Introduction
"How can I know if my client's problem is related to the medications he or she is
taking?" "How do I know if my client is depressed or showing symptoms of
dementia?" "What do I need to know to determine if my client can safely remain
in the community?" "At what point might my client need a guardian?"
"How far should I go in advocating for or against treatment if my client is
terminally ill?"
Practitioners providing services to the elderly ask questions such as these on a daily
basis. No field is more complex and challenging than the field of health, concerned with
life and death issues for people of every stage and station of life. As new knowledge
relentlessly grows in the technical domain of medicine, new knowledge is demanded in the
social and psychological domains. This book is intended to provide the gerontological
knowledge needed by interdisciplinary practitioners to answer these types of questions.
The workers for whom this book is intended represent a number of different specialties
in the field of health and aging services. They include social workers, case managers,
senior center personnel, recreation workers in adult day care centers, hospice care
workers, and ancillary therapists such as occupational and physical therapists, as well as
nurses, hospital intake workers, nutritionists, and physician assistants. For convenience,
throughout the book the authors primarily use the term "practitioner," but the
guidance being provided applies equally to social work practitioners and those other
workers listed above.
Health care professionals as a group are committed to helping people prevent or
minimize illness and disability or, when necessary, to maximize their coping abilities.
This humane goal is increasingly difficult as the advances of science and technology
propel us into a constantly changing world in which patients and their families need all
the help they can get to understand and benefit from these advances.
One of the most significant social changes that has resulted from the many miracles of
modern science is the phenomenally rapid increase in the number of people who survive to
old age. Because health problems accrue as people age, a large proportion of the patients
seen by health care professionals are elderly.
Although the basic principles that guide our practice are generic to all ages, certain
special characteristics of the aging experience must be understood for us to be effective
helpers to this population.
This book grew from the perceived practice needs for gerontological knowledge in a
hospital social work department. The social workers selected several areas of direct
applicability: understanding the process of aging; the context of practice in a rapidly
changing health care system; knowledge of health and illness in later life; knowledge of
medication use and misuse in elderly people; assessment skills in differentiating
depression, dementia, and other mental impairments; assessment skills and knowledge for
effective case management practice; family issues in practice with elderly people;
understanding ethnic influences in practice with elderly people; ethical dilemmas in
issues of autonomy versus protective services; and death and bereavement issues with
elderly people. The principles that are developed herein to maximize individual potential
in each of these special areas are transferable to the entire range of gerontological
practice.
From the vast body of gerontological research that has grown since that discipline's
beginning 50 years ago, the authors have selected those issues that are most relevant to a
humanistic perspective in health care for the aging. The humanistic perspective, centered
on humane values, asserts the dignity, worth, and boundless capacity of each individual,
even into advanced old age. Humanness is thus seen as having the potential for a constant
process of becoming, of developing in a constantly changing environment (Whittaker, 1974).
The issues chosen are those that provide a knowledge base for understanding some of the
most common problems that challenge the growth potential of the aging, such as supportive
family relationships, mental impairment, urinary incontinence, loss and bereavement, and
the need for case management.
A humanistic approach demands sensitivity and knowledge about ethnic and cultural
influences in the use of services. The authors have selected blacks and Hispanics as
particular groups to illustrate the need for culturally specific knowledge. The principles
given can be applied to all minorities, such as Native Americans, Jews, and Asians.
The above topics were the basis of training workshops presented by members of the
faculty of Florida International University for the Social Work Department of Mt. Sinai
Hospital in Miami Beach through the generosity of the Samuel D. and Isabel May Fund of the
Greenberg–May Foundation. Such collaborations between academia and agency staff are
mutually beneficial. Through testing of theoretical knowledge by direct practitioners,
each profession is better informed. The systematic evaluation of such informed health care
practice in geriatrics is a challenge that is only now beginning to receive sufficient
attention.
The authors compiled this second edition because of the continuing rapid expansion of
knowledge and the increasing challenges confronting health care professionals trying to
work effectively with the new elderly population. Although some gerontologists emphasize
the need to recognize the strength and creativity of older people (Cohen, 1993), a view to
which the authors fully subscribe, the reality is that health care practitioners more
often must grapple with the ethical dilemmas related to the frail and impaired. Therefore,
three new chapters have been added to address some of the most troubling concerns: elder
abuse, AIDS and the elderly, and the need for clarity regarding the usefulness of advance
directives.
This book reflects the diverse views of its editors and contributors, views that are
nevertheless unified by a common focus on developing an interdisciplinary understanding of
elderly people in the hard-to-understand world of health care.
References
Cohen, G. (1993, Winter/Spring). Comprehensive assessment: Capturing
strengths, not just weaknesses. Generations, 17, 47–50.
Whittaker, J. K. (1974). Social treatment. New York: Aldine.
Back to Gerontology for Health Professionals |
