THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
SCHOOL OF SOCIAL WORK
FALL 2011
COURSE NUMBER:
COURSE TITLE:
DAY AND TIME:
INSTRUCTOR:
OFFICE HOURS:
SOWO 843
Older Adults: Theory and Practice
Monday, 5:30 to 8:30pm, Room 102 Tate, Turner, & Kuralt
Denisé Dews, MSW
Office: Tate, Turner, & Kuralt, 335A
Phone: 919-962-6439
Email: ddews@unc.edu
Monday, 3pm to 5pm (by appointment)
COURSE DESCRIPTION: This course fosters understanding of normal aging, illness, and common
challenges associated with aging, and also practice skills to treat older adults and their families.
COURSE OBJECTIVES:
Upon completion of the course, students will demonstrate knowledge of:
1. Ethical values and discipline-based theories (e.g., biology, psychology, sociology) to understand
the aging process;
2. Issues of prevention as well as common diseases and functional disorders of older adults;
3. A strengths-based conceptual framework to view older people as resources and contributing
members of society;
4. The relationship between gerontological theory and practice with older adults;
5. The continuum of care represented in the aging service network;
6. How matters such as gender, race, ethnicity, culture, poverty, education, sexual orientation, and
rural residence relate to aging and their relevance for assessment, treatment, and case
management; and
7. Theories of cause and theories of change related to the development, assessment, and treatment
of five common challenges relevant to older adults: anxiety, depression, cognitive impairment,
caregiver stress, and end-of-life.
8. Evidence-based practice models for working with older adults and their families on problems
related to anxiety, depression, cognitive impairment, caregiver stress, and end-of-life care.
Also upon completion of the course, students will demonstrate skills in:
1. Assessment of older adults;
2. Collaboration with the families of older adults;
3. Individual, family, and group treatment with older adults;
4. Case management with older adults and their families related to case, program, and system
management; and
5. Assessment, treatment, and case management for anxiety, depression, cognitive impairment,
caregiver stress, and end-of-life.
EXPANDED DESCRIPTION: This course presents knowledge and theories from biological,
psychological, sociological, and other disciplines to understand normal aging, illness, and common
challenges associated with aging. This information is used to frame and inform practice and
develop skills to treat older adults and their families in the context of individual and family
treatment, group work, and case management; students also obtain knowledge and develop skills
related to assessment and care for anxiety, depression, cognitive impairment, caregiver stress, and
end-of-life.
REQUIRED BOOKS:
Carlton-LaNey, Iris. (2005). African Americans Aging in the Rural South. Durham, NC: Sourwood
Press, Inc.
Hooyman, N.R. & Kiyak, A.H. (2011). Social gerontology: A multi-disciplinary perspective (9th
ed.). Boston, MA: Allyn & Bacon.
REQUIRED READINGS: Are listed in the Course Outline. Most of these articles will be available on
the Blackboard course site.
RECOMMENDED TEXTS:
Blazer, D. G. & Steffens, D. C. (2011). The American Psychiatric Publishing Textbook of Geriatric
Psychiatry (4th ed.). Arlington, VA: American Psychiatric Publishing, Inc.
McInnis-Dittrich, K. (2005). Social work with elders. A biopsychosocial approach to assessment
and intervention (2nd ed.). Boston, MA: Allyn & Bacon.
Williamson, G.M., Shaffer, D.R., & Parmelee, P.A. (2000). Physical iIllness and depression in
older adults: A handbook of theory, research, and practice. Kluwer Academic/lenum
Publishers, New York.
RELATED READINGS: Numerous optional readings exist for students who wish to learn more about
the topics under discussion. Students should ask the instructor to suggest readings of interest.
TEACHING METHODS: This course consists of presentations and case-based skills practice.
Students are expected to come to class prepared to discuss the required readings. Further, a
supportive learning environment, reflecting the values of the social work profession, is expected.
This environment is fostered by listening to the ideas and views of others, appreciating a point of
view that is different from one’s own, and linking experience to readings and assignments.
CLASS ASSIGNMENTS: Three assignments must be completed. They are described below, along
with their proporationate value. Additional information will be provided in advance of their
completion. In addition to these assignments, students will receive credit for class participation
1. Attendance & Class Participation (10%). Attendance, punctuality, constructive contributions
to class discussions, and active participation in small group tasks determine this grade. A
number of in-class participation projects will be assigned throughout the semester. Projects
are designed to encourage participation, critical thinking, and the practical application of
course content. See Addendum A for an example of an in-class project.
