Download Social Work with Older Adults in Health Care Practice

Social Work with Older Adults in
Health Care Practice
Course: Health Care
Adelphi University School of Social Work
Acknowledgements
The development of this gerontology
teaching module was made possible
through a Gero Innovations Grant from
the CSWE Gero-Ed Center's Master's
Advanced Curriculum (MAC) Project and
the John A. Hartford Foundation.
Adelphi University Project Team: Judy
Fenster (Principal Investigator), Philip
Rozario, Patricia Joyce, and Bradley
Zodikoff.
Acknowledgments (Continued)
Source material for this module was
adapted from the course assigned
reading:
 Diwan, S., & Balaswamy, S. (2006).
Social work with older adults in healthcare settings. In S. Gehlert & T.
Browne (Eds.). Handbook of Health
Social Work (pp. 417-447). Hoboken,
NJ: John Wiley & Sons, Inc.
Growth in Older Adult Population
 Growth in Elderly Population
1900 – 4% of U.S. population was age 65+
2006 – 13% of U.S. population was age 65+
2030 - 20% predicted
 Number of people aged 85+ will
DOUBLE by 2030
Health and the Aging Population
 Co-morbidity: majority of older adults live
with one or more chronic conditions
 Most frequently occurring conditions among
older adults
 Hypertension (49.2%)
 Arthritis (36.1%)
 Heart disease (31.1%)
 Cancer (20%)
 Diabetes (15%)
Activities of Daily Living
 Among community residing older adults
65-74, one in five report difficulties in
activities of daily living (ADLs)
 Among community residing older adults
85+, over half report difficulties with
ADLs
Health Care Utilization of Older
Adults
 In 2002, hospital discharge rate for adults
65+ was over three times the rate for adults
45-64
 Older adults have more doctor visits than
their younger counterparts
 Older Americans spend 12.8% of their total
expenditures on health
 High out-of-pocket expenditures,
particularly for prescription drugs, remains
a critical issue for policy and practice
Implications of Demographic Trends
 Older adults will continue to comprise a
growing proportion of patients in all sectors
of the health care system
 In many health care settings, social workers
will have the opportunity to work with a
large and growing proportion of older adult
patients.
 Health social workers must possess
specialized knowledge to work effectively
with older adults and their caregivers in
health settings
Implications of Demographic Trends
 Employment opportunities for social workers
with background in health and aging include:
 hospitals
 primary care practices
 home care agencies
 assisted-living and senior housing
 long term care facilities
 hospice
Implications of Demographic Trends
 Shortened length of stays in hospitals and in
post-acute rehabilitation facilities:
 continued emphasis on discharge planning and
on the development of community-based care
models
 critical opportunities for health social workers
to participate in the development and
provision of community-based health care
models
 culturally competent models of care needed to
address minority older adult populations
Comprehensive Geriatric
Assessment (CGA)
 Older adults often experience complex problems
in multiple domains - physical, social,
psychological - resulting in unmet health needs
 Many problems experienced by older adults
require an assessment beyond the initial
diagnostic exam performed by a physician
 CGA is performed ideally by a multidisciplinary or
interdisciplinary team:
 Physicians, nurses, social workers,
occupational and physical therapists,
nutritionists, pharmacists, audiologists, speech
language pathologists, psychologists
Comprehensive Geriatric
Assessment (CGA)
 Per American Geriatrics Society, CGA should
address (at minimum):
 Mobility
 Continence
 Mental Status
 Nutrition
 Medications
 Personal, Family and Community Resources
 Integrated assessment plan: all disciplines
involved in care provision participate in CGA
 Ideally, older adult patient and family also
participate in developing the care plan that
emerges from the CGA
Comprehensive Geriatric
Assessment (CGA)
 CGA is useful in diagnosis and assessing
complex problems, but CGA does not
guarantee that team recommendations and
care plan will be followed
 Research has shown that care plan
recommendations from CGAs are not
consistently followed by either primary care
physicians or by patients, at times resulting
in poor outcomes
 CGAs are not provided routinely to older
adults across all settings due to the current
structure of the health care system: limited
reimbursement, lack of trained geriatricians,
lack of interdisciplinary teams
Geriatric Evaluation and
Management (GEM)
 Geriatric evaluation and management (GEM),
developed by the Veterans Affairs (VA)
system, explicitly connects comprehensive
assessment with the management of care. In
the GEM approach to inpatient and
ambulatory care, the interdisciplinary team
conducts the assessment and follows through
by implementing the entire care plan
 Social work functions in GEM: providing
psychosocial counseling to patients and
caregivers, referring patients to financial,
social, and psychological services, planning for
post-hospital discharge when required
Outcomes of GCA and GEM
 Positive outcomes associated with both
CGA and GEM models include: decreased
mortality rates, improvements in physical
and cognitive functioning, decreased
probability of hospitalization post-followup, and increased likelihood of living at
home
Biopsychosocial Assessment Domains
(see Table 14.1 in Diwan & Balaswamy, 2006)
 Physiological well-being and health
 Psychological well-being and mental health
 Cognitive capacity
 Ability to perform ADLs
 Social functioning
 Physical environment
 Assessment of family caregivers
 Economic resources
 Values and preferences
 Spiritual assessment
Physiological Well-Being and Health
 Health social workers must understand and assess the
relationship between an older adult’s health status and
how the individual functions and copes with daily life.
