Holistic Approach
Ashley Taylor
InterventionwiththeElderly.pdf
Chapter 8 Intervention With the Elderly
Michael J. Holosko, Jeffrey F. Skinner, Catherine A. Patterson, and Kimberly Brisebois
Purpose: This chapter offers an overview of current and practical issues related to social work interventions with the elderly. Rationale: With our aging population rapidly increasing, gerontological social workers will be needed more than ever. They require basic knowledge of the required intervention skills necessary for both entry and advanced levels of practice with the elderly. How evidence-informed practice is presented: We present a summary of current evidence-informed practice interventions and analyze this literature in terms of: conceptual/theoretical frameworks for treatment, effectiveness studies, and specified intervention and outcome studies. Implications for education are then discussed from this framework. Overarching question: How does evidence-informed practice inform social work interventions with the elderly?
This chapter presents an overview of issues related to interventions with the elderly. Gerontological social work is predicted to be one of the high- demand future job markets for our profession, as we in the United States are rapidly becoming an aging society (U.S. Bureau of Labor Statistics, 2004). Thus, it seems both relevant and timely to include a chapter about this area of social work practice. Prior to presenting the materials that assess the efficacy of evidence-based interventions with the elderly, a brief historical background provides the context and rationale for understanding this information.
Historical Background
The Demographic Reality
In most industrialized countries of the world, a demographic population explosion has occurred among those aged 65 and older. This is primar- ily attributed to improved medical treatment, earlier changes in lifestyle, reduced mortality rates, increased financial independence, old age pen- sions, governmental assistance, advances in technology, greater mobility
197 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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198 Social Work Practice With Individuals and Families
and access to health and social services, and formal and informal support networks (Holosko & Feit, 2004).
For the past 40 or 50 years, U.S. policy makers at federal, state, and/or local levels have both witnessed and acknowledged this exponential growth, but they don’t quite know how to deal with it. For example, in an article written by A. Otten in the Wall Street Journal, on Monday, July 10, 1984, a three-part series was titled: ‘‘The Oldest-Old: Ever More Americans Live into Their 80’s and 90’s and Cause Big Problems’’ [Part I]; ‘‘The Strain on Social Services and Relatives Will Rise: Should Care Be Rationed?’’ [II]; and, ‘‘A Five-Generation Family’’ [III]. Concerns about how to reconcile or address this reality are a long-standing and ubiquitous feature of our society. Breaking these data down a bit further provides additional insights into some interesting and challenging policy and practice realities for social workers practicing in this area.
Although there is some disagreement in the literature about what constitutes an elderly person, policy makers deem 65 as the present age benchmark (Holosko & Leslie, 2004). From a formative or Level I life-span perspective, persons over 65 represent the fastest growing age group in the United States. Projections are that by the year 2030, over 70 million Americans will be at least 65 years of age (Administration on Aging, 2003). At a Level II perspective, this subgroup is further broken down by current health, aging, and lifecycle markers as: young-old, or 65–75; moderately old, or 75–90; and old-old, being 90+ years. Indeed, since about 1988, the fastest growing cohort on our lifecycle continuum is the 85+ year-old category (Feit & Cueuves-Feit, 1991, 2004).
From a Level III demographic perspective, (a) there are and will continue to be more women than men who live beyond age 65 in the United States; (b) more of the 65+ age group will come from ethnically diverse groups; (c) more elderly will be actively employed in the future; (d) more elderly will be residing in urban centers rather than rural settings; and (e) more elderly will become meaningfully involved in our day-to-day lives, for example, in arts, literature, movies, athletics, politics, educational and economic institutions, and so on. Indeed, as indicated by Holosko and Holosko (2004), as a society, we can no longer take an out-of-sight, out-of- mind mentality with the elderly because they are and will continue to be in plain sight and clearly in our minds. Just where and when these three growth trends will subside or even plateau is nowhere to be seen on our current society’s horizon.
Practice Implications
In attempting to discern how these trends may impact on social work practice with the elderly, the first author conducted a literature search on emerging practice issues about the elderly from 1975 to 2006. Tables of contents for main teaching texts written by social workers, as well as training institute workshops offered by the Council on Social Work Edu- cation (CSWE) and the National Association of Social Workers (NASW), served as the database for this cursory review. One rather interesting
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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2 0 1 3 . Jo
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Intervention With the Elderly 199
finding emerged. The so-called emerging-practice issues cited early on in documents by Lowry (1979); Schneider, Decker, Freeman, Messerschmidt, and Syran (1984); and Greene (1988) were the same emerging practice top- ics listed by the Hartford Foundation’s Gero-Education Group at a recent CSWE Conference (www.Gero-EdCenter.org), almost verbatim circa 1988.
To the nascent reader of these admittedly rather spurious comparative data, it would appear that practice issues that were deemed on the forefront some 20 years ago by our profession are still on the forefront today. However, what has changed is not the issues themselves but (a) the sheer numbers of elderly; (b) their various subgroups; (c) their health and psychosocial problems, and the context in which they present; (d) the variety of interventions we offer to deal with these issues; and (e) our ability to assess the efficacy of our interventions. Sadly, what else has not changed (in this brief chronological snapshot) is the dire shortage of social workers educated and trained to practice in this area (Hooyman & Kayak, 2002; Lowry, 1979). A recently released NASW National Workforce Study of licensed social workers reported the number of new social workers providing services to older adults is decreasing, despite the projected increases in the number of older adults who will need social work services (NASW, 2006).
Defining and Assessing the Evidence-Based Practice Interventions
Social workers’ decade-long affair with evidence-based practice (EBP) has been significantly tempered (Gambrill, 2006). This is due in large part to the profession’s inability to realistically define the concept and practitioners’ inability to implement it in practice (Thyer & Kazi, 2004). An evolving and much more realistic definition of EBP is ‘‘the conscientious and judicious use of current best practice in making decisions for individual treatment’’ (Howard, McMillan, & Pollio, 2003; Pollio, 2002, 2006; Sackett, Richardson, Rosenberg, & Haynes, 1997). This less stringent definition is used in this chapter.
As a result, the information reviewed herein included both quanti- tative and qualitative research as well as evaluation research studies. In short, as long as empirical data were systematically collected to either inform or direct practice, they were retained for subsequent analyses. Figure 8.1 presents a three-cohort conceptualization of these data-driven studies.
Figure 8.1 shifts the perceptual lens of more traditionally delimiting definitions of EBP to a looser definition of ‘‘social work practice [in this case with the elderly] based on empirical data’’ or the actual evidence per se. Thus, published articles, studies, chapters, texts, or monographs not grounded in this way were not retained for analyses for this chapter.
Nonempirically based studies, historical reviews, frameworks (con- ceptual, theoretical, treatment) not based on empirical data, studies about gerontological workers themselves, policy analyses, critiques of practice, opinion pieces, and trend analyses were consequently excluded. Ironically, this latter literature accounted for approximately 35% of the published
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
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2 0 1 3 . Jo
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& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
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200 Social Work Practice With Individuals and Families
Figure 8.1 Three cohorts of evidence-based studies used in a review of interventions for the elderly
Conceptual/ theoretical frameworks
Cohort 1 Cohort 2 Cohort 3
Effectiveness studies
Evidence-based research and evaluation studies
Empirical data collected to inform and direct practice with the elderly—"the evidence"
Assessments of specified
interventions and outcomes
critical mass captured by the initial search parameters. Further, in order to keep this chapter relatively current, only literature from 1995 onward was reviewed. Key words used in searching these literature sources were: gerontology, interventions, outcomes, social work practice, effectiveness, assessing practice, and evidence-based practice.
In addition, we attempted to seek out EBP literature and present it in ways that emphasized the practice → evidence linkage. After a presentation of the summarized evidence-based intervention studies, as indicated in the three cohorts in Figure 8.1, a model for integrating such evidence into practice is then presented.
Summary of Current Evidence-Based Interventions With the Elderly
Cohort 1—Conceptual/Theoretical Frameworks
Too often in overviews of the literature of this nature, published accounts are summarily dismissed if they do not include a readily identifiable method section or empirical data, for example, tables of statistics. This nascant approach unfortunately delimits a host of important literature that, on further investigation, has an empirical basis to it. Figure 8.1 conceptualized literature in Cohort 1 as having an empirical basis to it. That is, empirical data were used to develop these conceptual and/or theoretical frameworks that guided gerontological social work practice.
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
Intervention With the Elderly 201
Three criteria were used to determine literature suitable for inclusion here. First, all these published accounts clearly had to be empirically linked to practice interventions with the elderly. This was operationalized in one of two ways: (1) greater than 50% of the references cited at the end of the chapter/article had to have analyzed/cited primary or secondary data, and/or (2) case examples were used in the document as the basis for the proposed conceptual/theoretical framework. For the most part, such chapters/articles grounded the rationale for the proposed framework in empirical studies that, in turn, presented the basis for their subsequent development.
As previously mentioned in this chapter, elders are living longer, proliferating in number, and incurring escalating costs of care. Ironically, many of these potential clients did not expect to live as long as they presently are, and their resources have significantly diminished as their lives are extended. As such, residential long-term care and end-of-life plan- ning were prevalent topics among many studies considered for inclusion in Cohort 1 (Table 8.1).
Thus, the quality of life in long-term care facilities is becoming a more salient issue. Solomon (2004) explored providing for quality of life in long-term residential homes for elderly clients by suggesting nine crite- ria that have a positive contributive influence. These were good physical care, pleasant environment, autonomy/choice, attentive staff, respect- ful treatment, personal meaning, engaging activities, opportunities for significant relationships, and interdisciplinary collaboration. Revisiting a common intervention for clinical practice with elderly populations (group work) with a unique taxonomy, Solomon presented four group types: self- government, support, educational, and resident volunteer. By using case examples, this study showed how providing for quality of life in residen- tial homes can improve overall health status, increase self-determination within the residents, foster interprofessional collaboration, and decrease misunderstandings that may occur among providers and recipients of this care modality.
Similarly, Pinquart, Sörensen and Peak (2004), recognized the familial imperative to develop a realistic care plan for later life relatives. They provided a strategic eight-step process model designed to support older adults through the preparatory development of their future care needs. Additionally, they suggested three contextual opportunities for intervention (i.e., educational settings, direct referrals, and discharge planning). This framework assists a social worker in enhancing a client’s right to self- determination, sense of wellness, and affects some alleviation of stress for the client’s extended family. It was shown that being knowledgeable about phenomena and tendencies common to older adults and their families related to the approaching need for care enables practitioners to better assist these clients.
Another study in this cohort addressed a social worker’s role in issues of death and dying. Hobart (2001) explored the ever-expanding role of the social worker in advance-care planning and end-of-life decision making.
