Week 6: Assessment of the Elderly/Aging

We are an aging society, as evidenced by the number of individuals from the baby boomer generation in the United States (born between 1946 and 1964) who have begun to turn 65. According to the United States Census Bureau (2013), there are more than 41 million Americans who are 65 and older. In Canada, the number of individuals over 65 years of age increased by over 14% between 2006 and 2011, and older adults now account for almost 15% of the entire population of that country (Statistics Canada, 2013). Across the world, populations are rapidly aging and there is a demand to understand the specific needs of this particular group. As with all clients, it is essential to address the concerns of the aging from a strengths and empowerment perspective. The aging are an identified vulnerable population and social workers should be mindful of the long-standing marginalization and oppression this population has experienced. Social workers should work hard to overcome the common prejudices and biases often expressed toward this group. Social workers should be careful to frame the lives and situations of the elderly from a perspective of strength, not deficit, avoiding the pitfall of focusing on loss.

Learning Objectives

Students will:

• Apply Christ and Diwan’s seven assessment domains to a case study
• Analyze the importance of abuse assessment of the elderly/aging
• Identify prevention/intervention strategies for elder abuse

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Åhsberg, E., Fahlström, G., Rönnbäck, E., Granberg, A., & Almborg, A. (2017). Development of an instrument for assessing elder care needs. Research On Social Work Practice, 27(3), 291-306.

Christ, G., & Diwan, S. (2008). Chronic illness and aging: The role of social work in managing chronic illness care. Council on social work education. Retrieved from http://www.cswe.org/getattachment/Centers-Initiatives/CSWE-Gero-Ed-Center/Teaching-Tools/Gero-Competencies/Practice-Guides/Assignments-Measurments/CI-Sec2-Role-SW.pdf.aspx 

Harrington, A. (2016). The importance of spiritual assessment when caring for older adults. Ageing And Society, 36(1), 1-16.

Paveza, G. J. (2013). Assessment of the elderly. In M. J. Holosko, C. N. Dulmus, & K. M. Sowers (Eds.), Social work practice with individuals and families: Evidence-informed assessments and interventions (pp. 177–195). Hoboken, NJ: Wiley.

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
The Petrakis Family (pp. 20–22)

Required Media

Laureate Education (Producer). (2013c). Petrakis family: Episode 3 [Video file]. Retrieved from https://class.waldenu.edu

Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptCredit: Provided courtesy of the Laureate International Network of Universities.

Optional Resources

Use this link to access the MSW home page, which provides resources for your social work program.

Discussion 1: Self-Determination

In the Christ & Diwan (2008) article, the authors list seven domains that social workers should address in order to fully assess an older client’s needs. Each domain is considered equally important. This comprehensive evaluation fits well with the social work perspective that it is important to not only address the internal concerns of clients but also their environment. Making decisions for older adults without their input occurs often. In society people sometimes treat their elders like children—making decisions for them based on what they think is best rather than from the client’s perspective. While at times this may be well intentioned, the potential for infantilism and, in turn, compromised self-determination, occurs.

For this Discussion, review the program case study for the Petrakis family. You will focus not on Helen, but on her mother-in-law, Magda. What decisions were made about Magda’s treatment without a formal assessment and/or her input? Consider how Christ & Diwan’s (2008) seven domains relate to Magda’s case. Complete an assessment for Magda and identify the choices that were made without her feedback.

By Day 3

Post a summary of your assessment of Magda’s situation that addresses the seven domains. Fill in the gaps in content as necessary. Describe ways you would have included Magda in the original assessment and treatment plan. Include questions you would have asked Magda and her professional support system (doctors, nurses, etc.) to gain further insight into the situation.

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

By Day 5

Respond to two colleagues and explain how their assessments support the NASW Code of Ethics (2017). Include two values and/or guiding principles to support your explanation.

