Gerontology: Biopsychosocial Aging and Social Work Practice with Older Adults
What This Domain Covers
The gerontology domain of the CSW-G exam tests whether you can apply a biopsychosocial, life-course lens to older adults instead of treating age as a diagnosis. Expect items on normative aging, cognition and mental health, family caregiving, elder mistreatment, community-based and institutional care, and the legal-ethical tools that protect self-determination. Items typically reward the least-restrictive, most integrated option and punish age-based assumptions.
Normal Aging Versus Disease
Normative changes include presbyopia, high-frequency hearing loss, reduced renal clearance, loss of lean muscle and bone density, slower processing speed, and largely preserved crystallized intelligence. These are not normal and always warrant assessment: delirium, incontinence, falls, rapid weight loss, and new cognitive change. Delirium is acute, fluctuating, and medical; dementia is progressive and insidious. Depression in later life often presents as somatic complaints and is not a normal part of aging.
Frameworks the Exam Rewards
- Erikson: integrity versus despair.
- Activity, disengagement, and continuity theories.
- Selective optimization with compensation (Baltes): selection, optimization, compensation.
- Socioemotional selectivity: narrowed networks, emotionally meaningful ties.
- Strengths and person-in-environment: assess ADLs (bathing, dressing, toileting, transferring, eating, continence) and IADLs (medications, finances, shopping, transportation, cooking), not just diagnosis.
Care Systems and Legal Tools
The Older Americans Act funds Area Agencies on Aging, congregate and home-delivered meals, and caregiver support. Medicare covers acute and post-acute care, hospice, and home health; Medicaid is the major payer for long-term nursing home care and home- and community-based services waivers. Advance directives and durable powers of attorney preserve autonomy; guardianship is a last resort after a functional-capacity assessment.
Worked Example
An 80-year-old widower is brought in by his daughter: he has stopped cooking, misses medications, and "seems confused" since a fall two weeks ago. The social worker does not chalk this up to aging. She screens for delirium and depression, arranges urgent medical evaluation (new confusion after a fall raises subdural hematoma and infection), and assesses IADLs. She then coordinates home-delivered meals, medication management, and a caregiver-support referral, and discusses advance directives while he can still participate.
Traps That Cost Marks
Calling treatable conditions "normal aging"; mixing Medicare and Medicaid; recommending guardianship before less restrictive options; missing elder mistreatment, including self-neglect; assuming family caregivers are available; and treating capacity as a global yes/no rather than decision-specific.