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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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 concluding chapter summarizes the major points regarding elder abuse (EA) presented in the preceding chapters. It concludes the chapter by taking one last opportunity to encourage exploration and initiation of system-level efforts to solve a major public health problem. The socioecological framework for violence prevention utilized within domestic and global public health work is applicable and extendable to EA. Throughout this book, the authors have argued that EA is a public health problem and that EA may well be among the most under-recognized and under-resourced population health problems of the early 21st century. Public health has frameworks, tools, approaches, relationships, structures, systems, and a variety of agents and organizations poised to address the problem of EA. The imprimatur of the growing population of older adults and the character of demographic transitions occurring globally provide the perfect rationale for action—now.
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:
- 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.
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.
- 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.
The importance of the field of geropsychology (psychology of aging) is seen in the ever-increasing demographics of older adults. A psychologist needs to understand the various life stages that define different cohorts of older adults. Older adults are affected by the forces of stigma and ageism, which are of four types: personal, institutional, intentional, and unintentional. A majority of older adults experience age discrimination and stigmatization after the age of 65. The use of medical model of psychopathology causes contradictions and distortions, one of which is the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 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 (MCI). Sexual interest remains high throughout old adult developmental stages, but sexual activity declines in most men as they age. While older adults are more likely to avoid illicit substances, many older adults having chronic pain from cancer or arthritis need opioid medications. Older adult abuse is a multifactorial phenomenon as the abuse may be emotional, financial, physical, sexual, or self-induced. Environmental geropsychology is based on Lewin’s field theory model Lawton and Nahemow’s ecological model, and an environmental geropsychologist focuses on the environmental component to develop interventions to change older adults’ interpersonal and intrapersonal experiences. Heightened awareness of coming of death results in an existential crisis for many older adults causing a loss of their sense of purpose for their lives.
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.
- Go to chapter: Special Populations: Medication Use in Children and Adolescents, Older Adults, and Women and Pregnancy
Special Populations: Medication Use in Children and Adolescents, Older Adults, and Women and Pregnancy
This chapter focuses on the unique characteristics presented by three special populations that frequently receive psychotropic medications–children and adolescents, older adults, and women who are pregnant or plan to become pregnant. It is intended to sensitize social work practitioners to the unique considerations frequently encountered with these populations and to highlight the importance of combining medication therapy with counseling when addressing the mental health needs of these special populations. The chapter also provides a sampling of some Diagnostic and Statistical Manual for Mental Disorders (5th ed.; DSM-5) diagnoses frequently identified in children and highlights the medications commonly used to treat the mental disorders. Assessing and determining the medications to use to assist children and adolescents suffering from a mental disorder is never easy. Two conditions that present a particular challenge for prescribers and other members of the collaborative team are attention deficit hyperactivity disorder (ADHD) and conduct-related disorders.
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.
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.
The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.
This chapter presents a broad and general overview of the structural and physiological changes that occur with aging as well as the underlying pathophysiology of age-related diseases. The body comprises eleven organ systems that include the integumentary, muscular, skeletal, nervous, circulatory, lymphatic, respiratory, endocrine, urinary/excretory, reproductive, and digestive systems. As such, the ensuing sections are arranged by organ system and structured to cover age-related physiological changes and common disorders. Older adults experience a myriad of physiological changes as they age. While some of these physiological changes are benign, other changes increase the risk of age-associated pathophysiological changes, which can result in significant functional impairment or morbidity. These pathophysiological changes are not to be considered part of the normative aging process. Thus, it is essential that providers distinguish between the two states.
This book fills a gaping void in the selection of textbooks to use in graduate courses on the psychology of aging. It serves as a primer for any graduate student who is going to work in a clinical setting with older adults, or in a research lab that studies some aspect of the psychology of aging. The book introduces students to the background knowledge needed in order to understand some of the more complex concepts in the psychology of aging. Additionally, it provides clear explanations of concepts (e.g., genetics of aging research, neuroimaging techniques, understanding of important legal documents for older adults). The book focuses solely on older adults, providing in-depth coverage of this burgeoning population. It also provides coverage on cognitive reserve, neurocognitive disorders, and social aspects of aging. The book is intended for graduate students or upper-level undergraduate students in psychology, biology, nursing, counseling, social work, gerontology, speech pathology, psychiatry, and other disciplines who provide services for, or perform research with, older adults. It is organized into four sections. Section I presents introduction to the psychology of aging. Section II gives a core foundation in biological aspects of aging. It covers general biological theories of aging, common physical health problems in older adults, and normal changes that occur to the brain with aging. Section III describes the psychological components of aging such as changes in personality and emotional development, mental health aspects of aging, normal changes in cognitive functioning, cognitive reserve and interventions for cognitive decline, neurocognitive disorders in aging, aging's impact on relationships and families, and working in late life and retirement. The final section presents the social aspects of aging, which includes death, bereavement, and widowhood, aging experience in ethnic and sexual minorities, and lastly, aging and the legal system.
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.
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.
