The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.
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The baby boom cohort brings with it multiple types of substance abuse. Bisexual older adults have more co-occurring psychological problems than heterosexual older adults, older gay males, and older lesbians. An interesting finding is that immigration is contributory to older adult substance abuse. Older adults with alcohol-abuse problems do not seek help for their problems. Rather, they are often identified as having an alcohol-use problem when seeking care for other medical or psychological problems. Social workers assessing an older adult for alcohol abuse often confuse symptoms of possible alcohol abuse with dementia. Prescribing opioids and synthetic opioids to an older adult is complicated. An older adult can suffer from many forms of inner tension. Combining motivational interviewing with cognitive behavioral therapy is shown to be more effective for treating substance abuse that either therapeutic modality alone.
For older adults, the phenomenon of death is accepted and does not induce the fear experienced by younger adults. Older adults who do not engage in end-of-life planning may receive unwanted, unnecessary, costly, and painful medical interventions or withdrawal of desired treatment. Many older people feel that the goal of palliative care is to make the best possible dying experience for the older adult and his/her family. In addition to palliative care, an older adult will most likely find himself or herself in an intensive care unit as part of his or her terminal care. Euthanasia, or hastened death, is seen by some as an alternative to palliative care. A psychological aspect of death that an older adult is concerned with, in addition to place of death, is whether he or she will die in his or her sleep or die suddenly, making the death experience an individual phenomenon.
This chapter focuses on informal caregiving among minority groups. It also focuses on context of caregiving and discuss the various specific challenges caregivers of minority older adults face. The chapter examines some of the specific caregiving interventions tailored for families of color and discuss the implications for practice, policy, and research. Medical advances and greater longevity point to healthier and longer lives for many, but both formal and informal caregiving remain a concern as individuals age and develop conditions that require care. Caregivers are often able to realize the positive aspects of caregiving when they are not struggling with financial or social support challenges. Despite the vast literature on caregiving in general, research pertaining to the needs and experiences of racial/ethnic minority older adults and their caregivers is limited, particularly for American Indians, Pacific Islanders, specific Asian American and Latino subgroups, and religious minorities groups such as Muslim Americans.
This chapter discusses current thinking in the field of social support and social relationships, and physical and mental health among older racial and ethnic minorities. Social relationships are an important predictor of health and psychological well-being across the life course. Many minority older adults will face the continued challenges of declining functional status due to physical and mental health conditions over the course of their lives. Most empirical studies on social support among older racial and ethnic minority adults explore the association between social support and both physical and mental health. The wealth of studies on social support among minority older adults has much to offer with respect to understanding the correlates of emotional support and patterns of assistance. The biological mechanisms explaining the link between social support and physical health outcomes have been largely unexplored among older racial and ethnic minority groups.
- Go to chapter: Informal Social Support Networks of African American, Latino, Asian American, and Native American Older Adults
Informal Social Support Networks of African American, Latino, Asian American, and Native American Older Adults
This chapter provides a selective review of research on social support among older African American, Hispanic, Asian American, and Native American adults. It focuses on social support as a dependent variable in relation to different sources and types of aid provided to older African American, Hispanic, Asian American, and Native American adults. The chapter highlights the findings in three specific areas: marriage and romantic relationships, extended family and non-kin as sources of informal social support, and black-white differences in informal social support. Informal social support networks are critical for individuals of all ages but especially for older adults who are dealing with difficult life circumstances. Older African Americans depend on informal social support networks of family and friends for assistance in emergency situations, as well as for help with various tasks of daily life. Elderly Asians often utilize kin and social support networks for a variety of reasons.
To truly understand how important and central memory is to us, it is important to understand what life is like for people who experience memory loss, or amnesia. This chapter examines the amnestic syndrome, which has been widely studied and the knowledge of which has significantly influenced theories of memory. The abilities and nonabilities of those with amnestic syndrome demonstrate that there are multiple independent systems of memory. The chapter also examines two controversial diagnoses, the main feature of which is memory loss dissociative identity disorder (DID) and psychogenic or dissociative amnesia. It discusses a form of memory loss that does not fit the technical definition of amnesia because it eventually affects not just memory but all cognition: Alzheimer’s disease (AD). AD is common among older adults and demonstrates how a worsening loss of memory and cognition can lead to a complete disruption of everyday life.Source:
The clinical social worker typically interfaces with older adult clients and their families in a variety of settings, providing diverse services ranging from assessment to clinical treatment to referral. This chapter discusses the ways in which cognitive behavior therapy (CBT) techniques can be used by social workers across different milieu to assist elderly clients who may be suffering from depression. These settings include the client’s home, an inpatient or outpatient mental health facility, a hospital or medical setting, a long-term care facility, or a hospice setting. The chapter provides an overview of how cognitive behavior techniques can be integrated throughout the range of services social workers may provide to elderly clients. Clinical examples demonstrate the use of CBT in a variety of settings. For many older adult clients, issues related to the need for increasing dependence on family, friends, and paid caretakers may become the central focus of counseling.