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2. Quizzes (30%). There will be 17 quizzes available, one for each chapter in the the text. Each
quiz is worth two points. Students are required to complete 15 of the quizzes. Students may
earn bonus points for completing additional quizzes. Quizzes will be taken online using
Sakai. Each quiz will be available for a two week window. Students needing assistance
navigating Sakai are encouraged to seek assistance from the Sakai support website:
https://sakai.unc.edu/portal. With the exception of Quiz 1, there will be only one
attempt/submission for each quiz (Quiz 1 will have unlimited attempts/submission). You
will have one hour to complete each quiz on Sakai. Due date: various dates – see Course
Outline in this syllabus.
3. Audacious Aging (10%). This paper will be a reflection assignment. See Addendum B for
assignment specifics. Due: September 6, 2010
4. Class Presentation: Mental Health Interventions (20%). Individually or in a small group,
students will deliver a 90 minute presentation on one of five common mental health
problems and challenges of later life: anxiety, depression, cognitive impairment, caregiver
stress, and end of life. The primary point of this assignment is to identify intervention
models to address the problem. An overview of DSM IV-R Diagnostic Criteria for the
disorder and therapeutic interventions should be included, and handouts are required. See
Addendum C for assignment specifics. Due October 24 and 31, November 7.
5. Discussion Question Responses (10%). See Addendum D for assignment specifics. Due
November 21.
6. Assessment and Treatment Paper (20%). Students will be required to submit a 10-12 page
paper (Note: page length does not include the title page or references) on the assessment
and treatment of an individual or family described in a case vignette. Several vignettes will
provided by the instructor and students will select one case description and then develop a
tailored assessment and treatment. Students will be required to include a clear rationale for
the approach, including the description of a guiding theoretical or therapeutic model, an
overview of the evidence-base for the approach, and individual factors to consider such as
client diversity, autonomy, or ethical dilemmas. See Addendum E for assignment specifics.
Due November 28.
GRADING SYSTEM: The School of Social Work operates on an evaluation system of Honors (H),
Pass (P), Low Pass (L), and Fail (F). A grade of P is considered entirely satisfactory. The grade of
Honors—which only a small percentage of students attain--signifies that the work is clearly
excellent in all respects. The numerical values of these grades are:
94-100 = H
80-93 = P
70-79 = L
≤ 69 = F
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POLICY ON INCOMPLETES AND LATE ASSIGNMENTS: Professional practice and administration
require attention to detail as well as timely completion of assignments. The classroom serves as an
environment in which to develop professional practices such as meeting deadlines and producing
high quality work. As such, class assignments are expected to be completed on time and to
represent the student’s highest level of effort. If there are circumstances that prohibit the timely
completion of an assignment, it is the responsibility of the student to contact the instructor at least
24 hours prior to the assignment due date. The instructor may grant an extension under certain
extenuating circumstances, but may choose not to grant an extension.
A paper is considered late if it is handed in later than the beginning of class on the day that it is due.
The grade for late papers will be reduced 10% per day, including weekend days. Therefore, a paper
that would merit a grade of 100 at the time class begins on Friday would receive a grade of 90 if
submitted later that day; a grade of 81 if submitted on Saturday; a grade of 73 if submitted on
Sunday; and a grade of 66 if submitted on Monday.
A grade of Incomplete is given on rare occasions when there is sufficient reason to warrant it. It is
the student’s responsibility to initiate a conversation with the instructor to request an Incomplete;
the instructor has no responsibility to give an Incomplete without such a request.
POLICY ON ACADEMIC DISHONESTY: It is the responsibility of every student to obey and support
the enforcement of the UNC Honor Code, which prohibits lying, cheating, or stealing in actions
involving academic processes of this class. All written work should contain a signed pledge stating:
“I have neither given nor received unauthorized aid in preparing this work.” In keeping with the
UNC Honor Code, if reason exists to believer that academic dishonesty has occurred, a referral will
be made to the Office of the Student Attorney General for investigation and determination if further
action is required.
