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.     

Advance care planning throughout the end-of-life: focusing the lens for social work practice

Advance care planning throughout the end-of-life is an increasingly important aspect of professional practice with older adults and their families. As the nation's population continues to live longer, more and more people will experience years of functional and cognitive decline prior to death. This article discusses the growing importance of advance care planning using a long-range, holistic perspective of examining care needs throughout the end of life. End-of-life care is conceptualized by three trajectories of decline leading to death, with about two-thirds of all older adults succumbing to four key conditions: congestive heart failure, emphysema, frailty, and dementia. Research regarding the advance care planning needs of older adults with the key conditions is presented. Further research is needed to enhance social work practice in this area.     

Veterans’ Informal Caregivers in the “Sandwich Generation”: A Systematic Review Toward a Resilience Model

Social work theory advanced the formulation of the construct of the sandwich generation to apply to the emerging generational cohort of caregivers, most often middle-aged women, who were caring for maturing children and aging parents simultaneously. This systematic review extends that focus by synthesizing the literature on sandwich generation caregivers for the general aging population with dementia and for veterans with dementia and polytrauma. It develops potential protective mechanisms based on empirical literature to support an intervention resilience model for social work practitioners. This theoretical model addresses adaptive coping of sandwich- generation families facing ongoing challenges related to caregiving demands.     

Overcoming Barriers to Serving the Aging/Mental Health Client

This paper presents a model, based upon a series of state-level initiatives in the Commonwealth of Pennsylvania, for improving coordination between the aging and mental health systems to better serve elderly persons with mental health problems. The mental health needs of the elderly are discussed and service delivery obstacles - systemic, individual, and agency/staff - are reviewed and synthesized. Policy initiatives by the Commonwealth of Pennsylvania that relate to these issues are presented as a case study, with a focus upon a series of regional conferences held around the state for providers in the aging and mental health networks to encourage better coordination of services. The process and outcomes of these conferences are discussed, together with an analysis of the implications for practice, policy, and teaching.     

The Multirole Practitioner in the Generic Orientation to Social Work Practice

Summary Generic Social Work practice theory is at a promising stageof development. Utilizing concepts from systems theory a numberof new holistic practice models are now available which canbe applied in any setting. A further frame of reference is requiredthat captures the wide range of social work activity. The aim of this paper is to propose eight tasks and thirteencommon roles of practice which are presented in the form ofa model designed to delineate the role and task matrix of thegeneric practitioner. Practice experience suggests that these tasks and roles constantlymerge into, or follow one another. Some of the roles and tasksseem better understood and theoretically developed than others. The formulation that is offered is currently being empiricallytested. Practitioners, educators and practice researchers areinvited to specify the roles and tasks they regard as centralto practice, to check these against the model offered here,and to present any fundamental differences in forms that lendthemselves to empirical research.     

An Ecological View of Aging

A transactional view of aging highlights the need for attachments throughout the life course. It emphasizes the environment, its supports, its nutritive and non-nutritive or noxious qualities as critical to our understanding of the aging process. This article discusses the aging process from an ecological perspective. It includes an exploration of theoretical developments and service delivery needs. It also provides a case example of a homeless 75-year-old woman to illustrate the dehumanizing gaps in our service delivery systems that make the consolidation of sense of ego integrity an unlikely outcome.     

Use of Space and Human Rights: Planning Dementia Friendly Settings

Environmental psychology has been a topic of great interest for many researchers in the field of aging and dementia. Thus, several orientations can be identified in the contemporary scientific literature concerning environmental design for people with dementia. In this article, we discuss recent research on environmental design models for people with dementia and propose an approach referring to the concept of use of space and human rights.We use a methodology based on observation of special care units to determine an environmental design framework that should be taken into account when designing residential facilities for people with dementia. Content analysis identified 6 primary dimensions and 13 secondary dimensions relevant to the rights of people with dementia. We then discuss the results according to the related literature in environmental psychology and gerontology in terms of well-being and quality of life.     

Accelerating the translation of research into practice in long term services and supports: a critical need for federal infrastructure at the nexus of aging and disability

The nexus of aging and disability, characterized by the phenomenon of aging with a disability, will become more visible as the population ages and the number of people with disabilities surviving to midlife increases. This article addresses 3 interrelated issues critical to the fields of aging and disability: increasing demand for community-based long-term services and supports, a paucity of evidence-based programs demonstrating effectiveness in facilitating independence for those aging with a disability, and lack of a federal infrastructure to support coordinated investments in research-to-practice for this population. Suggestions for federal interagency collaborations are given, along with roles for key stakeholders.     