- Go to chapter: The Productive Engagement of Older African Americans, Hispanics, Asians, and Native Americans
This chapter provides definitions and theoretical perspectives regarding the productive engagement of older adults. It explores the productive engagement of four ethnic minority groups African Americans, Hispanic Americans, Asian Americans, and Native Americans. The chapter discusses programs and policies that will help increase the productive engagement of older adults. It is possible that older adults will be judged by their ability to be productive and expected to be productive. Those older adults who have been disadvantaged across the life course will continue to be disadvantaged in later life when they still face discrimination in access to or support for productive engagement. Both definitions and theoretical perspectives are important to understanding the productive engagement of older racial/ethnic minorities. At the societal level, increasing the productive engagement of older adults, in general, may increase the supply of experienced employees, volunteers, and caregivers.
Improved nutritional status is an important component of efforts to improve the health of older adults, whose ability to consume a healthy diet is affected by comorbidities and behavioral, cognitive, and psychological factors. In addition to genetics and nutrition intake, nutritional status of the elderly could be affected by socioeconomic factors, such as education and income levels, and environmental factors, such as proximity to stores and transportation, that can affect food variety and availability. Nutrition and aging are connected inseparably because eating patterns affect progress of many chronic and degenerative diseases associated with aging. Anthropometric measurements are often used for nutritional assessment of older adults and are reliable across ethnicities. The Mini-Nutritional Assessment (MNA) tool was developed to evaluate the risk of malnutrition among frail older adults. Dietary patterns may better capture the multifaceted effects of diet on body composition than individual nutrients or foods.
- Go to chapter: Racial/Ethnic Minority Older Adults in Nursing Homes: Need for Culturally Competent Care
This chapter summarizes and discusses the findings of the predictors of nursing home admissions and the issues regarding access among four groups of racial/ethnic minority older adults: blacks/African Americans; Hispanics/Latinos; Asians/Pacific Islanders; and American Indians/Native Americans. It provides a summary of the need for providing culturally competent nursing home care and future directions for alleviating racial/ethnic disparities and segregation in nursing home care. Minority older adults were once disproportionately underrepresented among nursing home residents. With the demographic revolution among racial/ethnic minorities and older adults, the number of racial/ethnic minority nursing home residents will continue to increase. Improvement in the quality of nursing home care for racial/ethnic minorities also requires culturally competent care. In providing culturally competent nursing home care, nursing home administrators and staff should involve community representatives from faith/spiritual communities and from civic and cultural organizations in the facility’s planning, monitoring, and quality-improvement meetings.
Alzheimer’s disease (AD) and related cortical dementias are a major health problem. Patients with AD and related dementia have more hospital stays, have more skilled nursing home stays, and utilize more home health care visits compared to older adults without dementia. This chapter discusses the role of family caregivers and how they interact with in-home assistance, day care, assisted living, and nursing homes in the care of an individual with dementia. It also discuss important transitions in the trajectory of dementia care, including diagnosis, treatment decision making, home and day care issues, long-term care placement, and death. It highlights the importance of caregiver assessment, education, and intervention as part of the care process. Dementia caregivers are at risk of a variety of negative mental health consequences. Another important moderating variable for dementia caregiver distress is self-efficacy.
Social work is an applied discipline with a long tradition of using the theories and methods of social sciences to enhance practice, policy, and research. In their professional roles, social workers practice work with minority older adults and their families in diverse community-based and institutional settings that encompass social and health services. The conduct of social work practitioners and researchers in working with human populations is guided by the Code of Ethics of the National Association of Social Workers. A more sustained and concerted effort is required to ensure that there is a sufficient supply of gerontologically trained social workers to meet the growing demands of a more aged and diverse society. Social work researchers and practitioners will need to be responsive to the impact of government social spending cuts on the availability and delivery of services to their elderly clients who are most in need.
