Human Behavior -Soc Env II-Psychological Aspects of Aging

Human Behavior -Soc Env II-Winter 2025
Psychological Aspects of Aging
What does it mean to age “successfully”? Though the concept of success is relative, theories of successful aging explain factors that support individuals as they grow old. Factors such as maintaining physical and mental activity and disengaging from community obligations contribute to older adults’ ability to function. As a social worker, you must understand these supportive factors in order to address the needs of older clients and their families.
As you will see in this week’s media, situations involving Alzheimer’s or dementia, interpersonal conflict, and grief can complicate the process of successful aging. For this Discussion, you review one of two case studies involving an older woman and apply a theory of successful aging to the case.

To Prepare:
• Review the Zastrow et al. chapter on psychological aspects of later adulthood, focusing on key life events and on theories of successful aging.
• Access the Social Work Case Studies media and explore the cases of Sara and of Francine.
• Select a theory of successful aging to apply to either Sara’s or Francine’s case.
• .
BY DAY 4
Post a Discussion in which you:
• Identify whether you have chosen to analyze Sara’s or Francine’s case for the Discussion.
• Explain key life events that have influenced Sara’s or Francine’s psychological functioning. Be sure to substantiate what makes them key in your perspective.
• Explain how you as a social worker might apply a theory of successful aging to Sara’s or Francine’s case. Be sure to provide support for your strategy.
Please write out the sub headings)

Support your post with examples from the course text and any other resources used to respond to this Discussion. Demonstrate that you have completed the required readings, understand the material, and are able to apply the concepts. Include a full reference of resources at the bottom of the post.

Course book

Empowerment Series: Understanding Human Behavior and the Social Environment 11TH 19
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Resources
Required Readings
• Zastrow, C. H., Kirst-Ashman, K. K., & Hessenauer, S. L. (2019). Understanding human behavior and the social environment (11th ed.). Cengage Learning.
o Chapter 15, “Psychological Aspects of Later Adulthood” (pp. 672–702)
• Newell, J. M. (2019). An ecological systems framework for professional resilience in social work practice.Links to an external site. Social Work, 65 (1), 65–73. https://doi.org/10.1093/sw/swz044
• Teater, B., & Chonody, J. M. (2020). How do older adults define successful aging? A scoping review.Links to an external site. International Journal of Aging and Human Development , 91 (4), 599–625. https://doi.org/10.1177/0091415019871207
• Yousuf-Abramson, S. (2020). Worden’s tasks of mourning through a social work lens.Links to an external site. Journal of Social Work Practice , 1–13. https://doi.org/10.1080/02650533.2020.1843146

Media
• Walden University, LLC. (2021). Social work case studiesLinks to an external site. [Interactive media]. Walden University Canvas. https://waldenu.instructure.com/
o Navigate to Sara and to Francine.

• Walden University, LLC. (2021). Models of grieving Links to an external site. [Interactive media]. Walden University Canvas. https://waldenu.instructure.com/

SARA
Sara is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment with her 48-year-old daughter, Stephanie, and six cats. Sara and her daughter have lived together for the past 10 years since Stephanie returned home after a failed relationship and was unable to live independently. Stephanie has a diagnosis of bipolar disorder, and her overall physical health is good. Stephanie has no history of treatment for alcohol or substance use; during her teens she drank and smoked marijuana but no longer uses these substances. When she was 16 years old, Stephanie was hospitalized after her first bipolar episode. She had attempted suicide by swallowing a handful of Tylenol® and drinking half a bottle of vodka after her first boyfriend broke up with her. She has been hospitalized three times in the past 4 years when she stopped taking her medications and experienced suicidal ideation. Stephanie’s current medications are Lithium, Paxil®, Abilify®, and Klonopin®. Stephanie recently had a brief hospitalization as a result of depressive symptoms. She attends a mental health drop-in center twice a week to socialize with friends and receives outpatient psychiatric treatment at a local mental health clinic for medication management and weekly therapy. She is maintaining a part-time job at a local supermarket where she bags groceries and is currently being trained to become a cashier. Stephanie has active Medicare and receives Social Security Disability (SSD). Sara has recently been hospitalized for depression and has some physical issues. She has documented high blood pressure and hyperthyroidism, she is slightly underweight, and she is displaying signs of dementia. Sara has no history of alcohol or substance use. Her current medications are Lexapro® and Zyprexa®. Sara has Medicare and receives Social Security benefits and a small pension. She attends a day treatment program for seniors that is affiliated with a local hospital in her neighborhood. Sara attends the program 3 days a week from 9:00 a.m. to 2:00 p.m., and van service is provided free of charge. A telephone call was made to Adult Protective Services (APS) by the senior day treatment social worker when Sara presented with increased confusion, poor attention to daily living skills, and statements made about Stephanie’s behavior. Sara told the social worker at the senior day treatment program that, “My daughter is very argumentative and is throwing all of my things out.” She reported, “We are fighting like cats and dogs; I’m afraid of her and of losing all my stuff.” Home Visit During the home visit, the APS worker observed that the living room was very cluttered, but that the kitchen was fairly clean, with food in the refrigerator and cabinets. Despite the clutter, all of the doorways, including the front door, had clear egress. The family lives on the first floor of the apartment building and could exit the building without difficulty in case of emergency. The litter boxes were also fairly clean, and there was no sign of vermin in the home. 2 © 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Sessions: Case histories. Laureate International Universities Publishing. Upon questioning by the APS worker, Sara denied that she was afraid of her daughter or that her daughter had been physically abusive. In fact, the worker observed that Stephanie had a noticeable bruise on her forearm, which appeared defensive in nature. When asked about the bruise, Stephanie reported that she had gotten it when her mother tried to grab some items out of her arms that she was about to throw out. Stephanie admitted to throwing things out to clean up the apartment, telling the APS worker, “I’m tired of my mother’s hoarding.” Sara agreed with the description of the incident. Both Sara and Stephanie admitted to an increase in arguing but denied physical violence. Sara stated, “I didn’t mean to hurt Stephanie. I was just trying to get my things back.” The APS worker observed that Sara’s appearance was unkempt and disheveled

