Ageism is the most prevalent form of prejudice, and it affects older adults and younger people similarly (Bratt et al., 2020). Ageism occurs when someone is discriminated against based on their age, and this can happen at both ends of the life span (Raymer et al., 2017). This chapter focuses on topics such as ageism and reverse ageism; age-related mental health concerns; the effects of race, class, ethnicity, gender, and sexual identity related to aging and ageism; and competencies related to working with older clients. Cultural concepts focusing on the liberation counseling framework are discussed, as are aging and counseling ethics. Topics are discussed in the context of the life span as a whole and looking at the client from a humanistic model. Implications for counseling students, educators, and practitioners are provided.

Older adults and their families are highly heterogeneous. This chapter addresses diversity both within and among older adult populations and considers ways to improve service provision through flexibility and awareness. The concepts of cultural competence and cultural humility are introduced, and strategies for increasing one’s level of cultural competence are explored. It is important to note that diversity is not only about race and ethnicity but also includes age, ability, gender, geographic location, religion, sexual orientation, socioeconomic status, and so forth. Similarly, different perspectives and backgrounds are found among professionals working throughout the field of aging. Activities in this chapter promote recognizing that diversity is not the sole domain or concern of marginalized groups, that everyone has a culture and a social lens through which they view the world, and that this lens influences not only their perspective but also the way they interact with those around them.

This chapter focuses on aging as a natural process that affects every one of us. It provides an interdisciplinary overview on how older adults’ health needs and the relationships for them change with the aging process, conspiring their biopsychosocial vulnerabilities and assets during the later life years. Most importantly, it discusses the developmental aspects of aging, the meaning of age, issues affecting older adult people, and the significance of relationship support to successful aging. In doing so, the chapter surveys the demographics of aging and the evidence from aging-related research important to the health resourcing of older adults. Finally, the chapter considers a case illustration on the implications of aging to healthcare resourcing from family, cultural, and social policy perspectives.

Social workers in nursing homes are asked to include questions about trauma when gathering information from residents at the time of admission. Questions about the person’s past life can include a long list of likely traumatic events, e.g., living through a hurricane, and individual episodes of trauma, e.g., rape. For some older adults, trauma can be found in their childhood experiences, having a family member with a mental health or substance use disorder, violence in the community, poverty, and systemic discrimination. The effects of childhood abuse can be life-long and can include the need for resolution at the end of life. Older adults who have had adverse childhood experiences and/or childhood sexual abuse who have protective factors have an improved outcome in navigating symptoms and risks such as poor physical and/or mental health and suicidality when they have greater self-acceptance and higher extraversion. This chapter discusses the effects of these experiences on older adults, protective factors that help residents who are affected, and helpful interventions for social workers and the facility care team.

The frequency of pain and pain undertreatment in older persons has been increasingly brought to the forefront of the care of older adults in long-term care settings. Pain is a subjective experience and there are no specific tests to objectively measure it. Older adults who may be not able to communicate effectively about their pain are of particular importance to caregivers in long-term care settings. Older adults with untreated chronic pain also become less likely to engage in independent activities; their activities become more narrow and debility increases. The social worker can provide education to families about the physiological changes that occur in older adults that contribute to the absorption of medications, as well as comorbidities such as multiple diagnoses, chronic disease presence, and polypharmacy. In addition, the social worker can contribute to greater understanding of the need for pain management to avoid losses in physical function (ambulation), self-care, mental acuity, and socialization.

The importance of diagnosing depression and providing subsequent treatment to nursing home residents has been acknowledged and supported by the Centers for Medicare & Medicaid. The Mood section of the Minimum Data Set (MDS) 3.0 includes the Patient Health Questionnaire, Nine Questions (PHQ-9), in order to help identify depression. Depression is also associated with other chronic diagnoses such as Alzheimer’s disease, Parkinson’s disease, cancer, and arthritis. Substance use is often seen in the nursing home as a co-morbidity of depression for older adults. Depression and the diagnosis of depressed mood is a significant concern for social workers in long-term care. The social worker should be familiar with key signs and symptoms of depression, as well as the current modes of intervention, drug treatment, and psychotherapy.

The health status of an older person is the result of many factors, including lifelong health habits, genetics, and exposure to occupational and environmental hazards. The quality and availability of health care throughout the life course also plays a significant role in health in later life. These social determinants—the circumstances of our lives, including the neighborhoods in which we live—affect health risks and outcomes over the life course. Individual health behaviors are affected by the practices and habits of the people in one’s immediate social world, but they are also determined by the social circumstances of one’s life. This chapter explores the broad range of individual behaviors and social determinants that shape health in later life. It also examines the policies and practices within the U.S. health care system that shape access to and quality of health care for older adults.

This chapter presents specific issues faced by older adults in response to adaptations to chronic illness and disability. Some individuals have congenital disabilities and others acquire a disability early in life and are able to adjust fairly easily, aging with their disability. On the other hand, some individuals acquire a disability later in life and may experience great difficulty making the adjustments to their condition. The chapter presents information on the age-related concerns of older adults, components and perceptions of aging, assessment issues associated with older adults, vocational interests, and death and dying perspectives. It also discusses the implications for service delivery in the context in which older adults are served along with laws and regulations that apply to the population. Aging and geriatric persons often utilize a variety of services from multiple entities (e.g., social, legal, medical, financial, and counseling).