This chapter enhances the understanding of the multifaceted challenges that individuals, especially older adults, seeking housing with a criminal background face. It reviews the ways in which individuals, especially older adults, can be vulnerable in terms of safety and security in their housing settings. Older adults may be particularly concerned about security and safety at home because their homes have been shown to be places where they can be victimized, either by telephone scams, door-to-door solicitation, bullying in age-congregate settings, and witnessing other crimes occurring in their residences. The chapter discusses ways in which forensic practitioners can support vulnerable populations, including older adults. It also discusses the complexities of affordable and safe housing using case examples and descriptions focusing on the older adult population. The chapter provides further recommendations on other areas of assessment and intervention that forensic social workers can conduct.
Health promotion efforts will play a powerful role as we work to enhance function and reduce morbidity by intervening on modifiable risk factors such as physical activity (PA), inactivity, social engagement, and nutrition. This chapter examines the state of the art of theoretical foundations for health behavior change that are used to design and implement health promotion programs for older adults. The principles of social cognitive theory (SCT) have been used frequently in health behavior interventions. The chapter uses the ecological model as a guide to describe the level(s) targeted by each theory. It presents the most prominent multilevel approach, the social-ecological model. Recently, there has been a push toward broader ways of thinking about behavior change using structural approaches that target all levels of the social-ecological model. The chapter presents theories targeted at each level and argues for the use of multilevel interventions whenever possible.
This chapter begins with analysis of life-span development and life-course perspectives as applied to research on older adults and their families. It examines theories that are useful for guiding such research, thus yielding broader and deeper understanding of the ways older adults and their relatives negotiate family roles, responsibilities, and interactions in the context of both traditional and pluralistic family configurations. The chapter also examines the promise and problems associated with two key theoretical approaches that have been particularly effective in guiding family gerontology research in recent years, intergenerational solidarity and conflict, and intergenerational ambivalence. These approaches are strong in their own right and have the further advantage of linking well with life-span development and life-course perspectives. The chapter focuses on their theoretical tenets and principles, empirical applications, and strengths and limitations, with a critical assessment throughout. It considers theoretical and empirical directions for future research in family gerontology.
Housing communities for older adults are not a contemporary concept. The guiding concept of creating older communities is the desire to give older adults an alternative concept of housing that will allow them to sustain themselves economically, while giving choice and an element of control over their health care, social networks, and physical environment. Many older adults choose retirement communities for an added sense of personal security and continued independent living as a beginning preparation for their ultimate mortality. Aging in place encompasses an older adult staying in his or her home throughout the aging cycle or moving to housing that provides limited services such as an option for communal dining, cleaning services, and transportation. Like aging-in-place strategies, continuing care and assisted living facilities provide medical and nonmedical living services to older adults who are unable to live independently because of medical illness, cognitive decline, or disability.
The therapeutic alliance works based on the idea that the social worker is a willing participant whose primary concern is to support an older client’s effort for desired change. When considering theoretical orientations to treating an older adult that are consistent with the short-term constraints found in most mental health agencies, one is faced with a multitude of theories, some extended for older adults, most created for younger adults. Cognitive behavioral therapy (CBT) and various interpersonal psychotherapies are effective for older adults, though an older adult’s response to these therapies may have a different temporal course and require modifications in technique. Constructivist theory is a conceptual framework that is foundational to existential therapy, CBT, and narrative therapy. However, for older adults, reminiscence is a strength-based strategy employed to validate a sense of intimacy with the past, to integrate the many transitions of life, and as a preparatory method for death.
The process of assessing an older adult occurs on two levels. The first level takes place when an older client presents for assessment. The second level of the assessment process is used for gathering facts that are analyzed for diagnosis, treatment planning, and disposition. Most social workers treating older adults will be younger than their clients. Therefore, clinical authority and respect may become an issue. It is common to treat older adults experiencing hearing deficits who have trouble perceiving high frequencies. The social worker must evaluate the status of the client’s housing, transportation, food, clothing, recreation opportunities, social supports, access to medical care, kinship, contact with neighbors, and other environmental resources that the client or social worker considers important. During the collection of this data, the opportunity will arise while discussing social relationships to collect historical information on the client’s psychosocial development.
