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.
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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.
Older adults experiencing cognitive decline and any of the dementias are suffering in ever increasing numbers. With the aging of the baby-boom generation, the incidence of cognitive decline and dementia will exponentially escalate over the coming years. With this coming tsunami of dementia, older adults experiencing dementia, as well as their family members and caregivers, will need the services of psychologists. Psychologists are needed to help families recognize the importance of end-of-life planning for an older adult when first diagnosed with a dementia. When an older adult understands that he or she has responsibility for and choice in the decision to abuse a psychoactive substance, there is a greater probability of successful treatment and recovery from a substance abuse problem. Psychologists are in a unique position to assess whether older abuse is occurring and, when discovered, to intervene with advocacy initiatives.Source:
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.Source:
- Go to chapter: Historical Perspectives on the Research of Social Isolation, Loneliness, and Social Support
Social isolation and loneliness are distinct concepts with a research history that evolved separately over many decades in the disciplines of sociology, psychology, psychiatry, and epidemiology. This chapter provides a historical overview of highlights from the research on social isolation, loneliness, and social support, and considers the implications of that research on current practice. It also explains the diversity of perspectives in the way one analyze human social engagement and allows for more personalized assessment of social needs and more targeted delivery of social programs and services. Researchers continue in their efforts to find effective interventions for social isolation and loneliness and for effective delivery of social support, and while one await further guidance, one can use the concepts and theories developed over decades to inform our practice. Awareness of the long research history will result in more targeted and effective help for individuals who need it.
Although assisted living administrators do not serve as clinicians to older persons within their facility, understanding normal psychological changes related to the aging process allows administrators to perform their work more effectively. Understanding many of the normal aging-related changes in neurological functioning, mental health functioning, memory, and cognition can be important in understanding how elders function in assisted living communities. Furthermore, issues related to memory changes, dementia, depression, suicide risk, alcohol, and substance abuse can be commonly experienced by the elderly. An awareness and understanding of these issues can be beneficial to assisted living administrators. Many individuals associate memory changes and problems as an inherent part of the aging process. This chapter identifies and presents best practices in selected areas associated with psychological aspects of aging. Best practices can provide administrators with information and examples of strategies for approaching some of the psychological issues present in aging individuals.
Physical activity for older adults has become a central feature of our culture. Physical activity programs intended for older adults call for an understanding of the social, psychological, and physical factors that influence their receptivity and effectiveness in supporting individual well-being. This chapter is organized into three sections, each addressing older adult social integration and physical activity in specific ways that are applicable to health professionals. Section one defines key terms, presents concepts on aging, and offers evidence to enhance well-being through social integration and physical activity. Section two provides a practical approach to working with older adults through physical activity that includes benefits, guidelines, recommendations, opportunities and barriers to physical activity, and a resource guide to best practices and approaches for older adults. In section three, two cases, based on individuals the authors have worked with, provide physical activity progressions and considerations for social integration.
- Go to chapter: Avoiding Diagnostic Fixation Errors: A Person-Focused Approach to Human Factors Analysis
This chapter focuses on the enormity of preventable medical errors that cause injury or death and one root cause associated with those errors called “human factors”. Human factors have been identified as a root cause of medical errors, particularly diagnostic errors. The chapter talks about latent failures, mental models, misdiagnosis, and sentinel event. The science of psychology and physiology tells us that the human mind works very rapidly, which raises the risk of making a judgment error. Human factors reengineering is discussed as a much-needed mechanism to address fixation errors and decrease diagnostic errors. Misdiagnosis is much too common in health care. A diagnostic fixation error is a phenomenon of clinging to a single presumed diagnosis despite mounting evidence that one is on the wrong track. The application of human factors engineering can and should include data from patients and their families so as to capture the most optimal solutions.
There are positive and negative aspects of life at every age throughout the life span, and aging is no exception. This chapter presents a more balanced view of older adults’ mental health and cognitive abilities, one that moves away from the stereotypes. It focuses on mental health and cognitive abilities as people age, with a presentation of the many positive characteristics of older adults’ psychological and emotional well-being as well as difficulties some may face, such as depression and dementia. The chapter also describes how personality changes over the life span and how the creative arts can positively impact the lives of older adults. Finally, it discusses factors that can positively and negatively affect older adults’ mental and cognitive abilities. The Practical Application presented at the end of the chapter focuses on unique challenges faced by individuals currently around 80 and above due to mental health stereotypes and stigmas.