This chapter discusses several topics relevant to older adults' mental health including access and use of mental health services, prevalence of common mental health diagnoses, assessment of mental health symptoms, and empirically supported treatments for older adults. Although some topics presented in this chapter need additional research focused specifically on an older adult population, several conclusions can be drawn from the material. First, several studies have documented that older adults use mental health services less frequently than other age groups, although it is unclear why this is the case and likely involves a combination of barriers/access to treatment and stigma. Second, several of the mental health problems discussed may present differently among older adults, such as the specific symptoms of depression that older adults endorse. Third, assessment instruments for older adults need to be selected cautiously to ensure that adequate validity and reliability has been established for this population.
This chapter explores changes that occur to the brain, beginning with an overview of modern technologies that are used to answer questions about brain functioning in older adults. Next it summarizes the changes that occur to the brain with normal aging. Finally, the chapter presents an overview of neuroplasticity. Although the human brain clearly loses volume with age, the brain also shows plasticity that can be used to maintain functioning in old age. Research in the coming decades can use the principles of neuroplasticity described previously to enhance the functioning of older adults, whether they are experiencing normal age-related change or damage to the brain following strokes or other neurological events. Neuroimaging methods will continue to be developed that allow us to determine what happens to the brain with age, and in response to neurological events, and how neuroplasticity enables the brain to adjust to such changes.
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.
This chapter briefly discusses housing and housing education activities that offer several unique perspectives on understanding issues of housing for older adults. The housing education activities are as follows: (1) Find a Nursing Home, (2) Field Trips to Senior Facilities, (3) Household Disaster Planning Kits, (4) Long-Term Care Residence Disaster Planning and (5) Applying Anti-Racist Pedagogy to the Exploration of Senior Housing. Activity 1, simulates some of the challenges older adults and their families face by actively engaging participants in the process of evaluating nursing home quality. Activity 2, provides hands on context to understanding the diverse housing options in the senior housing continuum. Activity 3, addresses an often overlooked concern for persons aging in place. Activity 4, similarly addresses the issue of emergency preparedness, this time in the context of conducting research and a focus on institutional rather than individual planning.
This chapter begins with a description of multiple systematic reviews and meta analyses of problem-solving therapy (
PST) interventions. The number of studies evaluating PSThas increased over the past decade, so more reviews has been conducted. The chapter discusses PSTfor various mental and physical health problems and depression. Following this it also discusses PSTin primary care and among older adults. It briefly describes PSTfor diabetes self-management and control; vision-impaired adults and social problem-solving therapy in school settings. The chapter describes PSTas a transdiagnostic approach. It briefs the listing of PSTinvestigations and supports the characterization of this approach as a transdiagnostic intervention. The chapter also demonstrates its flexibility of applications. Finally, it highlights certain aspects of the recent outcome literature featuring various clinical problems (e.g., health and behavioral health disorders), populations (e.g., older adults, children, ethnic minorities), and modes of delivery (e.g., telehealth).
Cognitive decline that is significant enough to interfere with independent living is known as dementia, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) introduced the term major neurocognitive disorder to refer to this condition. This chapter reviews the most common causes of neurocognitive disorders in older adults. It begins with a discussion of delirium, which should be ruled out whenever an older adult is showing signs of cognitive decline. Next, it presents an overview of the current diagnostic terminology, including mild cognitive impairment (MCI), dementia, and the DSM-5 diagnoses of mild neurocognitive disorder and major neurocognitive disorder. The chapter next reviews traumatic brain injuries (TBIs), Alzheimer's disease, Lewy body disease, Parkinson's disease, vascular disease, frontotemporal degeneration, which includes a behavioral variant and a language variant, and alcohol-related dementia.
Digital social networking is essentially limitless, but it requires an Internet connection, a device, and the ability to use the technology. This chapter addresses the following questions: To what extent do older adults take advantage of the Internet and social media for their social interactions?; Is it possible to reduce the epidemic of social isolation through these technologies?. It is organized as follows: It first reviews some facts about how older adults are adopting new technologies and the barriers that prevent their adoption. It then introduces new research areas which utilize modern technologies and have implications for combating the modern-day social isolation epidemic. Finally, the chapter discusses some cautions and research areas that need to be addressed before advocating digital socialization among older adults. The chapter also share some interesting discussion exchanges among members of the Gerontological Society of America posted in its open forum a few months ago.
- Go to chapter: Our Aging Future—Persistent and Emerging Issues for the Aging Networks: A Call to Action
This chapter addresses emerging and persistent issues that need attention for the benefit of today's elders and the elders of tomorrow. It discusses several persistent and emerging issues that need to be addressed by the aging networks and by the field in general. The persistent issues include: ageism; professional competencies; the aging workforce on all levels; and LTSS in the community. The emerging issues include: goodness of fit and changing cohorts; diversity; and innovation and the aging networks. Services and programs of the aging network are components of the home- and community-based care system that, by definition, is a long-term care system. As the field of gerontology grows and the population of older adults continues to increase, the need for a gerontologically educated workforce becomes a critical factor in our ability to provide a good old age for everyone in our society.