It is the student’s responsibility to properly cite sources used in preparing written work. To avoid
difficulties with plagiarism, ideas that are not one’s own must be credited, whether or not those
ideas have appeared in print. Please refer to the APA Style Guide, The SSW Manual, and the SSW
Writing Guide for information on attribution of quotes, plagiarism and appropriate use of assistance
in preparing assignments.
POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES: Students with disabilities that
affect their participation in the course and who wish to have special accommodations should contact
the University’s Disabilities Services (disabilityservices.unc.edu) and provide documentation of
their disability. Disabilities Services will notify the instructor that the student has a documented
disability and may require accommodations. Students should discuss the specific accommodations
they require (e.g. changes in instructional format, examination format) directly with the instructor.
POLICIES ON THE USE OF ELECTRONIC DEVICES IN THE CLASSROOM: I prefer no computers in
the classroom but recognize that some students prefer to take notes electronically. There is to be no
recording or videotaping in the classroom unless special accommodations are required through the
University’s Disabilities Services. Use of electronic devices for non-class related activities such as
checking e-mail, surfing, IMing, blogging or playing games is prohibited. Use of electronic devices
for non-class related activities will result in a reduction of class participation grade.
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EXPECTATIONS FOR WRITTEN ASSIGNMENTS: Students are expected to use good academic
English; grades will be lowered for poor grammar, syntax, or spelling. Those who have difficulty
writing are strongly encouraged to use online resources of the campus Writing Center
(unc.edu/depts/wcweb) and/or to seek assistance from the Diane Wyant, the School’s editor
(dwyant@email.unc.edu).
The School of Social Work faculty has adopted APA style as the preferred format for papers and
publications. All written assignments for this course should be submitted in APA format. The web
sites listed below provide additional information regarding APA formatting, and students are
strongly encouraged to purchase the text that is listed first:




American Psychological Association. (2009). Publication manual of the American
Psychological Association, 6th Edition. Washington, D.C.: American Psychological
Association.
Apastyle.org/elecref.html (APA style for material in electronic formats)
Owl.english.purdue.edu/handouts/research/r_apa.html (general information about
documentation using APA style)
bartleby.com/141 (electronic version of Strunk's The Elements of Style)
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COURSE OUTLINE
WEEK
DATE
1
8/29/11
2
LABOR
DAY
3
4
TOPIC &
ACTIVITIES
Introductions,
Expectations, and
Review of the
Course Syllabus,
no class
9/12/11
The Aging
Population
Film: Big Mama
9/19/11
Cognitive
Impairment:
Assessment and
Treatment
Guest speakers:
Nina Browner,
MD, UNC
Neurology
and
Lindsay Penny,
MSW, UNC
Neurology
READINGS & ASSIGNMENTS DUE
□ Course Syllabus
Enjoy the break!
□ Hooyman & Kiyak – Part One – The Field of
Gerontology – Chapters 1 & 2
□ Rosowsky, E. (2005). Ageism and professional
training in aging: Who will be there to help?
Generations, 29, 55–58.
□ Sasson, S. (2000). Beneficence versus respect for
autonomy: An ethical dilemma in social work practice.
Journal of Gerontological Social Work, 33(1), 5-16.
□ Due: Quiz 1
□ Due: Quiz 2
□ Hooyman & Kiyak – Part Two – The Biological and
Physiological Context of Social Aging – Chapters 3 &
4
□ Gorin, S. H. (2010). Healthcare reform and older
adults. Health & Social Work, 35(1), p3-6
□ Ackerman, M. L., Edwards, J. D., Ross, L. A., Ball, K.
K. Lundsman, M. (2008). Examination of cognitive
and instrumental functional performance as indicators
for driving cessation risk across 3 years. The
Gerontologist, 48, 802-810.
□ Due: Quiz 3
□ Due: Quiz 4
□ In-class assignment: Biopsychosocialspiritual
Assessment for Big Mama
6
Older Adult
Sexuality
5
9/26/11
Film: Still Doing
It, the Intimate
Lives of Women
Over 65
Anxiety &
Depression:
Assessment and
Treatment
6
10/3/11
Guest speaker:
Elizabeth Welton,
MSW, LCSW
Private practice
7
10/10/11
Student prep for
presentations.
We will not meet
as a class on this
night. Groups are
expected to meet
on their own.