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

Submission and Grading Information

Grading Criteria

To access your rubric:
Week 6 Discussion 1 Rubric

Post by Day 3 and Respond by Day 5

To participate in this Discussion:
Week 6 Discussion 1

Discussion 2: Elder Abuse

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

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

By Day 4

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

By Day 5

Respond to two colleagues and explain how their assessments support the NASW Code of Ethics (2017). Include two values and/or guiding principles to support your explanation.

Discussion 1

Response 1

 Elizabeth Woodson RE: Discussion 1 – Week 6COLLAPSE

It doesn’t appear that Helen checked in with social services to see if her mother-in-law would qualify for in-home care. When Helen decided to hire a “trusted woman” to care for Magda it was never mentioned that she was qualified to work with an elderly patient that has dementia. Partnering with Magda’s medical team before hiring a caretaker or live in would have been beneficial because the medical team would educate the family of Magda’s short- and long-term needs. It seems like Helen did what she believed was best based on her capacity or lack thereof, which wasn’t the best for Magda’s needs. A A geriatric assessment could have helped the social worker build a rapport with Magda, observe her, determine the client’s preference and become culturally competent about elders to better help Magda (Christ & Diwan,2008). With the information from the assessment, the social worker could have helped Magda and Helen.

After assessing Magda referencing the major domains of assessment, I captured the following details: Her Physical well-being and health were at risk by not having the appropriate care for her illness. The “trusted woman” or Alec weren’t nurses which could have put Magda’s health at risk. Magda was diagnosed with Dementia which identifies a mental illness that will require an ongoing plan of care. She was in the early stages which means it hadn’t made severe impairments yet (Plummer, Makris & Brocksen,2014). Sitting down with Magda, her medical team and the family to discuss her desired plans for care should have been considered. She wasn’t included in her care plan and that caused her to not have her medicine and get money stolen from her. At the beginning of Helen’s assessment, she mentioned no history of drug abuse from her but didn’t mention Alec’s drug abuse. If the social worker knew about his drug habits then she could’ve made a better suggestion for Magda’s caregiving needs. A genogram could have been completed so general details about the family members would be known and that probably would’ve prompted a family session to address some issues before putting Magda in a potentially harmful situation with Alec.

Christ, G., & Diwan, S. (2008). Chronic illness and aging: The role of social work in managing chronic illness cases. Council on social work education. Retrieved from http://www.cswe.org/getattachment/centers-initiatives/CSWE-Gero-Ed-Center/Teaching-Tools/Gero-Competencies/Practice-Guides/Assignments-Measurements/CI-Sex2-Role-SW.pdf.aspx

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

Response 2

 larry harris RE: Discussion 1 – Week 6COLLAPSE

The biopsychosocial Seven Domains of Assessment support geriatric assessment, evaluation, and management to understand chronic illness care (Christ, Diwan, 2008).  As it pertains to Magda her physical well-being and health she has early stage of dementia and had a hip injury and cant get around like before.  Psychological well being and mental health Magda has dementia and can’t remember things to well, Cognitive capacity early stage of dementia but can still remember some things, Ability to perform ADL’S Magda can still perform getting dressed but as Helen stated she still has to buy the groceries, clean the house and keep track of the medication.  Social functioning Magda is mostly in the home due to the hip injury and limited mobility, The physical environment is the comfort of her home with the help of caregivers, Assessment of caregivers, Helen was overwhelmed even though she still helped 2 days a week when the caregiver suggestedby the church was there.  the grandson Alec being in recovery was a bad decision especially after the first incident.  

In the original assessment I would have asked Magda what she thought she needed.  I would also ask what her opinion was in having Alec come live with her.  I would also suggest other options to the family like assisted living facilities and helping Magda apply for medicaid and medicare to see if she qualified for a home health attendant.  I would ask Helen more questions about Alec and why she feels he would be a good fit and ask her just to share things about him.  That could have shed the light on why she was apprehensive in the beginning.  I would create a action plan with Magda being the head and do an assessment to determine her mental state and what she was capable of still doing.  Then I would help find resources to address the needs of Magda and make sure she has the proper care to address all of her needs.     

