Educating Our Future Colleagues: Creating an MSW Palliative Care Practicum

As the number of older adults and those with chronic medical conditions continues to rise, the need to train social work students in palliative and end-of-life competencies becomes critical. To address this growing need, the social work team at a large urban academic medical center in the Midwest developed an MSW concentration practicum in palliative and end-of-life care. During the practicum, students receive immersive training in palliative care social work values and the skills required for these specialized assessments, interventions, and evaluations. Their training culminates in their participation on an interdisciplinary team to provide psychosocial support to patients and families receiving palliative and end-of-life care throughout the medical center. This article describes the curriculum, practice immersion, training manual, teaching modules, and structure of student supervision which is applicable to and adaptable for other palliative care social work field instructors.     

Pathways to age-friendly communities in diverse urban neighborhoods: Do social capital and social cohesion matter?

ABSTRACT

Using a social capital and social cohesion lens, we reposition the concept of civic engagement among older adults to examine pathways for building age-friendly communities. We analyzed data drawn from a Community-Based Participatory Research study in the Southern U.S. that explored lived experiences of older adults, age 55 and above, who participated in individual interviews (n = 15) and six focus group discussions (n = 45) to examine their perceptions of social identity, social connectedness, and civic engagement geared toward an age-friendly city. Findings indicated that several older adults had access to social networks and socially invested resources, thereby having opportunities for civic engagement and building age-friendly neighborhoods. However, social, cultural, linguistic, and structural barriers were more evident among certain diverse ethnic populations. Marginalized low-income minorities and immigrants, such as Hispanic participants, felt the lack of social cohesion among the larger society limited their ability to give back, thus decreasing their civic engagement activities. In contrast, Caucasian and African-American older adults were able to contribute to the political process through more civic participation activities. We provide implications for examining the role of social capital and social engagement to bolster civic engagement among older adults in building age-friendly communities.     

Does Volunteering Experience Influence Advance Care Planning in Old Age?

Advance care planning (ACP) increases the likelihood patients will receive end-of-life care that is congruent with their preferences and lowers stress among both patients and caregivers. Previous efforts to increase ACP have mainly focused on information provision in the very late stage of life. This study examines whether a relationship exists between volunteering and ACP, and whether this relationship is associated with social support. The sample comprises 877 individuals who were aged 55+ in 2008, and were deceased before 2010. The sample is derived from seven waves (1998–2010) of data from the Health and Retirement Study. Logistic regression results showed that overall ACP and durable power of attorney for health care (DPAHC) were both higher (OR = 1.61 and 1.71, respectively) for older adults with volunteering experience in the past 10 years than those without such experience. Available social support (relatives and friends living nearby) was not associated with the relationship between volunteering and ACP. Other factors related to ACP included poorer health, death being expected, death due to cancer, older age, and being a racial minority. Involving older people in volunteer work may help to increase ACP. Future research is encouraged to identify reasons for the association between volunteering and ACP.     

Implementing reverse mentoring to address social isolation among older adults

ABSTRACT

Reverse mentoring is a means to address the social work Grand Challenge of social isolation. Among older adults, reverse mentoring can improve social connection by increasing the digital competence of older adults so they can use technology for social benefit, and by facilitating intergenerational connections with young adult mentors. In this paper, reverse mentoring is examined within an intergenerational program that serves older adults and utilizes the native technological knowledge and skills of young adults who mentor older adult participants. Qualitative data were collected through young adult mentor logs of each session, and through open-ended questions on the post-surveys collected from older adults and young adult mentors. Qualitative analysis revealed three themes related to social connection: (1) an increased sense of self-efficacy for older adults as they build confidence in technological use, and for young adults as they develop leadership skills through mentoring, (2) the breaking down of age-related stereotypes, and (3) intergenerational engagement and connection. The findings demonstrate that reverse mentoring can be used in various settings to decrease the social isolation of older adults by developing intergenerational connections and increasing older adult usage of technology.     

Civic Engagement for Nursing Home Residents: A Call for Social Work Action

Civic engagement has been found to be associated with a number of emotional and physical benefits for older adults. For those residing in nursing homes, however, opportunities for civic engagement are limited. Societal barriers such as ageism and practical issues such as transportation can limit their access to activities that promote civic engagement. In this article, we review past research on civic engagement for older adults and explore the challenges and barriers faced by nursing home residents. We conclude with a call for social work professionals to develop, implement, and evaluate interventions that increase civic engagement opportunities for this undervalued group.     

Linguistic competence/language access services (LAS) in end-of-life and palliative care: a social work leadership imperative

Despite the mandated and moral imperative to advance linguistic competence in all health care contexts, leadership that addresses this area of practice and study in end-of-life and palliative care is not readily obvious. Because social work is ideally suited to lead efforts to advance linguistically-accessible end-of-life and palliative care, social workers are encouraged to assume the challenge. This article focuses on topics that are elementary yet central to discussions on language diversity and leadership initiatives to advance language access in end-of-life and palliative care contexts: importance and function of language, extent of language diversity, inequity related to language diversity, mandates and standards related to language access, and approaches and competencies that contribute positively to language access.     

