Chapter 8
Intervention With the Elderly
Michael J. Holosko, Jeffrey F. Skinner,
Catherine A. Patterson, and Kimberly Brisebois
Copyright © 2013. John Wiley & Sons, Incorporated. All rights reserved.
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 highdemand 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 primarily attributed to improved medical treatment, earlier changes in lifestyle,
reduced mortality rates, increased financial independence, old age pensions, governmental assistance, advances in technology, greater mobility
197
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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-ofmind 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 Education (CSWE) and the National Association of Social Workers (NASW),
served as the database for this cursory review. One rather interesting
Holosko, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
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Intervention With the Elderly
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 topics 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).
Copyright © 2013. John Wiley & Sons, Incorporated. All rights reserved.
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 quantitative 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 (conceptual, 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, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
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199
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
Cohort 1
Cohort 2
Cohort 3
Conceptual/
theoretical
frameworks
Effectiveness
studies
Assessments
of specified
interventions
and outcomes
Evidence-based research and evaluation studies
Copyright © 2013. John Wiley & Sons, Incorporated. All rights reserved.
Empirical data collected to inform and direct practice
with the elderly—"the evidence"
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, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
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Intervention With the Elderly
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 planning 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 criteria that have a positive contributive influence. These were good physical
care, pleasant environment, autonomy/choice, attentive staff, respectful 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: selfgovernment, support, educational, and resident volunteer. By using case
examples, this study showed how providing for quality of life in residential 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 selfdetermination, 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, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
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202
Main Variables
Case Management
Rural Aging: Social
Work Practice
Models and
Intervention
Dynamics
Trauma and Aging
Bisman
(2003)
Graziano
(2003)
Three case examples representing
different trauma experiences across
the life cycle and differences in
trauma responses
Five theoretical models
Social support, family systems, group
work, case management, and
community practice; many authors
cited in section on intervention
ideas
Includes a small-scale, hospital study
30 days (following hospital discharge)
Naleppa and
Reid
(2003)
Nine primary qualities for a good
life in a nursing home (e.g.,
having autonomy and choice,
new relationships inside and
outside the institution)
Elderly in need of
Three components of the
multiple services
task-centered case management
practice model
Research conducted to evaluate and
develop the model
Rural elderly
Three central social work
components: assessment and case
theory, biopsychosocial
perspective, and
self-awareness/use of self
Four theoretical models and ideas to
guide intervention
Older adults who have
Trauma response manifestation
experienced trauma
theories
at any point in the life Partial list of those at risk for
cycle
re-emergence of traumatic stress
symptoms
Suggestions for incorporating a
trauma framework into practice
Residents of homes for
the aged and other
long-term facilities
The Role of the
Social Worker in
Long-Term Care
Series of all studies empirical
studying showing effectiveness for
these protocols
Solomon
(2004)
Efforts to increase research and
translate findings
A list of end-of-life references
Other Comments
Role-play exercises for
interprofessional collaboration.
Case example: self-determination
and relevant participation in group
work.
Helping Older Adults Older adults who have
Response styles regarding
Section on intervention strategies
and Their Families
no care plan, those
approaching need for care or help Three contexts for intervention,
Develop and
with unrealistic plans, Influences on preparation
eight-step process model of
Implement Case
families in conflict
Positive effects of preparing in
strategies. Case example for
Plans
about care plans
advance
process model application.
Older adults
Nursing home elderly,
Multidisciplinary
cognitive and sensory
misunderstandings, conflict, and
alert and impaired
interactions
elderly
Elderly group work dynamics
Special issues
Target Group
Pinquart,
Sörenson,
and Peak
(2004)
socialworkers End-of-Life Care
.org (2004)
Title of Citation
A Social Work
Perspective
Haight and
Gibson
(2005)
Conceptual/Theoretical Frameworks: Interventions for the Elderly
Reference
Table 8.1
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203
Looking Back at Life
and Its Influence
on Subjective
Well-Being
Death and Dying and Older adults
the Social Work
Role
Compassion Fatigue:
Considerations for
Working with the
Elderly
Peck (2001)
Hobart (2001)
Leon, Altholz,
and
Dziegielewski
(1999)
Older adults
Older adults
Alternative
Older adults, those
Interventions in
with Alzheimer’s
the Socioemotional
disease
Problems of Elders
McInnis-Dittrich
(2002)
Rural elderly
Rural Program
Planning and
Development for
Older Adults
Li and Blaser
(2003)
Copyright © 2013. John Wiley & Sons, Incorporated. All rights reserved.
