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171_11.pptxSwu 171 intro to social work
Dr. Hilary Haseley, PhD, MSW, ACUE
Overview
Chapter 11
Definitions
Aging: Changes that occur to an organism during its life span, from development to maturation to senescence
Senescence: The gradual decline of all organ systems, especially after age 30
Ageism: Negative attitudes, beliefs, and conceptions of the nature and characteristics of older persons that are based on age and distort their actual characteristics and abilities
Gerontology: The comprehensive study of aging and problems of older adults
Different conceptions of age
Chronological age: The number of years a person has lived, which is used as a standard to measure intelligence, behaviors, and so forth
Biological age: A measure of how well or poorly one’s body is functioning in relation to one’s actual calendar age. It describes a person’s development based on biomarkers, such as a cellular or molecular event, looking at the person as they are, not just when they were born
Psychological age: A subjective description of one’s experience using nonphysical features
Social age: An estimate of a person’s capabilities in social situations, relative to normal standards
AARP membership begins at age 50, a marker of chronological age
Social security has defined retirement age as 65 (moving toward 67)
People of the same older age have vastly different situations and experiences
Cohort: A group of people of the same generation sharing a statistical trait such as age, ethnicity, or socioeconomic status
Old, Older, Oldest
Young-old: A term used to denote a person who is between 55 and 75 years of age
Middle old: A term that refers to persons 75–84 years old
Oldest-old: A general term that refers to the population over age 85, which is the fastest-growing age group in the United States and some other nations
Centenarians: People who are 100 or more years old
Supercentenarians: A person who is significantly older than 100 years of age
Life expectancy
Life expectancy: How long, on average, a person is expected to live at a given age
Life span: The number of years a person actually lives
Longevity: Living an active life longer than the average person
Based on genetics and lifestyle
Current issues
More of the population is older than ever before
Increased life expectancy, decreased birth rates
Health-care workforce needs to grow in capacity to accommodate the growing older population, especially the oldest-old (85+)
Threats to well-being and lives of older adults living through the COVID-19 pandemic
Gerontological Social Work
Two specialties:
Gerontological social work: focuses on biopsychosocial-spiritual aspects of aging
Geriatric social work: focuses on physiological changes and health care
Evolution of gerontological practice
Older adults seen as target client population beginning in 1960s/1970s
1995: Social workers participated in National Forum for Geriatric Education
Hartford Foundation began funding social work research regarding care for older population
Gerontological Social Work
Work within client homes and institutions
Provide a range of client-focused direct services
Help clients choose Medicare Part D plan
Inform families about daycare facilities and provide referrals
Intervene in crisis situations
Provide grief counseling to clients and families
Provide referrals to home health and respite care
Provide and assist clients with applications for housing and transportation services
Mandated Reporters
Refer clients to adult protective services
Adult protective services: Services provided to ensure the safety and well-being of older individuals and adults with disabilities who are in danger of being neglected or mistreated or who cannot take care of themselves or protect themselves from harm and may have no one to help them
Social workers are mandated reporters and elder abuse is one of the three things social workers are mandated to report
https://des.az.gov/services/basic-needs/adult-protective-services
Advocates and Liaisons
Geriatric social workers serve as advocates and liaisons for older adults receiving treatment
Can link clients with nurses who can assist with activities of daily living
Activities of daily living (ADLs): Basic and complex dimensions of daily life, such as taking medicine, bathing, and preparing meals, as well as more instrumental activities such as managing money, preparing meals, shopping, and housekeeping
Assessment of clients is multifaceted and ongoing
Active and Successful Aging
Active and successful aging
Active aging: Becoming older but still active in community, family, society
Successful aging: Continuing active engagement, avoiding disease/disability
Housing Types
Assisted living: Apartment-style residences where older adults get individualized services to maximize their independence
Continuing care retirement communities: Communities that combine parts of assisted-living, independent-living, and skilled nursing home care to offer a tiered approach to helping people who are aging and changing
Nursing homes: Homes for older adults in which most residences require daily nursing care
Foster care homes, group homes, housing, and urban development housing projects: living options for older adults who have lifelong developmental or intellectual needs or are economically challenged
Cohousing community for older adults, where residing in the same building supports older adults’ independence and social interaction
Day Programs
Provide care for older adults while relative caregivers may be at work
Must honor their skills and help them make use of their areas of expertise and interest
Service options
Clubs and volunteer programs
Congregate meals
Adult daycare centers
Fitness centers with older adult classes
Senior centers
Foster grandparent programs
Benefit Programs
Medicare for adults 65+ provides coverage for hospital stays, home health, and end-of-life care; prescription benefits optional and available through Part D
Medicaid for low-income individuals, all-inclusive
Supplemental Security Income (SSI) recipients can be assisted in applying for Medicaid; provides funds for food, clothing, shelter
Social workers can be instrumental in helping older adults apply for benefits
Culturally Competent Care of Older Adults
Norms and values of clients’ cultures must be respected and honored
Respect for knowledge and accomplishments may be important
Cultural barriers for older adults who seek assistance for mental health or socioenvironmental issues
D, D, D, D
After age 30, gradual decline in organ systems
Aging process varies widely among different people
Four Ds of aging: death, dementia, depression, disability
About 80% of older adults will have at least one chronic condition that impacts their ability to carry out ADLs
Chronic pain is also common, along with vision impairment, incontinence, and a range of other issues
Assistive technology may help clients adjust to these changing ability levels and live as independently as possible
Five-Factor Model (Big Five)
Cognitive and psychological aspects of aging
Five-factor model (Big Five): A trait approach used to categorize people on the basis of personality. Five traits are neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness
Can be used to predict mortality
Neurocognitive disorders (dementias)
Diagnosed when one has both of the following: problems with at least two brain functions and inability to perform some ADLs
Alzheimer’s disease: A progressive degenerative disorder that attacks the brain’s nerve cells or neurons and causes premature senility
Vascular dementia: Dementia caused by stroke
Significantly impact family members, as they are unable to recognize the person with dementia anymore
Depression and Aging
Depression is not a normal part of aging but may occur
Often missed when someone is dealing with a chronic physical illness
Depression is a bigger risk when one has fewer social contacts
Family members should be a part of the treatment process
Substance use and Sexual Activity
Substance use and addictions
May begin in old age as one deals with losses and health changes
Small amounts of drug and alcohol use can significantly impact older adults
Prescription misuse is a growing problem, especially for women
Sexual activity
Sexual desire often continues, but physical challenges may arise
STI transmission is still possible
Sexuality among older clients should not be taboo, regardless of sexual orientation or relationship status
Loneliness and Suicide
Loneliness
Mobility changes and death of close friends and loved ones lead to increased loneliness
Emotional isolation and social isolation both have negative impacts on health
Being alone is not necessarily loneliness; some older adults enjoy it
Suicide
White men over age 85 are at highest risk for suicide of any group
Female suicide risk declines after age 60
Ageism
Ageism
Negative stereotypes may shorten life spans.