Many of today’s lesbian, gay, bisexual, and transgender (LGBT) older adults grew up in a time of intense homophobia and transphobia, when homosexual behavior was both criminalized and seen as a disease. The risk of social isolation for current LGBT older adults is likely increased as they are more than twice as likely to live along and four times less likely to have children than their non-LGBT peers. This chapter provides a brief description on: health well-being, and risks of social isolation for LGBT older adults; families of choice, social supports, and social networks; and disclosure management and access to services. Like all older adults, LGBT individuals need social connections to thrive as they age. Programs do exist to meet the social needs of LGBT elders. Fortunately progress is being made both within mainstream social and health services organizations and with increased development of specialized programs for LGBT older adults.
Interacting with persons with progressive declines in cognitive function poses a wide range of challenges, not only for families and care providers, but for the person with dementia as well. This chapter briefly discusses two activities that offer participants opportunities to develop and apply positive approaches to interacting with persons with dementia. In Activity 1, Dementia Communication and Empathy, participants are asked to role play scenarios where persons with dementia endeavor to communicate with their caregiver. Insight and increased empathy are promoted through the challenges participants' experience, not only in understanding the message being communicated, but also the challenges of conveying even a simple message while impaired by physical and/or cognitive limitations. Activity 2, Enhancing Students' Therapeutic Interaction Skills with Older Adults with Dementia, brings participants into the community to interact directly with persons with dementia.
Robert Butler coined the term “ageism”. Butler described ageism in three realms: stereotypes and prejudices against older adults, discrimination against individuals, and institutional practices and policy that disadvantage older adults or perpetuate discrimination. He believed that ageism accounts for disregard for older people's rights seen in public policy. He saw it in the failure of institutions to address the needs of older people or protect their rights, citing as evidence government's failure to protect older people against mistreatment or to enforce nursing home regulations. He saw it in the lack of attention to older people in disaster preparedness plans and in the institutional ageism that leaves many older people impoverished and vulnerable. Although Butler and others saw ageism as standing alongside other “isms” other forms of injustice and discrimination it never achieved their traction. This chapter explores why. The chapter discusses elder abuse, ageism in healthcare, workplace, and public policy and politics.
- Go to chapter: International Perspectives on Social Relationships, Social Isolation, and Well-Being Among Older Adults
International Perspectives on Social Relationships, Social Isolation, and Well-Being Among Older Adults
The interpersonal environment in which older adults are embedded strongly influences their health and well-being. A state of social isolation can be defined as the absence of a meaningful interpersonal environment. This chapter presents some important theoretical and methodological distinctions. It looks at the association between several key aspects of the interpersonal realm, on the one hand, and selected positive and negative well-being outcomes, on the other. It examines the contribution of the construct of network type, a composite measure of social relations, to the study and the understanding of the interpersonal domain of older people, and its role in well-being. Following this, it considers another indicator of social relations—this time, a scale of social connectedness—and how this measure disentangles the effects of social relations and social activity on well-being. Finally, the chapter presents findings on the implications of changes that occur in the interpersonal environment on the mental health.
This introductory chapter presents a brief description of the book and its contents. It begins with description of the concepts of truth, justice, and the American way. This book assumes that advocates for older people can increase their effectiveness by achieving a clearer understanding of Americans’ not-so-self-evident nor inalienable rights. It explores how social justice and human rights principles have applied to older adults in the past and are viewed today. The book examines how the interests of older adults compare to and are intertwined with those of other groups. In essence, it frames elder justice as the intersection between aging policy and policy that promotes human rights and justice. Finally, the chapter describes the organization of the book and presents a brief overview of each chapter.
The older adults most at risk for poverty are those who have experienced cumulative disadvantage as a result of low education attainment, entering the workforce for the first time during an economic recession, health problems that limit their ability to work over long periods of time, and involve extraordinary expenses for either themselves or family members and other vagaries of life. This chapter reviews the social insurance programs that support older Americans, poverty rates, modern retirement compared to “old-fashioned retirement”, gender differences, income equality, and the broad reach of Social Security. It also covers the mechanics of Medicare and Medicaid. There are three Voices in the chapter. One addresses the “comfortable retirement” and its differential meaning and possibility, another focuses on women 50 and over, and the final Perspective piece covers the broad reach of Social Security and its importance to families of all ages.
- Go to chapter: Older Americans Act Legislation and an Expanding Consumer Base: The Evolution of a Network
This chapter briefly outlines the history and structure of the Older Americans Act (OAA). It reviews the aging network of services and the network's development. In addition, the chapter provides an overview of the first major change in the operation of the OAA since its inception in 1965. The objectives of the OAA in Title I set the stage for a service philosophy that continues today, nearly 50 years after its enactment. The other titles of the act address specific policy initiatives and programs that address the policy intent of the act. Since its inception, the OAA has been an entitlement program based upon age and, more recently, special status such as being a family caregiver. Funding levels of OAA continue to be limited and most aging network services and programs are required to use additional resources to support the programs of importance to older adults.
Our ideas about spirituality and our connection to others, the universe, and the world around us vary over time, and, because spirituality is tied to the search for meaning, it becomes an interesting platform for gerontologists and their work with older adults. The two activities in this chapter bring both breadth and depth to the issue of spirituality in the context of end-of-life issues and, specifically, a direct assessment that connects students to their own selves and older adults. In Activity 1, Spiritual Assessment, Beran brings to the classroom a tool that allows students to reflect on their own spirituality and then compare that to an understanding of the broad concept of spirituality. In Activity 2, Exploring Cultural Death Practices Through Group Presentations, Claver and Goeller provide an opportunity for students to become more engaged in considering death and dying and later life in a cultural context.