Death and dying laws (e.g., Patient
Self-Determination Act) and
implication
2001 Ethnographic Study
Solutions for problems in
advance-care planning and
end-of-life medical decision
making (e.g., combining advance
directive forms into one
document)
Compassion fatigue definition
Contributing factors (e.g., the
labor-intensive yet short-term
nature of the work)
Effects on the worker (e.g., feelings
of incompetence)
Preventive measure (e.g., learning
to identify signs)
Model of subjective well-being and
explanations of key concepts.
Psychosocial development
influences.
Social work interventions
Description of social care systems
model
Description of the nature and use of
informal support networks and
formal services
Strategies for rural service and
program development
Music therapies
Art therapies
Drama therapies
Animal-assisted therapies
A case example is used to illustrate
variables contributing to
compassion fatigue (e.g., worker’s
age, personal dynamics, agency
factors)
6 months (included seven 1-hour
sessions and weekly SSS support
from psychiatric nurse)
Interventions
Life review therapy,
environment-focused interventions
Websites are listed at the end
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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-oflife 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 mezzolevels of social praxis and into macrolevel social work. These authors
suggest an integrative social-care systems model for rural program planning 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 essential 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), alternative 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, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
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Intervention With the Elderly
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 outcomes, 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.
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Cohort 2—Effectiveness Studies
The effectiveness studies in Cohort 2 (Table 8.2) illustrate the necessity 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 practitioner. 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, physiotherapy, pharmacological treatment, community-based and home-based
therapy, care through the medium of technology, and alternative rehabilitation 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, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
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206
Eating in
Acutely ill
48
supervised
patients who
dining hall
eat alone in
with nursing
their rooms
assistant
24 (control
group and
intervention
group)
Wright,
Hickson,
and Frost
(2006)
Assisted living
female
residents
with
depression
SRT, SSS
Stinson and
Kirk (2006)
Populations
Osteoarthritis
15
patients with
low trauma
fractures
Presenting
Problems
ED
Interventions
Provided
Lunch time in
cafeteria
6 weeks
6 months
Duration/
Occasion of
Interventions
Effectiveness
of
Interventions
Intervention group gained Food intake can be
weight
improved by using a
supervised dining room,
and this will potentially
lead to weight gain and
corresponding
improvements in
nutritional status and
rehabilitation.
Significant improvements Osteoporosis education in
in standardized scores,
elderly rehabilitation
e.g., osteoporosis
inpatients with fractures
questionnaire,
is effective, but requires
functional
adequate patient
independence measure,
cognitive skills.
and mini mental state
examination
Reminiscence has no
The study revealed an
significant decrease in
inverse relationship
depression and
between depression and
increase in
self-transcendence
self-transcendence
suggesting a need to
research alternative
therapies for treatment
of depression in the
older female.
Reminiscence offers a
possible intervention for
treatment of depression
in older women.
Outcomes
Effectiveness Studies of Interventions With Elderly Populations Between 2006 and 1995
Abrahamson
and Khan
(2006)
Reference
Table 8.2
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207
RCT, CIHBT,
PST,
PEARLS,
CBT
Ciechanowski
et al. (2004)
138
RCSG, SSS
Mittelman,
Roth, Coon,
and Haley
(2004)
Patients with
minor
depression
and/or
dysthymia
Acutely ill CDS 455
patients
receiving
Medicaremanaged
care at two
VA sites
Spouse406
caregivers of
Alzheimer’s
patients
Hospital-athome model
of care
27 dyads
(person and
agent = 54)
Leff et al.
(2005)
Highfunctioning,
CDS and
their
potential or
designated
health care
agents
EKI in senior
13
citizen home
STEP, ED, SSS
Mo-Kyung,
ED, PT
Belza,
LoGerfo, and
Cunningham
(2005)
Gutheil and
Heyman
(2005)
Copyright © 2013. John Wiley & Sons, Incorporated. All rights reserved.
29 months
9 years, 5
months
22 months
12 weeks
2 months (3
sessions)
Outcomes achieved (e.g.,
caregiving skills
increased, mobilized
support from family
networks increased,
and depressive
symptoms decreased)
Outcomes, decrease in
depressive symptoms
and increase in quality
of life
Improved outcomes on
muscle strength,
agility/balance, blood
pressure, exercise
adherence, and
self-satisfaction
Subjects had a shorter
length of stay and
lower mean costs of
treatment compared to
acute hospital care
Intervention group
outcomes, e.g., higher
scores in
communication,
knowledge of health
options, and positive
attitude toward
end-of-life planning
(continued overleaf )
The PEARLS program, a
community-integrated,
home-based treatment
for depression,
significantly reduces
depressive symptoms
and improves health
status.
