Grantham University Psychological Issues Related to Elderly Abuse Discussion Each year on or around June 15, communities and municipalities around the worl

Grantham University Psychological Issues Related to Elderly Abuse Discussion Each year on or around June 15, communities and municipalities around the world plan activities and programs to recognize World Elder Abuse Awareness Day, a day set aside to spread awareness of the abuse of the elderly (Center of Excellence on Elder Abuse & Neglect, 2013). The abuse of older adults is a growing concern and statistics suggest that the number of elders experiencing abuse is an alarmingly high number. Research suggests that close to half the people diagnosed with dementia experience some form of abuse (Cooper, C., Selwood, A., Blanchard, M., Walker, Z., Blizard, R., & Livingston, G., 2009; Wiglesworth, A., Mosqueda, L., Mulnard, R., Liao, S., Gibbs, L., & Fitzgerald, W., 2010, as cited on http://www.ncea.aoa.gov/Library/Data/index.aspx). Elder abuse takes on many forms and can include physical, emotional, psychological, and economic abuse. The legendary American actor, Mickey Rooney, spoke to the United States Senate, describing his own experiences of pain and neglect at the hands of his stepson, asking legislators to take seriously the abuse of the elderly.

For this Discussion, find a scholarly article that presents some of the most important psychosocial issues related to elder abuse.

BY DAY 4

Post a summary of the article you found. How does the article reinforce the importance of assessing potential abuse and neglect when working with the elderly? Describe prevention and/or intervention strategies on the micro, mezzo, and macro levels that can be used to address the issue of abuse and neglect of the elderly.

Support your posts with specific references to the Learning Resources. Be sure to provide full APA citations for your references.

CHOOSE THE ARTICLE AND YOU MUST ALSO INCORPORATE INFO FROM THR REQUIRED READINGS I ATTACHED…THE REQUIRED READINGS CANNOT BE THE ARTICLE OF CHOICE CHRONIC ILLNESS AND AGING
SECTION 2: THE ROLE OF SOCIAL WORK
IN MANAGING CHRONIC ILLNESS CARE
Grace Christ and Sadhna Diwan*
Synopsis
Managing chronic illness presents a profound challenge to the social work
profession, not only because of the myriad formal and informal services required by the
increasing number of chronically ill elders, but also because the caregivers, too, require
our support and empowerment. As professionals, social workers experience first?hand
the effects of the met and unmet patient needs, which brings with it a responsibility to
insure that practice and policy decisions give full recognition to the impact of
psychosocial aspects and services that provide total care to chronically ill older adults
and their caregivers.
This section describes some of the most recent literature addressing the role of
social workers in managing chronic illness care specifically related to conducting
biopsychosocial assessments, providing interventions, and in designing and
implementing effective models of health services delivery such as care coordination.
Characteristics of Chronic Illness
as They Impact the Social Work Role
Three important characteristics of chronic illnesses among older adults need to be considered
as they affect the social work role and function.
1. The trajectory for many serious illnesses has changed from an acute terminal
course to a much longer chronic period, with episodes of exacerbations and
remissions interspersed with extended periods of good functioning.
2. The trajectory of advanced chronic and terminal illnesses has changed from a
relatively brief period to a longer period in which both curative and
palliative treatments are combined. Research suggests that a long, advanced
chronic illness can be highly stressful for both patients and their families.
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*Grace Christ, DSW—Columbia University, School of Social Work
Sadhna Diwan, PhD—San Jose State University, School of Social Work
Christ & Diwan
Chronic Illness—Role of Social Work
3. The increase in the total number of older people with advanced chronic and
terminal illnesses will require more curative and palliative care being
provided in the home, with greater reliance on provision by family members.
Advances in medical care have changed the illness trajectory in ways that
dramatically alter the older adult’s experience of chronic illness. Facilitating and
enhancing positive health behaviors at all stages of life as well as effective management
of chronic illness is central to the social worker’s role, knowledge, value, and skill base
in health care.
The specific role of social workers in health care is to address psychological,
behavioral, and social factors by (1) assessing patient and family psychosocial health
needs, (2) providing interventions required to address their psychosocial needs and
promote their adaptation to illness and disability, and (3) developing and implementing
effective models of health services delivery. The following sections provide an overview
of issues related to Biopsychosocial Assessment of older persons with chronic
conditions; a description of the range of social work interventions relevant to the
management of chronic conditions; and a description of the evidence base of one model
of service delivery: care coordination for older persons.
