Social Work Challenges With the Elderly Mentally Ill Client Who Is Not a Native Born American Citizen

October 21, 2005 at 1:16 pm  •  Posted in Alzheimers Disease/Dementia by  •  0 Comments

By Susan Winston, MSW, LCSW


The fastest growing segment of the population in the United States are seniors over the age of 85. Older persons in the United States are faced with many challenges.

According to The Merck Manual of Geriatrics, Americans over age eighty-five account for about 12 percent of all elderly. This figure is expected to rise to 18 percent by the year 2040. The average number of years a person can be expected to live fairly free of physical or cognitive disability is 77 for men and 81 for women. This has many implications for the needs of or increasing older population.

Due to innovations in medicine, pharmacology, and other healthcare services, mortality and morbidity rates are declining. As a result, hospital stays have been sharply reduced, prompting an expansion of needed community-based services. This includes skilled and home-attendant, social work and psychiatric supports, senior centers and adult day health care programs, medical care, hospice care and more.

Due to increased longevity, seniors are often faced with inadequate savings and income because of increasing cost of living expenses. This is a stressful situation as well a serious threat to independence. High insurance co-payments, spend-downs (jargon), and prescription costs can be an obstacle to needed medical care.

The following illustrates an example of the special needs of the older client:

Mrs. R. is a 79-year-old divorced immigrant. She had been hospitalized several times to treat depression. Because she was feeling stressed by immigrating to this country and also felt depressed, she sought help at an outpatient clinic. Mrs. R. told the psychotherapist that she had been having trouble getting out of bed and carrying out her normal daily routine.

Mrs. R. received individual psychotherapy and medication management to address her depression and enable her to resume the tasks of daily living. Although she became psychiatrically stable with improved daily functioning, her medical health deteriorated. Mrs. R. was diagnosed with hepatitis C, high blood pressure, and asthma.

Since beginning chemotherapy treatment for hepatitis, her depression worsened. This is a common problem in the elderly where medications can have psychiatric and physical side effects. This can further impair functioning and complicate diagnoses and treatment. In this case, Mrs. R. stopped taking her psychotropic medication, her severe depression returned and a prolonged psychiatric hospitalization followed.

How Social Workers Help

A social worker helped Mrs. R. in the following ways.

  • Collaborated with the patient’s various medical and psychiatric providers.
  • Monitored Mrs. R’s medications and made sure she took them correctly and on schedule.
  • Linked Mrs. R. to a Medical Day Program who could provide daily medical and social and support as well as attend to her activities of daily living.

Collaboration and coordination was key to the success of this individual. Social workers routinely assess, intervene, and link patients like Mrs. R. to the services they need.

A Look Toward the Future Needs of the Elderly

Increased Adult Day Medical as well as Social Programs can improve the provision of daily medical oversight, bathing, and meals to insure proper nutrition, cognitive remediation, and social supports. They also serve as respite care for caregivers. Spirituality is often overlooked. Exploration into clients’ beliefs and faith can be an excellent source of support and can be incorporated into the social work interventions.

Cognitive Remediation is a growing need as well. For the elderly the three D’s are “Delirium,” “Dementia” and “Depression.” Each is prevalent, and negatively impact on daily functioning and quality of life, emotionally and physically. Services in medical and mental health programs need to increase focus on improving cognitive skills and helping clients cope and adapt to declining cognitive functioning.


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