Medical problems challenge older adults’ abilities to cope with illness, and at times they experience co-occurring psychological disorders. Therefore, social workers must provide services to assist older adults who are experiencing acute or chronic medical conditions. Older adults experiencing arthritic pain often experience a co-occurring depression. The major cancers experienced by older adults are breast cancer; chronic lymphocytic leukemia; lymphocytic lymphoma; colorectal cancer; lung cancer; mouth, head, and neck cancers; multiple myeloma; prostate cancer; skin cancers; and vulvae cancer. Those older adults suffering from diabetes have a greater chance of co-occurring vascular and cardiovascular conditions and a greater rate of institutionalization and subsequent mortality. Coordination with family members and caregivers about self-care issues, medicine compliance, safety issues, health socialization, and exercise is important because social workers often overlook psychoeducation with medically ill clients.
This chapter discusses the phenomenological realities, as well as the developmental and systemic experiences, of both middle and older adult women. The period of middle adulthood includes the years between the 40th and the 65th birthday. Older adulthood is being used to describe the period from the 65th birthday onward. The chapter explores both the intrinsic and extrinsic factors that influence the interpersonal and intrapersonal experiences of both middle and older adult women. Social and gender role analysis is useful for women in middle to older adulthood as the self-expression generated through feminist theory technique encourages them to break down the cultural stereotypes and presumptive obligations by which they have enacted their lives. Empowerment and self-expression are crucial for middle-aged and older women, since societal pressures may push women to shame themselves for their older age.
- Go to chapter: Theories That Guide Consumer-Directed/Person-Centered Initiatives in Policy and Practice
This chapter explores a paradigm shift in policy and practice related to the delivery of services and supports to older adults or adults of any age with disabilities-the growth of person-centered (PC) and participant-directed (PD) practice initiatives. It discusses new theoretical approaches, particularly the Consumer-Directed Theory of Empowerment (CDTE), which are salient to explaining the growth and impact of PC and PD initiatives as an evolving practice model that represents a paradigm shift from past approaches to working with older adults and persons with disabilities. Research is needed on recent practice and policy changes that have implications for the continued development and examination of theories that support PC and PD care. With both the aging and the increasing diversity of the US population combined with federal policy initiatives related to LTSS, the demand for PC and PD initiatives will continue to grow.
- Go to chapter: Theories of Help-Seeking Behavior: Understanding Community Service Use by Older Adults
This chapter focuses on the prominent psychosocial theories and models used to predict service utilization. It begins with a discussion of Andersen’s Behavioral Model of Health Services, the most commonly used framework for predicting formal service use among older adults. The need-use gap has been documented in use of mental health services, home and community-based services (HCBS) among non-Whites, among caregivers of older adults, and in the use of adult day care, respite care, personal care, meals, and transportation services. The chapter focuses on help-seeking behavior models that were not necessarily developed for or frequently used with older populations, but have the potential for enhancing the study of service use in late life. Developing new theories and further elaborating and testing existing models are essential for unraveling the use-need paradox and helping reduce the barriers to programs and services that, when accessed, can contribute to increased well-being of older adults.
Stigma is the foundation that distorts the many social constructs affecting how social workers view older adults. Many socially constructed optics produced by stigma can bias social workers’ views of older people. It is important for a social worker to understand that race, ethnicity, and sexual orientation are social constructs that bias clinical care. Additionally, stigma associated with race, ethnicity, and sexual orientation produce psychosocial stressors that converge on older clients, which exacerbate their physical and psychological health statuses. The stigma of mental illness serves to increase the suffering of older people struggling with psychological problems while increasing the suffering of family members, loved ones, and caregivers who experience courtesy stigma. The stigma of suffering from mental illness may also prevent an older person from seeking treatment for his or her psychological problems. Older adults suffering from dementia also suffer from the negative reactions to them because of their diagnosis.
Scholars studying social connectedness draw on the sociological theory of social capital. In recent years, social scientists have proposed theoretical and conceptual models to explore the role of social connectedness in the specific context of aging. Recent data on the social networks of older adults paint a rich picture of the individual, or egocentric, social networks of the elderly community-dwelling population. This chapter discusses the theory of social capital, and explores the main effects and stress-buffering models of social connectedness and health. Although social capital theory has effectively guided empirical research, new ideas and concepts in aging research are generating interest among scholars, and are taking the field in innovative directions. A series of studies based on the Veterans Affairs Normative Aging Study (NAS), an ongoing study of aging established in 1963, documents a relationship between air pollution and various health conditions such as increased blood pressure and inflammation.