This chapter focuses on Americans at risk for poor economic and health outcomes as they age—women, people of color, and lesbian, gay, bisexual, and transgender (
LGBT) individuals. It identifies older women, people of color, and members of the LGBTcommunity as being at risk for poverty during their later years. The chapter then explains the impact of caregiving responsibilities, partner status, and living arrangements on economic security of older adults at risk and highlights the detrimental effect of health inequities on their health outcomes. It stresses the importance of preventive health services for older adults at risk. Understanding the needs and risks of women, people of color, and LGBTindividuals is an important part of working in the field of gerontology. The Practical Application presented at the end of the chapter focuses on how to develop that understanding.
Everyone at every stage of their life benefits from community services and support. Different life stages call for different contributions. Many older adults certainly benefit from the services that their communities can provide for them. Yet, with their life-time experience and knowledge, older adults have much to give, too. Everyone benefits when they have reliable and safe ways to access opportunities to contribute to their communities. This chapter focuses on how older adults contribute to their communities and how they receive support. It outlines the many volunteer programs available to older adults and describes the services and programs primarily available through the federal government’s Aging Services Network, established by the Older Adults Act. The chapter also explores the issue of need and unmet need for services. The Practical Application presented at the end of the chapter highlights the tremendous contributions older adults make through their extensive volunteer work.
The family is the most basic social institution throughout the world. Families are studied in many disciplines, including anthropology, demography, economics, family studies, geography, gerontology, psychology, public health, social work, and sociology. This chapter explores what contemporary families look like around the globe, with a special focus on older members. This is a challenge, because one of the major characteristics of families is their diversity. The chapter begins with a brief example of the variability in contemporary definitions of the family. It then examines how population aging and global interconnections (specifically, economic and social factors) have changed the structure of families. Next, the chapter examines the living arrangements of older adults and their families, and looks at relationships within families. Finally, it explores macro- and microlevel factors that influence family functioning, and presents two important emerging roles of older adults in families.
Medicare and Medicaid are often confused with each other, likely due to their similar names. Older adults can benefit from both Medicare and Medicaid, if they meet the respective eligibility requirements of each program, in which case they are deemed dual-eligible beneficiaries. Although both programs relate to healthcare services, they are distinct programs. Medications play an essential role in the health of older adults. “Geriatric health care professionals and their patients rely heavily on pharmacotherapy to cure or manage diseases, palliate symptoms, improve functional status and quality of life, and potentially prolong survival.” This chapter outlines the various components of the Medicare and Medicaid programs. It describes some of the medication-related problems older adults experience and offers insights into how to avoid them. Managing multiple medications is particularly challenging for older adults; it is, therefore, the focus of the Practical Application presented at the end of the chapter.
Sexuality is “a central aspect of being human throughout life [encompassing] sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction.” The absence of conversations about sexuality in later life is in large part an outcome of ageism. It relegates older adults to “other,” it diminishes their quality of life, and it leads to a lack of attention to the serious consequences of sexual abuse and sexually transmitted infections, including
HIV. This chapter explores the topic of healthy sexual expression in older adults and identifies some of the barriers to older adult sexuality, including societal disregard and disapproval, lack of accommodation in residential care facilities, and certain health issues. It highlights the importance of safe sex practices and education about sexuality and aging. The practical application presented at the end of the chapter focuses on older adult sexuality within the context of residential care facilities.
This chapter briefly discusses health care and health care education exercises that provide students the opportunity to engage with various aspects of the health care system and for future health care professionals to engage with elders to minimize potential ageist attitudes. The health care education exercises are: (1) An Evidence-Based Team Approach: Benefits of a Gerontological Interdisciplinary Team, (2) Bingocize®: An Intergenerational Service- Learning Initiative to Improve Older Adults' Functional Fitness While Engaging Undergraduate Students and the Community, (3) Medical Students Community Engagement, and (4) What Would You Do? Getting Resources for Your Older Adult. Activity 1 helps to encourage nursing students and other future health care workers to interact with other disciplines in order to provide the best possible care for older adults and their families. Activity 2 encourages students to interact with older adults through exercise programs.
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).
Athletes are believed to be at greater risk for eating disorders than the general population. When examining the rates of autism spectrum disorder (ASD) among those with or without an eating disorder, an ASD diagnosis was found to be more common among those with an eating disorder. Accurately identifying older adults who may have an eating disorder has its challenges. Eating disorders understood in the context of physical disabilities reveal not so much an issue with respect to effectively and accurately diagnosing an eating disorder but in regard to the degree that body image issues can be pronounced among those who have a physical disability. Refusing to eat or engaging in fasting for spiritual reasons was a common practice during medieval times. The difference between those who benefit from having a religious faith and those who do not may lie in the difference between religion and spirituality.