Psychosocial Assessment of Older Adults with Chronic Conditions
Because of the frequency of multiple chronic conditions in older adults, a
comprehensive biopsychosocial assessment of needs and resources has become the
most important part of service delivery and is the beginning of the intervention process
to address the management of chronic conditions among them. The National
Association of Social Workers (NASW, 2005) and the American Geriatrics Society (AGS,
2005) recommend a biopsychosocial approach to the assessment of older adults. This
section reviews the evidence supporting comprehensive geriatric assessments and,
using a biopsychosocial framework, describes the rationale or evidence supporting
seven typical domains of psychosocial assessment for social workers in the
management of chronic illnesses.
Comprehensive Assessments
¡
Comprehensive geriatric assessment (CGA) and geriatric evaluation and
management (GEMs) programs have shown positive impact on improving or
maintaining cognitive and physical function (Urdangarin, 2000).
These programs have shown increased likelihood of patients living at home,
decreased likelihood of hospitalization during follow?up, and a reduction in mortality.
¡
The primary component of CGA and GEM programs is an interdisciplinary
team consisting primarily of physicians, nurses, and social workers.
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Christ & Diwan
Chronic Illness—Role of Social Work
Comprehensive assessment and management programs for the care of older adults
in the health care system have been evaluated in the U.S. over the last decade and have
shown positive outcomes. For example, the CGA programs without follow?up care and
the GEMS programs that incorporate follow?up care and management have reported
favorable effects on cognitive and physical functioning, an increased likelihood of living
at home, a decreased likelihood of hospitalization during follow?up, and a reduction in
mortality (Urdangarin, 2000). The primary component of these programs is an
interdisciplinary team consisting mainly of physicians, nurses, and social workers, but
also can include specialists from fields, such as occupational and physical therapy,
nutrition, pharmacy, audiology, and psychology (Agostini, Baker, & Bogardus, 2001;
Wieland & Hirth, 2003).
CGA is more effective when it is targeted to older adults with functional
impairments, geriatric syndromes, or high use of hospital and nursing home care. The
American Geriatrics Society (AGS) issued the following position statement in 2005:
“Comprehensive geriatric assessment has demonstrated usefulness in improving the
health status of frail, older patients. Therefore, elements of CGA should be incorporated
into the care provided to these elderly individuals”
(http://www.americangeriatrics.org). The degree to which those elements have an
impact on patients is still being evaluated, but components of CGA have already
become an accepted part of geriatric primary care and inpatient consultation services,
especially in managed health care programs.
¡
Comprehensive assessment, however, is not feasible for all older persons;
therefore, programs have developed criteria to target individuals most likely to
need such assessments.
These criteria include people who have functional impairments in their ability to
perform activities of daily living (ADLs); have one or more geriatric syndromes, such as
falls, depression, dementia, delirium, or weight loss; or show patterns of high use of
hospital or nursing home placements (AGS, 2005).
¡
With increasing numbers of elders with chronic illness living in the community,
screening and assessment has become increasingly important to the provision
of continuity of care to identify those with biopsychosocial needs.
Social workers provide health and mental health services to the elderly in a variety
of settings across the continuum of care (Berkman, Maramaldi, Breon, & Howe, 2002).
They help older people who are active and healthy, as well as those who have poor
health, and address the needs of the elderly who live in the community, as well as those
hospitalized or in long?term care institutions. Many people are not aware of available
social services, and families with serious social problems are not finding the community
resources and services they need. Regardless of site, screening and assessment of need
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Christ & Diwan
Chronic Illness—Role of Social Work
for psychosocial help are still the most important part of service delivery and mark the
beginning of the intervention process (Berkman et al., 2002).
Process of Conducting Geriatric Assessments
Conducting comprehensive geriatric assessments involves using general social
work clinical interviewing skills as well as knowledge of special conditions that may
apply to working with specific populations. Geron (2006) and Berkman and colleagues
(2002) summarize these skills and processes as:
h
Establishing rapport with the respondent
h
Explaining the purpose of assessment
h
Using observation and clinical judgment
h
Assessing the client’s preferences (Kane & Degenholtz, 1997)
h
Knowing human behavior and caregiver dynamics
h
Demonstrating cultural competency in addressing and understanding
diverse groups of older persons
For a review on the social work processes involved in conducting geriatric
assessments and a discussion of special issues in working with older persons, see Geron
(2006).
Biopsychosocial Framework for Seven Domains of Assessment
¡
The conceptual framework that supports comprehensive geriatric assessment,
evaluation, and management is a biopsychosocial approach to understanding
chronic illness care.
¡
To develop a substantive understanding of an older adult’s needs and resources
there are seven typical domains of assessment that are important for social
workers.
