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.

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 describes nursing care for sleep disorders in the primary care setting. The most prevalent sleep disorders in adults and older adults, and those most commonly seen in primary care settings are insomnia, sleep-disordered breathing, and restless legs syndrome. There is a compelling need for widespread access to sleep assessment and treatment among the large population of primary care clients who have sleep disorders-many of which are currently undetected. Primary care providers, especially nurses, are in an ideal position to assess, implement, and evaluate sleep promotion and sleep disorders treatment in primary care clients. The reach, adoption, implementation, and long-term maintenance of sleep promotion and sleep disorders treatment is most likely to be successful if implemented at the practice/organizational level. Nurses, especially advanced practice nurses play a pivotal role in implementing and evaluating policies and procedures to assure the translation and uptake of these important services.

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.

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.

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.

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.