Counseling and social
service support lead to
sustained benefits for
elderly spouse caregivers
of Alzheimer’s patients.
The STEP intervention can
help high-functioning
CDS with end-of-life
planning, acquiring
greater knowledge of
health-care roles,
responsibilities, and
options and foster
greater communication
skills.
The exercise program was
successful and should be
evaluated on a larger
population and in
populations of other
ethnic minorities.
The hospital-at-home
model is feasible, safe,
and efficacious for
certain older patients
with selected acute
medical illnesses.
Holosko, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
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208
Interventions
Provided
(Continued)
Presenting
Problems
Populations
Duration/
Occasion of
Interventions
RCT, Internet
education
and access
De Leo, Buono PST, SSS,
TeleHelpand Dwyer
TeleCheck
(2002)
service
White et al.
(2002)
6 months 2
week
intervention
(9 hours of
small group
training over
6 days)
10 years
Volunteers
100
from
residential
congregate
housing sites
and nursing
facilities
Users of a
18,641
telephone
help line and
emergency
response
service
Random CCT, Frail nursing
190
32 weeks
functionally
home
oriented
residents
endurance
and
resistance
exercise
training
Tsang, Mok,
RCT, ECG,
Patients with
50
12 weeks
Au Yeung,
Qigong (The
subacute
and Chan
Eight Section
chronic
(2003)
Brocades)
physical
illnesses and
depression
Solomon,
CCT, pharma- CDS with no
230 (203
6 weeks
Adams,
cological,
memory
completed
Silver,
MMSE
impairment
the intervenZimmer, and
tion)
DeVeaux
(2002)
Kapasi,
Ouslander,
Schnelle,
Kutner, and
Fahey
(2003)
Reference
Table 8.2
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Outcomes, fewer suicide
deaths among elderly
service users
Ginkgo provides no
measurable benefit in
memory or related
cognitive function to
adults with healthy
cognitive function.
Control group (who
received the Ginkgo
pharmacological
treatment) showed no
improvement in
memory or cognitive
function
Outcomes (e.g., reduced
depressive symptoms/
loneliness)
The Internet may prove to
be of psychosocial
benefit (i.e., reduction of
loneliness and
depressive symptoms) to
seniors who learn how
to use it and have access
to it.
The study confirms the
initial promise of the
TeleHelp-TeleCheck
service over a much
longer time period.
Qigong may prove to be an
alternative treatment for
subacute chronic
physical illnesses and
depression.
Control group expressed
improvement in
physical,
psychological, and
general health
Intervention did not bring The interventional exercise
beneficial or
program has no
detrimental effects on
demonstrable effect on
immune parameters in
immunity in frail elderly
the study population
residents in nursing
homes.
Outcomes
Effectiveness
of
Interventions
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209
ED
intervention
Personalized
simulated
presence,
MMSE
CCT, PCS,
NCEP
Kuhn and
Mendes de
Leon (2001)
Camberg et al.
(1999)
Inouye et al.
(1993)
General medicine
wards at
teaching
geriatric
hospital—frail
elders
Nursing home
residents with
ADRD
Alzheimer’s
caregivers
Native-American
CDS in urban
area
216
54
58
22
6 months
12 months
Ongoing
Ongoing
6 months
6 weeks
Physical and emotional
health can improve among
Native-American seniors
as a result of exercise and
nutritional training.
Study data suggests that
knowledge of Alzheimer’s
can assist caregiver
coping.
Simulated presence may
prove to be effective in
enhancing well-being and
decreasing problem
behaviors in nursing
home settings.
NCEP appears effective to
decrease functional
decline in targeted elderly
hospitalized medical
patients.
Beneficial effects (e.g.,
reduction of delirium,
functional impairment,
incontinence, and
pressure sores, were
achieved without
increasing per-day
hospital costs)
Rate of falls was lower in An individual program of
the exercise than in the
strength and balance
control group and
retraining exercises
balance improved
improved physical
function and was effective
in reducing falls and
injuries in women 80
years and older.
