9 Social Work with Older Adults

In this chapter, the student will focus on social work practice: social work with older adults. We will consider some important considerations in the study of gerontology, common health complications for the older adult, and some of the more common concerns for the geriatric social worker.

Gerontology

One of the fastest-growing populations that social workers provide services to is the aging population. For social workers, older adults offer unique challenges that are not present in other populations. There are many challenges that aging adults face in our society which range from medical and mental health to financial concerns. Below are some usual challenges that they face in this country that social workers will have to be familiar with.

Important Health Complications

Among the most shared challenges facing older adults are medical conditions that attack cognition. Dementia and Alzheimer’s Disease are the most common medical conditions that older adults suffer from; both directly impair cognition to various levels. Dementia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. The most common form of Dementia is Alzheimer’s disease. In 2023, there are roughly 4.7 million Americans over 65 have dementia from Alzheimer’s disease (Alzheimer’s Association, 2023). Each form of dementia has different symptoms and physical impact on the brain. Social workers will need to be versed in several types of dementia and the interventions available to best address their clients’ needs.

Along with medical conditions that impact cognition, there are also many illnesses and diseases that impact physical health. As we age, our body begins to break down over time. Our immune systems are no longer able to fight off infections and illnesses that could occur earlier in the lifespan. There are a multitude of illnesses and diseases that the elderly population are more susceptible to. All too often, physical health deterioration leads to elderly individuals to be placed in nursing facilities, as they can no longer care for themselves without medical professionals available around the clock.

Not only are older adults more prone to diseases that impact physical health and cognition, but the population has its own unique set of mental health concerns. As we age, there are also mental health concerns that are a direct result of growing older. Depression is common among the aging population due to a variety of reasons. Grief and loss are two contributing factors to elder depression. Isolation is also a contributing factor for depression. Isolation rates for older adults are high due to physical immobility and lack of transportation. Social workers working with this population must address grief, loss, and isolation with their clients to provide better mental health care.

Managing the Cost of Aging: Another major challenge of aging is the simple cost of aging. Most older adults are unemployed due to advanced age and physical health. Many live off Social Security and retirement benefits and many utilize Medicare and Medicaid for insurance. Those who live in assisted living communities or nursing facilities have a clear majority of their income allocated for their care. The cost of medications, general living expenses, and food often monopolizes the fixed income of older adults.

The Role of Caregivers for Older Adults

Caregivers can be medical professionals, family members, or everyday individuals that provide care for the aging population in the home. Caregivers often come in the form of family such as adult children taking care of their elderly parents. Caregiving can play a demanding and strenuous role.

Many caregivers are often faced with the challenges of working outside the home while still trying to provide care. However, caregivers play a key role in enabling older adults to remain in the community for as long as possible.

The Role of Assisted Living and Nursing Facilities for Older Adults:

Assisted living facilities are small communities or facilities that provide limited assistance for older adults. Most often, elderly couples and individuals who are still in good health will reside in these forms of care. Assisted living options offer more independence for those who reside in them. Assisted living facilities often do not employ social services, for the elders who need these services, they must be sought outside of assisted living services. Larger assisted living communities may contract with outside social service agencies to provide services.

Nursing facilities provide a wide range of services for residents. All meals and domestic services are covered by staff. There are a variety of medical professionals that are employed by these facilities. They provide 24-hour medical care for those who can no longer remain in the community and need extra support than assisted living facilities provide. Many nursing facilities also provide rehabilitation services such as physical therapy, for those recovering from surgery or serious illness.

Along with nursing staff, nursing facilities employ a broad range of professions to best provide services. Social workers, dietitians, physical therapists, maintenance staff, and environmental services are just some professions outside of nursing that are employed in these types of facilities. Social workers in nursing facilities are tasked with the residents’ mental health and emotional well-being. Social workers in these facilities most commonly work with residents who are experiencing depression, anxiety, grief and loss, and dementia. Social workers often play a significant role in nursing facilities as they may also help with admissions, day-to-day activities, and discharge planning.

Being a Geriatric Social Worker:

The aging population faces many unique challenges. Finances, health, mental health, and political considerations must all be considered when social workers provide services to the aging population. Growing older is inevitable, however, social workers can make the process smoother than those who have entered the later stages of life.

Competencies for the social worker with older adults:

1. The social worker must be aware of age-related personal and professional values. Such understanding is elicited with self-reflection and study.
2. As with all other populations, the social worker must be able to practice in a culturally competent manner (as is stated in the NASW (National Association of Social Workers) Code of Ethics).
3. Practice with a willingness to advocate for the aging population with health and social service agencies and as members of interdisciplinary teams on behalf of older adults and their families.
4. Assist older adults and their families in learning about their rights to available resources, and their right to be informed about any decisions and actions that will impact the older adult.
5. Competent to do the following with older adults and their families:
   1. To conduct a biopsychosocial assessment that is certainly inclusive of biological, psychological, and social factors, as well as attention to family, cultural, and spiritual factors.
   2. Be aware of community resources (the role of the broker) and link such resources to the older adult and their family.
   3. As alluded to in the cultural competency noted above, the social worker must be knowledgeable of the physical, language, and cognitive strengths and limitations of  older adults.

Summary

With the various and sometimes limited resources offered, social workers must know how to navigate a system to better provide for their clients. With the rising cost of health care and an ever-changing political environment, social workers are tasked with advocating and serving those in the population who may not be able to do so themselves. People of advanced age are valuable contributing members of our world and as social workers, we must stand to make a better future for all.

References

Alzheimer’s Association. (2023) 2023 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 19(4). DOI 10.1002/alz.13016.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.

Mullin, E. (2013, Feb 26). How to pay for nursing home costs: Medicare, Medicaid, and other resources can help minimize the cost of long-term care. U.S. News and World Report. Retrieved from https://health.usnews.com/best-nursing-homes/articles/how-to-pay-for-nursing-home-costs

National Center on Elder Abuse. (2005). Elder abuse prevalence and incidence. Washington, DC: National Center on Elder Abuse.

National Council on Aging. (2022). Get the facts on fall prevention. Retrieved from https://www.ncoa.org/article/get-the-facts-on-falls-prevention

Nursing Home Alert: Abuse and Neglect Lawsuit Resource. (2017). State Surveys. Retrieved from http://www.nursinghomealert.com/state-nursing-home-surveys

Sollitto, M. (2016). Urinary tract infections in the elderly. Retrieved from https://www.agingcare.com/articles/urinary-tract-infections-elderly-146026.htm