Improving the lives of older adults is the primary goal of those who work in the field of gerontology, and doing so invariably also improves the quality of life of those who spend time with them, whether they are family members, friends, neighbors, or those who work with and for older adults. This chapter explores the many career opportunities within the field of gerontology and explains how the study of aging can be applied to any position in any field. It outlines educational pathways, professional organizations, credentialing opportunities, and job-seeking resources for those interested in a career in gerontology. The chapter also highlights the importance of entrepreneurship and innovation to help address the unmet needs of older adults. The Practical Application offers concluding remarks about the unlimited opportunity in the field of gerontology.
This chapter reviews the basic concepts related to the delivery of social work services and the many roles of the social worker in restorative and long-term care (
LTC) settings. The efforts of the health care social worker generally involve assisting patients/clients/consumers and their families in these transitional LTCand restorative settings. According to the National Association of Social Workers, health care social workers in these types of facilities should follow practice standards in administration, advocacy, clinical practice, consultation, and education and follow personnel practices such as staying in compliance with governmental regulations as well as the professional code of ethics. The activities performed in LTCsettings and restorative care services can cross a spectrum of care. This chapter focuses mainly on the needs of older adults in these settings; however, other populations such as children, adolescents, and persons with disabilities may also receive these services.
This chapter provides brief description on malnutrition and aging, and nutrition and homelessness. It discusses nutritional impact of substance abuse, and nutrition assessment and intervention. The chapter explores the impact that homelessness and food insecurity has on the nutritional status of older adults. Interventions must be tailored to accommodate the patient’s financial resources, medical conditions, and ultimately his or her own personal goals in order to be effective. Patients may be completely disengaged from nutrition education and focused on other priorities, which are essential for survival, that is, shelter and safety, thus making nutrition education the least effective intervention for that patient at that moment in time. Ideally, the homeless geriatric person would be monitored and re-evaluated; however, follow-up may be unrealistic. What does nutrition assessment look like in action? The chapter provides a case study to describe this question.
This chapter discusses the major mental health disorders experienced by older adults, identifies the most effective counseling approaches and psychotropic medications used to address the mental health needs of older adults, and provides an overview of best practice counseling and treatment interventions used to address the mental health needs of older adults. In an overview of the literature regarding major depression and dysthymia, Zalaquett and Stens examined the effectiveness of four commonly used individual therapies for treating older adult depression: cognitive behavior therapy (CBT), interpersonal therapy (IPT), brief dynamic therapy (BDT), and reminiscence therapy (RT) and life review (LR) therapy. Counselors can develop brief checklists to assist clients in tracking their symptoms. Counselors should also educate themselves about the signs of excessive alcohol and substance abuse, noting that some medical conditions may have similar symptoms to drug or alcohol abuse.
The field of counseling is an exciting and challenging career choice. It is a profession that has a prolific history of enabling person-centered counseling approaches for individuals, couples, partners, and families, and facilitates therapeutic services for children, adolescents, adults, and older adults. This book offers an excellent resource for graduate-level coursework that relates to an orientation to the counseling profession, professional issues, and special topic seminars, as well as other counseling-related coursework. It provides both contemporary insight and practical strategies for working with the complexity of real-life issues related to assessment, diagnosis, and treatment of diverse clients and their families. The book provides professionals with chapters organized into the 10 CACREP and CORE content areas that address the awareness, knowledge, and skills required to work with children, adolescents, individuals, groups, couples, families, and persons from diverse cultural backgrounds. The content areas are: professional counseling identity, ethical and practice management issues, case management and consultation issues, multicultural counseling awareness, counseling theories and techniques, career counseling and human growth, assessment and diagnosis, counseling couples, families, and groups, counseling specific populations, and contemporary issues in counseling.
- Go to chapter: Trauma-Informed Care and Adverse Childhood Experiences with Older Adults in Nursing Facilities
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.
Health educators constitute an important profession that is necessary for promoting health, but is not sufficient. They must learn how—and be allowed—to collaborate with health providers who may not recognize their worth, and with patients/clients who may resist their guidance. Health professionals and older adults need to be informed about a great many health education topics. This chapter explores a few of these topics: smoking, alcohol, medication usage, injury prevention (fall prevention and motor vehicle/pedestrian safety), sexuality and intimacy, and sleep. Older adults can share intimate support in many ways. Practical health research findings are reported on in academic journals or popular media almost every day of the year and it is a challenge for health educators, providers, and patients/clients to stay current. A collaboration among the three groups is essential. Perhaps the most successful outcome of health education had to do with smoking cessation.
- Go to chapter: The Framework for Federal Involvement: The White House Conference on Aging and the Older Americans Act
The Framework for Federal Involvement: The White House Conference on Aging and the Older Americans Act
The Older Americans Act (OAA) passed in 1965 provides a foundation for such involvement through its original mandate to serve all older Americans through a plethora of services and supports designed to help maintain the independence, security, and well-being of older adults. In 1958, legislation was introduced that asked for a White House Conference on Aging, which would bring together persons from all parts of the country to make policy recommendations that would focus on the economic security of older persons. Indicators show that it has been helping homebound elderly at risk of nursing home placement to stay at home, and it has continued to build the capacity of state agencies and Area Agencies on Aging (AAAs) to implement comprehensive systems of care. To improve its performance, the Administration on Aging (AOA) is focusing on improving efficiency, improving client outcomes, and further targeting services offered to the vulnerable elderly.