1) Physical well?being and health
2) Psychological well?being and mental health
3) Cognitive capacity
4) Ability to perform basic ADLs and instrumental activities of daily living
(IADLs)
5) Social Functioning
6) Physical environment
7) Assessment of family caregivers
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Christ & Diwan
Chronic Illness—Role of Social Work
These domains of assessment along with the rationale or evidence supporting
specific areas of assessment are adapted from Diwan & Balaswamy, (2006) and
presented in Table 1.
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Christ & Diwan
Chronic Illness—Role of Social Work
Table 1. Biopsychosocial Assessment Domains and Specific Areas of Assessment Related to Chronic Illness Care
Major
Domains of
Assessment
Physical wellbeing and
health
Current Evidence or Rationale Supporting Specific Areas of Assessment Within Each Domain
ƒ
ƒ
ƒ
Psychological
well-being and
mental health
ƒ
ƒ
ƒ
Cognitive
capacity
ƒ
ƒ
Ability to
perform various
ADLs
ƒ
ƒ
ƒ
The prevalence of chronic diseases increases significantly with age, with the most common health problems being arthritis,
cardiovascular disease, cancer, and diabetes (Administration on Aging, 2007).
Important areas of assessment are overall health status; the presence of pain; nutritional status; risk for falling; incontinence;
sleep; alcohol and drug use; dental or oral health; sensory perception, especially vision and hearing (McInnis-Dittrich, 2004);
and use and misuse of medications (Kane & Kane, 2000).
These health conditions may significantly influence other domains: for example, by lowering psychological well-being, limiting
functional ability, and diminishing quality of life.
Depression, anxiety, and dementia are frequently under-diagnosed in elders, in part because symptoms can be misattributed to
health problems, and in part because of stereotypical beliefs that aging is associated with increased negative affect.
Substance use, misuse, or abuse (particularly of alcohol, prescription drugs, and over-the-counter medications) is also underdiagnosed, often because decreased activity among the elderly is attributed to other age-related factors. Consequently,
substance abuse is not seen as the cause of a disruption from work or social activities (Widlitz & Marin, 2002).
As an indicator of mental health problems, the rate of completed suicide in the U.S. is highest among people over 65 years of
age (DHHS, 1999)
Two distinct types of cognitive changes occur as people age: The first is the gradual decline in memory, selective attention,
information processing, and problem-solving ability that occurs with normal aging; the second is a progressive, irreversible,
global deterioration in capacity that occurs as a result of illnesses or diseases such as Alzheimer’s, Huntington’s, Parkinson’s,
and AIDS; or vascular dementia, often caused by strokes or tumors.
As the dementia progresses, significant changes occur in memory, language, object recognition, and executive functioning: the
ability to plan, organize, sequence, and abstract. Behavioral symptoms, such as agitation, hallucinations, and wandering also
are common. Individuals exhibiting these behaviors require increased supervision by family members and others, which often
causes considerable strain and burden on caregivers, both formal and informal.
Functional ability is measured through performance in the ADLs, which include dressing, bathing, eating, grooming, toileting,
transferring from bed or chair, mobility, and continence; and performance in the IADLs, which include cooking, cleaning,
shopping, money management, use of transportation, telephone, and administration of medications.
Increasing disability in performing these activities predicts a person’s movement along the continuum of care, ranging from
independent living to assisted living to nursing home care.
A variety of physical, psychological, cognitive, and environmental factors influence a person’s ability to perform ADLs and
IADLs. Therefore, an evaluation of all factors that may contribute to a person’s disability is recommended.
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Chronic Illness—Role of Social Work
Table 1 continued…
Major
Domains of
Assessment
Social
functioning
Specific Areas of Assessment Within Each Domain
ƒ
ƒ
ƒ
Physical
environment
ƒ
ƒ
ƒ
Assessment of
family
caregivers
ƒ
ƒ
ƒ
ƒ
Social integration (having social ties, roles, and activities) is associated with better health outcomes, such as lower risk of
mortality, cardiovascular disease, cancer mortality, and functional decline (Unger, McAvay, Bruce, Berkman, & Seeman,
1999).
Health also affects social functioning because people who are confined to bed or have severely impaired mobility are likely
to disengage from social activities.
Satisfaction with one’s social support is more strongly related to psychological well-being than are objective indicators of
social functioning, such as frequency of social contact (Krause, 1995).
The risk of falling increases exponentially with age and, among older adults, falls are the leading cause of deaths caused by
injury and are the most common cause of injuries and hospital admissions for trauma. For people ages 65 and older, twothirds to one-half of falls occur in or around the home (CDC, 2006).
