Social Work With Older Adults

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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