but her overall hygiene was adequate (i.e., clean hair and clothes). Stephanie was neatly groomed with good hygiene. The APS worker determined that no one was in immediate danger to warrant removal from the home but that the family needed a referral for Intensive Case Management (ICM) services. It was clear there was some conflict in the home that had led to physical confrontations. Further, the house had hygiene issues, including trash and items stacked in the living room and Sara’s room, which needed to be addressed. The APS worker indicated in her report that if not adequately addressed, the hoarding might continue to escalate and create an unsafe and unhygienic environment, thus leading to a possible eviction or recommendation for separation and relocation for both women. As the ICM worker, I visited the family to assess the situation and the needs of the clients. Stephanie said she was very angry with her mother and sick of her compulsive shopping and hoarding. Stephanie complained that they did not have any visitors and she was ashamed to invite friends to the home due to the condition of the apartment. When I asked Sara if she saw a problem with so many items littering the apartment, Sara replied, “I need all of these things.” Stephanie complained that when she tried to clean up and throw things out, her mother went outside and brought it all back in again. We discussed the need to clean up the apartment and make it habitable for them to remain in their home, based on the recommendations of the APS worker. I also discussed possible housing alternatives, such as senior housing for Sara and a supportive apartment complex for Stephanie. Sara and Stephanie both stated they wanted to remain in their apartment together, although Stephanie questioned whether her mother would cooperate with cleaning up the apartment. Sara was adamant that she did not want to be removed from their apartment and would try to accept what needed to be done so they would not be forced to move. Sessions Stephanie mentioned she was dissatisfied with her mother’s psychiatric treatment and

felt she was not getting the help she needed. She reported that her mother was very anxious and was having difficulty sleeping, staying up until all hours of the night, and buying items from a televised shopping network. Sara’s psychiatrist had recently 3 © 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Sessions: Case histories. Laureate International Universities Publishing. increased her Zyprexa prescription dosage to help reduce her agitation and possible bipolar disorder (as evidenced by the compulsive shopping), but Stephanie did not feel this had been helpful and wondered if it was contributing to her mother’s confusion. I asked for permission to contact both of their outpatient treatment teams, and the request was granted. I then arranged to meet with Sara and her psychiatrist to discuss her increased anxiety and confusion and the compulsive shopping. I requested a referral for neuropsychiatric testing to assess possible cognitive changes or decline in functioning. A test was scheduled, and it indicated some cognitive deficits, but at the end of testing, Sara told the psychologist who administered the tests she had stopped taking her medications for depression. It was determined Sara’s depression and discontinuation of medication could have affected her test performance and it was recommended she be retested in 6 months. I suggested a referral to a geriatric psychiatrist for Sara, as she appeared to need more specialized treatment. Sara’s psychologist agreed. Because they had both stated that they did not want to be removed from their home, I worked with Sara and Stephanie as a team to address cleaning the apartment. All agreed that they would begin working together to clean the house for 1 hour a day until arrangements were made for additional help from family members. To alleviate Sara’s

anxiety around throwing out the items, I suggested using three bags for the initial cleanup: one bag was for items she could throw out, the second bag was for “maybes,” and the third was for “not ready yet.” I scheduled home visits at the designated cleanup time to provide support and encouragement and to intervene in disputes. I also contacted Sara’s treatment team to inform them of the cleanup plans and suggested that Sara might need additional support and observation as it progressed. We then discussed placement for at least some of the cats, because six seemed too many for a small apartment. Sara and Stephanie were at first adamant that they could not give up their cats, but with further discussion admitted it had become extremely difficult to manage caring for them all. They both eventually agreed to each keep their favorite cat and find homes for the other four. Sara and Stephanie made fliers and brought them to their respective treatment programs to hand out. Stephanie also brought fliers about the cats to her place of employment. Three of the four cats were adopted within a week. During one home visit, Stephanie pulled me aside and said she had changed her mind—she did not want to continue to live with her mother. She requested that I complete a housing application for supportive housing stating, “I want to get on with my life.” Stephanie had successfully completed cashier training, and the manager of the supermarket was pleased with her performance and was prepared to hire her as a parttime cashier soon. She expressed concern about how her mother would react to this decision and asked me for assistance telling her.

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 use disorder in Francine’s family, and Francine used 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. Treatment Reasons for Seeking Counseling 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.

Referral to Physician
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. Behavioral Activation Technique 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 her depressive symptoms were improving. AA Meetings 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. Social Connections 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 LGBTQ 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 her to better recognize when she might need support in the future and to whom she could reach out for help if she needed it.

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