Outcome, significant
Depression is treatable in
recovery within the
elderly people receiving
home care.
treatment group
No significant change as
a result of intervention
Modest benefits in
knowledge of disease
and coping
Significant decrease in
blood pressure and
respirations
1 ADRD = Alzheimer’s disease and related dementia; AGECAT = Automatic geriatric examination for computer assisted taxonomy; CBT = Cognitive
behavioral therapy; CCT = Controlled clinical trial; CDS = Community-dwelling seniors; CIHBT = Community-integrated home-based treatment;
ECG = Educational control group; ED = Education; EKI = Elderly Korean immigrants; MMSE = Mini mental-state examination; NCEP = Nursingcentered educational program; NT = Nutritional training; PCS = Prospective cohort study; PEARLS = Program to encourage active rewarding lives for
seniors; PGT = Psychogeriatric team; PST = Problem solving therapy; PT = Physiotherapy; RCSG = Random controlled support group; RCT = Random
clinical trial; SRT = Structured reminiscence therapy; SSS = Social service support; SSW = Session with social worker; STEP = Start talking early
program; VA = Veterans Administration.
Campbell et al. RCT, PT, home Female general
233
(1997)
exercise
practice
program of
patients in New
strength and
Zealand who
balance
are at risk for
retraining
falling
exercises,
ECG
Depressed
69
Banerjee,
RCT, PGT,
disabled people
Shamash,
AGECAT,
pharmacoreceiving home
Macdonald,
logical
care
and Mann
(1996)
NT with
exercise
program
Kochevar,
Smith, &
Bernard
(2001)
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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 physical 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 internationally. 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
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Intervention With the Elderly
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 propensity to socially isolate oneself was addressed in the Wright, Hickson, and
Frost (2006) study. They evaluated a nurse-aided supervised dining intervention. Generally, acutely ill nursing-home patients have a tendency to
eat alone in their rooms. This self-imposed social isolation has a corroborative 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 corresponding 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, computers, 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 professional 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 studies was the aging-in-place model. The ubiquitous modality of care in the
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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 policy. 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-inplace 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 computerassisted 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 interventions, specified populations, particular time frames within which the
interventions were conducted, and targeted and/or specified outcomes.
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213
RCT, GEM
Interventions
Provided
Enguidanos,
Davis, and
Katz (2005)
Poon, Hui,
Dai, Kwok,
and Woo
(2005)
Thomas et al.
(2005)
160
Specified
Populations
Random CCT,
Tai Chi
exercise,
resistance
training
RCT, CBT,
CDS with mild 22
MDT,
dementia
telemedicine,
and mild
CBP, FTFG,
cognitive
videoimpairments
conferencing,
in China
SSS
153
RCT, PCCBT,
Moderately/
severely
PST, and
depressed
pharmacopatients
logic
referred to
aids
geriatric care
management
service
Patients with
1801
major
depression,
dysthymia,
or both in
primary care
clinics
Chinese
180
subjects
Males who
were aboveaverage
users of
outpatient
VA services
Presenting
Problems
19 months
12 weeks
12-month
longitudinal
study
36 months
48 months
Duration of
Interventions
The IMPACT model may
show the way to less
depression and greater,
overall health in older
adults.
The GEM program can
reduce the costs to
senior citizen veterans
who are proven to be
above-average users of
outpatient VA services.
Effectiveness of
Interventions
(continued overleaf )
Outcomes not achieved
Tai Chi as an intervention
(e.g., no cardiovascular
is no more or less
risk from Tai Chi)
beneficial to
cardiovascular risk in
the elderly.
MMSE, RBMT, HDS
Telemedicine is a feasible
showed higher scores
and acceptable means in
(e.g., attention,
providing cognitive
memory, spatial
assessments and
interventions to elder
construction, and
persons with mild
language)
cognitive deficits.
PCCBT efficacious (e.g.,
Education, PST, and
significantly reduced
PCCBT can help
depressive symptoms)
moderately/severely
depressed seniors to
reduce depressive
symptoms—case study
approach used.