Self-efficacy and psychological well-being of nursing home residents in China: the mediating role of social engagement

Abstract

The purpose of this study was to explore the role of self-efficacy and social engagement in psychological well-being of Chinese nursing home residents. A total of 307 residents completed the measurement of social engagement, self-efficacy and psychological well-being. The results showed that satisfaction with physical environment, social support, social activity engagement and self-efficacy were all positively correlated with psychological well-being. At the same time, social engagement partially mediated the effect of self-efficacy on psychological well-being. The results of this study should indicate additional actions for managers of nursing homes and social workers to improve the psychological well-being of older adults.     

Understanding Quality-of-Life While Living with Late-Stage Lung Cancer: An Exploratory Study

U.S. Veterans have a higher prevalence of advanced lung cancer and poorer survival outcomes compared to the general population; yet, no studies exist which specifically explore the psychosocial and existential quality-of-life (QOL) of late-stage lung cancer among this population. This article presents the perspectives of older veterans (N = 12) living with late-stage lung cancer who were receiving chemotherapy, routine hospice care, or both concurrently. Based on individual interviews, themes associated with loss of functionality, close relationships, and communicative acts contributed to veterans’ perceptions of diminished or enhanced QOL while living with advanced disease. An overarching theme, loss of the person I know myself to be, suggests that personhood is an important concept to consider in QOL assessment. While findings suggest that the experiences of older Veterans with late-stage lung cancer are similar to other populations of lung cancer patients, and persons with incurable cancer in general, further research regarding the influence of veteran identity at end-of-life is warranted. Further research is needed which explores the influence of a whole person approach to QOL during life-limiting illness and end-of-life decision-making, particularly while receiving late-stage cancer-directed therapy.     

“Res Ipsa Loquitur” … It Speaks for Itself … Social Work—Values,Pain, and Palliative Care

Abstract

Despite the mandated and moral imperative to advance linguistic competence in all health care contexts, leadership that addresses this area of practice and study in end-of-life and palliative care is not readily obvious. Because social work is ideally suited to lead efforts to advance linguistically-accessible end-of-life and palliative care, social workers are encouraged to assume the challenge. This article focuses on topics that are elementary yet central to discussions on language diversity and leadership initiatives to advance language access in end-of-life and palliative care contexts: importance and function of language, extent of language diversity, inequity related to language diversity, mandates and standards related to language access, and approaches and competencies that contribute positively to language access.     

Hardly Silent: Exploring Civic Engagement and Participation among a Panel of Adults Ages 85+

ABSTRACT

The past twenty years have seen a surge of resources for and public attention devoted to civic participation opportunities for older adults in the United States. At the same time, technology has transformed the way information related to political and social issues is spread and shared. As more older adults migrate to using a wider range of communication tools and the internet, technology-mediated forms of engagement represent a new way for the oldest old to participate in society. In this study, a panel of adults ages 85 and older was surveyed to understand their experiences engaging with political and social issues. Responses to a questionnaire (N = 24) and focus groups (n = 22) indicate the oldest old are interested in social and political issues, and there are opportunities for technology to facilitate the oldest olds’ civic and political action. This study identifies roles social workers may play in helping the oldest old engage with social and political issues in their communities.     

Facilitating Forgiveness and Peaceful Closure

Abstract

The importance of addressing psychosocial concerns with dying patients is pivotal to facilitating peaceful closure in end-of-life care. The social worker's role in recognizing and providing skilled, psychosocial intervention with patients and families in hospice programs is significant. In this article, the literature in this area is examined and a case example of a hospice patient's need for closure and the responsive social work intervention for the patient in his moment of death is provided. The case offers social work knowledge and skills and demonstrates the therapeutic benefit of addressing psychosocial needs in end-of-life care. The importance of targeted training and continued skill development for social workers in end-of-life treatment settings is emphasized.     

Enhancing the efficacy and empowerment of older adults through group formation

Research suggests that efficacy and empowerment are necessary for social engagement and that a sense of efficacy and empowerment exerts positive influences on older adults. However, little is known about how individual efficacy and empowerment are affected by group efficacy and empowerment in later life. To assess the impact of group involvement on the individual, the authors conducted a follow-up study with members of an art guild for older adults. Qualitative data were collected in 1997 and 2001 to ascertain the members' perceptions of group goals and accomplishments, membership benefits, the effect on the community, societal views about older adults, and the impact of group activities on the individual. The results clearly indicated that collective efficacy and empowerment through social engagement were beneficial to members as individuals and as a group, and contributed to well-being through a general sense of accomplishment and pride.     

