InstructionsIn 2009, an article was published by Kostigen, which.docx

Instructions
In 2009, an article was published by Kostigen, which
highlighted the names of 10 unethical business people. While
the names on similar lists change throughout the years, the
names on this 2009 list often strike most recall among the
business community. Examine this list, which can be found at
http://www.marketwatch.com/story/the-10-most-unethical-
people-in-business. Then, select one individual on this list to
focus your paper on.
· Provide information regarding the individual’s unethical
action/behavior.
· Based upon the research you conduct on this individual, utilize
the articles by Bagdasarov et al. (2016) and Schwartz (2016) to
analyze factors that might have contributed to this individual’s
unethical behavior. Focus specifically on how diversity (e.g.,
cultural, gender, religious, etc. could have impacted/influenced
the unethical behavior).
· Explain and justify the factors that may have influenced this
individual to make the decision that he/she did.
· Explain how the decision made is reflective of Figure 1 (e.g.,
the integrated ethical decision-making model), in the research
article by Schwartz (2016).
· Determine how this behavior could have been prevented if one
or more of the factors mentioned above were removed.
Support your paper with a minimum of five scholarly resources.
In addition to these specified resources, other appropriate
scholarly resources, including older articles, may be included.
Length: 5-7 pages, not including title and reference pages
Your paper should demonstrate thoughtful consideration of the
ideas and concepts presented in the course by providing new
thoughts and insights relating directly to this topic. Your paper
should reflect scholarly writing and current APA standards. Be
sure to

Chapter 8
Intervention With the Elderly
Michael J. Holosko, Jeffrey F. Skinner,
Catherine A. Patterson, and Kimberly Brisebois
Purpose: This chapter offers an overview of current and
practical issues related
to social work interventions with the elderly.
Rationale: With our aging population rapidly increasing,
gerontological social
workers will be needed more than ever. They require basic
knowledge of the
required intervention skills necessary for both entry and
advanced levels of
practice with the elderly.
How evidence-informed practice is presented: We present a
summary of
current evidence-informed practice interventions and analyze
this literature in
terms of: conceptual/theoretical frameworks for treatment,
effectiveness studies,
and specified intervention and outcome studies. Implications for
education are
then discussed from this framework.
Overarching question: How does evidence-informed practice
inform social
work interventions with the elderly?
This chapter presents an overview of issues related to
interventions with
the elderly. Gerontological social work is predicted to be one of

the high-
demand future job markets for our profession, as we in the
United States
are rapidly becoming an aging society (U.S. Bureau of Labor
Statistics,
2004). Thus, it seems both relevant and timely to include a
chapter about
this area of social work practice. Prior to presenting the
materials that
assess the efficacy of evidence-based interventions with the
elderly, a brief
historical background provides the context and rationale for
understanding
this information.
Historical Background
The Demographic Reality
In most industrialized countries of the world, a demographic
population
explosion has occurred among those aged 65 and older. This is
primar-
ily attributed to improved medical treatment, earlier changes in
lifestyle,
reduced mortality rates, increased financial independence, old
age pen-
sions, governmental assistance, advances in technology, greater
mobility
197
Holosko, Michael J., et al. <i>Social Work Practice with
Individuals and Families : Evidence-Informed Assessments and
Interventions</i>, John Wiley & Sons, Incorporated,
2013. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/waldenu/detail.action?docI

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198 Social Work Practice With Individuals and Families
and access to health and social services, and formal and
informal support
networks (Holosko & Feit, 2004).
For the past 40 or 50 years, U.S. policy makers at federal, state,
and/or local levels have both witnessed and acknowledged this

exponential
growth, but they don’t quite know how to deal with it. For
example, in an
article written by A. Otten in the Wall Street Journal, on
Monday, July 10,
1984, a three-part series was titled: ‘‘The Oldest-Old: Ever
More Americans
Live into Their 80’s and 90’s and Cause Big Problems’’ [Part
I]; ‘‘The Strain
on Social Services and Relatives Will Rise: Should Care Be
Rationed?’’ [II];
and, ‘‘A Five-Generation Family’’ [III]. Concerns about how to
reconcile
or address this reality are a long-standing and ubiquitous
feature of our
society. Breaking these data down a bit further provides
additional insights
into some interesting and challenging policy and practice
realities for social
workers practicing in this area.
Although there is some disagreement in the literature about
what
constitutes an elderly person, policy makers deem 65 as the
present age
benchmark (Holosko & Leslie, 2004). From a formative or
Level I life-span
perspective, persons over 65 represent the fastest growing age
group in
the United States. Projections are that by the year 2030, over 70
million
Americans will be at least 65 years of age (Administration on
Aging, 2003).
At a Level II perspective, this subgroup is further broken down
by current
health, aging, and lifecycle markers as: young-old, or 65–75;

moderately
old, or 75–90; and old-old, being 90+ years. Indeed, since about
1988,
the fastest growing cohort on our lifecycle continuum is the 85+
year-old
category (Feit & Cueuves-Feit, 1991, 2004).
From a Level III demographic perspective, (a) there are and will
continue to be more women than men who live beyond age 65 in
the
United States; (b) more of the 65+ age group will come from
ethnically
diverse groups; (c) more elderly will be actively employed in
the future;
(d) more elderly will be residing in urban centers rather than
rural settings;
and (e) more elderly will become meaningfully involved in our
day-to-day
lives, for example, in arts, literature, movies, athletics, politics,
educational
and economic institutions, and so on. Indeed, as indicated by
Holosko and
Holosko (2004), as a society, we can no longer take an out-of-
sight, out-of-
mind mentality with the elderly because they are and will
continue to be
in plain sight and clearly in our minds. Just where and when
these three
growth trends will subside or even plateau is nowhere to be seen
on our
current society’s horizon.
Practice Implications
In attempting to discern how these trends may impact on social
work