Although no increase in
survival of patient
indicated, intervention
achieved outcome
(e.g., costs of services
decreased at the 24- to
48-month period)
Outcomes achieved (e.g.,
depressive symptoms,
physical functioning,
quality of life,
self-efficacy, and
satisfaction of care)
Targeted
Outcomes
Specified Interventions and Outcomes With Elderly Populations Between 2006 and 1995
Hunkeler et al. RCT, CCM
(2006)
(IMPACT–
CBT, PST,
ED, pharmacological)
Engelhardt,
Toseland,
Gao, and
Banks
(2006)
References
Table 8.3
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214
RCT, MDT,
Patients
CGA, DEED II
discharged
program
home from
emergency
department
in urban
area,
Australia
GT
Depressed
(remotivation
assistedand
living
residents
supportive
therapy
techniques)
Caplan,
Williams,
Daly, and
Abraham
(2004)
Dipko, Xavier, ECG, ADE,
and Kohlwes
SSW,
(2003)
DPAHC, LW
Cummings
(2003)
RCT,
Sheltered
concordance,
housing
use of
residents in
medicine
United
organizer, ED
Kingdom
Ryan-Woolley
and Rees
(2005)
Specified
Populations
10 sessions, 5
weeks
17
Outpatients in 203 (ECG) and 33 months
primary care
13,913
clinic
(comparison
group)
30 days
(following
hospital
discharge)
and 18
month
follow-up
12 months
6 weeks
Duration of
Interventions
739
62
Patients
15
suffering
from chronic
pain
Affective
images
during PT
Tse, Pun, and
Benzie
(2005)
Presenting
Problems
Interventions
Provided
Continued
References
Table 8.3
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Effectiveness of
Interventions
Outcomes achieved (e.g., GT can increase life
participants
satisfaction and decrease
experienced significant
depressive symptoms in
decrease in depressive
assisted-living elderly
with depressive
symptoms and reported
symptoms.
higher degree of life
satisfaction)
Outcomes achieved (e.g., Group education is an
ECG was twice as
effective and time- and
effective as SSW,
cost-effective social
patients were more
work tool for
likely to complete
completion of advance
advance directives
medical directives for
independent of
elderly patients.
education strategy)
Affective images may
provide moderate,
nonpharmacological
intervention for elderly
persons with chronic
pain.
Outcomes achieved (e.g., Pharmacists using
more prescription
concordance and
change, decrease in the
medicine organizers can
number of
reduce medicine waste
prescriptions, less
and misuse.
waste of medicine)
Outcomes achieved (e.g., DEED II, a
lower rate of
multidisciplinary
emergency admissions,
intervention, can
greater degree of
improve health
mental and physical
outcomes for the elderly
function, lower costs of
and lower rates of
care for patients)
readmission to hospitals.
Outcomes achieved (e.g.,
subjects reported
increase in healthrelated quality of life)
Targeted
Outcomes
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215
RCT, ECG, and
competencybased
exercise
program to
increase
balance
RCT, CBT,
biofeedback,
and pelvic
muscle
exercise
Gill, Baker,
and
Gottschalk
(2002)
Residents in
120
nursing
homes in
United
Kingdom who
displayed
depression
and organic
symptoms
RCT, CBT, SSS
211
Rheumatoid
arthritis and
osteoarthritis
CCT, self-care,
ED
Mazzuca,
Brandt,
Katz,
Hanna, and
Melfi (1999)
Proctor et al.
(1999)
110
178
176
2,832
CBT, psychoed- Outpatient
ucation (GET
veterans with
SMART)
substance
abuse
problems
Rural women
with urinary
incontinence
Physically frail
patients of
primary care
practices who
live at home
Independently
living
residents in
six
metropolitan
areas
Schonfeld
et al. (2000)
Dougherty
et al. (2002)
RCT, CBT, ECG
Ball et al.
(2002)
Copyright © 2013. John Wiley & Sons, Incorporated. All rights reserved.
Outcomes achieved (e.g.,
increase in abstinence
among patients 6
months later and
longer time between
relapses reported by
patients)
Outcomes achieved (e.g.,
education reduced
frequency and cost of
primary care visits)
Outcomes achieved (e.g.,
participants reported
less urine loss and
greater quality of life)
Outcomes achieved (e.g.,
significant
improvement in speed
of processing, in
reasoning, and of
memory, cognitive
improvement)
Outcomes achieved (e.g.,
treatment participants
demonstrated
improvement in
physical functioning)
6 months
Outcomes (e.g., organic
and depressive
(included
symptoms improved
seven 1-hour
but behavioral and
sessions and
physical disability did
weekly SSS
not)
support from
psychiatric
nurse)
48 months
16 weeks
24 months
12 months
46 months
(continued overleaf )
Education can benefit
seniors in management
of pain from arthritic
conditions and reduce
health costs.
Behavioral outreach (CBT)
teams can assist elderly
with depressive and
organic symptoms but
are not efficacious to the
improvement of
behavioral or physical
symptoms.
In older rural women with
urinary incontinence, a
behavioral management
approach for continence
intervention reduced
urine loss.
GET SMART can be an
effective intervention
with elderly subjects
with substance abuse
problems.
Results support the
effectiveness and
durability of cognitive
training interventions in
improving
targeted-cognitive
abilities in the elderly.
In physically frail older
people, a home-based
intervention reduced the
functional decline in
subjects.
