Understanding Our Aging Society: Social Work Contributions

The aging of our society, both in the United States and globally, demands an increased focus on aging within the social work profession and the preparation of more social workers skilled in working with older people and their families. In this edition of the NASW Research Page, the Institute for the Advancement of Social Work Research (IASWR) highlights current aging relevant research across many domains, identifies gaps in our current knowledge, and suggests recommendations for future research endeavors.

What is gerontological social work research?

Social work researchers address the following issues:

The research foci are at the individual, family, group, agency and community levels, and address social work interventions; social workers as members of interdisciplinary teams; descriptive studies of client and caregiver characteristics; and issues related to the social work labor market.

Who funds gerontological social work research?

Support for gerontological social work research comes from many federal agencies, including several institutes at the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare and Medicaid Services (CMS), the Administration on Aging (AoA), the Department of Veteran’s Affairs (VA), and the Department of Housing and Urban Development (HUD).

Additional support also comes from national foundations (e.g., the John A. Hartford Foundation, Atlantic Philanthropies, the Robert Wood Johnson Foundation, and the Soros Foundation); state and local agencies; community agencies and foundations; and academic institutions. Click here for more information on foundation-supported projects.

Research Examples

The National Institutes of Health funded several aging relevant studies:

• Kathleen Ell, Multifaceted Home Care Depression Program (NIMH) 5R24MH061700
• Charles Emlet, HIV Stigma in a Population of Adults Age 50 and Over (NIMH) 1R03MH069334
• Rosalie Kane, Family Care of the Oldest Old (NIA) 5R01AG011133
• Nancy Morrow-Howell, Community Long Term Care Service And Outcomes-Burden Of Depression (NIA) 1R01AG017451
• Gregory Paveza, Aggression and Violence In Community Based Alzheimer’s Disease Families (NIA) 1R01AG014412
• Sheryl Zimmerman, End of Life Care in Residential Care and Nursing Homes (NIA) 5R01AG018967

The Agency for Healthcare Research and Quality (AHRQ) funded:

• Ronald Toseland, Health Education in an HMO: Effectiveness and Efficiency (AHRQ) 5R01HS008641

The Centers for Medicare and Medicaid Services (CMS) funded:

• Rosalie Kane, Measurement, Indicators, and Improvement of the Quality of Life in Nursing Homes (CMS)

Aging research intersects with research that can also be considered within other fields of social work practice. Previous research Web pages on cancer and mental health include aging research examples.

Berkman, B., Walker, S, Bonander, E., & Holmes, W. (1992). Early unplanned readmissions to social work of elderly patients: factors predicting who needs follow-up services. Social Work in Health Care. 17 (4): 103-19.

Social Work Summit on Palliative and End-of-Life Care. (2002, March). Social workers set goals to strengthen care for the dying and the bereaved.

Gilbar, O., Lowenstein, A., Naravitz, A. & Steiner, M. (2001). Elderly cancer patients and elders who do not have cancer: do they differ in quality of life? Journal of Gerontological Social Work. 35 (3), 3–16.

Ell, K., Vourlekis, B., Nissly, J., Padgett, D., Pineda, D., Sarabia, O., et. al (2002). Integrating mental health and abnormal cancer screening follow-up: An intervention to reach low-income women. Community Mental Health Journal. 38 (4), 311–315 .

Foundation-Supported Projects

In recent years several foundations have made major investments in supporting social work research, in supporting the development of social work research agendas, and testing social work-led interventions.

The John A. Hartford Foundation (JAHF):
www.jhartfound.org

• •The John A. Hartford Foundation has made investments in several domains in regard to gerontological social work research. These include support for 40 faculty scholars through the Faculty Scholars Program in Geriatric Social Work. The Foundation also supports a program to support doctoral studies in aging. For more information on these programs, which are cultivating faculty leaders in gerontological education and research, visit: http://www.geron.org/Hartford/socialwork.htm
• •  The Hartford Foundation, through the New York Academy of Medicine (NYAM) ( http://socialwork.nyam.org/resources/index.html#cost ) supported an effort to analyze social work research to examine the cost effectiveness of social work interventions. The Studies of the Efficacy of Social Work Services in Aging with a Focus on Cost Outcomes: Preliminary Key Points and Information , identify current knowledge on effectiveness of social work services, and can be a helpful resource for policy-makers, educators, practitioners, and researchers.
• •  The Council on Social Work Education (CSWE), through its Strengthening Aging and Gerontology Education for Social Work (SAGE-SW) project, supported by JAHF, developed an important document, Blueprint for the New Millennium ( http://www.cswe.org/sage-sw/resrep/blueprint.pdf ) The blueprintidentified that gerontological social work research- particularly practice-based, outcome research- is very limited, and suggests a set of recommendations to address this issue.

  The SAGE-SW project also developed a set of 65 gerontological social work competencies ( http://www.cswe.org/sage-sw/resrep/competencyitems.htm ), which provide a framework for the skills, knowledge, and values the profession should have to work with older persons and their families. These competencies provide domains for further research testing.