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
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202 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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en cy
fa ct
o rs
)
C o n tr
ib u ti
n g
fa ct
o rs
(e .g
., th
e la
b o r-
in te
n si
v e
ye t
sh o rt
-t er
m n at
u re
o f
th e
w o rk
) E ff
ec ts
o n
th e
w o rk
er (e
.g .,
fe el
in gs
o f
in co
m p et
en ce
) P re
v en
ti v e
m ea
su re
(e .g
., le
ar n in
g to
id en
ti fy
si gn
s)
203 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
204 Social Work Practice With Individuals and Families
The complexity of this advocacy role is highlighted as well as the obligatory responsibility of the social worker to be well versed on issues, legislation, policy, providers, and patient’s rights. Additionally, being able to navigate through the quagmire of psychosocial currents is crucial for the efficacy of the social worker’s praxis. Hobart discussed Advance Directive Education (ADE), right-to-die legislation, the Patient Self-Determination Act of 1991 (PSDA), and argued for ethnographic sensitivity in one’s approach to issues of death and dying. The conceptual framework provided here reminds us of the multiplicity of skills and working knowledge one must bring to the person in their environment. Among these studies, is a NASW end-of- life care protocol. This helpful study compiles, summarizes, and delimits a multitude of critical studies on end-of-life care that will prove advantageous to a clinician in his or her professional endeavors. More than 20 articles were presented in this review covering the broad gamut of issues relating to caring for this population as they prepare for the end of life.
Cohort 1 studies also included interventional theoretical frameworks for working with the elderly within a particular sociocultural situatedness, namely rural settings (Bisman, 2003; Li & Blaser, 2003). These studies highlight the unique challenges that social workers face when intervening with rural elderly populations. The lower-than-average general health, the narrow range of available services, the economic stratification of the clientele, the limited access to formal and diverse service providers, and the concomitant geographic isolation often exacerbate the presenting problems of this treatment group. Bisman (2003) suggested four theoretical models for intervention with rural elderly clients: social support, family systems, group work, and case management/community practice, thus reinforcing the ubiquitous modality for practice with the elderly. This article is efficacious to a practitioner and contains helpful information for further reading and research.
The Li and Blaser (2003) study moves beyond the micro- and mez- zolevels of social praxis and into macrolevel social work. These authors suggest an integrative social-care systems model for rural program plan- ning with older adults that amalgamates both formal and informal sources of care, community leaders and residents, and culture and creativity. This model seeks to provide for both the client as well as the community. Through the use of case studies, Li and Blaser (2003) illustrate the essen- tial strategies that are fundamental to success in rural program planning and development for older adults.
The last intervention area of these studies relates to the uniqueness of working with this population. Here, numerous conceptual/theoretical frameworks are provided that address issues of compassion fatigue (Leon, Altholz, & Dziegielewski, 1999), trauma as it relates to aging (Graziano, 2003), elder morbidity and subjective well-being (Peck, 2001), alterna- tive socioemotional interventions for depression (McInnis-Dittrich, 2002; Motohashi, Kaneko & Sasaki, 2004), and task-centered case management (Naleppa & Reid, 2003). The task-centered case-management practice model is for work with the elderly in need of multiple services. The model
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
Intervention With the Elderly 205
has three components: a core intervention model, parallel intervention functions, and alternative intervention modules. Each of the studies has important clinical implications that could benefit practitioners working in this area.
Leon et al. (1999) used case examples to reinforce the inherent danger to clinicians who work with elderly populations. Social work burnout can occur because of the short-term nature of the labor-intensive work with the elderly. Some contributive factors to compassion fatigue noted were feelings of incompetence, the experiences of secondary traumatic stress disorder, the misperception that the elderly client’s life cannot be improved (by interventions), the scarcity of resources for this treatment group, and the latent existential angst about the inevitability of aging and declining in health that the practitioner realizes for him- or herself. This study presented an eight-step process that could possibly prevent compassion fatigue.
The articles in Cohort 1, although not necessarily having specified out- comes, targeted populations, and rigorous evidence-based methodological designs, are evidenced based, based on the previous definition provided, and are important to gerontological social work practitioners. They present numerously empirically derived conceptual/theoretical frameworks for interventions with the elderly that, more often than not, have worked elsewhere. These modalities of intervention range from service among rural populations, residential populations with physical and/or cognitive impairment, and emotional/spiritual penury. Additionally, some of the studies in this cohort serve a perfunctory role in improving the quality of self-care in the social worker; advocacy for the client; and service to, with, and among elderly populations.
Cohort 2—Effectiveness Studies
The effectiveness studies in Cohort 2 (Table 8.2) illustrate the neces- sity of using multifaceted interventional strategies for multidimensional presenting problems of the elderly.
As the ever-burgeoning elderly population expands, a social worker’s knowledge of efficacious interventions must remain commensurate with the anticipated needs of these potential clients. Ascertaining what has worked for other clinicians can be of benefit to any social work prac- titioner. Essentially, the nature of the presenting problems within this cohort fell into one or more of the following categories: acute/chronic pain, depressive symptoms, social isolation, declining biopsychosocial health, and/or cognitive impairment (e.g., dementia, Alzheimer’s). The interventions reviewed in Cohort 2 ran the gamut of education, physio- therapy, pharmacological treatment, community-based and home-based therapy, care through the medium of technology, and alternative rehabil- itation through Eastern meditative practice and existential empowerment. Collectively, these studies did not specify designated, and/or anticipated outcomes, but rather, sought to determine the efficacy of the interventions. Additionally, the time frame or duration of the interventions varied in part
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
T ab
le 8.
2 E
ff ec
ti v en
es s
S tu
d ie
s o f
In te
rv en
ti o n
s W
it h
E ld
er ly
P o p u
la ti
o n
s B
et w
ee n
2 0 0 6
an d
1 9 9 5
R ef
er en
ce In
te rv
en ti
o n
s P
ro v id
ed P
re se
n ti
n g
P ro
b le
m s
P o p u
la ti
o n
s
D u
ra ti
o n
/ O
cc as
io n
o f
In te
rv en
ti o n
s O
u tc
o m
es
E ff
ec ti
v en
es s
o f
In te
rv en
ti o n
s
A b ra
h am
so n
an d
K h an
(2 00
6)
E D
O st
eo ar
th ri
ti s
p at
ie n ts
w it
h lo
w tr
au m
a fr
ac tu
re s
15 6
m o n th
s Si
gn ifi
ca n t
im p ro
v em
en ts
in st
an d ar
d iz
ed sc
o re
s, e.
g. ,
o st
eo p o ro
si s
q u es
ti o n n ai
re ,
fu n ct
io n al
in d ep
en d en
ce m
ea su
re ,
an d
m in
i m
en ta
l st
at e
ex am
in at
io n
O st
eo p o ro
si s
ed u ca
ti o n
in el
d er
ly re
h ab
il it
at io
n in
p at
ie n ts
w it
h fr
ac tu
re s
is ef
fe ct
iv e,
b u t
re q u ir
es ad
eq u at
e p at
ie n t
co gn
it iv
e sk
il ls
.
St in
so n
an d
K ir
k (2
00 6)
SR T
, SS
S A
ss is
te d
li v in
g fe
m al
e re
si d en
ts w
it h
d ep
re ss
io n
24 (c
o n tr
o l
gr o u p
an d
in te
rv en
ti o n
gr o u p )
6 w
ee k s
R em
in is
ce n ce
h as
n o
si gn
ifi ca
n t
d ec
re as
e in
d ep
re ss
io n
an d
in cr
ea se
in se
lf -t
ra n sc
en d en
ce
T h e
st u d y
re v ea
le d
an in
v er
se re
la ti
o n sh
ip b et
w ee
n d ep
re ss
io n
an d
se lf -t
ra n sc
en d en
ce su
gg es
ti n g
a n ee
d to
re se
ar ch
al te
rn at
iv e
th er
ap ie
s fo
r tr
ea tm
en t
o f
d ep
re ss
io n
in th
e o ld
er fe
m al
e. R
em in
is ce
n ce
o ff
er s
a p o ss
ib le
in te
rv en
ti o n
fo r
tr ea
tm en
t o f
d ep
re ss
io n
in o ld
er w
o m
en .
W ri
gh t,
H ic
k so
n ,
an d
F ro
st (2
00 6)
E at
in g
in su
p er
v is
ed d in
in g
h al
l w
it h
n u rs
in g
as si
st an
t
A cu
te ly
il l
p at
ie n ts
w h o
ea t
al o n e
in th
ei r
ro o m
s
48 L u n ch
ti m
e in
ca fe
te ri
a In
te rv
en ti
o n
gr o u p
ga in
ed w
ei gh
t F o o d
in ta
k e
ca n
b e
im p ro
v ed
b y
u si
n g
a su
p er
v is
ed d in
in g
ro o m
, an
d th
is w
il l p o te
n ti
al ly
le ad
to w
ei gh
t ga
in an
d co
rr es
p o n d in
g im
p ro
v em
en ts
in n u tr
it io
n al
st at
u s
an d
re h ab
il it
at io
n .
206 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
G u th
ei l an
d H
ey m
an (2
00 5)
ST E P , E D
, SS
S H
ig h -
fu n ct
io n in
g, C
D S
an d
th ei
r p o te
n ti
al o r
d es
ig n at
ed h ea
lt h
ca re
ag en
ts
27 d ya
d s
(p er
so n
an d
ag en
t =
54 )
2 m
o n th
s (3
se ss
io n s)
In te
rv en
ti o n
gr o u p
o u tc
o m
es ,
e. g.
, h ig
h er
sc o re
s in
co m
m u n ic
at io
n ,
k n o w
le d ge
o f
h ea
lt h
o p ti
o n s,
an d
p o si
ti v e
at ti
tu d e
to w
ar d
en d -o
f- li fe
p la
n n in
g
T h e
ST E P
in te
rv en
ti o n
ca n
h el
p h ig
h -f
u n ct
io n in
g C
D S
w it
h en
d -o
f- li fe
p la
n n in
g, ac
q u ir
in g
gr ea
te r
k n o w
le d ge
o f
h ea
lt h -c
ar e
ro le
s, re
sp o n si
b il it ie
s, an
d o p ti
o n s
an d
fo st
er gr
ea te
r co
m m
u n ic
at io
n sk
il ls
. M
o -K
yu n g,
B el
za ,
L o G
er fo
, an
d C
u n n in
gh am
(2 00
5)
E D
, P T
E K
I in
se n io
r ci
ti ze
n h o m
e 13
12 w
ee k s
Im p ro
v ed
o u tc
o m
es o n
m u sc
le st
re n gt
h ,
ag il it
y/ b al
an ce
, b lo
o d
p re
ss u re
, ex
er ci
se ad
h er
en ce
, an
d se
lf -s
at is
fa ct
io n
T h e
ex er
ci se
p ro
gr am
w as
su cc
es sf
u l an
d sh
o u ld
b e
ev al
u at
ed o n
a la
rg er
p o p u la
ti o n
an d
in p o p u la
ti o n s
o f
o th
er et
h n ic
m in
o ri
ti es
. L ef
f et
al .