□ Hooyman & Kiyak – Part Three – The Psychological
Context of Social Aging – Chapters 5
□ Anderson, K.A., Cimbal, A.N., & Maile, J. J. (2010).
Hairstylists’ relationships and helping behaviors with
older adult clients. Journal of Applied Gerontology,
29(3), 371-380
□ Ayalon, L., Gum, A. M., Feliciano, L., & Areán, P. A.
(2006). Effectiveness of nonpharmacological
interventions for the management of neuropsychiatric
symptoms in patients with dementia: A systematic
review. Archives of Internal Medicine, 166, 21822188.
□ Due: Quiz 5
□ Audacious Aging paper due
□ Hooyman & Kiyak – Part Three con’t – The
Psychological Context of Social Aging – Chapters 6 &
7
□ Gellis, Z.D. & McCracken, S.G. (2008). Anxiety
disorders in older adults. In S. Diwan (Ed.), Mental
Health and Older Adults Resource Review. CSWE
Gero-Ed Center, Master's Advanced Curriculum
Project.
□ Ayers, C. R., Sorrell, J. T., Thorp, S. R., & Wetherell,
J. L. (2007). Evidence-based psychological treatments
for late-life anxiety. Psychology and Aging, 22, 8-22.
□ Cummings, S. M. and Kropf, N. P. (2009). Formal and
informal support for older adults with severe mental
illness. Aging and Mental Health, 13, 619-627.
□ Due: Quiz 6
□ Due: Quiz 7
□ Hooyman & Kiyak – Part Four – The Social Context
of Aging – Chapters 8 & 9
□ Due: Quiz 8
□ Due: Quiz 9
7
8
9
10
11
12
13
□ Hooyman & Kiyak – Part Four con’t – The Social
Caregiver Stress:
Context of Aging – Chapter 10 & 11
Assessment and
□ Amirkhanyan, A. A., & Wolf, D. A. (2003). Caregiver
Treatment
stress and noncaregiver stress: Exploring the pathways
Guest speaker:
of psychiatric morbidity. Gerontologist, 43(6), 817Arlene D’Alli,
827.
10/17/11
LCSW, Caregiving □ Carpentier, N., & Ducharme, F. (2003). Care-giver
Film: Complaints
network transformations: The need for an integrated
of a Dutiful
perspective. Ageing & Society 23, 507-525.
Daughter
□ Due: Quiz 10
□ Due: Quiz 11
Student
10/24/11
presentations
If a group wants their audience to read something in
advance, please provide instructor a pdf file of the
Student
10/31/11
presentations
reading for posting on Blackboard one week prior to
presentation.
Student
11/7/11
presentations
□ Hooyman & Kiyak – Part Four con’t – The Social
Context of Aging – Chapter 12 & 13
□ Bern-Klug, M., Gessert, C., & Forbes, S. (2001). The
need to revise assumptions about the end of life:
Implications for social work practice. Health and
Social Work, 24(1), 38-48.
End of Life:
□ Steinhauser, K. E., Christakis, N. A., Clipp, E. C.,
Assessment and
11/14/11
McNeilly, M., McIntyre, L., & Tulsky, J. A. (2000).
Treatment
Factors considered important at end of life by patients,
family physicians, and other care providers. JAMA,
284(19), 2476-2482.
□ Assessment and Treatment Paper Due
□ Due: Quiz 12
□ Due: Quiz 13
□ Fredriksen-Goldsen, K. I. and Muraco, A. (2010).
Special
Aging and sexual orientation: A 25-year review of the
populations
literature. Research on Aging, 32, 372 – 413.
Guest speaker:
□ Brown, T. H. (2008). Divergent pathways?
11/21/11
Iris CarltonRacial/ethnic differences in older women's labor force
LaNey, MSW,
withdrawal. The Journals of Gerontology, 36, 122 Ph.D.
□ Due: Quiz 14
□ Due: Quiz 15
8
14
Settings of Care,
Case Management,
and Elder Abuse
Guest speaker:
Felicia McLeanTorry, MSW:
11/28/11
Adult Protective
Services &
Guardianship,
Orange Co.