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216
RCT, spouseassisted
CBT
RCT, CBP, ED
RCT, ED with
emphasis on
goal setting
and PST
RCT, maildelivered
ASMP
Tennstedt
et al. (1998)
Glasgow et al.
(1997)
Fries, Carey,
and
McShane
(1997)
Interventions
Provided
Continued
Keefe,
Caldwell,
Baucom,
Salley, and
Robinson
(1999)
References
Table 8.3
88
Specified
Populations
Rheumatoid
arthritis and
osteoarthritis
375
Adults from 40 434
senior
housing sites
in urban
area who
reported fear
of falling
CDS with type 206
2 diabetes
Osteoarthritis
knee pain
Presenting
Problems
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6 months
12 months
12 months
(6-week,
6-month,
and
12-month
follow-ups)
12 months
Duration of
Interventions
Outcomes achieved (e.g.,
overall higher
self-efficacy, lower
levels of psychological
and physical disability,
and improved pain
levels)
Outcomes (e.g.,
immediate but not
statistically significant
improvement in
mobility, social
functionality, and
mobility control)
Outcomes achieved (e.g.,
significant
improvements in food
habits, caloric
consumption, serum
cholesterol levels, and
percentage of fat)
Outcomes achieved (e.g.,
decreased pain, global
vitality increased, joint
count improved, and
clinical visits
decreased)
Targeted
Outcomes
Educational health
programs with emphasis
on goal setting and
problem solving can
work with elderly
patients with type 2
diabetes.
Self-management courses
can improve the health
of the elderly and
decrease costs of clinical
care for pain.
Spouse-assisted CBT is
effective in increasing
self-efficacy and
managing pain in seniors
with
osteoarthritis-related
knee pain.
Community-based
education to reduce fear
of falling in older adults
has modest beneficial
effects.
Effectiveness of
Interventions
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217
Maisiak,
Austin, and
Heck (1996)
Rich, Gray,
Beckham,
Wittenberg,
and Luther
(1996)
Slaets,
Kauffmann,
Duivenvoorden,
Pelemans,
and Schudel
(1997)
Sharpe et al.
(1997)
RCT, telephone
monitoring
and
counseling
Rheumatoid
arthritis and
osteoarthritis
RCT, MDT, NT, CHF patients
ED, and SSS
with poor
behavioral
medication
compliance
ED and physical Adults in rural
activity
congregate
program with
nutrition sites
emphasis on
strength,
balance,
motorcoordination,
and mobility
MDT, PSYG
Medical
team, CBT,
inpatients
and SSS
with poor
physical
functioning
156—
30 days
intervention
(following
group (80)
hospital
and
discharge)
conventional
care group
(76)
405
9 months
237—treatment 12 months
group (140)
(following
and control
discharge)
group (97)
110—treatment 12 months
group (61)
(twiceand
weekly
comparison
sessions)
group (49)
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Outcomes achieved (e.g.,
better health status
scores, number of
medical visits
decreased)
Outcomes achieved (e.g.,
medication compliance
in patients increased)
Outcomes achieved (e.g.,
improvement in the
physical functioning of
the treatment group
participants)
Outcomes achieved (e.g.,
greater improvements
in physical functioning
over the previous year
than the comparison
group)
(continued overleaf )
Combining elements
from psychiatric,
social service, and
geriatric consultation
with elements of
unit-driven service
improves physical
functioning among
the elderly.
A MDT can improve
medication
compliance during
first 30 days following
discharge from the
hospital in elderly
patients with CHF.
Elderly patients with
rheumatoid arthritis
and osteoarthritis are
responsive to
telephone counseling
and support for pain.
Low-intensity exercise
can benefit the
overall health and
physical functionality
of elderly subjects.
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ADE, ECG
Bailly and
DePoy
(1995)
Specified
Populations
CHF patients
282—
with poor
treatment
behavioral
group (142)
compliance
and control
to treatment
group (140)
who were at
risk for readmittance
to hospital
following
discharge
Clients at a
10
family
medical care
practice in
rural area
Presenting
Problems
2 weeks
90 days
(following
hospital
discharge)
Duration of
Interventions
Statistically significant
increase in knowledge
of ADE was not
reported
Outcomes achieved (e.g.,
hospital readmission
was significantly
reduced)
Targeted
Outcomes
Authors suggest that ADE
may be a family issue
rather than solely an
individual issue.
Nurse-directed MDT can
improve the quality of
life and reduce both
hospital use and medical
costs for elderly patients
with CHF.