(2 00
5) H
o sp
it al
-a t-
h o m
e m
o d el
o f
ca re
A cu
te ly
il l C
D S
p at
ie n ts
re ce
iv in
g M
ed ic
ar e-
m an
ag ed
ca re
at tw
o V
A si
te s
45 5
22 m
o n th
s Su
b je
ct s
h ad
a sh
o rt
er le
n gt
h o f
st ay
an d
lo w
er m
ea n
co st
s o f
tr ea
tm en
t co
m p ar
ed to
ac u te
h o sp
it al
ca re
T h e
h o sp
it al
-a t-
h o m
e m
o d el
is fe
as ib
le ,
sa fe
, an
d ef
fi ca
ci o u s
fo r
ce rt
ai n
o ld
er p at
ie n ts
w it
h se
le ct
ed ac
u te
m ed
ic al
il ln
es se
s.
M it
te lm
an ,
R o th
, C
o o n ,
an d
H al
ey (2
00 4)
R C
SG , SS
S Sp
o u se
- ca
re gi
v er
s o f
A lz
h ei
m er
’s p at
ie n ts
40 6
9 ye
ar s,
5 m
o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., ca
re gi
v in
g sk
il ls
in cr
ea se
d ,
m o b il iz
ed su
p p o rt
fr o m
fa m
il y
n et
w o rk
s in
cr ea
se d ,
an d
d ep
re ss
iv e
sy m
p to
m s
d ec
re as
ed )
C o u n se
li n g
an d
so ci
al se
rv ic
e su
p p o rt
le ad
to su
st ai
n ed
b en
efi ts
fo r
el d er
ly sp
o u se
ca re
gi v er
s o f
A lz
h ei
m er
’s p at
ie n ts
.
C ie
ch an
o w
sk i
et al
. (2
00 4)
R C
T , C
IH B
T ,
P ST
, P E A
R L S,
C B
T
P at
ie n ts
w it
h m
in o r
d ep
re ss
io n
an d /o
r d ys
th ym
ia
13 8
29 m
o n th
s O
u tc
o m
es ,
d ec
re as
e in
d ep
re ss
iv e
sy m
p to
m s
an d
in cr
ea se
in q u al
it y
o f
li fe
T h e
P E A
R L S
p ro
gr am
, a
co m
m u n it
y- in
te gr
at ed
, h o m
e- b as
ed tr
ea tm
en t
fo r
d ep
re ss
io n ,
si gn
ifi ca
n tl y
re d u ce
s d ep
re ss
iv e
sy m
p to
m s
an d
im p ro
v es
h ea
lt h
st at
u s.
(c on
ti n u ed
ov er
le a f)
207 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
T ab
le 8.
2 (C
on ti
n u ed
)
R ef
er en
ce In
te rv
en ti
o n
s P
ro v id
ed P
re se
n ti
n g
P ro
b le
m s
P o p u
la ti
o n
s
D u
ra ti
o n
/ O
cc as
io n
o f
In te
rv en
ti o n
s O
u tc
o m
es
E ff
ec ti
v en
es s
o f
In te
rv en
ti o n
s
K ap
as i,
O u sl
an d er
, Sc
h n el
le ,
K u tn
er , an
d F ah
ey (2
00 3)
R an
d o m
C C
T ,
fu n ct
io n al
ly o ri
en te
d en
d u ra
n ce
an d
re si
st an
ce ex
er ci
se tr
ai n in
g
F ra
il n u rs
in g
h o m
e re
si d en
ts
19 0
32 w
ee k s
In te
rv en
ti o n
d id
n o t
b ri
n g
b en
efi ci
al o r
d et
ri m
en ta
l ef
fe ct
s o n
im m
u n e
p ar
am et
er s
in th
e st
u d y
p o p u la
ti o n
T h e
in te
rv en
ti o n al
ex er
ci se
p ro
gr am
h as
n o
d em
o n st
ra b le
ef fe
ct o n
im m
u n it
y in
fr ai
l el
d er
ly re
si d en
ts in
n u rs
in g
h o m
es .
T sa
n g,
M o k ,
A u
Y eu
n g,
an d
C h an
(2 00
3)
R C
T , E C
G ,
Q ig
on g
(T h e
E ig
h t Se
ct io
n B
ro ca
d es
)
P at
ie n ts
w it
h su
b ac
u te
ch ro
n ic
p h ys
ic al
il ln
es se
s an
d d ep
re ss
io n
50 12
w ee
k s
C o n tr
o l gr
o u p
ex p re
ss ed
im p ro
v em
en t
in p h ys
ic al
, p sy
ch o lo
gi ca
l, an
d ge
n er
al h ea
lt h
Q ig
on g
m ay
p ro
v e
to b e
an al
te rn
at iv
e tr
ea tm
en t
fo r
su b ac
u te
ch ro
n ic
p h ys
ic al
il ln
es se
s an
d d ep
re ss
io n .
So lo
m o n ,
A d am
s, Si
lv er
, Z
im m
er , an
d D
eV ea
u x
(2 00
2)
C C
T , p h ar
m a-
co lo
gi ca
l, M
M SE
C D
S w
it h
n o
m em
o ry
im p ai
rm en
t
23 0
(2 03
co m
p le
te d
th e
in te
rv en
- ti
o n )
6 w
ee k s
C o n tr
o l gr
o u p
(w h o
re ce
iv ed
th e
G in
k go
p h ar
m ac
o lo
gi ca
l tr
ea tm
en t)
sh o w
ed n o
im p ro
v em
en t
in m
em o ry
o r
co gn
it iv
e fu
n ct
io n
G in
k go
p ro
v id
es n o
m ea
su ra
b le
b en
efi t
in m
em o ry
o r
re la
te d
co gn
it iv
e fu
n ct
io n
to ad
u lt s
w it
h h ea
lt h y
co gn
it iv
e fu
n ct
io n .
W h it e
et al
. (2
00 2)
R C
T , In
te rn
et ed
u ca
ti o n
an d
ac ce
ss
V o lu
n te
er s
fr o m
re si
d en
ti al
co n gr
eg at
e h o u si
n g
si te
s an
d n u rs
in g
fa ci
li ti
es
10 0
6 m
o n th
s 2
w ee
k in
te rv
en ti
o n
(9 h o u rs
o f
sm al
l gr
o u p
tr ai
n in
g o v er
6 d ay
s)
O u tc
o m
es (e
.g .,
re d u ce
d d ep
re ss
iv e
sy m
p to
m s/
lo n el
in es
s)
T h e
In te
rn et
m ay
p ro
v e
to b e
o f
p sy
ch o so
ci al
b en
efi t
(i .e
., re
d u ct
io n
o f
lo n el
in es
s an
d d ep
re ss
iv e
sy m
p to
m s)
to se
n io
rs w
h o
le ar
n h o w
to u se
it an
d h av
e ac
ce ss
to it
. D
e L eo
, B
u o n o
an d
D w
ye r
(2 00
2)
P ST
, SS
S, T
el eH
el p -
T el
eC h ec
k se
rv ic
e
U se
rs o f
a te
le p h o n e
h el
p li n e
an d
em er
ge n cy
re sp
o n se
se rv
ic e
18 ,6
41 10
ye ar
s O
u tc
o m
es ,
fe w
er su
ic id
e d ea
th s
am o n g
el d er
ly se
rv ic
e u se
rs
T h e
st u d y
co n fi
rm s
th e
in it
ia l p ro
m is
e o f
th e
T el
eH el
p -T
el eC
h ec
k se
rv ic
e o v er
a m
u ch
lo n ge
r ti
m e
p er
io d .
208 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
K o ch
ev ar
, Sm
it h ,
& B
er n ar
d (2
00 1)
N T
w it
h ex
er ci
se p ro
gr am
N at
iv e-
A m
er ic
an C
D S
in u rb
an ar
ea
22 6
w ee
k s
Si gn
ifi ca
n t
d ec
re as
e in
b lo
o d
p re
ss u re
an d
re sp
ir at
io n s
P h ys
ic al
an d
em o ti
o n al
h ea
lt h
ca n
im p ro
v e
am o n g
N at
iv e-
A m
er ic
an se
n io
rs as
a re
su lt
o f
ex er
ci se
an d
n u tr
it io
n al
tr ai
n in
g. K
u h n
an d
M en
d es
d e
L eo
n (2
00 1)
E D i
n te
rv en
ti o n
A lz
h ei
m er
’s ca
re gi
v er
s 58
6 m
o n th
s M
o d es
t b en
efi ts
in k n o w
le d ge
o f
d is
ea se
an d
co p in
g
St u d y
d at
a su
gg es
ts th
at k n o w
le d ge
o f
A lz
h ei
m er
’s ca
n as
si st
ca re
gi v er
co p in
g. C
am b er
g et
al .
(1 99
9) P er
so n al
iz ed
si m
u la
te d
p re
se n ce
, M
M SE
N u rs
in g
h o m
e re
si d en
ts w
it h
A D
R D
54 O
n go
in g
N o
si gn
ifi ca
n t
ch an
ge as
a re
su lt
o f
in te
rv en
ti o n
Si m
u la
te d
p re
se n ce
m ay
p ro
v e
to b e
ef fe
ct iv
e in
en h an
ci n g
w el
l- b ei
n g
an d
d ec
re as
in g
p ro
b le
m b eh
av io
rs in
n u rs
in g
h o m
e se
tt in
gs .
In o u ye
et al
. (1
99 3)
C C
T , P C
S, N
C E P
G en
er al
m ed
ic in
e w
ar d s
at te
ac h in
g ge
ri at
ri c
h o sp
it al
— fr
ai l
el d er
s
21 6
O n go
in g
B en
efi ci
al ef
fe ct
s (e
.g .,
re d u ct
io n
o f
d el
ir iu
m ,
fu n ct
io n al
im p ai
rm en
t, in
co n ti
n en
ce ,
an d
p re
ss u re
so re
s, w
er e
ac h ie
v ed
w it
h o u t
in cr
ea si
n g
p er
-d ay
h o sp
it al
co st
s)
N C
E P
ap p ea
rs ef
fe ct
iv e
to d ec
re as
e fu
n ct
io n al
d ec
li n e
in ta
rg et
ed el
d er
ly h o sp
it al
iz ed
m ed
ic al
p at
ie n ts
.
C am
p b el
l et
al .
(1 99
7) R
C T
, P T
, h o m
e ex
er ci
se p ro
gr am
o f
st re
n gt
h an
d b al
an ce
re tr
ai n in
g ex
er ci
se s,
E C
G
F em
al e
ge n er
al p ra
ct ic
e p at
ie n ts
in N
ew Z
ea la
n d
w h o
ar e
at ri
sk fo
r fa
ll in
g
23 3
12 m
o n th
s R
at e
o f
fa ll s
w as
lo w
er in
th e
ex er
ci se
th an
in th
e co
n tr
o l gr
o u p
an d
b al
an ce
im p ro
v ed
A n
in d iv
id u al
p ro
gr am
o f
st re
n gt
h an
d b al
an ce
re tr
ai n in
g ex
er ci
se s
im p ro
v ed
p h ys
ic al
fu n ct
io n
an d
w as
ef fe
ct iv
e in
re d u ci
n g
fa ll s
an d
in ju
ri es
in w
o m
en 80
ye ar
s an
d o ld
er .