According to the surgeon general’s report, regular exercise and physical activity improved health in a variety of ways, including a reduction in heart disease, diabetes, high blood pressure, colon cancer, depression, anxiety, excess weight, falling, bone thinning, muscle wasting, and joint pain. This chapter reports on studies showing evidence that exercise demonstrates considerable promise for older adults in a variety of areas of disease prevention and improved physical and cognitive function. Exercise as a weight maintenance strategy, though, becomes less efficient as we age. The best exercises for weight control are a combination of aerobics and strength building. The four components of a community exercise class are aerobics, strength building, flexibility and balance, and health education. The acceptance of the importance of exercise is now universal, including all age groups; however, the practice of exercise does not match the knowledge of its worth, and it becomes increasingly challenging with age.
The rights to health and health care in the event of illness, disability, or old age are detailed in Article 25 of the Universal Declaration of Human Rights (UNDHR). These rights are fundamental to the well-being of older adults as their needs for medical care increase with age. As episodes of acute illness decline, chronic conditions increase with age, impacting both individuals and society. Chronic conditions such as arthritis and heart disease permeate many areas of a person’s life, often increasing demands for an array of support. Medicare was developed in the 1960s to address the needs of the aging population with regard to health care. Medicaid, Title XIX, under the Social Security Act was passed in 1965 to provide health care for those below the poverty line. Consumer-directed care programs have the older person responsible for hiring the care provider and determining the services he or she wants.
Empowerment for an older person means having the opportunity to learn, discuss, decide, and act on decisions. From the perspective of the health professional or health educator, empowerment of older patients in the clinic setting or clients at a community site means not only to provide service to them, but also to collaborate with them, to encourage their participation. Certain personality characteristics, such as patience, tolerance, and a positive attitude, enhance the health educator’s chances for collaborating successfully on a health goal. There are health-promoting strategies that may help. For those who are behavior management-oriented and like recordkeeping, the health contract might be helpful. There are support groups to help with chronic diseases, caregiving, coping with loss, and alcohol or other addiction problems. Empowerment, with its rewards and risks, is fast becoming a requirement in the era of chronic healthcare conditions that must be managed, sometimes for decades.
This book provides a tool kit for helping professions responding to vulnerable populations and preparing populations prior to a disaster. Some populations are more vulnerable to the effects of a disaster than others, making it more difficult for them to prepare, evacuate, shelter, respond, and recover in the event of a disaster or emergency. Considering the needs of these groups requires special knowledge essential to preparedness, response, and recovery planning. In circumstances where there is mass evacuation, such as during Hurricanes Katrina and Sandy, there is always frequent media coverage of large-scale evacuations, including evacuation of medical facilities and nursing homes. Those with chronic medical conditions and older adults are two of the many categories worthy of consideration. Vulnerable populations also include pregnant women, prisoners, the homeless, those with functional mental health issues or addiction issues, those with transportation issues, persons in poverty, minorities, persons who are obese, and those who have special supervision needs. Socioeconomic status (SES) has recently been recognized as a significant vulnerability factor. Evacuation can also be an issue for those of a lower SES due to limited financial resources. Dealing with persons with substance abuse and dependency is one of the most neglected areas in the literature involving empirical evidence and guidelines for appropriate response in a disaster. Developing appropriate guidelines and interventions presents a thorny set of problems for both addicted individuals and emergency responders. A final consideration is the role of pets in disaster recovery. Those who engage in disaster preparedness and response with vulnerable populations should be aware of the characteristics that make those populations vulnerable and make special considerations during planning, response, and recovery. The book highlights some of those characteristics, providing responders with necessary guidelines to assess and intervene with those who are especially vulnerable.
This chapter discusses some countries and their policies to highlight the ways in which older adults are impacting society. Each of the countries discussed has developed policies to meet the needs of their older citizens with varying recognition and emphasis on their human rights. The policies of each reflect underlying sociocultural and economic factors and the ways in which aging and the aged are perceived in their society. Meeting the economic challenge of an older population along with changes in family structures requires planning and policies in several areas. Pensions, accessible health care, family assistance, housing and community services, and formal support programs that can assist older adults in their homes are among the areas where reforms are most needed. Specialists and long-term care facilities are rare, and there is a noticeable absence of mental health services in most countries.
The right to life, liberty, and security is most profoundly challenged by guardianship, which is a procedure that can severely constrict the older adult’s ability to act on his or her own and according to that individual’s own wishes. The Uniform Adult Guardianship and Protected Proceedings Jurisdiction Act (UAGPPJA) of 2007 attempts to improve the guardianship process by making it more uniform across states, and it is particularly important when a guardianship involves several states. The costs of programs such as continuing care, assisted living, and the village model remain too expensive for the majority of older Americans and federal assistance through subsidies is very limited. Transportation is a critical service necessary for many older adults to remain in the community. Efforts are being made to develop appropriate accessible transportation for older adults and those with disabilities.
