Biological Aspects of Later Adulthood

In 2011, the World Health Organization stated:
The world is on the brink of a demographic milestone. Since the beginning of recorded history, young children have outnumbered their elders. In about five years time, however, the number of people aged 65 or older will outnumber children under age 5. (p. 2)

As the world’s population ages, an understanding of issues and challenges related to aging is of paramount importance for individuals working in the helping professions. This week, you begin to explore the life-span phase Zastrow and Kirst-Ashman (2016) title “later adulthood.” You explore the biological changes aging individuals experience and consider how the environment might accelerate or decelerate the aging process. You also consider a topic of growing significance for social workers—end-of-life care.

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

Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment (10th ed.). Boston, MA:  Cengage Learning.
Chapter 1, “Introduction to human behavior and the social environment: The strengths perspective” (pp. 13)
Chapter 14, “Biological Aspects of Later Adulthood” (pp. 654-684)

Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
“Working With the Aging: The Case of Francine” (pp. 39–41)Note: This text is available as an eBook (electronic book). It will be provided to you via an email from the Walden University book store.

Working With the Aging: The Case of Francine

Francine is a 70-year-old, Irish Catholic female. She worked for 40 years as a librarian in an institution of higher education and retired at age 65. Francine has lived alone for the past year, after her partner, Joan, died of cancer. Joan and Francine had been together for 30 years, and while Francine personally identifies as a lesbian, she never came out to her family or to her colleagues. When speaking to all but her closest confidantes, Francine referred to Joan as her “best friend” or her “roommate.” Francine’s bereavement was therefore complicated because she did not feel she could discuss the true nature of her partnership with Joan. She felt that there was little recognition from her family, and even some of her close associates, of the impact and meaning of Joan’s death to Francine. There is a history of alcohol abuse in Francine’s family, and Francine abused alcohol from late adolescence into her mid-30s. However, Francine has been in recovery for several decades. Francine has no known sexual abuse history and no criminal history.

Francine sought counseling with me for several reasons, including an ongoing depressed mood, a lack of pleasure or enjoyment in her life, and loneliness and isolation since Joan’s death. She also reported that she had begun to drink again and that while her drinking was not yet at the level it had been earlier in her life, she was concerned that she could return to a dependence upon alcohol. Francine came to counseling with several considerable strengths, including a capacity to form intimate relationships, a successful work history, a history of having maintained her sobriety in the past for many years, as well as insight into the factors that had contributed to her current difficulties.

During our initial meetings, Francine stated that her goals were to feel less depressed, to reduce or stop drinking, and to feel less isolated. In order to ensure that no medical issues were contributing to her depression symptoms, I referred Francine to her primary care physician for an evaluation. Francine’s physician did not find any medical cause of her symptoms, diagnosing Francine with moderate clinical depression and recommending that Francine begin a course of antidepressant medication. Francine was reluctant to take medication and first wanted to try a course of counseling.

In order to help Francine meet her goal of reducing her depression symptoms, I employed a technique called behavioral activation (BA), which is drawn from principles of cognitive behavioral therapy and helps to reengage people in pleasant physical, social, and recreational activities. We began with a small initial goal of having Francine dedicate at least 5 minutes of each day to an activity she found pleasant or rewarding. Over the following weeks, we increased the time. Francine’s treatment progress was monitored through weekly completion of the Patient Health Questionnaire (PHQ-9) in order to determine whether or not her depressive symptoms were improving.

I helped Francine address her drinking by reconnecting her with effective coping strategies she had used in the past to achieve and maintain her sobriety. These included identifying triggers for the urge to drink and exploring her motivations for both continuing to drink and for stopping her use of alcohol. Francine began attending regular meetings of Alcoholics Anonymous™(AA) and found several meetings that were specifically for older women and for lesbians. In addition, Francine spoke regularly with a sponsor who helped her to remain abstinent during particularly stressful moments during her reengagement in sobriety.