practice with the elderly, the first author conducted a literature
search
on emerging practice issues about the elderly from 1975 to
2006. Tables
of contents for main teaching texts written by social workers, as
well as
training institute workshops offered by the Council on Social
Work Edu-
cation (CSWE) and the National Association of Social Workers
(NASW),
served as the database for this cursory review. One rather
interesting
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Intervention With the Elderly 199
finding emerged. The so-called emerging-practice issues cited
early on in
documents by Lowry (1979); Schneider, Decker, Freeman,
Messerschmidt,
and Syran (1984); and Greene (1988) were the same emerging
practice top-
ics listed by the Hartford Foundation’s Gero-Education Group at
a recent
CSWE Conference (www.Gero-EdCenter.org), almost verbatim
circa 1988.
To the nascent reader of these admittedly rather spurious
comparative
data, it would appear that practice issues that were deemed on
the forefront
some 20 years ago by our profession are still on the forefront
today.
However, what has changed is not the issues themselves but (a)
the
sheer numbers of elderly; (b) their various subgroups; (c) their
health and
psychosocial problems, and the context in which they present;
(d) the
variety of interventions we offer to deal with these issues; and

(e) our
ability to assess the efficacy of our interventions. Sadly, what
else has not
changed (in this brief chronological snapshot) is the dire
shortage of social
workers educated and trained to practice in this area (Hooyman
& Kayak,
2002; Lowry, 1979). A recently released NASW National
Workforce Study
of licensed social workers reported the number of new social
workers
providing services to older adults is decreasing, despite the
projected
increases in the number of older adults who will need social
work services
(NASW, 2006).
Defining and Assessing the Evidence-Based Practice
Interventions
Social workers’ decade-long affair with evidence-based practice
(EBP) has
been significantly tempered (Gambrill, 2006). This is due in
large part to the
profession’s inability to realistically define the concept and
practitioners’
inability to implement it in practice (Thyer & Kazi, 2004). An
evolving and
much more realistic definition of EBP is ‘‘the conscientious and
judicious
use of current best practice in making decisions for individual
treatment’’
(Howard, McMillan, & Pollio, 2003; Pollio, 2002, 2006;
Sackett, Richardson,
Rosenberg, & Haynes, 1997). This less stringent definition is
used in this

chapter.
As a result, the information reviewed herein included both
quanti-
tative and qualitative research as well as evaluation research
studies. In
short, as long as empirical data were systematically collected to
either
inform or direct practice, they were retained for subsequent
analyses.
Figure 8.1 presents a three-cohort conceptualization of these
data-driven
studies.
Figure 8.1 shifts the perceptual lens of more traditionally
delimiting
definitions of EBP to a looser definition of ‘‘social work
practice [in this
case with the elderly] based on empirical data’’ or the actual
evidence per
se. Thus, published articles, studies, chapters, texts, or
monographs not
grounded in this way were not retained for analyses for this
chapter.
Nonempirically based studies, historical reviews, frameworks
(con-
ceptual, theoretical, treatment) not based on empirical data,
studies about
gerontological workers themselves, policy analyses, critiques of
practice,
opinion pieces, and trend analyses were consequently excluded.
Ironically,
this latter literature accounted for approximately 35% of the
published

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http://www.Gero-EdCenter.org

Figure 8.1
Three cohorts of
evidence-based studies
used in a review of
interventions for the
elderly
Conceptual/
theoretical
frameworks
Cohort 1 Cohort 2 Cohort 3
Effectiveness
studies
Evidence-based research and evaluation studies
Empirical data collected to inform and direct practice
with the elderly—"the evidence"
Assessments
of specified
interventions
and outcomes
critical mass captured by the initial search parameters. Further,
in order
to keep this chapter relatively current, only literature from 1995
onward
was reviewed. Key words used in searching these literature
sources were:
gerontology, interventions, outcomes, social work practice,
effectiveness,
assessing practice, and evidence-based practice.

In addition, we attempted to seek out EBP literature and present
it in ways that emphasized the practice → evidence linkage.
After a
presentation of the summarized evidence-based intervention
studies, as
indicated in the three cohorts in Figure 8.1, a model for
integrating such
evidence into practice is then presented.
Summary of Current Evidence-Based Interventions
With the Elderly
Cohort 1—Conceptual/Theoretical Frameworks
Too often in overviews of the literature of this nature, published
accounts
are summarily dismissed if they do not include a readily
identifiable
method section or empirical data, for example, tables of
statistics. This
nascant approach unfortunately delimits a host of important
literature
that, on further investigation, has an empirical basis to it.
Figure 8.1
conceptualized literature in Cohort 1 as having an empirical
basis to it.
That is, empirical data were used to develop these conceptual
and/or
theoretical frameworks that guided gerontological social work
practice.

