Sleep/Appetite Status 29




Suicide Assessment 29




Rational Suicide 31




Homicidal Assessment 32




Mental Status Exam 33




Spirituality/Religion 36




Older Adult Abuse 36




Collateral Interviews 36




DSM-5
Diagnosis 36




The Case of Dr. Frank
37




Gender, Age, Ethnicity, Sexual Orientation 37




Presenting Problem 37




Environmental and Demographic Information 37




Developmental History 38




Medical Status 39




Sexual Assault History 40




Sexual History 40




Substance Use 40




Psychiatric History 40




Appearance 41




Attitude 41




Motor Status 41




Speech Quality 41




Thought Process 41




Mood/Affect 41




Sleep/Appetite Status 41




Suicide Assessment 42




Homicidal Assessment 42




Mental Status Exam 43




Sensorium 43




Spirituality/Religion 43




Older Adult Abuse 44




Collateral Interviews 44




DSM-5
Diagnosis 44




Goals for Change 44




Summary
44




Discussion Topics
45




3. Intervention Theories Informing the Clinician Treating Older Adults
47




Are Theories an Uncontaminated View of an Older Adult?
49




Sources of Contamination
49




Sorry, No Theory Available 49




Ageism 49




The New Ageism 50




The Incompetence Model 50




The Geriactivist Model 50




Theoretical Orientations for Treating Older Adults
51




Foundations Underlying Existential, Brief Solution, Cognitive Behavioral,




and Narrative Therapies
51




Empowerment Theory and the Strength Perspective 51




Constructivist Theory 52




Existential Theory 52




Cognitive Behavioral Theory 55




Narrative Theory 56




Reminiscence Therapy 58




Feminist Theory 58




The Case of Henriqua
59




Summary and Applications of Theoretical Orientations to Henriqua’s Case
60




Henriqua Through the Optic of Existential–Phenomenological Theory 60




Henriqua Through the Optic of Cognitive Behavioral Theory 62




Henriqua Through the Optic of Narrative and Reminiscence Theory 63




Henriqua Through the Optic of Feminist Theory 64




Discussion Topics
64




4. Stigma and Older Adults
65




Examples of Optics Affected by Stigma and Their Subsequent Effects on Older




Adults
66




Ageism 67




Race/Ethnicity/Sexual Orientation 68




Gender 69




Poverty 70




Policy 71




Psychological Problems 72




Medical Illness 75




The Internet: A Tool for Fighting Stigma
76




The Case of Michael
77




Summary
79




Discussion Topics
79




PART II: SPECIALIZED PROBLEMS AND ORIENTATIONS IN




GERONTOLOGICAL SOCIAL WORK PRACTICE




5. Psychopathological Problems in Older Adults
83




The Medical Model of Psychopathology
83




Psychopathological Problems in Older Adults
85




Anorexia Tardive 86




Anxiety Disorders 86




Co-Occurring Psychological Disorders and Substance Abuse/Dependence




Disorders 87




Delusional Disorder 88




Mood Disorders 88




Personality Disorders 90




Schizophrenia 91




Suicide 91




The Case of Anthony
93




Summary
94




Discussion Topics
95




6. Alzheimer’s Disease and Other Dementias
97




Mild Cognitive Impairment
97




Vascular Dementia
98




Dementia With Lewy Bodies
98




Frontal Lobe Dementia (Including Pick’s Disease)
99




Korsakoff Syndrome
99




Parkinson’s Disease
99




Alzheimer’s Disease
99




Stage 1 100




Stage 2 100




Stage 3 100




Stage 4 100




Stage 5 101




Stage 6 101




Stage 7 101




A Basic Guide to Medicines for Alzheimer’s Disease
101




Neurotransmitters 102




Therapeutic Interventions for Alzheimer’s Disease Patients
104




Agitation States Common to Dementias 104




Caregiver Support Groups 105




Psychotherapeutic Interventions in Early-Stage Dementias 105




Psychoeducational Support Groups for Alzheimer’s Disease Patients 105