Finally, in order to address Francine’s goal of feeling less lonely and isolated, we explored potential avenues to increase her social networks. In addition to spending time with her family, friends, and her AA sponsor, Francine began to visit the local lesbian, gay, bisexual, and transgender (LGBT), center for the first time in her life and attended a support group for women who had lost their partners. Francine also began spending time at her local senior center and went there at least three times a week for exercise classes, other recreational activities, and lunch. She also began to do volunteer work at her local library once a week.

Over several months of counseling, Francine stopped drinking; significantly increased her daily involvement in pleasant and rewarding activities, including social and recreational activities; and reported feeling less lonely, despite still missing her partner a great deal. Francine’s scores on the PHQ-9 gradually decreased over time, and after 16 weeks of counseling, Francine reported that she no longer felt she needed the session to move on with her life. In addition, Francine visited her primary care physician, who found upon evaluation that her depression had lifted considerably and that an antidepressant was no longer indicated. By the end of counseling, Francine’s focused work on identifying her depression symptoms and her triggers for drinking equipped 

Bosma, H., Johnston, M., Cadell, S., Wainwright, W., Abernethy, N., Feron, A., & … Nelson, F. (2010). Creating social work competencies for practice in hospice palliative care. Palliative Medicine, 24(1), 79–87.
Note: You will access this article from the Walden Library databases.

Cagle, J. G., & Kovacs, P. J. (2009). Education: A complex and empowering social work intervention at the end of life. Health & Social Work, 34(1), 17–27.
Note: Retrieved from the Walden Library databases.

Nelson, T. D. (2016). Promoting healthy aging by confronting ageism. American Psychologist, 71(4), 276–282.
Note: Retrieved from the Walden Library databases.

Reese, D. J. (2011). Interdisciplinary perceptions of the social work role in hospice: Building upon the classic Kulys and Davis study. Journal of Social Work in End-of-Life & Palliative Care, 7(4), 383-406.
Note: Retrieved from the Walden Library databases.

Optional Resources

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

Guindon, S., & Cappeliez, P. (2010). Contributions of psychological well-being and social support to an integrative model of subjective health in later adulthood. Ageing International, 35(1), 38–60.

Discussion: The Aging Process

As individuals grow older, they experience biological changes, but how they experience these changes varies considerably. Senescence, or the process of aging, “affects different people, and various parts of the body, at different rates” (Zastrow & Kirst-Ashman, 2016, p. 658).

What factors affect the aging process? Why do some individuals appear to age faster than others? In this Discussion you address these questions and consider how, you, as a social worker, might apply your understanding of the aging process to your work with older clients.

To prepare for this Discussion, read “Working With the Aging: The Case of Francine” in Social Work Case Studies: Foundation Year.

By Day 3

Post a Discussion in which you:

• Apply your understanding of the aging process to Francine’s case. How might Francine’s environment have influenced her aging process? How might you, as Francine’s social worker, apply your knowledge of the aging process to her case?
• Identify an additional strategy you might use to apply your knowledge of the aging process to social work practice with older clients in general. Explain why you would use the strategy.

By Day 5

Read a selection of your colleagues’ posts.

Respond to at least two colleague’s post in one of the following ways:

• From a strength’s perspective, critique your colleague’s approach to addressing Francine’s case. Provide support for your critique.
• Critique your colleague’s strategy for applying knowledge of the aging process to work with older clients. Discuss how cultural, ethnic, and societal influences might affect the application of this strategy.

Assignment: End-of-Life Care and Social Work Practice

The death of an elderly individual may occur in a variety of settings and circumstances. For example, an individual may die painlessly at home surrounded by the support of many loved ones, or an individual may suffer severe pain for months before dying in a health facility with little social support. In addition, it is possible that many health and helping professionals may interact with the dying person and his or her family.

For this Assignment, you consider a social worker’s role in end-of-life care. In addition to reading this week’s resources, conduct your own research and obtain at least one additional journal article that addresses how a social worker might support clients as they plan end-of-life care.