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Three criteria were used to determine literature suitable for
inclusion
here. First, all these published accounts clearly had to be
empirically linked
to practice interventions with the elderly. This was

operationalized in one
of two ways: (1) greater than 50% of the references cited at the
end of
the chapter/article had to have analyzed/cited primary or
secondary data,
and/or (2) case examples were used in the document as the basis
for
the proposed conceptual/theoretical framework. For the most
part, such
chapters/articles grounded the rationale for the proposed
framework in
empirical studies that, in turn, presented the basis for their
subsequent
development.
As previously mentioned in this chapter, elders are living
longer,
proliferating in number, and incurring escalating costs of care.
Ironically,
many of these potential clients did not expect to live as long as
they
presently are, and their resources have significantly diminished
as their
lives are extended. As such, residential long-term care and end-
of-life plan-
ning were prevalent topics among many studies considered for
inclusion
in Cohort 1 (Table 8.1).
Thus, the quality of life in long-term care facilities is becoming
a
more salient issue. Solomon (2004) explored providing for
quality of life
in long-term residential homes for elderly clients by suggesting
nine crite-
ria that have a positive contributive influence. These were good

physical
care, pleasant environment, autonomy/choice, attentive staff,
respect-
ful treatment, personal meaning, engaging activities,
opportunities for
significant relationships, and interdisciplinary collaboration.
Revisiting a
common intervention for clinical practice with elderly
populations (group
work) with a unique taxonomy, Solomon presented four group
types: self-
government, support, educational, and resident volunteer. By
using case
examples, this study showed how providing for quality of life in
residen-
tial homes can improve overall health status, increase self-
determination
within the residents, foster interprofessional collaboration, and
decrease
misunderstandings that may occur among providers and
recipients of this
care modality.
Similarly, Pinquart, Sörensen and Peak (2004), recognized the
familial
imperative to develop a realistic care plan for later life
relatives. They
provided a strategic eight-step process model designed to
support older
adults through the preparatory development of their future care
needs.
Additionally, they suggested three contextual opportunities for
intervention
(i.e., educational settings, direct referrals, and discharge
planning). This
framework assists a social worker in enhancing a client’s right

to self-
determination, sense of wellness, and affects some alleviation
of stress for
the client’s extended family. It was shown that being
knowledgeable about
phenomena and tendencies common to older adults and their
families
related to the approaching need for care enables practitioners to
better
assist these clients.
Another study in this cohort addressed a social worker’s role in
issues
of death and dying. Hobart (2001) explored the ever-expanding
role of the
social worker in advance-care planning and end-of-life decision
making.
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The complexity of this advocacy role is highlighted as well as
the obligatory
responsibility of the social worker to be well versed on issues,
legislation,
policy, providers, and patient’s rights. Additionally, being able
to navigate
through the quagmire of psychosocial currents is crucial for the
efficacy of
the social worker’s praxis. Hobart discussed Advance Directive
Education
(ADE), right-to-die legislation, the Patient Self-Determination
Act of 1991
(PSDA), and argued for ethnographic sensitivity in one’s
approach to issues
of death and dying. The conceptual framework provided here
reminds us
of the multiplicity of skills and working knowledge one must
bring to the
person in their environment. Among these studies, is a NASW
end-of-
life care protocol. This helpful study compiles, summarizes, and
delimits a
multitude of critical studies on end-of-life care that will prove
advantageous
to a clinician in his or her professional endeavors. More than 20
articles
were presented in this review covering the broad gamut of
issues relating
to caring for this population as they prepare for the end of life.
Cohort 1 studies also included interventional theoretical
frameworks
for working with the elderly within a particular sociocultural
situatedness,
namely rural settings (Bisman, 2003; Li & Blaser, 2003). These
studies

highlight the unique challenges that social workers face when
intervening
with rural elderly populations. The lower-than-average general
health,
the narrow range of available services, the economic
stratification of
the clientele, the limited access to formal and diverse service
providers,
and the concomitant geographic isolation often exacerbate the
presenting
problems of this treatment group. Bisman (2003) suggested four
theoretical
models for intervention with rural elderly clients: social
support, family
systems, group work, and case management/community practice,
thus
reinforcing the ubiquitous modality for practice with the
elderly. This
article is efficacious to a practitioner and contains helpful
information for
further reading and research.
The Li and Blaser (2003) study moves beyond the micro- and
mez-
zolevels of social praxis and into macrolevel social work. These
authors
suggest an integrative social-care systems model for rural
program plan-
ning with older adults that amalgamates both formal and
informal sources
of care, community leaders and residents, and culture and
creativity. This
model seeks to provide for both the client as well as the
community.
Through the use of case studies, Li and Blaser (2003) illustrate
the essen-

tial strategies that are fundamental to success in rural program
planning
and development for older adults.
The last intervention area of these studies relates to the
uniqueness
of working with this population. Here, numerous
conceptual/theoretical
frameworks are provided that address issues of compassion
fatigue (Leon,
Altholz, & Dziegielewski, 1999), trauma as it relates to aging
(Graziano,
2003), elder morbidity and subjective well-being (Peck, 2001),
alterna-
tive socioemotional interventions for depression (McInnis-
Dittrich, 2002;
Motohashi, Kaneko & Sasaki, 2004), and task-centered case
management
(Naleppa & Reid, 2003). The task-centered case-management
practice
model is for work with the elderly in need of multiple services.
The model
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has three components: a core intervention model, parallel
intervention
functions, and alternative intervention modules. Each of the
studies has
important clinical implications that could benefit practitioners
working in
this area.
Leon et al. (1999) used case examples to reinforce the inherent
danger
to clinicians who work with elderly populations. Social work
burnout can
occur because of the short-term nature of the labor-intensive
work with

