Victoria M. Rizzo, PhD - Columbia University, School of Social Work
Jessica Seidman, MSW - Columbia University, School of Social Work.
The study of successful aging supported by the MacArthur Foundation provided many important findings and paved the way for future progress in the field of geriatrics and health promotion (Rowe & Kahn, 1998). Many outcomes of the study suggested that collaborative work among the various disciplines involved in health care (e.g., physicians, nurses, psychologists, and social workers) is necessary to work most effectively with people aged 65 and older. According to the study, each discipline, independently, is inadequately prepared to address the older population’s needs. In response to this finding, the foundation promoted studies involving collaboration of experts from diverse helping professions to achieve an authentic interdisciplinary science (Rowe & Kahn, 1998).
To foster the skills needed for effective team care, The John A. Hartford Foundation supported the development of programs that called for geriatric interdisciplinary team training (GITT) for students in nursing, social work, and medicine. In addition they supported the development of a national model to forge partnerships between educational institutions and providers of geriatric care for the purpose of designing curricula for use in training interdisciplinary teams and for testing new models of training for practicing professionals (Fulmer et al., 2005).
Although these programs have resulted in some changes in the attitudes and skills of team members, few changes have occurred with regard to care planning and team dynamics (Institute of Medicine [IOM], 2008, Fulmer et al., 2005). Consequently, further research is needed to determine which methods of training are most effective for imparting the knowledge and skills necessary to work effectively as members of a team and for demonstrating how such training can affect patterns of practice with older adults (Cooper & Fishman, 2003; Hall & Weaver, 2001; Remington, Foulk, & Williams, 2006).
During the 20th century, social workers increasingly became members of multidisciplinary public health teams and developed skills in promoting competent teams in health care institutions (Marshall & Altpeter, 2005). These collaborative teams drew on models of health promotion and disease prevention to meet the needs of contemporary health-related social issues throughout the life-span. In the field of gerontology, health promotion was applied to chronic illnesses, including, but not limited to, cancer and Alzheimer’s. In the 21st century, multidisciplinary teams strive to implement a broad range of health promotion programs in response to the growing older population and the inevitable increase in the health care needs of this population (Cooper, 2003; Fulmer, 2005).
Because the social work profession is fundamentally committed to individual- and community-level evidence-based interventions, such as individual and family development, community organizing, and advocacy, its interventions incorporate the skills and values necessary to implement effective health promoting practices at multiple systemic levels. For example, using education and counseling, social workers, on an individual basis, can help to address diseases, such as obesity, that are so prevalent in American society.
In addition, social workers are uniquely positioned to promote health, good nutrition, and wellness among individuals and families on the programmatic, organizational, and community-advocacy levels. Alone or with other members of interdisciplinary teams, they can advocate for implementation of practices and programs within institutional and residential settings that promote health. Finally, they can offer their expertise and support to larger local and national community initiatives that encourage active aging.
Marshall and Altpeter (2005) recommended eight ways that social workers can take the lead in creating communities engaged in promoting health among older adults. The following represent a modification of these strategies.
Examples of challenges that older adults face are lack of knowledge and motivation, insufficient support from family and peers, inaccessibility of available programs, and policies that promote unhealthy behaviors.
Educational programs have proven to be helpful in providing older adults with skills and knowledge about how to make healthier life-style choices. Person-centered programs that work one-on-one with individuals to set goals and make decisions that enhance their health and quality of life also yielded positive results. However, the information individuals receive must not only stress the importance of adopting healthy behaviors but also include information that will motivate them to change their behavior. According to the Center for the Advancement of Health (2006), physicians who counsel their older patients about health, include the patients in developing a personalized health plan, and follow-up regarding their progress have reported better outcomes. According to the center’s report, motivational techniques, including self-monitoring, personal communication with health care providers, and multiple channels of communication, are necessary to encourage healthy habits and achieve long-term results. In addition, the report mentions two key factors leading to improved use of healthy behaviors: ongoing reminders and support. Social workers’ knowledge and skills in intervening at the individual, environmental, and community levels, and their capacity to identify and build on an individual’s strengths makes them ideal professionals to design and implement health-promoting strategies that incorporate these two critical factors.
Programs focused on nutrition and physical activity are important examples of interventions that social workers can use to promote the health of older adults. Nutritional programs represent micro-level methods, whereas programs that promote physical activity often require community-level efforts to improve individuals’ health.
The nutritional health of older people is important (Johnson, 2004; Wellman, 2004). Consequently, when completing a nutritional assessment, the social worker needs to examine the individual’s food consumption, medical history, medications, financial circumstances, mobility, and accessibility to community institutions (Center for the Advancement of Health, 2006). Evidence-based support groups and educational programs provide older people with hands-on experience with how to adjust their eating habits. Other effective interventions include delivery of nutritious meals to individuals who are disabled, homebound, and economically disadvantaged.
