Geriatric Social Workers
Social workers, often with relevant education and/or certification in geriatric or gerontological practice, serving older adults and their families in adjusting to biopsychosocial and environmental challenges associated with aging into the latter decades of the life course, ongoing challenges which persist from earlier stages of life, or their intersections.
Today’s older adults have lived through a transformational era where population aging radically altered the landscape of families, communities, politics, economics, and health-care systems. In the year 1900, older adults accounted for only 4% of the US population. This proportion grew to 8% by 1946 – the year when the baby boomer generation began – and then continued to increase to 13% by 2010. The US Census Bureau projects that older adults will account for over 20% of the population by 2050 (Vincent and Velkoff 2010). Longer lifespans are the welcomed result of significant achievements in public health, medicine, and community and organizational safety. Yet, aging into very advanced years of life also increases the likelihood of confronting a number of challenges which threaten quality of life and emotional well-being for individuals and families (Hooyman and Kiyak 2018) (See “Multidimensional Views on Aging and Old Age”).
Social workers and other helping professionals have both the opportunity and responsibility to support and assist older adults in facing their unique challenges. Social workers are trained in distinct areas of competence to utilize assessment and intervention skills and relevant knowledge of human behavior and systems change to empower clients to achieve personal goals that will optimize quality of life (See “Social Work”). This requires simultaneous work to overcome individual and familial challenges, community and service system barriers, and problematic policies which govern service delivery, health care and insurance, and income and housing.
Key Roles and Settings
Geriatric social workers respond to the biopsychosocial, environmental, economic, and spiritual impacts of aging for older adults, their families, and society (Kaplan and Berkman 2015). Their clients include healthy older adults who lead fulfilling lives, as well as older adults who are challenged by chronic physical and mental health conditions, intellectual and developmental disabilities, neurological or substance-use disorders, incarceration, isolation, poverty and homelessness, and mistreatment and neglect, as well as their family and other caregivers (See “Healthy Aging” “Psychological Theories of Health and Aging” “Geriatric Mental Health”). They practice in community-based health and social service settings, long-term care facilities, palliative and end-of-life care agencies, educational programs, justice systems, individual and family counseling centers, and specialized health settings such as neurology clinics. They develop policies and programs affecting retirement, employment and voluntarism, housing, transportation, health, mental health, and caregiving for older adults (See “Adult Protective Services” “Home and Community-Based Services (HCBS)” “Social Services Utilization”).
As such, geriatric social workers provide comprehensive biopsychosocial assessments, cognitive-behavioral interventions, crisis mitigation, family counseling, supportive psychoeducation, program planning and evaluation, community organizing and advocacy work, and case management and care coordination services (See “Case Management” “Mental Health Services” “End-of-Life Care”). They are driven by unique values (National Association of Social Workers 2017) which guide strengths-based and solution-focused practice with older adults and the use of approaches to empower individuals and communities (See “Person-Centered Approach”). They attend to significant historical and contemporary issues facing older adults with particular attention to the intersectionality of aging with gender, race, ethnicity, nationality, class, sexual orientation, religion, and physical and mental disability (See “Aging and Health Disparities” “Caregiving and Ethnicity” “Gender Inequity” “LGBT in Old Age” “Sexism and Ageism” “Socioeconomic Status”). Their commitments to social justice demand continual work to celebrate human diversity while fighting against ageism, building knowledge about the harmful effects of the cumulative disadvantages which result from oppression and discrimination, and creating innovative models of inclusive and equitable care and community (See “Theory of Cumulative Disadvantage/Advantage”).
Example: Geriatric Social Workers and Dementia Care
Neurocognitive disorder, or dementia, is a syndrome creating devastation in nearly every domain of existence, with serious negative impacts which reverberate through families, communities, and society (See “Alzheimer’s Disease” “Dementia”). Dementia is the 6th leading cause of death in the USA but the only 1 of 10 leading causes of death which cannot be prevented or cured (Alzheimer’s Association 2017). It is a syndrome caused by nearly 60 distinct diseases and conditions (Qui et al. 2007). Dementia is present in 1/10th of older adults, and any setting serving older adults and their families routinely interacts with people who are struggling with dementia.
In order to understand and to respond effectively to the needs of their clients with dementia, geriatric social workers study the complex interactions of disease pathology, individual strengths, environmental conditions, informal supports, formal resources, and societal influences such as health-care policies. They are able to identify evidence-informed interventions for clients throughout the unpredictable fluctuations and evolving needs across stages of dementia (See “Care Needs” “Social Support“). Importantly, geriatric social workers also work to explain the multidimensional needs of families confronting dementia in order to educate interdisciplinary care teams about the importance of addressing psychosocial factors.
While there are considerable needs to increase the overall quality and quantity of providers who can meet the mental health needs of older adults (Shah and Kaplan 2015) and a significant need for enhanced supervision in gerontological care (Kaplan et al. 2018), geriatric social workers are already situated throughout the continuum of care and are appropriately trained to tackle the multidimensional impacts of the dementia syndrome. They are skillful in delivering clinical interventions and coordinating complementary supportive services with individuals with dementia and their families. Social workers are driven by values which inform the ethical application of person-centered care to promote human and community well-being, which is essential in the context of dementia care (Kaplan and Andersen 2013).
Geriatric social workers serve older adults in any number of health, mental health, social service, or community-based care settings. They strive to create equitable access to effective programs that will respond to the complex needs of diverse older adults and their families and communities. The interventions of geriatric social workers promote personhood and dignity, self-determination, safety, emotional well-being and fulfillment, optimal functioning, and a high quality of life.
Comprehensive reference materials and educational guidance on geriatric social work can be found in the following sources: (1) Oxford Handbook of Social Work and Aging (Kaplan and Berkman 2015) and (2) Oxford Bibliographies (if accessible through university or public library subscriptions), offering annotated lists of readings on social work and aging, geriatric health and mental health, gerontological assessments and practice interventions, family caregiving, public policies, and health insurance programs. In addition, the National Association of Social Workers offers geriatric social work credentials, a specialty practice section on aging, and published standards and guidelines on social work practice with family caregivers of older adults, palliative and end-of-life care, and services in long-term care facilities.
- Alzheimer’s Association (2017) Alzheimer’s disease facts and figures. Alzheimer’s & Dementia 13(4):325–373Google Scholar
- Hooyman NR, Kiyak HA (2018) Social gerontology: a multidisciplinary perspective, 10th edn. Allyn & Bacon, BostonGoogle Scholar
- Kaplan DB, Berkman B (eds) (2015) The Oxford handbook of social work in health and aging, 2nd edn. Oxford University Press, New YorkGoogle Scholar
- Kaplan DB, Silverstone B, Zlotnik JL et al (2018) NASW’s Supervisory Leaders in Aging: an effective and acceptable model for training and supporting social work supervisors. Clin Soc Work J, Special Issue: Clinical Supervision and Field Education in Social Work 46(4):321–330. https://doi.org/10.1007/s10615-018-0673-6
- National Association of Social Workers (2017) Code of ethics of the National Association of Social Workers. Retrieved 14 Feb 2019, from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
- Shah A, Kaplan DB (2015) Hard truth, with dire consequences: America lacks trained mental health workers to care for an aging population. Aging Today 36(2):8–14Google Scholar
- Vincent GK, Velkoff VA (2010) The next four decades: the older population in the United States: 2010 to 2050. Current population reports number P25-1138. U.S. Census Bureau, Washington, DCGoogle Scholar