This chapter combines the increasing number of studies that pertain to the stereotype embodiment theory (SET) and reflects upon to represent the current state of this theoretical perspective and how it can help explain age stereotypes’ contributions to health and aging. It describes the history, cultural context, and nature of age stereotypes and age self-stereotypes in a largely ageist society. The chapter presents SET, which provides a framework for explaining how age stereotypes are acquired to subsequently influence health outcomes. It discusses replication studies conducted in different countries, as well as meta-analyses, to demonstrate the validity of this theory as well as to illustrate the meaning and impact of its components. The chapter illustrates how SET may be applied to shape future healthy aging research, policy, and practice. Empirical evidence supports the importance of age stereotype self-relevance among older adults.
The concept of being an old gay male adult, old lesbian adult, old bisexual adult, or old transgender adult is remote and insignificant to most people. There is an abundance of literature about the younger lesbian, gay, bisexual, and transgender (LGBT) community and a dearth of literature about the older LGBT community. Coming out is a difficult process for anyone, at any developmental stage. It is most difficult when old gay men or old lesbians do not initiate a decision to disclose their sexual identity until late life. Older adults with HIV disease are a significant subpopulation of the current older adult cohort. Transgender older adults are more likely to have a history, as compared with nontransgender people, of sex work, substance and alcohol abuse, and depression. Advocacy model can be adapted to meet the social and clinical needs of the LGBT community.
In older adults, sexual activity declines as a result of multiple causes like medical illness, disability, psychological problems, and social constructs that exist in institutional settings. Another phenomenon of older adult sexuality is that many older adults are aging without major health problems that would limit their sexual functioning. Older men often reveal their problem with erectile dysfunction to a health care provider or social worker. There are multiple approaches to treating erectile dysfunction in older men. The first and primary intervention is referral to an urologist. Functional problems contributing to the decline in sexual activity of older women include co-occurring anxiety or depression, urinary incontinence, thyroid conditions. Many older adults suffering from various forms of dementia become sexually disinhibited and show increasing hypersexuality as their cognitive deficits increase. Social workers have an opportunity to provide psychoeducation to families and caregivers in managing hypersexuality exhibited by patients suffering from dementia.
This chapter includes a discussion of the practice-oriented framework for service use delineated by Yeatts, Crow, and Folts and the caregiver identity theory articulated by Montgomery and Kosloski. Throughout history, family members, most often women, have been the primary providers of care for individuals, young and old, who are in need of assistance. What has occurred in the past century is significant growth in the number of family members who are providing care and expansion of the responsibilities that these family caregivers now assume. The steady expansion of family caregiving has been mirrored by the steady expansion of research focused on caregivers and interventions to support them. The behavioral model of services utilization has been used to study the use of a wide range of health services by older adults and caregivers.
Many older adults are diagnosed with mild cognitive impairment (MCI), a condition that does not meet the criteria for dementia. MCI is considered a risk factor for Alzheimer’s disease-related disorders (ADRD). Although Alzheimer’s disease is a serious problem, this chapter focuses on the five types of dementia commonly seen in practice. These include vascular dementia, dementia with Lewy bodies, Korsakoff syndrome, frontal lobe dementia (including Pick’s disease), and Alzheimer’s disease. Psychoeducational support groups allow the merging of learning about dementia with concomitant psychological support. The breaking of denial enables older adults in these support groups to make better sense of their disease, increasing their abilities to comply with treatments and caretakers. Leisure activities, whether community based or solitary, are shown to be protective against dementia or, at the least, stall the onset of dementia.
The book examines various theories of aging including a contrast between the strengths-based person-in-environment theory and the pathologically based medical model of psychological problems. It advocates truly engaging with the older client during the assessment phase, and discusses a variety of intervention modalities. The book integrates an advanced clinical social work practice with in-depth knowledge of evidence-based practice as well as geriatric medicine, psychiatry and gerontology. The social worker must evaluate the status of the client’s housing, transportation, food, clothing, recreation opportunities, social supports, access to medical care, kinship and other factors considered important by the social worker or the client. Constructivist theory is a conceptual framework that is foundational to existential therapy, cognitive behavioral therapy (CBT), and narrative therapy, which are effective for older adults. Stigma associated with race, ethnicity, and sexual orientation produce psychosocial stressors that converge on older clients. The book discusses several medical conditions affecting older adults such as Alzheimer’s disease, arthritic pain, diabetes and various types of cancers. Older adults may also suffer from substance abuse-related problems, hypersexuality, and various types of abuse such as neglect. The book also highlights the problems faced by the older adult LGBT community and those suffering from HIV disease. It ends with discussions on care and residential settings for the older adults, and palliative care and euthanasia.