Zelda Foster and her contributions to social work in end-of-life care

This article is both a memoir of one social worker's professional collaboration with Zelda Foster and a tribute to Zelda's legacy in the form of an educational resource on end-of-life care. It reviews achievements of Zelda Foster in social work practice and teaching related to death and dying. Resources presented in this article were supported by the Soros Foundation's Project on Death in America, a funded grant project to which Zelda contributed. The end-of-life care education, training and informational tools discussed in this article are examples of ongoing efforts in the social work profession to improve the lives of the dying and bereaved.     

The Forgotten: Dementia and the Aging LGBT Community

Although research documenting the experience of lesbian, gay, bisexual, transgendered (LGBT) aging in general is gaining traction, and literature on dementia continues to proliferate, few articles attend to how dementia affects members of the aging LGBT community. This article reviews the current state of knowledge on the experience of dementia for LGBT older adults, and suggests areas for further research. In addition, it aims to promote social work’s engagement with related disciplines and global dementia care. The article’s ultimate goal is to encourage development of care practices tailored to the experiences, expectations and needs of older LGBT individuals affected by dementia.     

Perceptions of preparedness to assist elders with end-of-life care preferences

Using a systematic sample of Florida licensed clinical social workers (N = 272), this study found that respondents perceived themselves capable of assisting elders with end-of-life care decisions and considered themselves moderately knowledgeable of resources available to elder clients. Respondents indicated slightly positive attitudes for work with elders and elders with Alzheimer's disease, and most respondents believed that elders should have the right of physician-assisted suicide. Using multivariate analysis, four predictor variables were identified that account for 61.3% of the adjusted variance of the dependent variable of preparedness to assist elders with end-of-life care preferences. These predictor variables were (a) knowledge of resources available to elders, (b) desirability of working with elders, (c) desirability of working with elders with Alzheimer's disease, and (d) attitude toward assisted suicide.     

Facilitating forgiveness and peaceful closure: the therapeutic value of psychosocial intervention in end-of-life care

The importance of addressing psychosocial concerns with dying patients is pivotal to facilitating peaceful closure in end of- life care. The social worker's role in recognizing and providing skilled, psychosocial intervention with patients and families in hospice programs is significant. In this article, the literature in this area is examined and a case example of a hospice patient's need for closure and the responsive social work intervention for the patient in his moment of death is provided. The case offers social work knowledge and skills and demonstrates the therapeutic benefit of addressing psychosocial needs in end-of-life care. The importance of targeted training and continued skill development for social workers in end-of-life treatment settings is emphasized.     

Enhancing the Efficacy and Empowerment of Older Adults Through Group Formation

ABSTRACT

Research suggests that efficacy and empowerment are necessary for social engagement and that a sense of efficacy and empowerment exerts positive influences on older adults. However, little is known about how individual efficacy and empowerment are affected by group efficacy and empowerment in later life. To assess the impact of group involvement on the individual, the authors conducted a follow-up study with members of an art guild for older adults. Qualitative data were collected in 1997 and 2001 to ascertain the members' perceptions of group goals and accomplishments, membership benefits, the effect on the community, societal views about older adults, and the impact of group activities on the individual. The results clearly indicated that collective efficacy and empowerment through social engagement were beneficial to members as individuals and as a group, and contributed to well-being through a general sense of accomplishment and pride.     

Perceptions of Preparedness to Assist Elders with End-of-Life Care Preferences

Abstract

Using a systematic sample of Florida licensed clinical social workers (N = 272), this study found that respondents perceived themselves capable of assisting elders with end-of-life care decisions and considered themselves moderately knowledgeable of resources available to elder clients. Respondents indicated slightly positive attitudes for work with elders and elders with Alzheimer's disease, and most respondents believed that elders should have the right of physician-assisted suicide. Using multivariate analysis, four predictor variables were identified that account for 61.3% of the adjusted variance of the dependent variable of preparedness to assist elders with end-of-life care preferences. These predictor variables were (a) knowledge of resources available to elders, (b) desirability of working with elders, (c) desirability of working with elders with Alzheimer's disease, and (d) attitude toward assisted suicide.     

Social work and end-of-life care: reviewing the past and moving forward

This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized.     

Zelda Foster and Her Contributions to Social Work in End-of-Life Care

ABSTRACT

This article is both a memoir of one social worker's professional collaboration with Zelda Foster and a tribute to Zelda's legacy in the form of an educational resource on end-of-life care. It reviews achievements of Zelda Foster in social work practice and teaching related to death and dying. Resources presented in this article were supported by the Soros Foundation's Project on Death in America, a funded grant project to which Zelda contributed. The end-of-life care education, training and informational tools discussed in this article are examples of ongoing efforts in the social work profession to improve the lives of the dying and bereaved.