Thus, assessing the fit between the older person’s capabilities and his or her home environment is an important assessment
domain, and the prevention of falls is a critical area of intervention. Typical home assessments will examine the condition,
adequacy, and accessibility of lighting, flooring, and carpeting, including obstacles or potential hazards for falling; bathing
and toileting, including the need for assistive devices; kitchen; heating and cooling; access to the home from outside; access
to rooms within the home; and personal safety issues, such as neighborhood conditions.
Older adults may prefer to live in an environment regarded as inadequate by a professional, but one that permits them more
freedom and social connection. Kane & Kane, (2000) suggest integrating the concept of “negotiated risk,” into the
assessment process whereby older persons have a voice in determining their level of risk-taking,
Approximately 66% of community-dwelling people who need long-term care rely solely on family and friends for help, and
28% receive a combination of informal and formal care (Liu, Manton, & Aragon, 2000).
With declining functional ability associated with chronic illness and dementia, increasing numbers of older people are in
need of care. The need for increased vigilance puts considerable strain on caregivers, which in turn not only puts the elderly
person at greater risk for entering a nursing home but also increases the likelihood of abuse or neglect.
Thus, assessing both objective and subjective components of caregivers’ strain is important for gaining a better
understanding of their needs.
Objective components of burden refer to the disruption in finances, family life, and social relations, whereas subjective
components refer to caregivers’ appraisal of their situation as stressful (Gaugler, Kane, & Langlois, 2000).
ADLs: activities of daily living; IADLs: instrumental activities of daily living
Adapted from Diwan & Balaswamy (2006).
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Christ & Diwan
Chronic Illness—Role of Social Work
Biopsychosocial Needs and Services for Chronic Illness Care
¡
Aging populations require diverse biopsychosocial services from both formal
and informal sources.
Biopsychosocial services are defined as those psychological, social, and health care
services that enable patients, their families, and health care providers to manage the
psychological, behavioral and social aspects of illness and its consequences and thus
promote better health (Institute of Medicine, 2007). When informal support is
insufficient to address a patient’s needs, more formal services are needed. Table 2 lists
the common biopsychosocial health needs of elders with chronic illnesses together with
typical community?based services that can be helpful in meeting these needs (Institute
of Medicine, 2007).
¡
The evidence supporting the effectiveness of various biopsychosocial services is
mixed.
In a comprehensive review of the literature on the effectiveness of psychosocial
health services for patients with cancer, the Institute of Medicine (2007) notes that there
is generally good evidence (through meta analyses of randomized controlled trials) of
the effectiveness of psychotherapeutic services, especially cognitive behavioral therapy,
that help ameliorate emotional distress that co?occurs with many chronic illnesses. A
similar level of evidence exists for behavioral interventions that help individuals
manage their symptoms and improve their overall health. However, many
interventions, such as the provision of transportation, financial assistance, and
medication assistance, have not been examined specifically for effectiveness but are
widely accepted as humanitarian services necessary to address basic needs. Many of the
services and studies reviewed in this report address not just cancer, but a number of
other chronic illnesses as well.
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Christ & Diwan
Chronic Illness—Role of Social Work
Table 2. Biopsychosocial Health Needs of Chronically Ill
Older Adults and Evidence-Informed Services
Biopsychosocial Health
Needs
Information and education about
illness, treatments, costs, health
maintenance, and services
available for patients.
Evidence Informed Services for Addressing
Needs
ƒ
ƒ
ƒ
Help in managing illness
throughout its different phases:
e.g., prevention, diagnosis,
treatment, remissions and
exacerbations, and advanced
illness.
ƒ
Help in coping with emotions
accompanying illness and
treatment.
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
Continuous access to information and education about
illness, treatments, and their effects, costs, health
maintenance, and psychosocial and financial services.
Decision-making support for patients and family who are
considering options for treatment and care
arrangements.
Useful information and support through services such as
health education classes, disease management seminars,
and health coaches.
Care coordination interventions to facilitate more
appropriate delivery of services and assist with
transitions in care.
Comprehensive disease management/self-care
programs.
Interventions vary by characteristics of the disease (e.g.,
life threatening) degree of functional and role
impairment, amount of pain and discomfort, and
available supports.
Community and peer support programs.
Coaching/supportive counseling for patient and family.
Pharmacological treatment for depression/anxiety
coupled with psychotherapy.
Pain and coping skills training for pain and discomfort.
Assistance in changing behaviors
to minimize impact of disease an…
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