Clinical gerontological social work practice with older adults is a rapidly growing field encompassing many practice venues. The social work mission with older adults encompasses micro practice, mezzo practice, and overriding macro policies affecting an older adult. Because of the increasing population of older adults, gerontological social work education must be expanded to meet the needs of this population. Collingwood, Emond, and Woodward (2008) propose a theoretical orientation that is adaptable to a social worker assisting older adults. The case of Georgina is an example of how a social worker must understand and implement knowledge of developmental stage theory, environmental influences, and resilience theory when working with an older adult in crisis. A social worker working with older adults must employ advocacy skills and provide concrete services, as well as psychotherapeutic interventions.
This chapter discusses prominent theoretical models that link age-related changes in emotional processes with changes in cognition. It also discusses the dynamic integration theory (DIT), which outline how older adults may optimize emotional experience to compensate for reduced affective complexity resulting from declines in fluid cognitive processing. The chapter evaluates the current evidence for and the potential contributions of these theories. It introduces neuroscientific perspectives and reviews how these perspectives interpret age-associated changes in the brain in terms of cognitive-emotional processing. Aging Brain model (ABM) and DIT, therefore, provide more neurologically based explanations for age-related changes in emotional processing, whereas socioemotional selectivity theory (SST) postulates motivation as the cause of such changes. Another theory that might be relevant to the aging literature is the arousal competition biased theory, which posits that the affective state of the perceiver may also play a role in the salience of information.
Contemporary psychotherapy addresses behavioral issues of an older adult by focusing on the degree to which an older adult is able to cope positively with the environmental stressors converging on him or her. An environmental geropsychologist focuses on the environment component of Lewin’s equation and develops interventions to change older adults’ interpersonal and intrapersonal experiences with psychosocial stressors with interventions aimed at the environment. The theory of affordances states that the perceptions that older adults have of their physical environments have functional significance for older adults, and shape older adults’ behaviors. The tri-dimensional intervention model states that there is a comprehensive interaction among the cognitive, conative, and affective components in an older adult’s environment. All three components are the targets for intervention by an environmental geropsychologist. The conative component is the aspect of the brain that acts on one’s thoughts and feelings.
A psychologist must confront many prejudices against older adults that are manifested in most people in non-older adult cohorts. Clinical psychologists specializing in geropsychology work with individual older adults; family members of older adults, including spouses/partners, siblings, and adult children; and caregivers when treating the psychological problems experienced by older adults and dealing with issues of caregiving to older adults experiencing mental illness, dementia, and/or psychological reactions to co-occurring medical illnesses. Unfortunately, despite the fact that older adults are affected by the forces of ageism and stigma, and the fact that community psychologists strive to understand and improve social inequalities and to enable empowerment of marginalized people, there is a significant dearth of research in the field of community psychology. There are four types of ageism: personal, institutional, intentional, and unintentional. The majority of older adults have experienced age discrimination and stigmatization at some time after the age of 65.
This chapter talks about psychoactive substances that are commonly misused or abused by older adults. It is important for a psychologist to understand the psychopharmacological dynamics of each substance, how they are administered by an older adult, the symptoms of intoxication and withdrawal, and the psychosocial consequences experienced by the older adult misusing or abusing psychoactive substances. Unlike younger adults, older adults are more likely to avoid illicit substances such as cocaine, heroin, methamphetamine, psychedelics such as lysergic acid diethylamide (LSD) or mescaline, and designer drugs. Historically, the psychoactive substance of choice was alcohol. There are two general types of opioid psychoactive substances: naturally occurring opioids and synthetic opioids. Naturally occurring opioids include opium and its derivatives morphine and codeine, and heroin, which is a chemical manipulation of morphine. Unfortunately, many older adults suffer with chronic pain from cancer, arthritis, or injuries, causing a need for opioid medications.
This chapter focuses on using humanistic sandtray as a structured play therapy intervention with clients aged 9 years and older. Humanistic sandtray therapy is a type of play therapy that can be used with clients of many ages, from preadolescents to older adults. This approach to sandtray emphasizes the primacy of the therapeutic relationship and views the relationship as the curative factor in therapy. In sandtray, therapists and clients benefit from the symbolic nature of the experience because it increases safety and provides clients with a metaphorical and indirect mode of expression. The chapter illustrates the case example to help clients go deeper into their inner experiencing and awareness so that they might move in the direction of becoming a more fully functioning person. Fully functioning people are moving in the direction of increasingly trusting their inner experiencing and becoming open to a wide range of emotions.