Effectiveness of
Interventions
ADE = Advance directive education; ASMP = Arthritis self-management program; CBP = Community-based group; CBT = Cognitive behavioral therapy;
CCM = Collaborative care management; CCT = Controlled clinical trial; CDS = Community-dwelling seniors; CGA = Comprehensive geriatric
assessment; CHF = Congestive heart failure; DEED II = Discharge of elderly from the emergency department program; DPAHC = Durable power of
attorney for health care; ECG = Educational control group; ED = Education; FTFG = Face to face group; GEM = Geriatric evaluation and management
program; GET SMART = Geriatric evaluation team: substance misuse/abuse recognition and treatment program; GT = Group therapy; HDS =
Hierarchical dementia scale; LW = Living will; MDT = Multidisciplinary team; MMSE = Mini-mental-state examination; NT = Nutritional training;
PCCBT = Patient-centered cognitive behavioral therapy; PRT = Prospective randomized trial; PST = Problem solving therapy; PSYG = Psychogeriatric;
PT = Physiotherapy; RBMT = Rivermead behavioral memory test; RCT = Random clinical trial; SSS = Social service support; SSW = Session with social
worker; VA = Veterans Administration.
PRT, Nursedirected
MDT, NT,
ED, and SSS
Interventions
Provided
Continued
Rich et al.
(1995)
References
Table 8.3
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Intervention With the Elderly
They employed a range of practitioners including professionals, semiprofessionals, health-care agents, and family members of the subjects examined.
Additionally, interventions were offered in clinical and nonclinical locations 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 interventions 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 multiinterventional strategies to address presenting problems (Caplan, Williams,
Daly & Abraham, 2004; Poon, Hui, Dai, Kwok, & Woo, 2005; Rich, Gray,
Beckham, Wittenberg, & Luther, 1996; Slaets, Kauffmann, Duivenvoorden, Pelemans, & Schudel, 1997). Multidisciplinary teamwork in treating
the elderly is the norm and appears to be the most effective interventional 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 multidisciplinary 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 pharmacological 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 technology 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
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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 inextricable 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 concomitant 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 arthritis 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
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Intervention With the Elderly
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.
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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 intervention 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
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Social Work Practice With Individuals and Families
Levels of
intervention
Societal
themes
Knowledge
domains
Level 1
Interventions
Level 2
Interventions
Applying evidence
to levels of intervention:
individual, family,
group, community,
organization, society
Practice
decisions
Evidence
Practitioner
reflection
and integration
Making EBP social work
practice decisions
Figure 8.2
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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
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Intervention With the Elderly
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).
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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
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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 gerontological 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 professional 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.
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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
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Intervention With the Elderly
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).
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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 exception, 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
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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 interventions, 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.
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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) statistical 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
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Intervention With the Elderly
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 effectiveness 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) configured 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 intervention 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 interventions 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
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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:
•
•
•
•
•
•
•
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•
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 generalizability 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 betterinformed 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?
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Intervention With the Elderly
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.
Copyright © 2013. John Wiley & Sons, Incorporated. All rights reserved.
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 provides information on the ways to improve the health of older Americans.
References
Abrahamson, S. J., & Khan, F. (2006). Brief osteoporosis education in an inpatient
rehabilitation setting improves knowledge of osteoporosis in elderly patients
with low-trauma fractures. International Journal of Rehabilitation Research,
29(1), 61–64.
Administration on Aging (2003). A profile of older Americans. Retrieved from
www.aoa.gov/prof/Statistics/profile/2003/profiles2003.asp
Bailly, D., & DePoy, E. (1995). Older people’s responses to education about advance
directives. Health and Social Work, 20(3), 223–229.
Ball, K., Berch, D. B., Helmers, K. F., Jobe, J. B., Leveck, M. D., Marsiske,
M., . . . Willis, S. L. (2002). Effects of cognitive training interventions with
older adults: A randomized controlled trial. Journal of the American Medical
Association, 288(18), 2271–2281.
Holosko, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
from http://ebookcentral.proquest.com
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Social Work Practice With Individuals and Families
Banerjee, S., Shamash, K., Macdonald, A. J. D., & Mann, A. H. (1996). Randomized controlled trial of effect of intervention by psychogeriatric team on
depression in frail elderly people at home. British Medical Journal, 313(7064),
1058–1061.
Bisman, C. D. (2003). Rural aging: Social work practice models and intervention
dynamics. Journal of Gerontological Social Work, 41(1/2), 37–58.
Bradley, N., & Poppen, W. (2003). Assistive technology, computers and Internet
may decrease sense of isolation for homebound elderly and disabled persons.