the elderly. Some contributive factors to compassion fatigue
noted were
feelings of incompetence, the experiences of secondary
traumatic stress
disorder, the misperception that the elderly client’s life cannot
be improved
(by interventions), the scarcity of resources for this treatment
group, and
the latent existential angst about the inevitability of aging and
declining in
health that the practitioner realizes for him- or herself. This
study presented
an eight-step process that could possibly prevent compassion
fatigue.
The articles in Cohort 1, although not necessarily having
specified out-
comes, targeted populations, and rigorous evidence-based
methodological
designs, are evidenced based, based on the previous definition
provided,
and are important to gerontological social work practitioners.
They present
numerously empirically derived conceptual/theoretical
frameworks for
interventions with the elderly that, more often than not, have
worked
elsewhere. These modalities of intervention range from service
among
rural populations, residential populations with physical and/or
cognitive
impairment, and emotional/spiritual penury. Additionally, some
of the
studies in this cohort serve a perfunctory role in improving the
quality of
self-care in the social worker; advocacy for the client; and

service to, with,
and among elderly populations.
Cohort 2—Effectiveness Studies
The effectiveness studies in Cohort 2 (Table 8.2) illustrate the
neces-
sity of using multifaceted interventional strategies for
multidimensional
presenting problems of the elderly.
As the ever-burgeoning elderly population expands, a social
worker’s
knowledge of efficacious interventions must remain
commensurate with
the anticipated needs of these potential clients. Ascertaining
what has
worked for other clinicians can be of benefit to any social work
prac-
titioner. Essentially, the nature of the presenting problems
within this
cohort fell into one or more of the following categories:
acute/chronic
pain, depressive symptoms, social isolation, declining
biopsychosocial
health, and/or cognitive impairment (e.g., dementia,
Alzheimer’s). The
interventions reviewed in Cohort 2 ran the gamut of education,
physio-
therapy, pharmacological treatment, community-based and
home-based
therapy, care through the medium of technology, and alternative
rehabil-
itation through Eastern meditative practice and existential
empowerment.
Collectively, these studies did not specify designated, and/or

anticipated
outcomes, but rather, sought to determine the efficacy of the
interventions.
Additionally, the time frame or duration of the interventions
varied in part
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48
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00
1)
E
D i
n
te
rv
en
ti
o
n
A
lz
h
ei
m
er
’s
ca
re
gi
v
er
s

58
6
m
o
n
th
s
M
o
d
es
t
b
en
efi
ts
in
k
n
o
w
le
d
ge
o
f

d
is
ea
se
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d
co
p
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St
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at
a
su
gg
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th
at
k
n
o

w
le
d
ge
o
f
A
lz
h
ei
m
er
’s
ca
n
as
si
st
ca
re
gi
v
er
co
p

in
g.
C
am
b
er
g
et
al
.
(1
99
9)
P
er
so
n
al
iz
ed
si
m
u
la
te

d
p
re
se
n
ce
,
M
M
SE
N
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in
g
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m
e
re
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en
ts
w

it
h
A
D
R
D
54
O
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go
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g
N
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gn
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ca
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t
ch
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as

a
re
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te
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Si
m
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la
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m

ay
p
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to
b
e
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ct
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en
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n
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in

g
h
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in
gs
.
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o
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(1
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3)
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S,
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al
m
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w
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s
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at
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sp
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al
—
fr
ai
l
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d
er
s
21
6
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go
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g

B
en
efi
ci
al
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ct
s
(e
.g
.,
re
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ss
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p
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-d
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h
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sp
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co
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s)
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P
ap
p
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iv

e
to
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d

er
ly
h
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sp
it
al
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m
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p
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.
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et
al
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h
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p
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f
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p
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p
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in
N
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la
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sk
fo
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fa
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23
3
12
m
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th

s
R
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f
fa
ll
s
w
as
lo
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th
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ex
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th
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th

e
co
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tr
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p
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p
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A
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d

iv
id
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p
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gr
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gt
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tr
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in
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im
p
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p
h
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ct
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d
w

as
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fe
ct
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fa
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s
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ju
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w
o

m
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80
ye
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d
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ld
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an
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je
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am
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d
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M
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p
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m
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lo
gi
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l
D
ep
re
ss
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d
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ab
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d
p

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p
le
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6
m
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th
s
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tc
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m
e,
si
gn
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w
it
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th
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tr
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tm
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gr

o
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p
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ep
re
ss
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is
tr
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b
le
in
el
d
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p
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p
le

re
ce
iv
in
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h
o
m
e
ca
re
.
1
A
D
R
D
=
A
lz
h
ei
m
er
’s

d
is
ea
se
an
d
re
la
te
d
d
em
en
ti
a;
A
G
E
C
A
T
=
A
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to

m
at
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ge
ri
at
ri
c
ex
am
in
at
io
n
fo
r
co
m
p
u
te
r
as
si

st
ed
ta
xo
n
o
m
y;
C
B
T
=
C
o
gn
it
iv
e
b
eh
av
io
ra
l
th

er
ap
y;
C
C
T
=
C
o
n
tr
o
ll
ed
cl
in
ic
al
tr
ia
l;
C
D
S
=

C
o
m
m
u
n
it
y-
d
w
el
li
n
g
se
n
io
rs
;
C
IH
B
T
=
C
o

m
m
u
n
it
y-
in
te
gr
at
ed
h
o
m
e-
b
as
ed
tr
ea
tm
en
t;
E
C

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=
E
d
u
ca
ti
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n
al
co
n
tr
o
l
gr
o
u
p
;
E
D
=
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d
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ca
ti
o

n
;
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K
I
=
E
ld
er
ly
K
o
re
an
im
m
ig
ra
n
ts
;
M
M
SE
=