Leisure Activities and Therapeutic Recreation 106




Cognitive Training Intervention Programs 107




Driving Retirement
107




Fall Risk With Dementia
108




Inappropriate Sexual Behaviors
108




Dementia in Imprisoned Older Adults
108




Long-Term Care for Dementia
108




The Case of Daiki
108




Summary
110




Discussion Topics
111




7. Medical Problems in Older Adults
113




Commonly Occurring Medical Problems Experienced by Older Adults
113




Arthritis 113




Cardiovascular Diseases 114




Cancers 116




Chronic Obstructive Pulmonary Disease 117




Diabetes 117




Eye Disorders 118




Hearing Disorders 119




Osteoporosis 119




Pain 120




Pressure Ulcers 121




Sleep Disorders 121




Urinary Disorders 121




Interventions for Older Adults With Chronic Illnesses and Their Families 122




The Case of Miguel
122




Summary
124




Discussion Topics
125




8. Older Adult Substance Abusers
127




Chronic Versus Situational Substance Abuse
129




Alcohol Abuse/Dependence
130




Nonalcohol Substance Use Disorders
132




Benzodiazepine Abuse/Dependence Disorders 132




Opioid/Synthetic Opioid Abuse/Dependence Disorders 133




An Existential Analysis of Older Adult Substance Abuse/Dependence
134




Motivational Interviewing
135




Cognitive Behavioral Interventions
136




Integrating Motivational Interviewing With Other Therapeutic Modalities
137




The Case of Pauline
138




Summary
139




Discussion Topics
140




9. Older Adult Sexuality
141




Men
142




Erectile Dysfunction Treatments 143




Women
143




Gay Male and Lesbian Couples
144




Heterosexual Couples
144




Sexuality and Dementia
146




Caregiver Sexual Education for Dementia Patients
146




HIV/AIDS
147




Nursing Homes
148




Older Adult Sexuality and Religion/Spirituality
149




The Case of Lim and Jun
149




Summary
150




Discussion Topics
151




10. Older Adult Abuse
153




Prevalence of Older Adult Abuse
155




Perpetrators of Older Adult Abuse
156




Assisted Living Facilities and Nursing Homes
156




Long-Term Care at Home
157




Older Adults’ Perceptions as Potential Crime Victims
158




Sexual Violence
158




Disabled Older Adults
159




Older Adult Prisoner Abuse
159




Historical Programs to Address Older Adult Prisoner Abuse 159




Older Adults’ Self-Abuse
160




Self-Neglect 160




Self-Harm 161




Interventions for Older Adult Abuse, Self-Neglect, and Self-Harm
162




The Case of Gloria
164




Summary
166




Discussion Topics
166




11. Gay Male, Lesbian, Bisexual, and Transgender Older Adults
167




Coming Out in Later Life
168




Older LGBT Sexuality and HIV
169




Substance Abuse
170




Older Gay Inmates
171




Clinical Intervention 171




Concerns About Health Service Delivery
172




Interventions 173




Mental Health Issues
173




Retirement and Housing
175




The Case of Sheri and Camila
176




Summary
177




Discussion Topics
178




12. Care and Residential Settings for Older Adults
179




Retirement Communities
180




Gay-Oriented Retirement Communities 181




Aging in Place
181




Adult Day Care Services
182




Continuing Care and Assisted Living
183




Housing for Aging Inmates: A New Type of Aging in Place
185




Nursing Homes
185




Goals for Improved Experiences in All Types of Care and Residential




Settings
186




The Case of Adanna
188




Summary
190




Discussion Topics
191




13. Dying and Death
193




End-of-Life Planning
193




End-of-Life Palliative Care
195




Intensive Care and Terminal Illness
198




Euthanasia
199




Place of Death
200




End-of-Life Psychotherapy
201




Grief Counseling
201




The Case of Yael
204




Summary
205




Discussion Topics
205




References 207




Index 251