Technology & Disability, 15(1), 19–25.
Camberg, L., Woods, P., Ooi, W. L., Hurley, A., Volicer, L., Ashley, J., . . . McIntyre,
K. (1999). Evaluation of simulated presence: A personalized approach to
enhance well-being in persons with Alzheimer’s disease. Journal of the American Geriatrics Society, 47(4), 446–452.
Campbell, J. A., Robertson, M. C., Gardner, M. M., Norton, R. N., Tilyard, M. W.,
& Buchner, D. M. (1997). Randomized controlled trial of a general practice
program of home based exercise to prevent falls in elderly women. British
Medical Journal, 315(7115), 1065–1069.
Caplan, G. A., Williams, A. J., Daly, B., & Abraham, K. (2004). A randomized,
controlled trial of comprehensive geriatric assessment and multidisciplinary
intervention after discharge of elderly from the emergency department: The
DEED II Study. Journal of the American Geriatrics Society, 52(9), 1417–1423.
Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr,
P., . . . LoGerfo, J. (2004). Community-integrated home-based depression treatment in older adults: A randomized controlled trial. Journal of the American
Medical Association, 291(13), 1626–1628.
Council in Social Work Education (2006, February). Gero-Ed Forum [Abstract].
Chicago. Retrieved from www.Gero-EdCenter.org
Cummings, S. (2003). The efficacy of an integrated group treatment program for
depressed assisted living residents. Research on Social Work Practice, 13(5),
608–621.
Cummings, S. M., & Kropf, N. P. (Eds.). (2009). Handbook of psychosocial
interventions with older adults: Evidence-based approaches. NY: The Haworth
Press.
De Leo, D., Buono, D., & Dwyer, J. (2002). Suicide among the elderly: The longterm impact of a telephone support and assessment intervention in northern
Italy. British Journal of Psychiatry, 181(3), 226–229.
Dipko, L., Xavier, K., & Kohlwes, R. (2003). Advance directive group education in
a VA outpatient clinic. Social Work in Health Care, 38, 93–106.
Dougherty, M. C., Dwyer, J. W., Pendergast, J. F., Boyington, A. R., Tomlinson
U., Coward, R. T., . . . Rooks, L. G. (2002). A randomized trial of behavioral
management for continence with older rural women. Research in Nursing and
Health, 25(1), 3–13.
Dunlop, J., & Holosko, M. J. (2006). Technology and evidence-based practice [Special guest edition]. Journal of Evidence-Based Social Work Practice,
3(3/4).
Engelhardt, J. B., Toseland, R. W., Gao, J., & Banks, S. (2006). Long-term effects
of outpatient geriatric evaluation and management on health care utilization,
cost, and survival. Research on Social Work Practice, 16, 20–27.
Enguidanos, S. M., Davis, C., & Katz, L. (2005). Shifting the paradigm in geriatric
care management: Moving from the medical model to patient-centered care.
Social Work in Health Care, 41(1), 1–16.
Holosko, M. J., Dulmus, C. N., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and interventions. Retrieved
from http://ebookcentral.proquest.com
Created from waldenu on 2019-11-07 05:26:53.
Copyright © 2013. John Wiley & Sons, Incorporated. All rights reserved.
Intervention With the Elderly
Feit, M. D., & Cuevas-Feit, N. (1991). An overview of social work practice with
the elderly. In M. J. Holosko & M. D. Feit (Eds.), Social work practice with the
elderly (2nd ed., pp. 3–27). Toronto, Canada: Canadian Scholar’s Press.
Feit, M. D., & Cuevas-Feit, N. (2004). An overview of social work practice with
the elderly. In M. J. Holosko & M. D. Feit (Eds.), Social work practice with the
elderly (3rd ed., pp. 3–27). Toronto, Canada: Canadian Scholar’s Press.
Formiga, F., Chivite, D., Ortega, C., Cassas, S., Ramon, J. M., & Pujol, R. (2004).
End-of-life preferences in elderly patients admitted for heart failure. Quarterly
Journal of Medicine, 97, 803–808. doi: 10.1093/9jmed1hch135
Fries, J. F., Carey, C., & McShane, D. J. (1997). Patient education in arthritis: Randomized controlled trial of a mail-delivered program. Journal of Rheumatology,
24(7), 1378–1383.
Gambrill, E. (2006). Evidence-based practice and policy: Choices ahead. Research
on Social Work Practice, 16(3), 338–358.
Gibbs, L. (2005, October). Using...
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