M
in
i
m
en
ta
l-
st
at
e
ex
am
in
at
io
n
;
N
C
E
P
=
N
u
rs

in
g-
ce
n
te
re
d
ed
u
ca
ti
o
n
al
p
ro
gr
am
;
N
T
=
N
u
tr
it

io
n
al
tr
ai
n
in
g;
P
C
S
=
P
ro
sp
ec
ti
v
e
co
h
o
rt
st
u
d

y;
P
E
A
R
L
S
=
P
ro
gr
am
to
en
co
u
ra
ge
ac
ti
v
e
re
w
ar
d

in
g
li
v
es
fo
r
se
n
io
rs
;
P
G
T
=
P
sy
ch
o
ge
ri
at
ri
c
te

am
;
P
ST
=
P
ro
b
le
m
so
lv
in
g
th
er
ap
y;
P
T
=
P
h
ys
io
th

er
ap
y;
R
C
SG
=
R
an
d
o
m
co
n
tr
o
ll
ed
su
p
p
o
rt
gr
o
u
p

;
R
C
T
=
R
an
d
o
m
cl
in
ic
al
tr
ia
l;
SR
T
=
St
ru
ct
u
re

d
re
m
in
is
ce
n
ce
th
er
ap
y;
SS
S
=
So
ci
al
se
rv
ic
e
su
p
p

o
rt
;
SS
W
=
Se
ss
io
n
w
it
h
so
ci
al
w
o
rk
er
;
ST
E
P
=

St
ar
t
ta
lk
in
g
ea
rl
y
p
ro
gr
am
;
V
A
=
V
et
er
an
s
A

d
m
in
is
tr
at
io
n
.
209
D=1106529.
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2
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3

.
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h
n
W
ile
y
&
S
o
n
s,
I
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co
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.
A
ll
ri
g
h
ts

r
e
se
rv
e
d
.
because of the absence of targeted outcomes specified prior to
the study.
Their methodological criteria allowed these studies to be
dichotomized
into two practice effectiveness categories, namely, those
interventions that
worked and those that did not.
At first glance, you might think that the needs of the elderly
have
remained quite consistent over the past 20 years. However, the
studies
in Cohort 2 (and the subsequent Cohort 3) reveal that the
presenting
problems of the elderly have become more complicated than
before. The
cost of adequate care has escalated far beyond the economic
viability
of the client group. Even though technology has created the
possibility
of instantaneous digital interactivity, it appears that social
groups and
communities have become more polarized and collectivities

have become
ever more stratified (Dunlop & Holosko, 2006). With these
societal changes
anonymously thrust on the variegated collectivities that make
up our
culture, we witness the exacerbation of the numerous presenting
problems
of the elderly. Thus, interventional strategies have become more
strategic,
multidimensional, and time framed as needs arise.
These studies sought to ascertain the efficacy of various
interventions
ranging from education to structured reminiscence therapy, from
physi-
cal therapy to supervised eating in social settings, from Eastern
Chinese
meditative/movement oriented practices to pharmacological
interventions
for depression. The wide array in Cohort 2 exemplified the
clinician’s
creativity and willingness to experiment in order to address the
presenting
problems within the elderly community. Some tested
educational curricula,
whereas others investigated the utility of technology and
physiotherapy.
These studies were selected, in part, because they satisfied the
criteria
of our search, and also because they represented a considerable
range in
interventional approaches in a variety of settings both locally
and interna-
tionally. Some were clinically based, whereas others were
community- or
home-based interventions.

Among the clinically based interventions, Abrahamson and
Khan
(2006) found that osteoporosis education among elderly patients
with low
trauma fractures significantly improved the functional
independence and
psychological well-being of the patients. This educational
intervention did
not reduce levels of actual pain experienced by the subjects.
However,
the interrelated connection between cognitively understanding
the disease
and cultivating strategies to manage the pain of the disease
resulted in
both greater physical confidence and decreased depressive
symptoms. This
study demonstrated the direct corollary between the experience
of pain
and declining ambulatory function to depressive symptomology.
Tsang, Mok, Yeung, and Chan (2003) also recognized the
correlation
between pain and depression in their study of the efficacy of
Quigong.
From the Chinese words Qi [chi], which means energy and gong
[kung]
which means skill, this ancient practice merges meditation and
deliberate
movement. Quigong is famous in China for reducing stress,
lowering blood
pressure, and fostering a better attitude about life. Tsang et al.
(2003) found
that elderly patients with chronic subacute physical illnesses
and pain also
experienced depressive symptoms. The control group that

received the
D=1106529.
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ig
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3
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W
ile
y
&
S

o
n
s,
I
n
co
rp
o
ra
te
d
.
A
ll
ri
g
h
ts
r
e
se
rv
e
d
.

Quigong intervention for 12 weeks showed significant
improvement in
physical, psychological, and general health well-being. The
results of this
study suggested that alternatives to pharmacological
interventions for pain
and depression exist.
The relationship among acute illness, pain, recovery, and the
propen-
sity to socially isolate oneself was addressed in the Wright,
Hickson, and
Frost (2006) study. They evaluated a nurse-aided supervised
dining inter-
vention. Generally, acutely ill nursing-home patients have a
tendency to
eat alone in their rooms. This self-imposed social isolation has
a cor-
roborative negative effect on recovery, weight-loss, and general
health.
Their intervention involved encouraging these elderly residents
to go to
the formal dining hall during lunchtime rather than eating alone
in their
rooms. The simple act of communal dining, rather than social
isolation,
resulted in increased food intake, healthy weight gain, and
correspond-
ing improvements in nutritional status and rehabilitation. The
effect of
communal interactivity on the general health status of the
geriatric client
cannot be overstated.
Community-based interventions were also quite common among

