Gerontology: Aging Processes, Assessment, and Practice
Core concepts
Gerontological social work rests on distinguishing normal aging from disease and from social stereotype. Know the difference between chronological, biological, psychological, and social age; a 78-year-old marathoner and a frail 78-year-old are the same chronological age. Understand life-course and disengagement vs. activity vs. continuity theory only well enough to recognize them, and prioritize the empirically supported frameworks: person-in-environment, strengths perspective, and the biopsychosocial model.
Key clinical content includes age-related sensory and cognitive change, polypharmacy and pharmacokinetics (older adults metabolize drugs more slowly, raising fall and delirium risk), elder mistreatment (physical, emotional, sexual, financial, neglect, self-neglect), grief and multiple loss, caregiver burden, and ageism in service delivery. Know the difference between delirium (acute, fluctuating, often medical emergency), dementia (progressive cognitive decline), and depression (pseudodementia pattern).
Traps in questions
- Assuming confusion is "just aging" - new confusion warrants medical evaluation.
- Confusing capacity (clinical/functional judgment for a specific decision) with competence (a legal determination).
- Overlooking self-neglect as a reportable category distinct from caregiver-perpetrated neglect.
- Choosing a protective/controlling response when the older adult has decision-making capacity and the ethical answer is supported autonomy.
Rule of thumb
When an older client refuses a service but demonstrates capacity, assess and document, educate, offer alternatives, and respect the choice - do not override autonomy. Escalate only when imminent danger or impaired capacity is present.
Worked example: An 82-year-old with mild cognitive impairment declines home care and her apartment is cluttered but safe. Best answer: explore her reasoning, provide information, document capacity, and monitor - not file a protective services report absent danger.