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.
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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.
This book serves as the pillar for clinical care teams to improve health equity among homeless older adults. Interdisciplinary care teams are essential in complex homeless older population clinical practice, as all disciplines must work together to address medical, surgical, behavioral, nutritional, and social determinants of health. All clinicians who treat older adults, from the independent to the frail, should approach problem solving via an inclusive approach that includes social work, pharmacy, nursing, rehabilitation, administrative, and medicine inputs. The social determinants of health that contribute to the complexities of clinical care outcomes cannot be addressed within silos. The book reflects a holistic care model to assist clinicians in the complicated homeless population that is continuing to change in the instability of the homeless environment. The book is divided into 14 chapters. The chapters in are organized by problems most commonly faced by clinicians in servicing homeless populations: mental, social, medical, and surgical challenges. Chapter one presents definition and background of geriatric homelessness. Chapter two discusses chronic mental health issues (psychosis) in the geriatric homeless. Chapters three and four describe neurocognitive disorders, depression, and grief in the geriatric homeless population. The next two chapters explore ethical, legal, housing and social issues in the geriatric homeless. Chapters seven and eight discuss infectious diseases in homeless geriatrics population. Chapter nine is on cardiovascular disease in homeless older adults. Chapter 10 describes care of geriatric diabetic homeless patients. Chapter 11 discusses geriatric nutrition and homelessness. Chapter 12 presents barriers and applications of medication therapy management in the homeless population. Chapter 13 describes dermatologic conditions in the homeless population. Finally, the book addresses end-of-life considerations in homelessness and aging.
Diabetes mellitus (DM) is one of the most common chronic conditions in older, homeless adults. This chapter provides brief description on DM and prediabetes, and discusses post-hospital admission and clinical manifestations of DM. Careful and deliberate data gathering must take place to understand current health behaviors. Importantly, the patient’s health literacy, memory, and performance of activities of daily living and instrumental activities of daily living will help assess functional status. The chapter covers topics such as nutrition status and food security, fall risk assessment, depression, cognitive impairment, vision, social history, and polypharmacy. It discusses physical exam, diagnostic tests, further work-up, patient education and self-management, prevention, and treatment of DM. The chapter finally provides description on noninsulin versus insulin and oral versus injection, oral noninsulin medications, and strategies to reduce common diabetic complications.
Aging and physical vulnerability go hand in hand, so it is not surprising that older adults pay particular attention to what they eat and drink. Dehydration, constipation, hypertension, overweight, and malnourishment are just some of the age-related challenges facing older adults. Nutrition screenings examine characteristics known to be associated with dietary and nutritional problems, in order to identify high-risk individuals. One such screening initiative resulted in the production of a manual that begins with a checklist, “Determine Your Nutritional Health”. The manual includes a variety of screening tools on nutrition and related topics, including body mass index, eating habits, functional status, cognitive status, and depression. Medicare recognizes that not only is obesity a disease, but it is an epidemic in America. By offering free weight-management counseling for older adults, this is a step in the right direction.
Mental health is a multifaceted concept and difficult to define. Clinicians and researchers refer to
DSMguidelines or state how a condition deviates from them. Critics of the guidelines may argue that the number of clinical characteristics that identify a mental illness, and the time parameters that are employed for having these characteristics, are arbitrary. But flawed though they may be, there is no consensus on guidelines that could even be criticized, much less adopted, for the components of mental health. Thus, this chapter attempts to correct this imbalance and reflects a combination of the two perspectives: mental health and mental illness. As is true of most of the literature, the author has organized chapter subheadings largely around mental illness terms and also attempted to focus as much overall attention on mental health content as on mental illness. In addition to examining a topic like depression, the chapter explores life reviews, and in addition to examining Alzheimer’s disease, it explores cognitive stimulation.