B an
er je
e, Sh
am as
h ,
M ac
d o n al
d ,
an d
M an
n (1
99 6)
R C
T , P G
T ,
A G
E C
A T
, p h ar
m ac
o -
lo gi
ca l
D ep
re ss
ed d is
ab le
d p eo
p le
re ce
iv in
g h o m
e ca
re
69 6
m o n th
s O
u tc
o m
e, si
gn ifi
ca n t
re co
v er
y w
it h in
th e
tr ea
tm en
t gr
o u p
D ep
re ss
io n
is tr
ea ta
b le
in el
d er
ly p eo
p le
re ce
iv in
g h o m
e ca
re .
1 A
D R
D =
A lz
h ei
m er
’s d is
ea se
an d
re la
te d
d em
en ti
a; A
G E C
A T
= A
u to
m at
ic ge
ri at
ri c
ex am
in at
io n
fo r
co m
p u te
r as
si st
ed ta
xo n o m
y; C
B T
= C
o gn
it iv
e b eh
av io
ra l th
er ap
y; C
C T
= C
o n tr
o ll ed
cl in
ic al
tr ia
l; C
D S
= C
o m
m u n it y-
d w
el li n g
se n io
rs ;
C IH
B T
= C
o m
m u n it
y- in
te gr
at ed
h o m
e- b as
ed tr
ea tm
en t;
E C
G =
E d u ca
ti o n al
co n tr
o l gr
o u p ; E D
= E d u ca
ti o n ;
E K
I =
E ld
er ly
K o re
an im
m ig
ra n ts
; M
M SE
= M
in i m
en ta
l- st
at e
ex am
in at
io n ; N
C E P
= N
u rs
in g-
ce n te
re d
ed u ca
ti o n al
p ro
gr am
; N
T =
N u tr
it io
n al
tr ai
n in
g; P C
S =
P ro
sp ec
ti v e
co h o rt
st u d y;
P E A
R L S
= P ro
gr am
to en
co u ra
ge ac
ti v e
re w
ar d in
g li v es
fo r
se n io
rs ; P G
T =
P sy
ch o ge
ri at
ri c
te am
; P ST
= P ro
b le
m so
lv in
g th
er ap
y; P T
= P h ys
io th
er ap
y; R
C SG
= R
an d o m
co n tr
o ll ed
su p p o rt
gr o u p ; R
C T
= R
an d o m
cl in
ic al
tr ia
l; SR
T =
St ru
ct u re
d re
m in
is ce
n ce
th er
ap y;
SS S
= So
ci al
se rv
ic e
su p p o rt
; SS
W =
Se ss
io n
w it
h so
ci al
w o rk
er ; ST
E P
= St
ar t
ta lk
in g
ea rl
y p ro
gr am
; V
A =
V et
er an
s A
d m
in is
tr at
io n .
209 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
210 Social Work Practice With Individuals and Families
because of the absence of targeted outcomes specified prior to the study. Their methodological criteria allowed these studies to be dichotomized into two practice effectiveness categories, namely, those interventions that worked and those that did not.
At first glance, you might think that the needs of the elderly have remained quite consistent over the past 20 years. However, the studies in Cohort 2 (and the subsequent Cohort 3) reveal that the presenting problems of the elderly have become more complicated than before. The cost of adequate care has escalated far beyond the economic viability of the client group. Even though technology has created the possibility of instantaneous digital interactivity, it appears that social groups and communities have become more polarized and collectivities have become ever more stratified (Dunlop & Holosko, 2006). With these societal changes anonymously thrust on the variegated collectivities that make up our culture, we witness the exacerbation of the numerous presenting problems of the elderly. Thus, interventional strategies have become more strategic, multidimensional, and time framed as needs arise.
These studies sought to ascertain the efficacy of various interventions ranging from education to structured reminiscence therapy, from physi- cal therapy to supervised eating in social settings, from Eastern Chinese meditative/movement oriented practices to pharmacological interventions for depression. The wide array in Cohort 2 exemplified the clinician’s creativity and willingness to experiment in order to address the presenting problems within the elderly community. Some tested educational curricula, whereas others investigated the utility of technology and physiotherapy. These studies were selected, in part, because they satisfied the criteria of our search, and also because they represented a considerable range in interventional approaches in a variety of settings both locally and interna- tionally. Some were clinically based, whereas others were community- or home-based interventions.
Among the clinically based interventions, Abrahamson and Khan (2006) found that osteoporosis education among elderly patients with low trauma fractures significantly improved the functional independence and psychological well-being of the patients. This educational intervention did not reduce levels of actual pain experienced by the subjects. However, the interrelated connection between cognitively understanding the disease and cultivating strategies to manage the pain of the disease resulted in both greater physical confidence and decreased depressive symptoms. This study demonstrated the direct corollary between the experience of pain and declining ambulatory function to depressive symptomology.
Tsang, Mok, Yeung, and Chan (2003) also recognized the correlation between pain and depression in their study of the efficacy of Quigong. From the Chinese words Qi [chi], which means energy and gong [kung] which means skill, this ancient practice merges meditation and deliberate movement. Quigong is famous in China for reducing stress, lowering blood pressure, and fostering a better attitude about life. Tsang et al. (2003) found that elderly patients with chronic subacute physical illnesses and pain also experienced depressive symptoms. The control group that received the
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
Intervention With the Elderly 211
Quigong intervention for 12 weeks showed significant improvement in physical, psychological, and general health well-being. The results of this study suggested that alternatives to pharmacological interventions for pain and depression exist.
The relationship among acute illness, pain, recovery, and the propen- sity to socially isolate oneself was addressed in the Wright, Hickson, and Frost (2006) study. They evaluated a nurse-aided supervised dining inter- vention. Generally, acutely ill nursing-home patients have a tendency to eat alone in their rooms. This self-imposed social isolation has a cor- roborative negative effect on recovery, weight-loss, and general health. Their intervention involved encouraging these elderly residents to go to the formal dining hall during lunchtime rather than eating alone in their rooms. The simple act of communal dining, rather than social isolation, resulted in increased food intake, healthy weight gain, and correspond- ing improvements in nutritional status and rehabilitation. The effect of communal interactivity on the general health status of the geriatric client cannot be overstated.
Community-based interventions were also quite common among the studies reviewed (Ciechanowski et al., 2004; Kochevar, Smith, & Bernard, 2001). Both studies sought to explore the correlation between physical and general health and the biopsychosocial wellness of the subjects. Kochevar et al. (2001) utilized nutritional training and a physical exercise program among Native-American urban elders for 6 weeks. As a result of this intervention, the physical and emotional health of the subjects significantly increased. Ciechanowski et al. (2004) evaluated an educational program, Program to Encourage Active Rewarding Lives for Seniors (PEARLS), among 138 elderly patients with minor depression and/or dysthymia. PEARLS proved to be an efficacious community-integrated, home-based treatment for depression by significantly reducing depressive symptoms and improving the general health status of the participants.
Several studies employed technology, for example, telephones, com- puters, Internet, and recording devices, as an integral part of their interventional strategy (Bradley & Poppen, 2003; Camberg et al., 1999; De Leo, Buono, & Dwyer, 2002; White et al., 2002). These interventions ranged in duration from 6 months to 10 years. Cohort 2 studies also included pro- fessional and semiprofessional practitioners in the administering of their interventions.
Other studies integrated physiotherapy and education (Campbell et al., 1997; Kapasi, Ouslander, Schnelle, Kutner, & Fahey, 2003; Kochevar et al., 2001; Mo-Kyung, Belza, LoGerfo, & Cunningham, 2005; Tsang et al., 2003). The duration of these interventions ranged from 12 to 32 weeks. Some addressed specific ethnic groups, that is, elderly Korean immigrants (Mo-Kyung et al., 2005), whereas others focused on specific impairments and risks, that is, elderly frail women who are at risk of falling (Campbell et al., 1997). Regardless of the population, merging physiotherapy and education proved to be efficacious among geriatric clients, in general.
One final trend to highlight within gerontological work and these stud- ies was the aging-in-place model. The ubiquitous modality of care in the
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
212 Social Work Practice With Individuals and Families
past was the institutionalization of the elderly in personal care/residential homes. For the past two decades, however, the devolution of health care has challenged the federal role in domestic health and human-services pol- icy. Consequently, in light of the contextual verities of the managed-care movement, the sociodemographics of aging, and the preferential biases of the elderly to die at home, a new paradigm for elder care is emerging.
In North America, much of the decision making in health-related issues has been devolved to local authorities. The raison d’être behind such a new model of care emerges from three areas of concern: (1) the governmental expectation for equitable care; (2) the providers’ economic, social, and health-related interests; and (3) the clients’ health care-related preferences and needs (Lomas, Woods, & Veenstra, 1997). The aging-in- place model has transpired as a new model for care, particularly among aging populations, as a response to the escalating costs of care (Mollica & Morris, 2005), the scarcity of adequate space for an ever-increasing population of elderly, and in response to the expressed desires of the elderly to die at home (Formiga, Chivite, Ortega, Cassas, Ramon & Pujol, 2004; Groth-Juncker & McCusker, 1983).
Two of the studies in Cohort 2 addressed the aging-in-place model (Banerjee, Shamash, Macdonald, & Mann, 1996; Leff et al., 2005). The fact that these two studies were conducted nearly a decade apart demonstrates that the aging-in-place model of health care continues to be prototypical of present and future modalities of treatment. Banerjee et al. (1996) involved 69 disabled patients suffering from depression. For a period of 6 months, the subjects received a multifaceted intervention combining pharmacological aides and automatic geriatric examination for computer- assisted taxonomy assessment (AGECAT) from a psychogeriatric team in the clients’ home settings. The treatment group experienced significant alleviation of depressive symptoms and an overall increase in their general health status.
In the Leff et al. (2005) study, 455 acutely ill community-dwelling seniors received the hospital-at-home model of care for 22 months. As a result, the subjects had a shorter length of stay and lower mean costs of treatment compared to acute hospital care. This study demonstrated the efficacy of the hospital-at-home model as feasible, safe, and cost effective for certain older patients with selected acute medical illnesses. The aging-in-place paradigm underlying this study will continue to be an important impetus in future interventional strategies, particularly among aging populations.
Cohort 3—Specified Intervention and Outcome Studies
Cohort 3 represents a summarized collection of studies retained from the hundreds reviewed that satisfied certain criteria.
Namely, these studies (Table 8.3) contained clearly identified inter- ventions, specified populations, particular time frames within which the interventions were conducted, and targeted and/or specified outcomes.
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
T ab
le 8.