Before developing programs on the basis of individuals’ needs, however, the social worker must take into account their readiness to change their nutritional behavior. In addition, an individual’s cultural identity is a highly relevant factor because ethnicity and tradition, including attitudes’ about what foods are appropriate and beliefs about the healing properties of foods, can heavily influence a person’s eating habits, Thus, the social worker must be culturally sensitive and seek out culturally appropriate options encouraging an individual to change dietary behavior (Center for the Advancement of Health, 2006; Johnson & Smith, 2002). Indeed, individuals may be unaware of ingredients that adversely affect their health and need information as to how they can modify the ingredients to improve the food’s nutritional value yet adhere to important cultural and social traditions.
Malnutrition in the older population increases health care costs, whereas a diet that improves health and promotes more rapid recovery from illness reduces the use of medical services and related costs to society (Wellman, 2004). Dr. Wellman proposed the following ways that families, friends, and social workers can help older adults improve their nutritional intake and overall health.
The current literature provides evidence that regular moderate exercise fosters strength, energy, and coordination; reduces the risk of falls and fractures; heightens mood; and relieves symptoms of depression. Despite the evidence regarding the virtues of physical activity, however, the percentage of older people who lead physically active lives is low (CDC, 2007). This section provides examples of community and organizational programs focused on increasing the level of physical activity among older adults. Social workers are integral members of the partnerships that design and implement these programs at the community level.
A program titled “The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older” (CDC, 2007) is an example of a collaborative effort of national foundations, government agencies, and other organizations devoted to health care and aging (Center for the Advancement of Health, 2006). Some of the organizations involved include AARP, the American College of Sports Medicine, the American Geriatrics Society, the Centers for Disease Control and Prevention, the National Council on Aging, the National Institute on Aging, and the Robert Wood Johnson Foundation.
The National Blueprint details the importance of physical activity, outlines the barriers older adults face and proposes recommendations for overcoming those barriers. In 2002, the collaborating organizations identified 18 strategies designed to increase physical activity among the population aged 65 and older and designated leading organizations as having the responsibility to implement the strategies The implementation was accomplished by developing programs targeted at both the individual and organizational levels for the clinicians who would be responsible for carrying out the programs. Programs targeted at the organizational level conduct marketing campaigns and research, whereas programs targeted at the individual level develop guides concerning effective intervention techniques, feedback, and information-sharing tools.
An example of a community-level program is the Building Healthy Communities for Active Aging (Environmental Protection Agency [EPA], 2007), which organized a steering committee assigned the job of creating a document outlining 10 strategies designed to help communities successfully adapt community techniques of encouraging older adults to become more physically active. The steering committee believes that active aging is a result of including both structured and unstructured activities in an older person’s life-style (EPA, 2007). Therefore, communities need to facilitate the availability of structured programs and devise ways to encourage self-directed activities, such as walking, biking, and using fitness trails.
The following strategies are listed in the Environmental Protection Agency’s (EPA’s) proposal for community-level interventions that promote physical activity among the older population.
The Administration on Aging has created a national campaign called “You Can! Steps to Healthier Aging,” which is intended to increase the level of physical activity among older adults and enhance their dietary intake. According to Loughrey (2004), the campaign is a good example of how public health officials and medical experts are becoming increasingly aware and supportive of the belief that positive change, even if it occurs in moderate increments, helps to improve the older population’s health and quality of life. The goal of the campaign is to enlist organizations with a variety of relevant interests from across the United States. Among the diverse organizations enlisted in the plan are hospitals, state and local agencies on aging, park departments, and faith-based groups. Their mission is to provide older members of the community with information, activities, and/or programs that promote physical activity and better nutritional decisions. In 2004, the Administration on Aging successfully engaged more than 1,000 organizations across the country. However, its overall objective was to enlist more than 2,000 organizations and reach at least 2 million older adults by 2006 (Loughrey, 2004).
The failure to meet the health care needs of all members of society is challenged further by poorly understood and inadequately defined health care outcomes among older members of minority groups. In addition, as Johnson and Smith pointed out, members of minority groups are underrepresented among health care professionals in the American health care system. To begin to address these disparities, Johnson and Smith suggested that interventions designed to reduce currently existing disparities must address multiple interrelated systemic issues, in the form of questions, such as the following.
Other approaches to promoting health in older adults from culturally diverse populations include the following.
The World Health Organization (WHO) has developed a policy framework for active aging that is generalizable to aging populations in all. In the organization’s report entitled, Active Ageing: A Policy Framework countries (World Health Organization [WHO], 2002), key policy proposals for the three pillars (health, security, and participation) are outlined. The key proposals in the health arena include developing and implementing policies and programs that:
As we begin to develop new policies to address the needs of the growing population of older adults worldwide, the WHO policy framework can be used as a guide to developing sound policies that can address the multiple factors that impact the health of older adults.
As the tsunami wave of older adults approaches between now and the year 2020, health promotion has become a topic of great importance in the United States and globally. In this chapter, we presented:
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