the
studies reviewed (Ciechanowski et al., 2004; Kochevar, Smith,
& Bernard,
2001). Both studies sought to explore the correlation between
physical and
general health and the biopsychosocial wellness of the subjects.
Kochevar
et al. (2001) utilized nutritional training and a physical exercise
program
among Native-American urban elders for 6 weeks. As a result of
this
intervention, the physical and emotional health of the subjects
significantly
increased. Ciechanowski et al. (2004) evaluated an educational
program,
Program to Encourage Active Rewarding Lives for Seniors
(PEARLS),
among 138 elderly patients with minor depression and/or
dysthymia.
PEARLS proved to be an efficacious community-integrated,
home-based
treatment for depression by significantly reducing depressive
symptoms
and improving the general health status of the participants.
Several studies employed technology, for example, telephones,
com-
puters, Internet, and recording devices, as an integral part of
their
interventional strategy (Bradley & Poppen, 2003; Camberg et
al., 1999; De
Leo, Buono, & Dwyer, 2002; White et al., 2002). These
interventions ranged
in duration from 6 months to 10 years. Cohort 2 studies also
included pro-
fessional and semiprofessional practitioners in the

administering of their
interventions.
Other studies integrated physiotherapy and education (Campbell
et al., 1997; Kapasi, Ouslander, Schnelle, Kutner, & Fahey,
2003; Kochevar
et al., 2001; Mo-Kyung, Belza, LoGerfo, & Cunningham, 2005;
Tsang et al.,
2003). The duration of these interventions ranged from 12 to 32
weeks.
Some addressed specific ethnic groups, that is, elderly Korean
immigrants
(Mo-Kyung et al., 2005), whereas others focused on specific
impairments
and risks, that is, elderly frail women who are at risk of falling
(Campbell
et al., 1997). Regardless of the population, merging
physiotherapy and
education proved to be efficacious among geriatric clients, in
general.
One final trend to highlight within gerontological work and
these stud-
ies was the aging-in-place model. The ubiquitous modality of
care in the
D=1106529.
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te
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.
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ll
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ts
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e
d
.
past was the institutionalization of the elderly in personal
care/residential
homes. For the past two decades, however, the devolution of
health care
has challenged the federal role in domestic health and human-
services pol-
icy. Consequently, in light of the contextual verities of the
managed-care
movement, the sociodemographics of aging, and the preferential
biases of
the elderly to die at home, a new paradigm for elder care is

emerging.
In North America, much of the decision making in health-
related
issues has been devolved to local authorities. The raison d’être
behind
such a new model of care emerges from three areas of concern:
(1) the
governmental expectation for equitable care; (2) the providers’
economic,
social, and health-related interests; and (3) the clients’ health
care-related
preferences and needs (Lomas, Woods, & Veenstra, 1997). The
aging-in-
place model has transpired as a new model for care, particularly
among
aging populations, as a response to the escalating costs of care
(Mollica
& Morris, 2005), the scarcity of adequate space for an ever-
increasing
population of elderly, and in response to the expressed desires
of the
elderly to die at home (Formiga, Chivite, Ortega, Cassas,
Ramon & Pujol,
2004; Groth-Juncker & McCusker, 1983).
Two of the studies in Cohort 2 addressed the aging-in-place
model
(Banerjee, Shamash, Macdonald, & Mann, 1996; Leff et al.,
2005). The fact
that these two studies were conducted nearly a decade apart
demonstrates
that the aging-in-place model of health care continues to be
prototypical
of present and future modalities of treatment. Banerjee et al.
(1996)

involved 69 disabled patients suffering from depression. For a
period of
6 months, the subjects received a multifaceted intervention
combining
pharmacological aides and automatic geriatric examination for
computer-
assisted taxonomy assessment (AGECAT) from a
psychogeriatric team in
the clients’ home settings. The treatment group experienced
significant
alleviation of depressive symptoms and an overall increase in
their general
health status.
In the Leff et al. (2005) study, 455 acutely ill community-
dwelling
seniors received the hospital-at-home model of care for 22
months. As
a result, the subjects had a shorter length of stay and lower
mean costs
of treatment compared to acute hospital care. This study
demonstrated
the efficacy of the hospital-at-home model as feasible, safe, and
cost
effective for certain older patients with selected acute medical
illnesses.
The aging-in-place paradigm underlying this study will continue
to be an
important impetus in future interventional strategies,
particularly among
aging populations.
Cohort 3—Specified Intervention and Outcome Studies
Cohort 3 represents a summarized collection of studies retained
from the

hundreds reviewed that satisfied certain criteria.
Namely, these studies (Table 8.3) contained clearly identified
inter-
ventions, specified populations, particular time frames within
which the
interventions were conducted, and targeted and/or specified
outcomes.
D=1106529.
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.
A
ll
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ts
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e
d
.
T
ab
le
8.
3
S
p
ec
ifi
ed
In
te
rv
en
ti
o
n
s
an
d
O

u
tc
o
m
es
W
it
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ld
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ly
P
o
p
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la
ti
o
n
s
B
et
w
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n
2
0
0
6
an
d
1
9
9
5
R
ef
er
en
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s
In
te
rv
en
ti
o
n
s
P

ro
v
id
ed
P
re
se
n
ti
n
g
P
ro
b
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m
s
S
p
ec
ifi
ed
P
o
p

u
la
ti
o
n
s
D
u
ra
ti
o
n
o
f
In
te
rv
en
ti
o
n
s
T
ar
g

et
ed
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tc
o
m
es
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ff
ec
ti
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en
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s
o
f
In
te
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en
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s
E
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ge
lh
ar
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t,
T
o
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la
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an
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00
6)
R
C
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,
G
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M
M
al
es
w
h
o
w
er
e
ab
o
v
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av
er

ag
e
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se
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o
f
o
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tp
at
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n
t
V
A
se
rv
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es
16
0
48
m
o

n
th
s
A
lt
h
o
u
gh
n
o
in
cr
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se
in
su
rv
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al
o
f
p
at
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n

t
in
d
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at
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,
in
te
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en
ti
o
n
ac
h
ie
v
ed
o
u
tc
o
m
e