Recognition of posttraumatic stress disorder (PTSD) in older adults is often difficult due to its complicated presentation. Once recognized, trauma symptoms can, in accordance with (inter)national guidelines, be successfully treated with eye movement desensitization and reprocessing (EMDR) therapy. However, limited empirical research has been done on the expression and treatment of PTSD in older adults. This article explains trauma and age in the context of psychotherapy. It discusses the interaction between age and pathology and summarizes the cognitive issues related to age, PTSD, and anxiety. It provides practical suggestions for how these can be addressed in treatment. Age-related challenges related to motivation are identified with practical suggestions for addressing them. The case illustrates the necessary additions and subtractions for older adults, with clear explanations and instructions. This article points the way for future research.
- Go to article: Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study
Cognitive Behavioral Therapy for Older Adults With Anxiety and Cognitive Impairment: Adaptations and Illustrative Case Study
Anxiety is a prevalent condition in older adults with neurocognitive disorders such as dementia. Interventions based on cognitive behavioral therapy (CBT) appear to be an emerging area of treatment innovation for treating anxiety in older adults with cognitive impairment. Drawing on the empirical literature on CBT for late-life anxiety and recent trials of CBT for anxiety in persons with mild-to-moderate dementia, this article provides an overview of the customization of CBT to the needs of older adults with anxiety and cognitive impairment. Adaptations for assessment, case conceptualization, socialization, therapeutic alliance, and treatment strategies are discussed. A case study to illustrate implementation of these adaptations is presented. Limitations to the current state of the literature on the efficacy and feasibility of CBT for anxiety in older adults with cognitive impairment are identified, and future directions for treatment research are proposed.
Old age brings with it unique challenges in diagnosis, treatment, and care; dementia complicates these issues even more. Improving the management and care of persons with dementia has positive implications for patients, caregivers, and physicians alike. Two types of secondary complications can be analyzed in relation to dementia: conditions that arise outside of the dementia and then conditions that appear to develop due to the neurological degeneration inherent in dementia. Examples of psychiatric complications include depression, anxiety, and psychosis. Medical problems consist of issues such as stroke, cardiovascular problems, cancer, infections, orthopedic issues, diabetes, nutritional disorders, vision and hearing problems, as well as general pain. The high comorbidity of dementias with other psychiatric and medical issues can complicate the diagnosis and treatment of patients with dementia. Issues in the central nervous system (CNS) have long been looked at as possible predictors of dementia.
- Go to article: The Lived Experience of Community-Dwelling Older Adults With Chronic Obstructive Pulmonary Disease (COPD) in a Rural Community in Northern Thailand
The Lived Experience of Community-Dwelling Older Adults With Chronic Obstructive Pulmonary Disease (COPD) in a Rural Community in Northern Thailand
The purpose of this study was to describe the experience of community-dwelling older adults living with chronic obstructive pulmonary disease (COPD) in a rural community in Northern Thailand. The study was grounded in Parker and Barry’s model of community nursing practice model based on the concepts and values of respect, persons in their wholeness, and caring in nursing. Data were generated and analyzed using Giorgi’s phenomenological approach. Four themes were revealed: confronting a life-threatening illness, caring for self, keeping meaningful relationships, and living guided by spiritual beliefs. The meaning of the experience was synthesized as finding balance between living with a threatening illness and living meaningful lives.
This study proposes a novel cooperative caring model for older adults with dementia. Crucially, in this model, nurses need to understand older adults with dementia as active contributors to caring interactions rather than passive recipients of care. Our approach emphasizes that a caring relationship develops by virtue of complementary cooperation, one through which both parties make positive contributions to the other party's actions. With such an approach, the active role of older adults with dementia is revealed, which creates a positive cycle wherein both parties change.
- Go to article: Improving Social Work Student Competence in Practice With Older Adults Affected by Substance Misuse: Spotlight on the Bronx
Improving Social Work Student Competence in Practice With Older Adults Affected by Substance Misuse: Spotlight on the Bronx
Through the lens of a case study, this article suggests ways to increase social work student competence in gerontology and substance abuse treatment to better meet needs of growing numbers of diverse clients in urban settings. Focusing on a client residing in the Bronx, New York, it explores how changing demographics and a lack of workforce preparedness can combine in an urban context to increase risks for older adults and reduce quality of life in late life. Aiming to reduce knowledge and service gaps, suggestions are made on how to improve social work student competence. These include interpreting client cases through a theoretical framework to deepen understanding about the intersection of advancing age and substance use and improving treatment skills.Source:
Online dating is becoming more and more common among younger people as well as older adults. There are many different websites that people interested in online dating can use or subscribe to nowadays. There are also many dating services that aim at a large part of the population and try to distinguish themselves by means of the particular matching services they offer or by the number of potential partners people have access to through their site. Throughout most of human history, until very recently, one's choice of dates was restrained by geography. In addition, there are biological approaches that can be used as a complement to dating websites and are often integrated into these sites. Often people move their conversations off the dating website relatively quickly and converse by e-mail or phone to get to know each other better.Source:
This chapter aims to discuss the cohort effects, health disparities and cultural stressors, and factors contributing to the resiliency and growth of ethnic, sexual, and gender minority older adults. Being part historian, student, and investigator can help clarify how these multifaceted aspects of identity affect the experiences of older adults in your personal and professional lives. The intersectionality of these factors makes for complex, inspiring, and sometimes distressing stories about overcoming adversity, achieving new heights, and at times sitting with the pain and frustration of discrimination and prejudice. The diversity within older adult populations also affords invaluable research opportunities to improve our knowledge of aging and enhance our provision of care. Moreover, developing a greater appreciation for older adults, including their strengths and hard-fought battles, can help us appreciate the privileges and civil rights we often take for granted.