Developing the NICE/SCIE Guidelines for Dementia Care: The Challenges of Enhancing the Evidence Base for Social and Health Care

Internationally, interest is developing in the challenges ofdeveloping evidence-based guidelines for social work practice.The paper reports on the process of establishing the UK’sfirst joint health and social care evidence-based practice guideline,which is in dementia care. The paper addresses the methodologicaland procedural challenges of reviewing, meta-analysing and synthesizingknowledge for health and social care given the contrasting historiesof the two sectors in relation to the emergence of evidence-basedpractice. Dementia care is a complex domain within which socialand clinical perspectives intersect, reinforcing the desirabilityof producing ‘joined up’ health and social carepractice guidelines that are relevant to integrated services.It is suggested that the exemplar of producing a joint healthand social care guideline for dementia may be a model for futuredevelopment of practice guidelines. Some of the main recommendationsare presented to illustrate the character of the joint guideline,lessons are drawn for future guideline development, and implicationsfor policy and practice implementation are considered.     

Learning Experiences of Older Volunteers in a Community-based Social Program for People with Dementia

Abstract

This qualitative study aimed to explore older adults’ perspectives on volunteering in an activity-based social program for community-dwelling people with dementia called Stepping Stones. Semi-structured interviews were individually conducted with eight older adults who had volunteered in Stepping Stones. Interpretative phenomenological analysis was used to analyze interview data. Four themes related to learning experiences of older volunteers in Stepping Stones emerged. These themes include (a) self-growth and confidence in working with people with dementia; (b) understanding dementia, people with dementia, and needed support for people with dementia and their families; (c) desire not to develop dementia, while recognizing that anything can happen in old age; and (d) exercising person-centered approaches and taking on advocacy roles. Findings suggest that older volunteers gain feelings of personal growth and confidence in working with people with dementia, better understanding, and enhanced attitudes toward people with dementia through volunteering in an activity-based social program for people with dementia. Older adults will be able to fill the needs of community programs for people with dementia, while experiencing benefits from volunteering and learning in later life. Further research is needed to examine to what extent having previous dementia experiences make their experiences and learning different.     

To Coordinate Information in Practice: Dilemmas and Strategies in Care Management for Citizens with Dementia

ABSTRACT

This qualitative study, based on 19 interviews with care managers, explores the experiences of care-managers involved in assessing the need for social services for people with dementia. The study shows that social workers, as care managers, face several dilemmas in their practice concerning people with dementia, in relation to the exchange of information and in regards to conflicting interests between different actors involved in the assessment of the need for support for people with dementia. Strategies used to handle problematic situations that arise in their work are using other sources for information (e.g., relatives and actors from other professions), persuading, and pursuing creative forms of consent. However, the study shows that dilemmas and strategies used generate other, prominently moral, dilemmas for care managers in their practice, which relate to participation and self-determination by the person with dementia. The study shed light on the problematic situation for care managers in their work to coordinate information and further the new “realities“ that they encounter as well as on how to handle these new situations. This study suggests possible ways to improve the everyday work of care managers, as well as how policies concerning social work and people with dementia can be improved.     

Chapter 18. The Aging Network and the Future of Long-Term Care

SUMMARY

Federal and state governments face a significant challenge in meeting the long-term care needs of an older population that will double in size between 2000 and 2020 and continue to increase through 2050. States have made significant improvements in their long-term care systems for the elderly. However, they are still spending a significant proportion of their long-term care funds on nursing homes. Any effort to improve long-term care for the elderly qualitatively, and not just on the margins, must be focused on developing a more flexible and balanced long-term care system that is responsive to consumer choice.

The Aging Services Network is poised to play a significant role in this transformation process. The strengths of the Network include the ability to develop and manage consumer-driven community-based programs; to assess the needs and resources of individual older persons and provide cost-effective community supports; to operate within fixed, capped budgets; and to identify and maintain roles for informal caregivers. Now is the time for national aging organizations, state units on aging, and area agencies on aging to use existing opportunities to move towards the establishment of a balanced system of long-term care.     

It Takes a Village: Community Practice,Social Work,and Aging-in-Place

The US population of older adults will increase significantly in the coming decades. Most of these individuals prefer to age in their homes/communities. However, most communities are not prepared to handle the long-term care needs of an aging population. This article examines one model that communities are using to help older adults age-in-place, the Village. A conceptual lens based in community practice and empowerment theory is offered to explicate this model and critically evaluate social work's role in it. It also presents challenges to social work roles in facilitation and evaluation of the model.     