(e
.g
.,
co
st
s
o
f
se
rv
ic
es
d
ec
re
as
ed
at
th
e
24
-
to
48

-m
o
n
th
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d
)
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h
e
G
E
M
p
ro
gr
am
ca
n
re
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th
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co
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V

A
se
rv
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.
H
u
n
k
el
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et
al
.
(2
00
6)
R
C
T
,
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C
M

(I
M
P
A
C
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–
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B
T
,
P
ST
,
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,
p
h
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th
ym

ia
,
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r
b
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th
in
p
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re
cl
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ic
s
18
01
36
m
o
n

th
s
O
u
tc
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m
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h
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.,
d
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m

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P
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h
o

m
as
et
al
.
(2
00
5)
R
an
d
o
m
C
C
T
,
T
ai
C
h
i
ex
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ci

se
,
re
si
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C
h
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es
e
su
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je
ct
s
18
0

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-m
o
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th
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n
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y
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tc
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m
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h

ie
v
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.,
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o
m
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i)
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ai
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as
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te
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is
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m
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le
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b
en
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ci
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to
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rd
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v
as
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la
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ri
sk
in
th
e
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ly
.
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o
o
n
,
H
u
i,
D
ai
,
K
w
o
k
,
an
d
W
o
o
(2
00
5)
R
C
T

,
C
B
T
,
M
D
T
,
te
le
m
ed
ic
in
e,
C
B
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,
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F
G
,

v
id
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g,
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S
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w
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en
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e
im
p
ai
rm
en
ts
in
C
h
in
a

22
12
w
ee
k
s
M
M
SE
,
R
B
M
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H
D
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sh
o
w
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n
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w
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co
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iv
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ci
ts
.
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n
gu
id
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o
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D
av
is
,
an
d
K
at
z
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00
5)
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C
T
,
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C
C
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T
,
P
ST
,

an
d
p
h
ar
m
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15
3
19
m
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(c
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D=1106529.
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C
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In
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R
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s
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s.
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17
10
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s
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cr
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ti
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p
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it
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2
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.
Jo
h
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ile
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&
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il
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o
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k
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m
p
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b
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ro
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17
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m
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je

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o
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ty
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C
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ra
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m
en
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17
8
24
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o
n
th

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ri
n
e
lo
ss
an
d
gr
ea
te
r
q
u
al
it
y
o
f
li

fe
)
In
o
ld
er
ru
ra
l
w
o
m
en
w
it
h
u
ri
n
ar
y
in
co
n
ti

n
en
ce
,
a
b
eh
av
io
ra
l
m
an
ag
em
en
t
ap
p
ro
ac
h
fo
r

co
n
ti
n
en
ce
in
te
rv
en
ti
o
n
re
d
u
ce
d
u
ri
n
e
lo
ss
.
Sc

h
o
n
fe
ld
et
al
.
(2
00
0)
C
B
T
,
p
sy
ch
o
ed
-
u
ca
ti
o
n

(G
E
T
SM
A
R
T
)
O
u
tp
at
ie
n
t
v
et
er
an
s
w
it
h
su

b
st
an
ce
ab
u
se
p
ro
b
le
m
s
11
0
16
w
ee
k
s
O
u
tc
o
m

es
ac
h
ie
v
ed
(e
.g
.,
in
cr
ea
se
in
ab
st
in
en
ce
am
o
n
g
p
at

ie
n
ts
6
m
o
n
th
s
la
te
r
an
d
lo
n
ge
r
ti
m
e
b
et
w
ee

n
re
la
p
se
s
re
p
o
rt
ed
b
y
p
at
ie
n
ts
)
G
E
T
SM
A
R

T
ca
n
b
e
an
ef
fe
ct
iv
e
in
te
rv
en
ti
o
n
w
it
h
el
d
er

ly
su
b
je
ct
s
w
it
h
su
b
st
an
ce
ab
u
se
p
ro
b
le
m
s.
M
az

zu
ca
,
B
ra
n
d
t,
K
at
z,
H
an
n
a,
an
d
M
el
fi
(1
99
9)
C
C

T
,
se
lf
-c
ar
e,
E
D
R
h
eu
m
at
o
id
ar
th
ri
ti
s
an
d
o
st

eo
ar
th
ri
ti
s
21
1
48
m
o
n
th
s
O
u
tc
o
m
es
ac
h
ie
v

ed
(e
.g
.,
ed
u
ca
ti
o
n
re
d
u
ce
d
fr
eq
u
en
cy
an
d
co
st
o
f

p
ri
m
ar
y
ca
re
v
is
it
s)
E
d
u
ca
ti
o
n
ca
n
b
en
efi
t
se

n
io
rs
in
m
an
ag
em
en
t
o
f
p
ai
n
fr
o
m
ar
th
ri
ti
c
co

n
d
it
io
n
s
an
d
re
d
u
ce
h
ea
lt
h
co
st
s.
P
ro
ct
o
r
et
al

.
(1
99
9)
R
C
T
,
C
B
T
,
SS
S
R
es
id
en
ts
in
n
u
rs
in
g

h
o
m
es
in
U
n
it
ed
K
in
gd
o
m
w
h
o
d
is
p
la
ye
d
d
ep
re

ss
io
n
an
d
o
rg
an
ic
sy
m
p
to
m
s
12
0
6
m
o
n
th
s
(i

n
cl
u
d
ed
se
v
en
1-
h
o
u
r
se
ss
io
n
s
an
d
w
ee
k
ly
SS
S

su
p
p
o
rt
fr
o
m
p
sy
ch
ia
tr
ic
n
u
rs
e)
O
u
tc
o
m
es
(e
.g

.,
o
rg
an
ic
an
d
d
ep
re
ss
iv
e
sy
m
p
to
m
s
im
p
ro
v
ed

b
u
t
b
eh
av
io
ra
l
an
d
p
h
ys
ic
al
d
is
ab
il
it
y
d
id
n
o
t)