3 S p ec
ifi ed
In te
rv en
ti o n
s an
d O
u tc
o m
es W
it h
E ld
er ly
P o p u
la ti
o n
s B
et w
ee n
2 0 0 6
an d
1 9 9 5
R ef
er en
ce s
In te
rv en
ti o n
s P
ro v id
ed P
re se
n ti
n g
P ro
b le
m s
S p ec
ifi ed
P o p u
la ti
o n
s D
u ra
ti o n
o f
In te
rv en
ti o n
s T
ar g et
ed O
u tc
o m
es E
ff ec
ti v en
es s
o f
In te
rv en
ti o n
s
E n ge
lh ar
d t,
T o se
la n d ,
G ao
, an
d B
an k s
(2 00
6)
R C
T , G
E M
M al
es w
h o
w er
e ab
o v e-
av er
ag e
u se
rs o f
o u tp
at ie
n t
V A
se rv
ic es
16 0
48 m
o n th
s A
lt h o u gh
n o
in cr
ea se
in su
rv iv
al o f
p at
ie n t
in d ic
at ed
, in
te rv
en ti
o n
ac h ie
v ed
o u tc
o m
e (e
.g .,
co st
s o f
se rv
ic es
d ec
re as
ed at
th e
24 -
to 48
-m o n th
p er
io d )
T h e
G E M
p ro
gr am
ca n
re d u ce
th e
co st
s to
se n io
r ci
ti ze
n v et
er an
s w
h o
ar e
p ro
v en
to b e
ab o v e-
av er
ag e
u se
rs o f
o u tp
at ie
n t
V A
se rv
ic es
.
H u n k el
er et
al .
(2 00
6) R
C T
, C
C M
(I M
P A
C T –
C B
T , P ST
, E D
, p h ar
m a-
co lo
gi ca
l)
P at
ie n ts
w it
h m
aj o r
d ep
re ss
io n ,
d ys
th ym
ia ,
o r
b o th
in p ri
m ar
y ca
re cl
in ic
s
18 01
36 m
o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., d ep
re ss
iv e
sy m
p to
m s,
p h ys
ic al
fu n ct
io n in
g, q u al
it y
o f
li fe
, se
lf -e
ffi ca
cy ,
an d
sa ti sf
ac ti o n
o f
ca re
)
T h e
IM P A
C T
m o d el
m ay
sh o w
th e
w ay
to le
ss d ep
re ss
io n
an d
gr ea
te r,
o v er
al l h ea
lt h
in o ld
er ad
u lt s.
T h o m
as et
al .
(2 00
5) R
an d o m
C C
T ,
T ai
C h i
ex er
ci se
, re
si st
an ce
tr ai
n in
g
C h in
es e
su b je
ct s
18 0
12 -m
o n th
lo n gi
tu d in
al st
u d y
O u tc
o m
es n o t
ac h ie
v ed
(e .g
., n o
ca rd
io v as
cu la
r ri
sk fr
o m
T ai
C h i)
T ai
C h i as
an in
te rv
en ti
o n
is n o
m o re
o r
le ss
b en
efi ci
al to
ca rd
io v as
cu la
r ri
sk in
th e
el d er
ly .
P o o n ,
H u i,
D ai
, K
w o k ,
an d
W o o
(2 00
5)
R C
T , C
B T
, M
D T
, te
le m
ed ic
in e,
C B
P , F T
F G
, v id
eo -
co n fe
re n ci
n g,
SS S
C D
S w
it h
m il d
d em
en ti
a an
d m
il d
co gn
it iv
e im
p ai
rm en
ts in
C h in
a
22 12
w ee
k s
M M
SE , R
B M
T , H
D S
sh o w
ed h ig
h er
sc o re
s (e
.g .,
at te
n ti
o n ,
m em
o ry
, sp
at ia
l co
n st
ru ct
io n ,
an d
la n gu
ag e)
T el
em ed
ic in
e is
a fe
as ib
le an
d ac
ce p ta
b le
m ea
n s
in p ro
v id
in g
co gn
it iv
e as
se ss
m en
ts an
d in
te rv
en ti
o n s
to el
d er
p er
so n s
w it
h m
il d
co gn
it iv
e d efi
ci ts
. E n gu
id an
o s,
D av
is ,
an d
K at
z (2
00 5)
R C
T , P C
C B
T ,
P ST
, an
d p h ar
m ac
o -
lo gi
c ai
d s
M o d er
at el
y/ se
v er
el y
d ep
re ss
ed p at
ie n ts
re fe
rr ed
to ge
ri at
ri c
ca re
m an
ag em
en t
se rv
ic e
15 3
19 m
o n th
s P C
C B
T ef
fi ca
ci o u s
(e .g
., si
gn ifi
ca n tl y
re d u ce
d d ep
re ss
iv e
sy m
p to
m s)
E d u ca
ti o n , P ST
, an
d P C
C B
T ca
n h el
p m
o d er
at el
y/ se
v er
el y
d ep
re ss
ed se
n io
rs to
re d u ce
d ep
re ss
iv e
sy m
p to
m s—
ca se
st u d y
ap p ro
ac h
u se
d .
(c on
ti n u ed
ov er
le a f)
213 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
T ab
le 8.
3 C on
ti n u ed
R ef
er en
ce s
In te
rv en
ti o n
s P
ro v id
ed P
re se
n ti
n g
P ro
b le
m s
S p ec
ifi ed
P o p u
la ti
o n
s D
u ra
ti o n
o f
In te
rv en
ti o n
s T
ar g et
ed O
u tc
o m
es E
ff ec
ti v en
es s
o f
In te
rv en
ti o n
s
T se
, P u n , an
d B
en zi
e (2
00 5)
A ff
ec ti v e
im ag
es d u ri
n g
P T
P at
ie n ts
su ff
er in
g fr
o m
ch ro
n ic
p ai
n
15 6
w ee
k s
O u tc
o m
es ac
h ie
v ed
(e .g
., su
b je
ct s
re p o rt
ed in
cr ea
se in
h ea
lt h -
re la
te d
q u al
it y
o f
li fe
)
A ff
ec ti v e
im ag
es m
ay p ro
v id
e m
o d er
at e,
n o n p h ar
m ac
o lo
gi ca
l in
te rv
en ti
o n
fo r
el d er
ly p er
so n s
w it
h ch
ro n ic
p ai
n .
R ya
n -W
o o ll ey
an d
R ee
s (2
00 5)
R C
T ,
co n co
rd an
ce ,
u se
o f
m ed
ic in
e o rg
an iz
er , E D
Sh el
te re
d h o u si
n g
re si
d en
ts in
U n it ed
K in
gd o m
62 12
m o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., m
o re
p re
sc ri
p ti
o n
ch an
ge ,
d ec
re as
e in
th e
n u m
b er
o f
p re
sc ri
p ti o n s,
le ss
w as
te o f
m ed
ic in
e)
P h ar
m ac
is ts
u si
n g
co n co
rd an
ce an
d m
ed ic
in e
o rg
an iz
er s
ca n
re d u ce
m ed
ic in
e w
as te
an d
m is
u se
.
C ap
la n ,
W il li am
s, D
al y,
an d
A b ra
h am
(2 00
4)
R C
T , M
D T
, C
G A
, D
E E D
II p ro
gr am
P at
ie n ts
d is
ch ar
ge d
h o m
e fr
o m
em er
ge n cy
d ep
ar tm
en t
in u rb
an ar
ea ,
A u st
ra li a
73 9
30 d ay
s (f
o ll o w
in g
h o sp
it al
d is
ch ar
ge )
an d
18 m
o n th
fo ll o w
-u p
O u tc
o m
es ac
h ie
v ed
(e .g
., lo
w er
ra te
o f
em er
ge n cy
ad m
is si
o n s,
gr ea
te r
d eg
re e
o f
m en
ta l an
d p h ys
ic al
fu n ct
io n , lo
w er
co st
s o f
ca re
fo r
p at
ie n ts
)
D E E D
II , a
m u lt id
is ci
p li n ar
y in
te rv
en ti
o n , ca
n im
p ro
v e
h ea
lt h
o u tc
o m
es fo
r th
e el
d er
ly an
d lo
w er
ra te
s o f
re ad
m is
si o n
to h o sp
it al
s.
C u m
m in
gs (2
00 3)
G T (
re m
o ti
v at
io n
an d
su p p o rt
iv e
th er
ap y
te ch
n iq
u es
)
D ep
re ss
ed as
si st
ed -
li v in
g re
si d en
ts
17 10
se ss
io n s,
5 w
ee k s
O u tc
o m
es ac
h ie
v ed
(e .g
., p ar
ti ci
p an
ts ex
p er
ie n ce
d si
gn ifi
ca n t
d ec
re as
e in
d ep
re ss
iv e
sy m
p to
m s
an d
re p o rt
ed h ig
h er
d eg
re e
o f
li fe
sa ti sf
ac ti o n )
G T
ca n
in cr
ea se
li fe
sa ti sf
ac ti o n
an d
d ec
re as
e d ep
re ss
iv e
sy m
p to
m s
in as
si st
ed -l
iv in
g el
d er
ly w
it h
d ep
re ss
iv e
sy m
p to
m s.
D ip
k o ,
X av
ie r,
an d
K o h lw
es (2
00 3)
E C
G ,
A D
E ,
SS W
, D
P A
H C
, L W
O u tp
at ie
n ts
in p ri
m ar
y ca
re cl
in ic
20 3
(E C
G )
an d
13 ,9
13 (c
o m
p ar
is o n
gr o u p )
33 m
o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., E C
G w
as tw
ic e
as ef
fe ct
iv e
as SS
W ,
p at
ie n ts
w er
e m
o re
li k el
y to
co m
p le
te ad
v an
ce d ir
ec ti
v es
in d ep
en d en
t o f
ed u ca
ti o n
st ra
te gy
)
G ro
u p
ed u ca
ti o n
is an
ef fe
ct iv
e an
d ti
m e-
an d
co st
-e ff
ec ti v e
so ci
al w
o rk
to o l fo
r co
m p le
ti o n
o f
ad v an
ce m
ed ic
al d ir
ec ti
v es
fo r
el d er
ly p at
ie n ts
.
214 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
B al
l et
al .
(2 00
2) R
C T
, C
B T
, E C
G In
d ep
en d en
tl y
li v in
g re
si d en
ts in
si x
m et
ro p o li ta
n ar
ea s
2, 83
2 46
m o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., si
gn ifi
ca n t
im p ro
v em
en t
in sp
ee d
o f
p ro
ce ss
in g,
in re
as o n in
g, an
d o f
m em
o ry
, co
gn it
iv e
im p ro
v em
en t)
R es
u lt s
su p p o rt
th e
ef fe
ct iv
en es
s an
d d u ra
b il it
y o f
co gn
it iv
e tr
ai n in
g in
te rv
en ti
o n s
in im
p ro
v in
g ta
rg et
ed -c
o gn
it iv
e ab
il it
ie s
in th
e el
d er
ly .
G il l,
B ak
er ,
an d
G o tt
sc h al
k (2
00 2)
R C
T , E C
G , an
d co
m p et
en cy
- b as
ed ex
er ci
se p ro
gr am
to in
cr ea
se b al
an ce
P h ys
ic al
ly fr
ai l
p at
ie n ts
o f
p ri
m ar
y ca
re p ra
ct ic
es w
h o
li v e
at h o m
e
17 6
12 m
o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., tr
ea tm
en t
p ar
ti ci
p an
ts d em
o n st
ra te
d im
p ro
v em
en t
in p h ys
ic al
fu n ct
io n in
g)
In p h ys
ic al
ly fr
ai l o ld
er p eo
p le
, a
h o m
e- b as
ed in
te rv
en ti
o n
re d u ce
d th
e fu
n ct
io n al
d ec
li n e
in su
b je
ct s.