It takes a Village: community practice, social work, and aging-in-place

The US population of older adults will increase significantly in the coming decades. Most of these individuals prefer to age in their homes/communities. However, most communities are not prepared to handle the long-term care needs of an aging population. This article examines one model that communities are using to help older adults age-in-place, the Village. A conceptual lens based in community practice and empowerment theory is offered to explicate this model and critically evaluate social work's role in it. It also presents challenges to social work roles in facilitation and evaluation of the model.     

A perfect storm: Challenges encountered by family caregivers of persons with Alzheimer’s disease during natural disasters

ABSTRACT

Since Hurricane Katrina there has been a movement across the U.S. to examine best practice for disaster response within the aging population. However, little is known about the experience of natural disasters from the perspective of family caregivers of persons with Alzheimer’s disease and related dementia (ADRD). In this exploratory, qualitative study, family caregivers (n=27) were interviewed about their experience with the historic 2015 South Carolina flood. By using thematic analysis, themes were identified to better understand what unique challenges caregivers of person with ADRD experienced. While many caregivers stated they had experienced a natural disaster previously, none had ever done so in their current caregiving role. The caregiving role affected their ability to prepare for the storm and influenced their decision-making regarding evacuation and utilization of recovery resources. Thus, caregivers were confronted by a “perfect storm” of circumstances and uncertainty. Family caregivers need to have actionable emergency plans for disasters that are specific to their role as caregivers of persons with ADRD. Study implications also suggest the role social work professionals can have in educating, advocating, evaluating, and coordinating support to assist caregivers of persons with ADRD as a potentially vulnerable and at-risk population during all phases of disaster.     

Processes of conservation and change in Arab society in Israel: Implications for the health and welfare of the Arab population

Azaiza F. Processes of conservation and change in Arab society in Israel: Implications for the health and welfare of the Arab population This article reports on a study that examined how modernisation processes affect the Arab citizens of Israel on various levels and how the processes are reconciled with traditional ideals. Modernisation affects formal and informal support systems, affects family lifestyles, has resulted in changes in the treatment of elderly people and has seen modern ideas of health and wellness incorporated with traditional values and ideals. For the Arab citizens of Israel, the conflict of tradition versus modernisation is evident throughout society. Studying the processes of both modernisation and preservation and their implications allows us to better understand and address the needs of the Arab population in Israel. Based on the research presented in this review, processes of modernisation and conservation are conceptualised as a continuum along four dimensions: perceptions of self, sources of social support, health roles and gender roles. The implications of these changes are explored as they relate to various phenomena.     

Utilizing Social Support to Conserve the Fighting Strength: Important Considerations for Military Social Workers

This article is a continuation of a conference panel dialogue that focused on providing individualized, culturally responsible treatment of secondary traumatic stress (STS) for military social workers. Key aspects of the roles and responsibilities, professional and ethical challenges of military social workers and social work officers serve as focal points for understanding the importance of social support. This article discusses ways social support might help to moderate the impact of STS. The “buddy system” describes a culturally unique protective factor, which is a well‐known and effective type of social support utilized throughout the military. This article provides valuable information on how the “buddy system” can serve as a blueprint for managing STS experienced by military social workers. The article concludes with research, policy, and practice implications.     

Charging and Quasi-Markets in Community Care: Implications for Elderly People with Dementia

Social services authorities in the UK are increasingly involved in charging and fee collection activities with clients in receipt of community care services. This article explores the implications of these developments for elderly people with dementia. The starting point of the article is a critique of existing legal and administrative options for handling other people's money, including the difficulties and dilemmas raised for both paid and unpaid carers by the existing arrangements. This is then related to the failure of charging and fee collection systems which have developed as a result of the community care reforms to address the particular needs of elderly people with dementia. A case study of policies in one local authority is outlined and this is followed by the presentation of the view of 37 fieldlevel professionals who were interviewed in focus groups. The concerns of these respondents included the complexity of the assessment task, conflicts between care managers and finance/revenue staff, the difficulty of defining and responding to financial abuse, and dilemmas over the extent to which relatives and carers should be trusted. The final section of the article considers the implications of a move to quasi-markets in social care for elderly people with dementia, particularly in terms of their vulnerability to financial exploitation.     

Research,Macro Practice and Aging in the Social Work Education Curriculum

Summary

This paper presents a model that used a macro emphasis for teaching research using older adults. Faculty developed the teaching model to address three key areas of concern in the education of Bachelor of Social Work (BSW) students for generalist practice: (1) research, (2) macro-level practice, and (3) aging. The paper explores the nature of these concerns and draws upon previous literature to delineate a teaching model designed to strengthen these areas of generalist practice by integrating content on macro-level concerns and aging into the curriculum of a research course. The development and evaluation of the research course within the context of a community and college project are described, as are the benefits for students, the social work program and the community. Preliminary findings indicate some support for the use of such a model.