References

Christ, G., & Diwan, S. (2008). Chronic illness and aging: The role of social work in managing chronic illness case. Council on social work education. Retrieved from http://www.cswe.org/getattachment/centers-initiatives/CSWE-Gero-Ed-Center/Teaching-Tools/Gero-Competencies/Practice-Guides/Assignments-Measurements/CI-Sex2-Role-SW.pdf.aspx

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014a). Sessions: case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

Discussion 2

 Britney Fallen RE: Discussion 2 – Week 6COLLAPSE

Elder Abuse was printed by the Salem Press Encyclopedia of Health, within this article and today’s society it not a secret that the baby boomers are now aging causing the elderly population to increase (2013). The article continues by discussing what abuse is such as deliberate harm and exploitation. Elder abuse also states, Transgenerational violence is learned behavior  passed through generations (2013). Exchange theory was mentioned stating dependencies between a victim and the perpetrator related to reactions and responses that continue through adulthood (Stark, 2013). Numerous tips and ‘red flags’ are addressed for example, a client under using or overusing medications (Stark, 2013). In terms of screening, health care providers are suppose to assess elderly annually.  Salem Press Encyclopedia of Health directly reinforces that even though we are mandated reporters by law as social workers, anyone can report abuse, it is so important to raise public awareness for prevention or interventions (2013).

At the micro level, elderly abuse can be prevented by speaking directly to the patient and family. By providing education, knowledge of resources and even coping skills for the family to reduce stress levels and possibly reduce abuse or neglect. As stated in the article Elder Abuse, some caregivers have demonstrated outbursts of aggression toward an elder (2019). This is said to be caused by lack of knowledge or coping skills. Intervention and even prevention at the mezzo level with elderly abuse can consist of attending community board meetings. This to advocate with the client the importance of keeping up with community safety issues like crooked sidewalks or unstable railings. Macro level is more large system based. This can start with lobbying with the client to address health care / mental health policies for the elderly. This could include keeping a social policy the same or implementing a new one. 

References:

Stark, S. W. (2019). Elder abuse. Salem Press Encyclopedia of Health. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=93871903&site=eds-live&scope=site

Response 2

 Nakesha Morgan RE: Discussion 2 – Week 6COLLAPSE

This article focused on elder mistreatment and explained how its the risk or harm to a vulnerable elder by a trusted relationship with individual or the caregiver.  The elder may not be protected by that caregiver or the basic needs are not met.  It is consider to be an repeated act or lack of action to the elder.  It can consist of neglect, physical, sexual abuse, emotional abuse or abandonment (Daly & Jogerist, 2001).  It is very important to assess elders to see if they had any prior occurance with abuse or neglect in the past.  It better help worker have an understanding as to their needs and emotional feelings towards others.  Elderly may feel threaten if they have experienced abuse or neglect which will make it difficult for them to build trust.

Some of the prevention strategies when dealing with elder abuse and neglect individuals will be to ensure to keep in contact with the elders regularly.  A worker must understand the rights of the elders to ensure that they are protected.  Working with elderly on a macro level it is to focus on social policy changes to ensure that abuse can be prevented.  Having communication about the topic is important for individuals working directly with the elders and the elders themselves.  Having meetings and allowing the elders to sit in and ask questions can be helpful.  Working with elders on a micro level will be interacting with the individual personally or with the family.  Coming up with coping skills and finding ways to help reduce the abuse or neglect.  When working with elders on a mezzo level it consist of working with the institution rather than the client themselves.  This can consist of having meetings within the various senior living facilities.  A worker must ensure policies and procedures are in place within the facility and workers are mandated to report elder abuse or any neglect that may be witnessed around them.

Daly JM, Jogerist GJ.  Statute Definitions of Elder Abuse:  Journal of Elder Abuse & Neglect. 2001; 13(4); 39-57.