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Who Holds Tomorrow: Geriatric Social Work Practice in Behavioral Health Care
Martha Adams Sullivan, DSW,
Executive Vice President, Program Services, Lower Eastside Service Center,
Inc.
The number of Americans over age 65 is expected to double in the next 30 years. Currently, there are nearly 1.3 million New Yorkers age 60 and over. As the “baby boomers”, born between 1946 and 1964, ‘age in’, there will be increasing numbers of older adults who have fewer or no children, or whose children are living further away from them. The ‘elder boom’ will be accompanied by increasing ethnic/racial and class diversity, greater numbers of the very old, i.e., those age 85 and older, and changing family structures that may impact informal caregiving capacity. These changes have implications for geriatric behavioral health inasmuch as they impact factors known to place older adults at risk: living alone, living in poverty, lack of social support and lack of access to quality care. It will be important to develop policy and service planning which take these factors into account.
While most people adapt to the challenges of aging by drawing on coping
strategies accumulated over a lifetime, deteriorating health and the stresses
associated with later life changes do negatively impact the behavioral
health status of some older adults.
Anxiety and mood disorders are the most prevalent disorders among older
adults. Alcohol abuse/dependence and dementias, especially Alzheimer’s
and vascular dementia are also prevalent. Nearly half of those over age
85 will experience dementia.
Depression is strongly associated with suicide. The highest suicide rates
of any age group occur among persons aged 65 and older. In New York City
(1998), the elderly represented only 13% of the population, yet 19% of
all suicide deaths.
National Institute on Drug Abuse (NIDA) estimates that up to 17 percent,
or three times as many adults aged 60 and older, abuse prescribed drugs.
There is some indication that abuse of illicit drugs is increasing due
to the aging-in of individuals with an addiction as well as increasing
incidence of late life onset. Clinicians and families too often misidentify
substance abuse problems among older adults as ‘senility’
or as normal aging.
These are treatable disorders that respond to medication, psychotherapy
and psychosocial interventions. Strengthening social support is key in
the care and treatment of older adults because doing so reduces the risk
of developing a mental health disorder and also promotes better health
outcomes, i.e., deferred functional and/or physical deterioration.
Families continue to be the major caregivers for developmentally disabled
older adults; where 80% of all adults live at home. There is great need
for supportive housing outside of the family home as the numbers of older
adults age 60 and older are also expected to double.
There are significant barriers to accessing quality behavioral health
care for older adults. Health care financing systems are too complex and
lack parity in coverage of mental health and chemical dependency services.
Insufficient and inadequate services, ageism and a lack of professionals
trained in geriatric practice contribute to the fact that behavioral health
problems among older adults, too often, are unidentified and untreated
or under-treated.
As a discipline, social work is uniquely positioned to respond to the
growing behavioral health needs of older adults. Social workers provide
counseling as well as supportive social services in a variety of settings
such as: health care and specialty behavioral health clinics, nursing
homes, senior centers, home care and other in-home services. However,
the demand for trained social workers, particularly minority social workers,
to provide preventive and treatment services for older adults, greatly
exceeds the current supply.