A psychologist’s first task when assessing an older adult for dementia is to discriminate between normal cognitive decline, mild cognitive impairment (MCI), and dementia. Teaching an older adult how to increase positive neuroplasticity is a useful intervention that will improve functioning in an older adult experiencing mild cognitive impairment, and will delay the progression of cognitive deterioration in an older adult experiencing dementia. Assessment of deficits in olfactory functioning are potentially useful for a psychologist who is attempting to differentiate between cognitive disturbances of normal aging and mild cognitive impairment that may progress to Alzheimer’s disease. Alzheimer’s disease is a chronic, debilitating disease process that begins with inclusions of abnormal proteins in neurons in the brain, although this stage of the illness does not demonstrate any cognitive impairment in the older adult.
The medical model of psychopathology currently guides psychiatrists and many psychologists who are treating older adults experiencing psychological problems. Use of this model causes contradictions and distortions for the treating clinician and limits the effectiveness of treatment for older adults experiencing psychological problems. There are three areas of concern that illustrate these contradictions and distortions. The first area of concern is the fact that only two classes of psychiatric diagnoses meet the characteristics of a disease. The second area of concern is how the current use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) continues a tradition among psychiatry, managed-care companies, and insurance companies that puts pressure on psychiatrists, psychologists, hospitals, and psychiatric rehabilitation facilities to treat in the most cost-effective and short-term manner. The third area of concern is the relationship that has occurred between psychiatry and pharmaceutical marketing forces.
Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.
The heightened awareness of coming of death, and the anticipation of dying, results in many older adults experiencing an existential crisis. For some older adults approaching or in the age bracket of 75 to 84 years of age, the expectation of death becomes acute and triggers a need for end-of-life planning, also referred to as advance care planning. Palliative care is considered a good death because it keeps an older adult comfortable, provides counseling, and is a means to control pain that a dying older adult would otherwise experience. There is a significant need for psychologists to provide counseling to older adults experiencing disenfranchised grief because adults experiencing this type of grief suffer from difficulty experiencing their loss when it is not validated by others. Euthanasia is accomplished by an older adult’s request to his or her physician based on the intention of ending pain and suffering when terminally ill.
Psychologists work with micro-level and macro-level orientations. Clinical psychologists with a micro-level orientation focus on individuals, families, and small groups when performing psychotherapy. Community psychologists have a macro-level orientation. The aging population presents many opportunities for psychologists, both those engaged in scholarship and those working clinically with older adults, and for community psychologists addressing issues relating to social structures and organized communities of older adults, economic issues such as poverty and access to medical services, and issues relating to senior housing. Contemporary theory indicates that it is equally important for psychologists working with older adults to focus on the positive aspects of aging when addressing the psychopathological problems older adults are experiencing. Erikson’s stage theory originally had seven stages: basic trust versus basic mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; identity versus role confusion; intimacy versus isolation; and generativity versus stagnation.
Social work has a long-standing commitment to healthcare and the recognition of the inextricable link to quality of life and well-being across the lifespan. This book emphasizes the critical importance of health for all members of society and the significant role of social work in the field. It presents essential information about health and social work critical to understanding today’s complex health care systems and policies. The book is intended as a core text for masters of social work (MSW) and advanced bachelor of social work (BSW) courses on health and social work, social work and health care, health and wellness, social work practice in health care, and integrative behavioral health taught in social work, public health, and gerontology. The book is organized into three parts containing 18 chapters. The first chapter describes the role of social work in healthcare. The second chapter discusses ethics and values in healthcare social work. The next three chapters present social determinants of health, intersectionality, and social work assessment. Chapter six discusses health promotion and public health. Chapter seven presents integrated behavioral healthcare. Chapter eight describes substance misuse, abuse, and substance-related disorders. Chapters nine and ten discuss palliative care, end-of-life care, correctional healthcare, and psychosocial care. Chapter 11 describes children and family health. Chapter 12 explores healthcare and work with older adults and their caregivers. Chapters 13 to 15 delve on immigrants and refugee health, health and HIV/AIDS, and LGBTQ health. Chapters 16 and 17 describe healthcare and disability, and healthcare and serving veterans. The final chapter discusses future direction of healthcare and social work.