By Day 7

Submit a 2- to 4-page paper that analyzes the role of the social worker in helping to plan end-of-life care. Include possible consideration of palliative care, euthanasia, hospice care, the living will and advanced directives, and other factors. Research and cite at least one journal article to support your analysis.

Responses

 Ashley Burk RE: 

Hello Everyone,

            Francine is a seventy-year-old, who had a successful forty-year career as a librarian, and was in a dedicated relationship for thirty years.  She recently lost her life partner and is have difficulty dealing with this loss since she never came out to her family, friends, or colleagues (Plummer, Makris, & Brocksen, 2014).  She is also a recovering alcoholic, and due to the stressors, she is currently experiencing her starting drinking again.  She is in good health but is struggling with depression and feelings of isolation (Plummer, Makris, & Brocksen, 2014).  As people age stressors have more severe effects on the physical aspects of a body and unless effective coping strategies are used this can have serious health consequences (Zastrow, & Kirst-Ashman, 2016).  It is imperative that the depression and isolation Francine is feeling are addressed in constructive ways.  Encouraging her to become involved in her community can have positive results as it relieves loneliness and helps her feel like she is contributing to society again.  Also, encouraging her to become involved in the LGBTQ community could help give her a safe place to explore her grief and isolation in a safe place.  Francine has never referred to herself as a lesbian and denying this part of her identity could be part of the reason; she is feeling depressed and isolated.  Francine also expressed worry about her drinking.  It is crucial for a social worker to help her connect with people to constructive address this worry.  Alcoholics Anonymous would be an excellent way to address this and reduce her isolation.  Francine is a strong woman with many protective factors that will help her successfully navigate her new circumstances.  Working to reduce stress, feelings of loneliness and depression, and minimizing Francine’s drinking will help her live a fulfilling life. 

As a social worker in practice with older adults helping reduce stress is vital as it lowers the optimal biological functioning in older adults resulting in lower life expectancy and a less fulfilling experience (Zastrow, & Kirst-Ashman, 2016).  Teaching older adults constructive ways to reduce stress will be beneficial for physical and mental health (Zastrow, & Kirst-Ashman, 2016).  Taking the roles of educator, facilitator, and collaborator will help a social worker teach, develop, and engage older adults in learning techniques and strategies to reduce stress and therefore live longer and fuller lives. 

Kate Fullmer 

                                                                                               The Aging Process

How might Francine’s environment have influenced her aging process? There are many factors that can influence the aging process for an individual. According to Zastrow and Kirst-Ashman 2016, “Environmental factors can contribute to the aging process. These factors can include how physically and mentally active a person is, negative thinking, a lack of anyone to talk to, insecurity, and exposure to strange environments.” (P.667). This can be applied to Francine as she recently lost her partner of 30 years and has now been living alone which can be considered a foreign environment. Francine did not come out to friends or family and was not able to confide in anyone openly and honestly about the extent of her grief and loss. She also began using alcohol again after being in recovery for many years. These are all factors of Francine’s current environment that could influence her aging process. 

As Francine’s social worker, I would apply my knowledge of the aging process to her case by being mindful of her current environment. The aging process is intricate and unique to each individual. For Francine, it is important for the social worker to review her history and genetics, but most importantly examine what is happening in her current environment. Francine’s loss of her partner, not having people to talk to, adjusting to the new living environment, and her relapse with alcohol are the key factors to explore when considering contributions to the aging process. 

An additional strategy that might be utilized when applying knowledge of the aging process to social work practice with older clients in general: As I mentioned above, an individual’s way of thinking can influence the aging process. I would take a close look at this when working with older clients. A positive or negative outlook can make a difference with many aspects of a persons life. I would utilize the strengths perspective regarding frame of mind and attitude. According to Zastrow and Kirst-Ashman (2016), ” Focusing on strengths can provide a solid path towards empowerment.” (P.14). When a client is able to recognize their strengths this can not only lead to empowerment but result in improved health as well.