D o u gh
er ty
et al
. (2
00 2)
R C
T , C
B T
, b io
fe ed
b ac
k ,
an d
p el
v ic
m u sc
le ex
er ci
se
R u ra
l w
o m
en w
it h
u ri
n ar
y in
co n ti
n en
ce
17 8
24 m
o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., p ar
ti ci
p an
ts re
p o rt
ed le
ss u ri
n e
lo ss
an d
gr ea
te r
q u al
it y
o f
li fe
)
In o ld
er ru
ra l w
o m
en w
it h
u ri
n ar
y in
co n ti
n en
ce ,
a b eh
av io
ra l m
an ag
em en
t ap
p ro
ac h
fo r
co n ti
n en
ce in
te rv
en ti
o n
re d u ce
d u ri
n e
lo ss
. Sc
h o n fe
ld et
al .
(2 00
0) C
B T
, p sy
ch o ed
- u ca
ti o n
(G E T
SM A
R T
)
O u tp
at ie
n t
v et
er an
s w
it h
su b st
an ce
ab u se
p ro
b le
m s
11 0
16 w
ee k s
O u tc
o m
es ac
h ie
v ed
(e .g
., in
cr ea
se in
ab st
in en
ce am
o n g
p at
ie n ts
6 m
o n th
s la
te r
an d
lo n ge
r ti
m e
b et
w ee
n re
la p se
s re
p o rt
ed b y
p at
ie n ts
)
G E T
SM A
R T
ca n
b e
an ef
fe ct
iv e
in te
rv en
ti o n
w it
h el
d er
ly su
b je
ct s
w it
h su
b st
an ce
ab u se
p ro
b le
m s.
M az
zu ca
, B
ra n d t,
K at
z, H
an n a,
an d
M el
fi (1
99 9)
C C
T , se
lf -c
ar e,
E D
R h eu
m at
o id
ar th
ri ti
s an
d o st
eo ar
th ri
ti s
21 1
48 m
o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., ed
u ca
ti o n
re d u ce
d fr
eq u en
cy an
d co
st o f
p ri
m ar
y ca
re v is
it s)
E d u ca
ti o n
ca n
b en
efi t
se n io
rs in
m an
ag em
en t
o f
p ai
n fr
o m
ar th
ri ti
c co
n d it
io n s
an d
re d u ce
h ea
lt h
co st
s. P ro
ct o r
et al
. (1
99 9)
R C
T , C
B T
, SS
S R
es id
en ts
in n u rs
in g
h o m
es in
U n it ed
K in
gd o m
w h o
d is
p la
ye d
d ep
re ss
io n
an d
o rg
an ic
sy m
p to
m s
12 0
6 m
o n th
s (i
n cl
u d ed
se v en
1- h o u r
se ss
io n s
an d
w ee
k ly
SS S
su p p o rt
fr o m
p sy
ch ia
tr ic
n u rs
e)
O u tc
o m
es (e
.g .,
o rg
an ic
an d
d ep
re ss
iv e
sy m
p to
m s
im p ro
v ed
b u t
b eh
av io
ra l an
d p h ys
ic al
d is
ab il it y
d id
n o t)
B eh
av io
ra l o u tr
ea ch
(C B
T )
te am
s ca
n as
si st
el d er
ly w
it h
d ep
re ss
iv e
an d
o rg
an ic
sy m
p to
m s
b u t
ar e
n o t
ef fi
ca ci
o u s
to th
e im
p ro
v em
en t
o f
b eh
av io
ra l o r
p h ys
ic al
sy m
p to
m s.
(c on
ti n u ed
ov er
le a f)
215 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
T ab
le 8.
3 C on
ti n u ed
R ef
er en
ce s
In te
rv en
ti o n
s P
ro v id
ed P
re se
n ti
n g
P ro
b le
m s
S p ec
ifi ed
P o p u
la ti
o n
s D
u ra
ti o n
o f
In te
rv en
ti o n
s T
ar g et
ed O
u tc
o m
es E
ff ec
ti v en
es s
o f
In te
rv en
ti o n
s
K ee
fe ,
C al
d w
el l,
B au
co m
, Sa
ll ey
, an
d R
o b in
so n
(1 99
9)
R C
T , sp
o u se
- as
si st
ed C
B T
O st
eo ar
th ri
ti s
k n ee
p ai
n 88
12 m
o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., o v er
al l h ig
h er
se lf -e
ffi ca
cy ,
lo w
er le
v el
s o f
p sy
ch o lo
gi ca
l an
d p h ys
ic al
d is
ab il it y,
an d
im p ro
v ed
p ai
n le
v el
s)
Sp o u se
-a ss
is te
d C
B T
is ef
fe ct
iv e
in in
cr ea
si n g
se lf -e
ffi ca
cy an
d m
an ag
in g
p ai
n in
se n io
rs w
it h
o st
eo ar
th ri
ti s-
re la
te d
k n ee
p ai
n .
T en
n st
ed t
et al
. (1
99 8)
R C
T , C
B P , E D
A d u lt s
fr o m
40 se
n io
r h o u si
n g
si te
s in
u rb
an ar
ea w
h o
re p o rt
ed fe
ar o f
fa ll in
g
43 4
12 m
o n th
s (6
-w ee
k ,
6- m
o n th
, an
d 12
-m o n th
fo ll o w
-u p s)
O u tc
o m
es (e
.g .,
im m
ed ia
te b u t
n o t
st at
is ti
ca ll y
si gn
ifi ca
n t
im p ro
v em
en t
in m
o b il it
y, so
ci al
fu n ct
io n al
it y,
an d
m o b il it
y co
n tr
o l)
C o m
m u n it
y- b as
ed ed
u ca
ti o n
to re
d u ce
fe ar
o f
fa ll in
g in
o ld
er ad
u lt s
h as
m o d es
t b en
efi ci
al ef
fe ct
s.
G la
sg o w
et al
. (1
99 7)
R C
T , E D
w it
h em
p h as
is o n
go al
se tt
in g
an d
P ST
C D
S w
it h
ty p e
2 d ia
b et
es 20
6 12
m o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., si
gn ifi
ca n t
im p ro
v em
en ts
in fo
o d
h ab
it s,
ca lo
ri c
co n su
m p ti
o n , se
ru m
ch o le
st er
o l le
v el
s, an
d p er
ce n ta
ge o f
fa t)
E d u ca
ti o n al
h ea
lt h
p ro
gr am
s w
it h
em p h as
is o n
go al
se tt
in g
an d
p ro
b le
m so
lv in
g ca
n w
o rk
w it
h el
d er
ly p at
ie n ts
w it
h ty
p e
2 d ia
b et
es .
F ri
es ,
C ar
ey ,
an d
M cS
h an
e (1
99 7)
R C
T , m
ai l-
d el
iv er
ed A
SM P
R h eu
m at
o id
ar th
ri ti
s an
d o st
eo ar
th ri
- ti
s
37 5
6 m
o n th
s O
u tc
o m
es ac
h ie
v ed
(e .g
., d ec
re as
ed p ai
n ,
gl o b al
v it
al it
y in
cr ea
se d ,
jo in
t co
u n t
im p ro
v ed
, an
d cl
in ic
al v is
it s
d ec
re as
ed )
Se lf -m
an ag
em en
t co
u rs
es ca
n im
p ro
v e
th e
h ea
lt h
o f
th e
el d er
ly an
d d ec
re as
e co
st s
o f
cl in
ic al
ca re
fo r
p ai
n .
216 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
Sh ar
p e
et al
. (1
99 7)
E D
an d
p h ys
ic al
ac ti
v it
y p ro
gr am
w it
h em
p h as
is o n
st re
n gt
h ,
b al
an ce
, m
o to
r- co
o rd
in at
io n ,
an d
m o b il it
y
A d u lt s
in ru
ra l
co n gr
eg at
e n u tr
it io
n si
te s
11 0—
tr ea
tm en
t gr
o u p
(6 1)
an d
co m
p ar
is o n
gr o u p
(4 9)
12 m
o n th
s (t
w ic
e- w
ee k ly
se ss
io n s)
O u tc
o m
es ac
h ie
v ed
(e .g
., gr
ea te
r im
p ro
v em
en ts
in p h ys
ic al
fu n ct
io n in
g o v er
th e
p re
v io
u s
ye ar
th an
th e
co m
p ar
is o n
gr o u p )
L o w
-i n te
n si
ty ex
er ci
se ca
n b en
efi t
th e
o v er
al l h ea
lt h
an d
p h ys
ic al
fu n ct
io n al
it y
o f
el d er
ly su
b je
ct s.
Sl ae
ts ,
K au
ff m
an n ,
D u iv
en v o o r-
d en
, P el
em an
s, an
d Sc
h u d el
(1 99
7)
M D
T , P SY
G te
am ,
C B
T ,
an d
SS S
M ed
ic al
in p at
ie n ts
w it
h p o o r
p h ys
ic al
fu n ct
io n in
g
23 7—
tr ea
tm en
t gr
o u p
(1 40
) an
d co
n tr
o l
gr o u p
(9 7)
12 m
o n th
s (f
o ll o w
in g
d is
ch ar
ge )
O u tc
o m
es ac
h ie
v ed
(e .g
., im
p ro
v em
en t
in th
e p h ys
ic al
fu n ct
io n in
g o f
th e
tr ea
tm en
t gr
o u p
p ar
ti ci
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(c on
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217 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
T ab
le 8.
3 C on
ti n u ed
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In te
rv en
ti o n
s P
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gr am
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T =
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en ti a
sc al
e; L W
= L iv
in g
w il l;
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T =
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is ci
p li n ar
y te
am ; M
M SE
= M
in i-
m en
ta l- st
at e
ex am
in at
io n ; N
T =
N u tr
it io
n al
tr ai
n in
g; P C
C B
T =
P at
ie n t-
ce n te
re d
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it iv
e b eh
av io
ra l th
er ap
y; P R
T =
P ro
sp ec
ti v e
ra n d o m
iz ed
tr ia
l; P ST
= P ro
b le
m so
lv in
g th
er ap
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G =
P sy
ch o ge
ri at
ri c;
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= P h ys
io th
er ap
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B M
T =
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C T
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p p o rt
; SS
W =
Se ss
io n
w it
h so
ci al
w o rk
er ; V
A =
V et
er an
s A
d m
in is
tr at
io n .
218 Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
h n W
ile y
& S
o n s,
I n co
rp o ra
te d . A
ll ri g h ts
r e se
rv e d .
Intervention With the Elderly 219
They employed a range of practitioners including professionals, semiprofes- sionals, health-care agents, and family members of the subjects examined. Additionally, interventions were offered in clinical and nonclinical loca- tions and in an array of social settings, including urban, suburban, and rural, both in the United States and abroad.