Department of
Social Services
15
12/5/11
TBD
□ Hooyman & Kiyak – Part Five – The Societal Context
of Aging – Chapters 16 & 17
□ Fogler, S. (2009). Using conflict theory to explore the
role of nursing home social workers in home- and
community-based service utilization. Journal of
Gerontological Social Work. 52(8), 859 – 869.
□ Firman, J., Nathan, S., & Alwin, R. (2009). Meeting
the needs of economically disadvantaged older adults:
A holistic approach to economic casework.
Generations, Journal of the American Society on
Aging. 33(3). 74-80.
□ Discussion Question Responses Due
□ Due: Quiz 16
□ Due: Quiz 17
TBD
9
Addendum A
Biopsychosocialspiritual Assessment & Intervention Plan Assignment
Biopsychosocialspiritual Assessment and Intervention Plan
You will be watching a video from which you will develop a biopsychosocialspiritual assessment
and intervention plan. The video Big Mama chronicles the experience of an older widowed
grandmother who is raising her young grandson. A biopsychosocialspiritual outline will be
provided to help guide the format of your data collection.
Peer Feedback
Class time for peer feedback will be used to ensure that you are not only following the assignment
as requested, but that your paper is also readable and professionally written. Be prepared to
exchange your paper with a classmate. You will be responsible for reading your classmates
assessment and plan then offer constructive feedback on the content.
This assignment has been adapted from:
10
Addendum B
Audacious Aging
Go to http://www.livingto100.com/ (or any other life-expentency calculator). The calculator asks
you 40 quick questions related to your health and family history, and takes about 10 minutes to
complete. This is not a scientific exercise.
1. Identify the personal, lifestyle, family, medical, and nutritional factors that determined the
calculated age. Are their behaviors you could change to increase the calculated age?
2. Take your life expentency calculated age and subtract five years. Now, imagine you are this
age (e.g. the calculated life expentency age is 81; 81-5=76; imagine you are 76 years old):
a. Where you are living, how long you have lived there, whether you live alone/with
others, your source and mount of income, your current health, your significant
relationships (e.g. close family, friends).
b. Identify personal characteristics such as gender, ethnic background, nationality, race,
class, sexual orientation, and explain their influence on your life.
c. Identify at least one personal value that has changed over time in your life and
describe why.
d. Reflecting back on your life, discuss any regrets and accomplishments not mentioned
above.
3. How did it feel to complete this exercise?
This paper should be approximently 3-5 typed, double-spaced pages and include thoughtful
discussion of all elements listed above.
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Addendum C
Class Presentation: Mental Health Problems and Challenges
Alone or in small groups, students will deliver a 90 minute presentation on one of five common
mental health concerns or challenges of later life: anxiety, depression, cognitive impairment,
caregiver stress, and end of life. The presentation will include a detailed description of the concern,
an overview of the DSM IV-R Diagnostic Criteria (if warranted), and a critical review of possible
treatment approaches; handouts are required.
For this assignment you will present a critical review of several practice-oriented treatment
approaches design to address one of the five mental health concerns/challenges listed above. Your
selected treatment approaches should be relevant to social work practice and older adults. Feel free
to be creative with your presentation format – just be sure that, whatever style you choose, you meet
the objective of the assignment and clearly communicate your ideas.
The beginning of the presentation should provide the audience with an overview of your selected
concern or challenge. This usually includes some background information about why the topic is
pertinent for social workers working with older adults, as well as a concise definition of the issue
(which should include the DSM IV-R diagnostic criteria). Based on your area of concern, select a
few (i.e., 3 or 4) intervention approaches that have been proposed to address the concern. Provide a
clear description of the essential components for each treatment approach.
Give the audience your critical assessment of the treatment approaches by comparing and
contrasting them with one another. You may want to consider: evidence of efficacy, ethical
considerations, cost effectiveness, use with diverse or vulnerable populations, feasibility, or the
theoretical assumptions on which the approaches are based. Be sure to answer this question: If you
had to recommend one treatment strategy, which one would you recommend, and why?
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Addendum D
African Americans Aging in the Rural South
Discussion Questions
Please respond thoughtfully to six of the following discussion questions. You may draw from
classroom presentations, readings, and personal experience.
1. Discuss ways that the elders in African Americans Aging in the Rural South were
empowered through their storytelling narratives. Identify and discuss strategies for using
storytelling to empower elders in long term care facilities, elder caregivers, and others who
are providers or recipients of care.