 Chronic health conditions in later life may decrease
psychological well-being, may limit functional ability,
and may lower quality of life
 Example: arthritis, diabetes
 Social workers address how older adults cope with
health and illness
 Polypharmacy: receiving different prescriptions from
different doctors without proper coordinated
management of all drug interactions and side effects
Psychological Well-Being and Health
 Mental health problems in older adults
are frequently under-diagnosed
 Many symptoms of mood disorders (e.g.,
sleeplessness, fatigue) may be
misattributed to health problems
 Stereotypical attitudes of health
providers, families, and older adults
themselves re: belief that depression is a
normal part of aging
Cognitive Capacity
 3% of older adults 65-74 have Alzheimer’s
disease; nearly half of older adults 85+ may
have Alzheimer’s disease (AD)
 Small declines in memory, selective attention,
information processing and problem-solving
ability may occur with normal aging, though
change in cognitive capacity varies greatly
among older adults
 Social workers assist persons with AD and their
families: provide caregiver support groups,
behavior management training, counseling, home
care, long term care arrangements
Functional Ability
 Activities of Daily Living (ADLs): personal
care activities such as bathing, eating,
grooming, toileting, getting in and out of
bed or chair, urinary and bowel
incontinence
 Instrumental Activities of Daily Living
(IADLs): community-setting activities
such as cooking, cleaning, shopping,
money management, transportation,
telephone, medication administration
Social Functioning
 social support: help received
 social networks: persons in individual’s
circle
 social activities: attendance at events and
frequency of contacts
 social roles: volunteer and employment,
grandparent, caregiver
Physical Environment
 Assess the fit of the home environment
with capabilities of the individual
 Lighting, flooring, carpeting, access to
bathtub and toilet and sink, access to
kitchen, heating and cooling,
neighborhood conditions, personal safety
 Fall prevention
Assessment of
Family and Informal Support
 Number and relationship of family helpers
 Amount and type of help provided
 Strain or burden experienced by caregivers
 Positive aspects of caregiving
 Definition of who is a family member
 Elder abuse assessment
Economic Resources
 Income
 Pension
 Health insurance
 Other assets
 Critical to determine eligibility for public
benefits and programs
Values and Preferences
(R.A. Kane, 2000 cited in Diwan & Balaswamy, 2006)
 Preferences for end-of-life care
 Preferences for post-hospital care
 Preferences about housing arrangements
 Preferences about how routines of daily
life are conducted
Values and Preferences
(R.A. Kane, 2000 cited in Diwan & Balaswamy, 2006)
 Preferences for religious practices
 Preferences re: privacy
 Preferences re: safety vs. freedom and
the right to take risks
 Preferences related to exercising control
over one’s own care
Spiritual Assessment
 Religious and spiritual activity are known
to influence individual’s psychological and
social functioning, ability to cope with
stress, and quality of life
 Religious beliefs may influence
community-based and institutional long
term care plans/choices for the individual
older adult and family
Social Work Practice Skills
in Health-Care Settings
(see Table 14.2 in Diwan & Balaswamy, 2006)
 Screening
 Assessment
 Communication skills
 Interpersonal engagement skills
 Clinical skills
 Group Facilitation
 Mediation/Negotiation
 Documentation
Social Work with Older Adults in
Health-Care Settings
 Primary health care settings
 Inpatient hospital settings
 Home health-care settings
 Nursing home settings
In-Class Case Discussions
 Learning Exercise 14.1 in Diwan &
Balaswamy (2006), p. 439
“Mr. & Mrs. C”: hospital d/c
 Learning Exercise 14.2 in Diwan &
Balaswamy (2006), p. 440
“Mr. & Mrs. C”: home health care