The collective interventional framework of the studies in Cohort 3 can be generalized into two overlapping spheres, mental health and physical health. This may be due to the fact, in part, that the presenting problems of many elderly patients/clients are diametrically related to the unique transitions of later life, for example, declining health, chronic and acute pain, increased limitations in physical performance, loss of social connections and relationships, sociocultural isolation, cognitive changes, the escalating cost of health care, and anxiety and depressive disorders. And many of these are interrelated. As the unprecedented increase in the number of elderly continues to proliferate and the life expectancy of older adults extends, empirical evidence-based research on efficacious interven- tions will continue to be an essential tool to the social work practitioner (Cummings & Kropf, 2009). Curiously, of the hundreds of studies reviewed here, most of the discipline-specific social work publications failed to meet the stringent intervention-outcome identified criteria in Table 8.3.
Many of these study designs included interdisciplinary, and/or multi- interventional strategies to address presenting problems (Caplan, Williams, Daly & Abraham, 2004; Poon, Hui, Dai, Kwok, & Woo, 2005; Rich, Gray, Beckham, Wittenberg, & Luther, 1996; Slaets, Kauffmann, Duivenvoor- den, Pelemans, & Schudel, 1997). Multidisciplinary teamwork in treating the elderly is the norm and appears to be the most effective interven- tional stratagem. Perhaps this is due in part to the complexities that are concurrent to later-life experiences and its respective host of challenges. Among the uniqueness of gerontological practice is the biopsychosocial holistic approach to using interventions with the client. Using a multidisci- plinary approach is one way of addressing the whole person in his or her environment.
Cohort 3 studies clearly reveal an eclectic methodological range in their interventions. These interventions range in duration from 2 weeks to 48 months and every possibility in between. Some synthesized phar- macological and therapeutic stratagems to address presenting problems of severe depression in the elderly subjects (Enguidanos, Davis, & Katz, 2005; Hunkeler et al., 2006). Others utilized a collaborative approach of tech- nology and therapy to address presenting problems ranging from cognitive impairment to chronic pain, from depression to arthritis, and from urinary incontinence to dementia (Dougherty et al., 2002; Poon et al., 2005; Tse et al., 2005).
Since the 1950s, the ubiquitous modality for treating the elderly is group work (Husaini et al., 2004). This approach continues to be apparent, having success in both achieving desired outcomes (Ball et al., 2002) and
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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& S
o n s,
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te d . A
ll ri g h ts
r e se
rv e d .
220 Social Work Practice With Individuals and Families
nonsuccess in accomplishing specified outcomes (Bailly & DePoy, 1995; Gill et al., 2002). Thus, from these data, group work/therapy remains an efficacious interventional stratagem within the elderly population. Many of such interventions included problem solving, remotivational, and/or cognitive-behavioral therapy (Ball et al., 2002; Cummings, 2003; Dougherty et al., 2002; Enguidanos et al., 2005; Glasgow et al., 1997; Hunkeler et al., 2006; Keefe et al., 1999; Proctor et al., 1999; Schonfeld et al., 2000). This finding was recently corroborated in another review of evidence and outcome literature with this population (Kolomer, 2008).
The eclecticism of these interventions demonstrates the expediency of taking more than one approach to a presenting problem. In short, they suggest that multifaceted presenting problems require multimethodological interventions. Rich et al.’s (1996) study on congestive heart failure patients who demonstrated poor behavioral compliance to their treatment were at risk of readmission to the hospital, thus increasing the cost of care and potentially exacerbating their physical ailment. By utilizing a nurse-led multidisciplinary team that provided nutritional training, education, and social service support, hospital readmission was significantly reduced among those in the treatment group, thus reducing the costs of care and increasing the general health of these subjects.
Further, when examining the overall cohort, we recognize that the variegated interventions are quite similar in their recognition of the inex- tricable connection between pain and depressive symptoms. Acute and chronic pain have the potential to lower health-status scores, quality of life, self-efficacy, and social functioning of elderly clients/patients. These studies show that many of the targeted outcomes of the interventions were consistently related to the symptomatic experiences that are con- comitant to chronic and acute pain. For example, Maisiak et al. (1996) conducted a study on elderly patients suffering from rheumatoid arthritis and osteoarthritis. The chronic and acute pain of these conditions lowered the health-status scores of the study group and increased the number of medical visits, thus increasing the cost and inconvenience of health care for these 405 subjects. The 9-month intervention of telephone monitoring and counseling bettered the health-status scores, decreased the number of medical visits, and decreased the concomitant costs of care for these subjects. This study showed that elderly patients with rheumatoid arthri- tis and osteoarthritis are responsive to telephone counseling and support for pain.
Overall, the studies in Cohort 3 suggest that the greater the specificity of the target group, the more precise the interventional strategy, the more defined the desired/targeted outcomes, the greater likelihood of success. Additionally, they reveal that the complexities of experiences in later life necessitate interdisciplinary multi-interventional strategies that synthesize several methods toward specific and desired outcomes. The implication for the social work practitioner is that he or she must become more adept at reviewing, conducting, and using evidence-based empirical research and
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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r e se
rv e d .
Intervention With the Elderly 221
become acquainted with a variety of disciplines in order to navigate the quagmire of the biopsychosocial experiences of elderly clients (Cummings & Kropf, 2009).
In these studies, the specified targeted outcomes ranged from the very broad; for example, reduction of depressive symptoms, increase in degree of life satisfaction, improvement in physical functioning, and/or increase of knowledge about end-of-life planning, to the very specific; for example, reducing the loss of urine, lowering serum cholesterol levels, completion of advance directives, and/or lowering costs for outpatient services over a 48-month period. These studies also reflect the well-known bias of published literature, that is, treatments that work. Nevertheless, the contributive importance of these studies along the continuum of practice presented in this chapter help social workers understand the inimitable synergistic value of using EBP for their intervention strategies.
Limitations of the Evidence
As with any overview chapter of this nature, the search process used to collect the articles/chapters/published accounts of EBP interventions may not have captured all of the available published literature. For this we apologize. Second, the processes used to define evidence-based practice and the subsequent conceptualization of it depart somewhat from more traditional notions of its use in reviews of this nature (e.g., Cummings & Kropf, 2009).
Despite these limitations and based on Figure 8.1, we collected and analyzed literature according to three cohorts: (1) conceptual/theoretical frameworks for treatment, (2) effectiveness studies, and (3) specified inter- vention and outcome studies. Prior to a discussion of these subsections, the limitations and conceptualization of how the residual published accounts were retained is discussed.
What became apparent in this overall review is the need for the social work profession to develop a more relevant definition of EBP. This has been noted before (Gambrill, 2006; Holosko, 2004; Pollio, 2002, 2006; Sackett et al., 1997; Thyer & Kazi, 2004). Such a definition should embrace the practice reality of professionals working in our field, have an empirical basis to it, and should inform and direct practice in meaningful ways. All of the submissions offered in this chapter meet these minimal criteria.
Implications for Social Work at Micro-, Mezzo-, and Macrolevels
If we were to look at various practice trends in the field of gerontology, four main trends prevail. First, there are and will continue to be a shortage of trained personnel to work in this area. Second, education and training needs far exceed the ability for practitioners working in this area to provide
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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222 Social Work Practice With Individuals and Families
Societal themes
Knowledge domains
Level 2 Interventions
Applying evidence to levels of intervention:
individual, family, group, community,
organization, society Evidence
Making EBP social work practice decisions
Levels of intervention
Practitioner reflection
and integration
Practice decisions
Level 1 Interventions
Figure 8.2 Minimal knowledge and skills necessary to use evidence-based practice with the elderly
adequate, timely, and much needed care. Third, practitioners are required to integrate specialized knowledge, skills, and interventions in order to be effective in working with the elderly. Fourth, social work practitioners must embrace the principles of advanced generalist practice and move fluidly and seamlessly in providing competent interventions to their clients. The latter implies that the micro/mezzo/macro distinction delimits our ability to be effective with such clients (Holosko, White, & Feit, 2004).
In an effort to illustrate how EBP underpins practice in this field, Figure 8.2 illustrates how a cumulative progression of societal issues, levels of intervention, and the application of such evidence to practice results for better-informed practice decisions. Rather than illustrating what evidence should be used to affect practice, this figure shows how evidence directs and informs our practice. In each step of Figure 8.2, a series of current and minimal knowledge requirements are identified. Then, the assumptions underpinning each will be identified followed by a brief discussion.
Societal Themes Issues
Social workers require a formative contextual knowledge of what’s going on in society and in my community with the elderly. Having such awareness allows us to understand how broader issues truly impact day-to-day practice realities in working with the elderly. These current themes are presented in Table 8.4.
The main assumptions around these cornerstone societal issues or themes are (a) as society evolves, these themes will inevitably change, (b) they systemically interrelate with each other, and (c) all gerontological practice in any ‘‘community of care’’ is shaped by broader societal issues that frame such practice.
In regard to the latter, workers need to (a) understand how to work creatively in limited resources; (b) demystify stereotypes typically
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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rv e d .
Intervention With the Elderly 223
Table 8.4 Current Societal Issues/Themes The escalating number of elderly and their unique and specialized health,
mental health, and social issues ‘‘Aging-in-place’’ or supporting individuals to reside in their homes and
communities for as long as possible Not enough resources to adequately serve and treat the demands of this
subpopulation The impact of new technologies that can be used to better serve and treat this
subpopulation The systematic devolution of federal and state monies and supports to local
community-based initiatives Out-migration of elderly person from rural to urban centers to avail
themselves of services Long-standing and prevailing ageism challenges our ability to practice in this
field
presented about elderly persons; (c) understand policies, procedures, and best practices that shape how and what they do; and (d) not practice in a contextual vacuum. Indeed, gerontological social work has been a forerunner in recognizing and responding to the political, societal, and practice realities of the elderly today. Our long-standing work with the marginal and vulnerable populations of society has perhaps made us more prepared and clearer about how to effectively approach practice in a time of limited and rationed health and social services (Holosko & Holosko, 2004).
Basic Knowledge Areas
The minimal knowledge areas in quadrant 2 (Figure 8.2) for social work practitioners working with the elderly are presented in Table 8.5.
The main assumptions underpinning Table 8.5 are (a) each involves core knowledge, values, and skills that are differentially applied to each
Table 8.5 Basic Knowledge Areas for Working With the Elderly Biopsychosocial holistic approach Formal and informal support systems Grief and loss Death and dying Sexuality Medical conditions unique to the elderly Mental health conditions unique to the elderly Social and family situations and conditions unique to the elderly Spirituality Diversity and culture Unique family situations
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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224 Social Work Practice With Individuals and Families
client or client situation; and (b) there are minimal knowledge requirements in each area that practitioners need in order to offer responsible and ethical practice (Vourlekis, Zlotnick, & Simons, 2005).