Positive beliefs can lengthen lives.
Social workers need to dispel myths.
https://www.who.int/news-room/questions-and-answers/item/ageing-ageism
Aging in Place
Ability to live independently in one’s home and community safely and comfortably
Supports the idea that people should be allowed to remain at their homes as long as is feasible, rather than going to nursing facilities
Naturally occurring retirement communities are options for aging in place as well
Sandwich Generation
Families provide 80–90% of care for older adults in their own homes
Care work is disproportionately done by women and can be exhausting
Sandwich generation: Caring for both one’s children and one’s parents
Caregiving norms vary from culture to culture
Rural residents and those with developmental disabilities require special care as well
The Village
Long-term care:
Special insurance is available to cover long-term care
Typical insurance and Medicare do not cover extended custodial care
Less than 3% have such coverage
The village concept:
Provide way for older adults to age in place with dignity
Members of the village pay a monthly or annual fee into a fund that will help them obtain services when needed
https://www.kqed.org/stateofhealth/22411/village-movement-for-aging-seniors-faces-some-challenges
Risk Factors in Aging
More likely to be victimized by crime
Demands of caring for older people may make caregivers lash out
500,000+ cases reported yearly, with millions unreported
Forms
Physical abuse
Emotional or psychological abuse
Sexual abuse
Neglect and abandonment
Financial abuse
Spirituality and Religion
Benefits of spirituality and religion in old age
Related to enhanced feelings of well-being, inner emotional peace, and satisfaction with life
Affiliation with religious groups can decrease isolation
Aging and spirituality
Spirituality is the most frequently addressed topic of hospice visits with those who are terminally ill
People worry their death will be more painful or undignified than they would have chosen
Aging and religion
Buffering effect of religion and spirituality
Promotion of connectedness and decreased isolation from affiliation with religious institutions
Illness, death, and faith
Death with dignity legislation continues to be controversial
https://www.youtube.com/watch?v=0V_5m4TYB_0
Policies
Pensions
Social security is the best known
Private and public employers may also offer pensions
Health insurance and Medicare
Medicare Part A: Hospital coverage
Medicare Part B: Outpatient hospital care, doctor’s services
Medicare Part C: Nursing home care and blood draws, partial coverage
Medicare Part D: Prescription drug coverage
Area agencies on aging
Older Americans Act in 1965
Encourages independent living as long as possible
Approved in 1981, Area Agencies on Aging provide services for non-English-speaking adults, legal services and transportation, homemakers, in-home services
Class and Aging
Class may shift as one moves into retirement
Close to half of older Americans have lived at or near the poverty line for at least a year
Likelihood of lower class increases with minority status
Socioeconomic status is a key factor that determines the quality of life of older Americans
Risks
Women are the majority of older population
At risk for poverty more than older men due to several factors
Lower lifetime earnings
Changes in marital status
Preexisting economic status
Length of time spent in widowhood
Women more likely to experience the loss of a spouse
LGBTQ+ older adults have similar needs but have been doubly stigmatized
Sexual orientation may be something they are reluctant to disclose due to fear of judgment
Senior care facilities don’t typically accommodate same-sex couples as they do heterosexual couples
Current Issues
Most older adults are not in nursing homes—not even most of the oldest-old
Abilities range tremendously among older people
Increasing obesity rates among older adults
Alzheimer’s disease has a significant impact
Advocacy
Advocacy for clients’ transportation needs
Recognize the economic needs and vulnerability of older clients
Battling stereotypes can help clients’ self-esteem and help practitioners identify conditions in need of treatment
Supportive environment
People in poorer areas have more risks and may struggle with access to care
Caregivers’ locations in respect to care receivers can impact their wellness
Need for home modifications
Human Needs and Rights
Addiction may emerge in older age not as recreation but as an attempt to cope
Use of these substances can impair functioning more than the older users may realize
Gerontological social workers can keep these issues in public eye
Caregivers experience both burdens and benefits