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.
The issues evoked by an aging world pose new challenges with regard to employment, health, retirement, families, and the economy. Societies respond to these challenges in varying ways and these responses can be subsumed under the rubric of social policies. Human rights apply to everyone; they do not diminish with age. This book discusses many of the key issues and concerns confronting older adults in the United States and the policies formulated to deal with them. The ways in which these policies reflect human rights is key in each chapter. The first chapter presents the background on social policy and human rights and how they pertain to and impact older adults. The second chapter focuses on the Older Americans Act (OAA), the foundation of aging policy in the United States, as well as on the federal government involvement by discussing the White Housing conferences on aging. While the third chapter addresses economic supports for older adults, the fourth chapter examines policies associated with liberty and security. The fifth and sixth chapters discuss physical and mental health, and focus on employment and the workplace. This is followed by a discussion on the social policy and the family and by examining how policy relates to vulnerable populations of older adults. The penultimate chapter of the book explores the ways in which various countries are developing policies for their older population and how these reflect human rights. The last chapter looks at the future policy challenges that must be met in order to ensure that rights of older adults are addressed.
Policies that promote social ties, social networks, activities, and the involvement of older adults in communities would simultaneously combat isolation and age discrimination and benefit society as a whole. Discrimination marginalizes and disenfranchises older adults, and in doing so treats them as a problem to be solved rather than as equal members of the community who are entitled to the same basic human rights. Social Security is the primary source of income for most older Americans and is particularly important for minorities, older women, and those who have had lifetimes of low earnings. Continuing care communities and assisted-living facilities which could enable many to remain in the community are unaffordable for the majority of older adults. The Medicare program continues to focus on acute rather than chronic care and thus fails to address the health care needs of many older adults.
Vulnerability places older adults at grave risk of having many of their human rights violated. These are persons who have faced discrimination throughout their lives, and if they become dependent with age they are bound to face increasing inequalities. Vulnerability itself can be a precursor to the most extreme violation of human rights, elder abuse. The inequality that women face throughout their life span makes them particularly vulnerable to having rights ignored in their later years. In addition to being more likely to be living alone, older women are nearly twice as likely as older men to be poor. Long-term care is a significant burden for older women, as they are more likely than men to be both caregivers and care receivers. Medicare plays an important role in the lives of older women who comprise more than half of all beneficiaries.
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 introduces some of the concepts that are important in the psychology of aging. It starts by discussing definitions of older adulthood and some characteristics, as a whole, of older adults. It then reviews the data on the projected increase in older adults in the United States and internationally. The chapter discusses the importance of birth cohort and continues to be an important theme throughout this book. Specifically, it reviews characteristics of the Baby Boom generation since most of the current generation of older adults were born in that era. Erik Erikson and Paul Baltes are two researchers who have made substantial contributions to the development of aging studies. The chapter then reviews development of the professional field and training resources that are available to students and professionals, and ends with a discussion of research methods that attempt to untangle the effects of age, cohort, and time of measurement.
This chapter reviews age-related changes in personality and emotional functioning. There are several theoretical approaches to studying personality, and most of them have examined the extent to which the theory applies to older adults. For example, Joan Erikson's proposal of a ninth stage of psychosocial development, as well as ways in which attachment processes may be important in late life, and ways in which coping strategies change with age, all represent the application of existing theories to later life. The chapter focuses on emotional functioning in late life. Overall happiness and life satisfaction tends to increase with age. Older adults also show more effective strategies for regulating emotions, including situation selection and attentional deployment toward more positive features of the situation. Some of these changes can be accounted for through two theoretical models: socioemotional selectivity theory and the strength and vulnerability integration (SAVI) model.
This chapter explores what major factors contribute to and detract from older adults’ ability to sustain sexual and romantic satisfaction well into the last half of their lives. It pays particular attention to the ways in which being single can both inhibit and be a positive part of this new stage of love, sexuality, and intimacy for older adults. The chapter concentrates on the demographic traits of the post-50 population that affect sexual and romantic longevity; however, it discusses toward some of the psychosocial variables that can impact sex after 50 (such as societal stigma and personal communication styles between partners) as well as some of the more inevitable obstacles to sex older men and women experience. It also looks at how institutional practices such as the current state of long-term care facilities often have policies that inhibit their residents’ ability to be sexually active.
Older adults who are not only living longer, but actually in better health too, could boost the economy by virtue of their longer periods of productivity, their ability to earn and save more income over time, and their purchases and consumption of more goods. Furthermore, because of their accumulated wisdom, skills, and talents, they have much that they can contribute to our social environment. This chapter focuses on the longevity dividend and the importance of mobilizing all sectors of the society to realize the opportunities and address the challenges of an aging society. It includes demographic information related to aging in the United States as compared with that of other countries, as well as a discussion about the detrimental effects of ageism on older adults and on society as a whole. It is especially important for gerontology professionals to understand and avoid ageism.