2. What are some of the greatest risk factors for elderly African Americans in the rural south?
3. Identify and discuss some of the common protective factors of the women presented in
African Americans Aging in the Rural South. How have these protective factors served them
as they age? Identify protective factors for rural elderly African Americans by level of
influence. Include 1) environmental factors, 2) interpersonal and social factors and 3)
individual factors.
4. What advantages do these elders experience from having “aged in place?” Are these
advantages beneficial enough to offset the possible economic and/or physiological cost?
5. How can broader systems such as County or State Divisions on Aging or Area Agencies on
Aging benefit from exposure to content like that presented in African American Aging in the
Rural South? How can this content help these organizations to be more effective and more
culturally responsive?
6. What personal and/or professional traits would be most useful and desirable in social
workers, nurses, occupational therapists, physical therapists and Certifies Nursing Assistants
(CNAs) who provide direct services to elders like these in African Americans Aging in the
Rural South?
7. Discuss the ways that these elders’ lifestyles and life experiences contribute to their sense of
powerlessness over resources in the service sector. Is it possible that this sense of
powerlessness may contribute to their failure to seek formal services? On the other hand, do
you see them experiencing power over their lives? Explain.
8. What positive attributes have operated in the presence of risk or adversity to see these elders
through difficult times of poverty, institutional discrimination, poor health, etc.?
9. What policy changes would you recommend to better provide an integrated service delivery
system for African American elders in rural communities?
10. What has been the dominant public policy approaches to elders in rural communities in the
past three decades? Have African American elders benefited from these policies?
11. What policy recommendations would you make to address the fragmented/piecemeal service
delivery system?
12. Identify and discuss ways to preserve the memory and life experiences of your elderly family
members. What are the steps? How can you involve your extended and fictive kin network
in the project? What do you see as the benefits of such an endeavor? Who are the
beneficiaries?
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Addendum E
Assessment and Treatment Paper
Students will be required to submit a 10-12 page Assessment and Treatment Paper (Note: page length does
not include the title page or references). Students will select one case from the available case vignettes and
develop an assessment and tailored treatment plan. The paper should include a clear rationale for the
selected treatment approach, including the description of a guiding theoretical or therapeutic model, an
overview of the evidence-base for the approach, and individual factors to consider such as client diversity,
autonomy, or ethical dilemmas.
The assignment should follow the outline below:
Overview (1 page): Using the information provided in the case vignette, incorporate relevant course
content to provide a broader perspective of the circumstances. What is known about this particular
population and setting?
Psychosocial Assessment (1-2 pages): Describe your assessment of the situation. If additional
information is required, what questions need to be asked/answered? The assessment should
demonstrate use of the person-in-environment perspective by describing the relevant biopsychosocial-spiritual issues. Your assessment should result in a summary of the important
problems, challenges, and strengths involved in the case. Be sure to prioritize which of these
problems, challenges, and strengths need to be addressed first, and why.
Social Work Treatment Plan (1-2 pages): This is a general plan of action to address the concerns
that you identified during the assessment. Note: the Specific Application of a Theory/Treatment
Model is a smaller component of this broader, more comprehensive plan. This section should
primarily address of the concerns that are not covered in the next section.
Specific Application of a Theory/Intervention/Treatment Model (4-8 pages): In this section focus
on how you would address 1 or 2 of the key problems, challenges, or strengths that you identified in
the assessment section of the paper. Give a general description of the theoretical/treatment approach
and then explain how you would apply it to your selected case. Your treatment approach should be
sufficiently detailed so that a reader could easily replicate your approach (i.e., Specifically, what
would you say and do?). If you use an approach developed by someone else, that’s fine. Just be sure
to acknowledge your source, and explain how the treatment might need to be modified for your
client(s) and environment, if at all. Also, be sure to provide a brief rational for why you selected this
treatment approach -- and be sure to comment on its evidentiary support. You should also include a
critical assessment of the approach (What are its weaknesses and limitations?).
Personal and Professional Reflections (1 page): This is where you include your personal thoughts,
feelings, and biases about the case -- as well as a discussion of the professional values and ethics
pertinent to the case. Be sure to highlight any personal or ethical dilemmas, and comment on how
you would attempt to resolve them.
Conclusion (1/2 page).
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