As a precursor to the application of interventions with the elderly, these then are deemed as the basic knowledge domains of any geronto- logical social work practitioner. Indeed, there is much to learn here, and a healthier reframe might be to look at these as a process of career pro- fessional learning and systematically developing and accruing knowledge about each area on a case-by-case basis. Seeking and finding relevant empirical evidence to understand such knowledge and integrating it into day-to-day practice are challenges that every worker faces in his or her unique way.
Level 1—Intervention Skills
As indicated in the numerous studies previously reviewed in this chapter, a variety of interventions often multiplied and differentially applied are the norm, not the exception, for practitioners who work in this field (see Tables 8.1, 8.2, and 8.3). These are referred to as ‘‘Level 1—Skills’’ because they are the basic or minimal ones necessary to work at the entry levels of practice with the elderly. As Figure 8.2 also illustrates, they are cumulative in nature or build on a practitioner’s ability to integrate both the previously described societal themes and formative knowledge domains. These are presented in Table 8.6.
In today’s practice reality, these Level 1 skills are typically provided in any accredited BSW program in North America. It is how they are used with the elderly, however, that characterizes their uniqueness for practitioners working in this field. There are two underlying assumptions about their current use with the elderly: (1) all need to be grounded in a strengths-based perspective, and (2) they require an overt client-centered focus in their application.
From a strengths-based framework, the notion is to apply such interventions to promote factors of successful aging. These include the avoidance of disease and disability, involvement in society, continued
Table 8.6 Level 1 Intervention Skills Assessment Counseling Discharge planning Treatment planning and monitoring treatment Case management Group work Advocacy and brokering Community outreach coordination Education
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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Intervention With the Elderly 225
high cognitive and physical impairment, and maintained or acquired sense of purpose and autonomy (Rowe & Kahn, 1998). As society gives responsibility for care back to individuals, families, and communities, clearly there is renewed support for a client-centered focus with the elderly. The elderly person, then, despite capacity, physical abilities, and financial resources is to be considered as the person with the resources to make changes in his or her situation to be more functional (Holosko & Holosko, 2004, p. 37).
Level II Intervention Skills
Building on the previous areas, Table 8.7 presents a list of minimal Level II intervention skills that gerontological practitioners require. Again, many of these were mentioned in the numerous evidence-based studies previously reviewed in Tables 8.1 and 8.2, which assessed practice efficacy.
Table 8.7 presents a set of skills that clearly delineate specialization criteria for social workers working with the elderly. Although such skills are more likely to be offered in our MSW, rather than BSW curricula (Holosko, 1995), they require more knowledge, specialized training, and education than these curricula currently offer. The two assumptions on which they stand are (1) you must be an advanced generalist practitioner in order to be effective in this field, and (2) instilling hope with each client and client situation and needs to become integrated into each intervention offered.
Gerontological social worker practitioners epitomize the essence of advanced generalist practice. Staying current with new developments in the field, working simultaneously and fluidly with all levels—micro/ mezzo/macro—and evaluating their practice are the norm, not the excep- tion, for such practitioners (Holosko & Feit, 2004; Vourlekis et al., 2005). It is at this level that one begins to see how judiciously using empirical data, seeking and using current literature and case material and the best available evidence, and judiciously using these data to direct and inform practice are part-and-parcel of everyday gerontological practice. Thus, there is no option for not integrating empirical data into practice, whether
Table 8.7 Level II Intervention Skills Defining what is unique about social work practice with the elderly Complex ethical decision making Capacity assessment Caregiving dynamics End-of-life protocols and caring Working in multisystem levels Working effectively and creatively with minimal resources Anchoring all interventions in the best available evidence Routinely evaluating one’s own practice effectiveness
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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it is secondary or primary data collected by the practitioners themselves or learned from the literature (Rosen, 2003).
The issue of the instillation of hope into each client, client situation, intervention, and so on becomes a formidable challenge for practitioners working in this field. We cannot rely solely on the outcomes of our inter- ventions, for example, ‘‘most clients should do better after the 12 weeks of treatment,’’ to be the only indicator of our intervention successes or failures. Neither can we ‘‘buy in’’ to self-pitying clients or colleagues who have given up hope on themselves or their situations. These challenges are consistently confronted in areas such as advanced stages of dementia, chronic physical disease, and/or end-of- life transitions.
Applying Evidence to Render Better Practice Decisions
The final grid and circle synthesizing the integration of these areas in this cumulative process implies applying evidence to impact a better practice decision. Whether such evidence results in a better set of practice questions (Gibbs, 2005), it is the synergy of the application of the available evidence through an intervention that results in better-informed practice decisions. This then becomes the culmination (in this model) of the evidence-informing practice process.
One of the three intersecting circles in Figure 8.2 involves practice reflection and integration. Thus, having the evidence and knowing how to apply it requires some practice wisdom, as we used to say. This is truly where the art side of practice meets the empirical side, and both are necessary to render better-informed practice decisions. The perennial false dichotomy that has polarized these two areas of social work (for a number years) is, therefore, rooted in this synthesis model.
For instance, if social work practitioners use the best available evidence to render a practice decision as such, they cannot be accused of dismissing either side of the science-art continuum. It is the precise synthesis of their interaction that is the trigger for the eventual practice decision. However, if a practice decision is made without this synthesis, it would be deemed unethical and irresponsible by default (Gambrill, 2006).
This critical intersect is the very place where (a) a looser definition of EBP can be rationalized (as is argued in this chapter); (b) statisti- cal and clinical significance can be deemed as equally relevant; and, most importantly, (c) practitioners working in this field can render an empirically based practice decision in a reflective, individualized, and integrative knowledge-based fashion—EBP defined in gerontological social work practice.
Conclusion
This chapter presented an overview of EBP interventions with the elderly. At the onset, it was suggested that understanding the context in which
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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Intervention With the Elderly 227
these interventions occurred may help social work practitioners to better understand the literature and data presented herein. These broader contexts included: the demographic reality of a rapidly growing aging society, social policies or so-called best practices that shape current gerontological practice and practice implications.
A model (Figure 8.1) based on a less stringent definition of EBP categorized these literature/studies into three related cohorts. Cohort 1 was called conceptual/theoretical frameworks, Cohort 2 was called effec- tiveness studies, and Cohort 3 was intervention and outcome studies. The parameters of each of these and their conceptual rationales were presented prior to a discussion of the data within them.
After a discussion of these data, a second figure (Figure 8.2) con- figured a relationship about not what this evidence was, but how it could be used in a practice model. Thus, the integration of evidence into gerontological practice was then discussed.
Based on this chapter, the question becomes—What do social work practitioners need to know about evidence-based interventions with the elderly? There are a few things that seem important.
First, despite the fact that more social workers are practicing with the elderly than ever before and considerable progress has been made in the profession’s ability to conduct more research and evaluation (Padgett, 2005), we must strive to continue to evaluate our practice interventions with the elderly. Morrow-Howell and Burnette (2001) indicated that the top priority identified by gerontological social workers and researchers was the development and tending of psychosocial interventions with the elderly.
In a recent review of literature about evidence-based practice with the elderly, Cummings and Kropf (2009) concluded their insights review by stating:
Researchers acknowledge that greater understanding about how different inter- vention approaches promote beneficial outcomes within the diversity of the older population is required. Since limited evidence exists in many areas of practice with older adults, researchers have abundant opportunities to conduct research that will add to the knowledge base about effective intervention approaches. Indeed, continuing to build a social work research agenda about practice inter- ventions is seen as being essential to developing timely knowledge about our practice efforts.
Second, as is argued in this chapter, the social work profession has acknowledged that it requires a more relevant definition of evidence-based practice (Gambrill, 2006). This definition should guide and inform practice and be able to be easily operationalized in the practice worlds of our practitioners (Pollio, 2006). The integrative model (Figure 8.2) presented a case supporting this contention. The cohort definitions on which this model was based (Figure 8.1) further argued for a new definition of EBP. Indeed, as is presented throughout this chapter, the nexus for understanding the relationship between research/evaluation and practice is first how
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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research/evaluation data guides/directs/informs practice. Second, how it becomes integrated into day-to-day practice activities is where the real proof is in the pudding—to quote an old English proverb.
Overall, Tables 8.1, 8.2, and 8.3 taken together revealed that:
• Social work is not the only profession taking a leadership role in assessing practice efficacy with the elderly.
• Inherent internal and external validity threats, for example, history, maturation, subject and experimenter expectancy, and generalizabil- ity are part and parcel of conducting research/evaluations of practice interventions with this population.
• Multidisciplinary team interventions are the norm for practitioners working in this field.
• Group-work intervention is still the prevailing practice modality for providing intervention to the elderly.
• Multiple intervention strategies targeting specific multifaceted problems are the current practice in this field.
• Empowerment and strengths-based approaches have significantly influenced social work practice with the elderly.
• Issues, problems, and concerns of the elderly are slowly being reframed as normalized, not pathological.
• Describing and measuring our practice outcomes in more precise ways has resulted in ameliorating specific problems of clients, better time framed treatment protocols, sharper interventions, and better- informed practice decisions.
Finally, gerontological social work practice holds a promising future for our profession. It is a field rife with both challenges and opportunities in which social work can take an active leadership role. Basing our practice and interventions on empirical evidence that directs and informs judicious practice decisions is an important way for us to impart such leadership. Social work has the necessary knowledge, values, and skills to affect such responsible and ethical practice.
Key Terms
Elderly
Interventions
Outcomes
Evidence
Data
Review Questions for Critical Thinking
1. What is the contributive importance of evidence-based practice for gerontological social work intervention strategies?
Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
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Intervention With the Elderly 229
2. Why is worker self-awareness and self-care especially important when working with the elderly?
3. Explain why client autonomy and sense of control may be especially important when working with an aging population. What barriers do you foresee that may impede self-determination for the elderly client?
4. According to the NASW, social workers involved in palliative care must be prepared to deal with ethical dilemmas inherent in this type of work. Discuss the potential value conflicts that could arise for social workers dealing with end of life issues.
5. Describe those activities that will promote specialization for social workers working with the elderly.
Online Resources
http: / / seniors.lovetoknow.com / Social_Work_Skills_for_Working_With_ the_Elderly This website highlights necessary social work skills for working with the elderly.
http: / / www.naswdc.org / practice / bereavement / standards / default.asp This link directs the reader to the NASW standards for social work practice in palliative and end-of-life care.
http://www.state.gov/m/dghr/flo/c23141.htm This website provides practical information on caring for elderly parents. Some highlights include communicating with the aging parent, elder care options, and deterioration warning signs.
http://www.longtermcarelink.net/ This website contains resources and information on long-term care planning and elder-care services.
http://www.ahrq.gov/research/olderam/oldam1.htm This website pro- vides information on the ways to improve the health of older Americans.
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Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
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2 0 1 3 . Jo
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Holosko, Michael J., et al. <i>Social Work Practice with Individuals and Families : Evidence-Informed Assessments and Interventions</i>, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1106529. Created from waldenu on 2019-08-04 18:14:10.
C o p yr
ig h t ©
2 0 1 3 . Jo
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& S
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I n co
rp o ra
te d . A
ll ri g h ts
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