• Burnette, Morrow-Howell and Chen, with support from JAHF, used a Delphi process to gather information from researchers and practitioners to develop a gerontological social work research agenda (see agenda setting).
• JAHF also supported, the Social Work Labor Market: A First Look , by Michael C. Barth The report developed recommendations that can build on existing research to help the profession proactively influence the job market for social work practitioners. For more information, see:

Barth, M. C. (2003). Social work labor market: A first look. Social Work , 48 (1) , 9–19.

Robert Wood Johnson Foundation:
www.rwjf.org

The Robert Wood Johnson Foundation, the Department of Health and Human Services (DHHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE), and the Administration on Aging (AoA) are making an investment in social work research and social work- relevant plans and programs.

Kevin Mahoney of Boston College (http://www.bc.edu/bc_org/rvp/pubaf/04/medicaid.html ), received a grant for the expansion of Cash & Counseling (http://www.cashandcounseling.org/index.html), a successful model program in which disabled Medicaid consumers decide for themselves how their personal assistance needs will be met. Program participants use the allocation to purchase their own care-with the option of hiring friends, family members, or others-instead of receiving it from an agency. They can also use their budgets to modify their homes or vehicles or to purchase a range of items-from chair lifts to touch lamps-to help them live independently. Consulting and bookkeeping services are available to help participants weigh their options and keep up with required paperwork.

Atlantic Philanthropies
www.atlanticphilanthropies.org

Atlantic Philanthropies is funding the Institute for Geriatric Social Work (IGSW) at Boston University ( http://www.bu.edu/igsw/ ), to address the critical need for research that documents the effectiveness of geriatric social work practice and interventions. IGSW will conduct at least one randomized clinical trial in a health care setting to demonstrate the effectiveness of targeted geriatric social work interventions. State-of-the-science meetings will be held to refine research designs, review research findings, and identify appropriate interventions to study.

Soros Foundation
http://www2.soros.org

The Soros Foundation has just completed funding for the Project on Death in America Social Work Leadership Development awards. The awards supported several cohorts of social workers, to ” promote innovative research and training projects that reflect a collaboration between schools of social work and practice sites that will advance the ongoing development of social work practice, education, and training in the care of the dying.” http://www2.soros.org/death/social_funding.htm

Gerontological Social Work Research Agenda

Early on in the initiation of the Hartford Geriatric Scholars Program, the profession was challenged to identify a gerontological social work research agenda. Denise Burnette ( Columbia University ) and Nancy Morrow-Howell ( Washington University ) launched a Web-based Delphi method input process to get input from practitioners and researchers in the setting of such an agenda. The report of the priorities identified by the researchers is reviewed in a recent article:

(Burnette, D., Morrow-Howell, N., & Chen, L. (2003). Setting priorities for gerontological social work research. The Gerontologist 43(6) , 828-838).

The agenda setting process identified priorities in regard to intervention research (developing and testing psychosocial interventions across populations and conditions was the highest priority item); housing and living arrangements; service delivery; detection and assessment; family caregiving; health-mental health; and workforce (p. 836). The social work research priorities fit well with key issues highlighted in the NIA Strategic Plan ( http://www.nia.nih.gov/strat-plan/2001-2005/ ), especially around the following priorities: Improve health and quality of life of older people; reduce health disparities among older persons and population; and enhance resources to support high quality research.

Important Links

Several key government reports address issues relevant to social work and aging research priorities and help to frame opportunities to support social work research.

• The Office of the Inspector General, Department of Health and Human Services, issued a 2003 report on Psychosocial Services in Skilled Nursing Facilities ( http://oig.hhs.gov/oei/reports/oei-02-01-00610.pdf ) identifying key gaps in services, and suggesting areas for further study.
• The Centers for Disease Control and Prevention’s (CDC) Injury Research Agenda(http://www.cdc.gov/ncipc/pub-res/research_agenda/agenda.htm) highlights areas of study that address intentional injury (e.g., elder abuse) and unintentional injury (e.g., falls).
• The National Institute of Mental Health’s National Advisory Mental Health Council recently released a report titled, Mental Health for a Lifetime: Research on the Mental Health Needs of Older Americans ( http://www.nimh.nih.gov/council/agingreport.pdf ). The report recommended increased attention to mental health issues and aging, recognizing the need for research to promote mental health for the growing proportion of older Americans, and to better understand the needs of individuals living with mental illness as they grow older.
• The National Institute on Aging’s research plan on minority aging , Review of Minority Aging Research at the NIA , http://www.nia.nih.gov/research/minority/execsummary.htm
• NIA Strategic Plan ( http://www.nia.nih.gov/strat-plan/2001-2005/ ) includes goals of improving health and quality of life for older people by preventing or reducing age related diseases, disorders, and disability. Other goals include maintaining health and functioning, enhanding older adults societal roles and interpersonal supports, and reducing social isolation. All of the above are relevant to social work research.

NIA’s behavioral and social science research interests include:

• Health Disparities
• Aging Minds
• Increasing Health Expectancy
• Health, Work, and Retirement
• Interventions and Behavior Change
• Genetics, Behavior, and the Social Environment
• The Burden of Illness and the Efficiency of Health Systems