The broad array of community-based services for older adults has developed over time as a result of the Older Americans Act (OAA) and the Administration on Aging (AoA) and the funding allocated to this act by Congress. With an expanding consumer base, the result of population aging, the aging networks have had to evolve over time, and while there have been and will continue to be some growing pains, there continues to be concerted efforts on many fronts to be support for providing services and programs that increase the quality of life for older adults. This chapter explores the expanding consumer base of the aging. It describes how long-term services and supports (LTSS) can be better managed and paid for to support those who need long-term support and services. Finally the chapter discusses how aging networks can and will evolve over time to serve the changing cohorts of older adults.
Myriad statutory, procedural, and technological innovations have been made in the criminal and civil justice systems to increase access to courts and legal services for older people and people with disabilities. This chapter describes basic legal concepts that pertain to individual rights and explains some of the criticisms that have been leveled against aging and elder abuse policy on legal grounds. It points out the role that courts play in interpreting rights, determining when they have been violated, and finding that statutes and executive actions are invalid. It focuses on a few examples that have attracted scrutiny, particularly with respect to elder abuse and neglect. Among the constitutional amendments that are most relevant to elder justice are the Fifth, which limits the government's authority to infringe on life, liberty, and the pursuit of property without due process, and the Fourteenth, which provides equal protection under the law.
Socially isolated older adults often lack opportunities to establish the social connections that support positive health and well-being. Volunteering, either formal or informal, is one strategy to prevent and even address social isolation among older adults. The act of volunteering, particularly for older adults, is well researched and has been found to be associated with many positive health and well-being outcomes, including improved physical and mental health, increased physical activity and socialization, the development of personal resilience against stress, gains in knowledge and skills, and reduced mortality risk. This chapter presents vignette illustrating the personal significance of volunteer work is based on the experience of a volunteer participating in a Retired and Senior Volunteer Program. It discusses some existing pathways that can lead an older adult into formal and informal volunteer service and opportunities for engagement that can be either accessed locally or replicated through new program efforts.
While high-income nations have experienced increasing life expectancy as a consequence of better healthcare and healthier lifestyles, this does not mean that the size of the aging population will be the highest globally. The issue of HIV and older adults will continue to be a public health issue across the globe and will require the attention of factors related to socioeconomic context as well as sexual health and education. Regardless of the income of specific nations, families provide essential and important support for elders. The support of the oldest-old and those who require long-term supports and services earlier in life will be the most pressing issue for all nations going forward—rich and poor alike. These issues, in and of itself, is a great reason to participate and learn about international issues and global aging so that we can in fact face the challenge of change in our aging world.
A dramatic shift has occurred in the field of long-term care in recent decades in how providers talk about those they serve. This chapter explains what consumer rights are and suggests how they might apply in long-term care. It considers obstacles that older consumers with physical and cognitive disabilities may face as well as barriers imposed by the markets themselves, such as the failure of healthcare to respond to market forces that are supposed to drive prices down and lead to new and improved products. It acknowledges the special rights of users of medical care, nursing homes, assisted living facilities, and health plans as articulated in patients' rights and residents' rights declarations and agreements. The chapter finally makes the case that consumers' rights should be a component of elder justice and that elder justice advocates and the public need to understand how to exercise and protect them.
This chapter offers insight into the context of growing older in small towns and rural areas, including the unique challenges faced by rural elders and the special strengths that they possess. It gives attention to the nature of social relationships, the roles of health and human services professionals, and effective interventions and programs in the rural context. The chapter uses, an ecological definition of rural, focusing on an area’s size, population, and location in relation to other communities (particularly, urban areas). It is important to keep in mind, however, that rural and urban can also exist on a continuum from completely rural to completely urban and everything in between. Although the World Health Organisation age-friendly guidelines relate primarily to urban settings, many of the guidelines can be easily applied to rural communities and small towns. Practitioners in the field of aging should consider working collaboratively with community developers and planners.
Much of what has been accomplished in elevating elder rights and abuse prevention internationally has been accomplished by nongovernmental organizations (NGOs) that work in collaboration with the United Nations (UN), are supported by the UN, or that focus on influencing UN policy and programs. The UN also has “specialized agencies”, committees, councils, and commissions that play significant roles in promoting elder justice. UN entities employ a wide range of strategies to address aging issues, which are International Assemblies, Sustainable Development Plans, Treaties and Conventions, Public Awareness Events and Observances, and Special Procedures. American advocates have much to gain from participating in the systematic, deliberative, and inclusive processes that the UN and international NGOs have applied to aging, elder rights, and elder abuse prevention. This includes the UN's tripartite approach to age as a matter of human rights, public health and social development.