B
eh
av
io
ra
l
o
u
tr
ea
ch
(C
B
T
)
te
am
s
ca
n
as
si
st
el
d

er
ly
w
it
h
d
ep
re
ss
iv
e
an
d
o
rg
an
ic
sy
m
p
to
m
s
b

u
t
ar
e
n
o
t
ef
fi
ca
ci
o
u
s
to
th
e
im
p
ro
v
em
en
t
o

f
b
eh
av
io
ra
l
o
r
p
h
ys
ic
al
sy
m
p
to
m
s.
(c
on
ti
n
u
ed

e
d
.
T
ab
le
8.
3
C
on
ti
n
u
ed
R
ef
er
en
ce
s
In
te
rv
en

ti
o
n
s
P
ro
v
id
ed
P
re
se
n
ti
n
g
P
ro
b
le
m
s
S
p
ec

ifi
ed
P
o
p
u
la
ti
o
n
s
D
u
ra
ti
o
n
o
f
In
te
rv
en
ti
o
n

s
T
ar
g
et
ed
O
u
tc
o
m
es
E
ff
ec
ti
v
en
es
s
o
f
In
te

rv
en
ti
o
n
s
K
ee
fe
,
C
al
d
w
el
l,
B
au
co
m
,
Sa
ll
ey

,
an
d
R
o
b
in
so
n
(1
99
9)
R
C
T
,
sp
o
u
se
-
as
si
st
ed

C
B
T
O
st
eo
ar
th
ri
ti
s
k
n
ee
p
ai
n
88
12
m
o
n
th
s
O

u
tc
o
m
es
ac
h
ie
v
ed
(e
.g
.,
o
v
er
al
l
h
ig
h
er
se
lf
-e

ffi
ca
cy
,
lo
w
er
le
v
el
s
o
f
p
sy
ch
o
lo
gi
ca
l
an
d
p
h
ys

ic
al
d
is
ab
il
it
y,
an
d
im
p
ro
v
ed
p
ai
n
le
v
el
s)
Sp
o
u

se
-a
ss
is
te
d
C
B
T
is
ef
fe
ct
iv
e
in
in
cr
ea
si
n
g
se
lf
-e

ffi
ca
cy
an
d
m
an
ag
in
g
p
ai
n
in
se
n
io
rs
w
it
h
o
st
eo

ar
th
ri
ti
s-
re
la
te
d
k
n
ee
p
ai
n
.
T
en
n
st
ed
t
et
al

.
(1
99
8)
R
C
T
,
C
B
P
,
E
D
A
d
u
lt
s
fr
o
m
40
se
n
io
r

h
o
u
si
n
g
si
te
s
in
u
rb
an
ar
ea
w
h
o
re
p
o
rt
ed
fe
ar
o

f
fa
ll
in
g
43
4
12
m
o
n
th
s
(6
-w
ee
k
,
6-
m
o
n
th
,
an

d
12
-m
o
n
th
fo
ll
o
w
-u
p
s)
O
u
tc
o
m
es
(e
.g
.,
im
m
ed
ia

te
b
u
t
n
o
t
st
at
is
ti
ca
ll
y
si
gn
ifi
ca
n
t
im
p
ro
v
em

en
t
in
m
o
b
il
it
y,
so
ci
al
fu
n
ct
io
n
al
it
y,
an
d
m
o
b
il
it

y
co
n
tr
o
l)
C
o
m
m
u
n
it
y-
b
as
ed
ed
u
ca
ti
o
n
to
re

d
u
ce
fe
ar
o
f
fa
ll
in
g
in
o
ld
er
ad
u
lt
s
h
as
m
o
d
es
t

b
en
efi
ci
al
ef
fe
ct
s.
G
la
sg
o
w
et
al
.
(1
99
7)
R
C
T
,
E

D
w
it
h
em
p
h
as
is
o
n
go
al
se
tt
in
g
an
d
P
ST
C
D
S
w

it
h
ty
p
e
2
d
ia
b
et
es
20
6
12
m
o
n
th
s
O
u
tc
o
m
es

ac
h
ie
v
ed
(e
.g
.,
si
gn
ifi
ca
n
t
im
p
ro
v
em
en
ts
in
fo
o
d

h
ab
it
s,
ca
lo
ri
c
co
n
su
m
p
ti
o
n
,
se
ru
m
ch
o
le
st
er

o
l
le
v
el
s,
an
d
p
er
ce
n
ta
ge
o
f
fa
t)
E
d
u
ca
ti
o
n
al
h

ea
lt
h
p
ro
gr
am
s
w
it
h
em
p
h
as
is
o
n
go
al
se
tt
in
g
an

d
p
ro
b
le
m
so
lv
in
g
ca
n
w
o
rk
w
it
h
el
d
er
ly
p
at

ie
n
ts
w
it
h
ty
p
e
2
d
ia
b
et
es
.
F
ri
es
,
C
ar
ey
,
an

d
M
cS
h
an
e
(1
99
7)
R
C
T
,
m
ai
l-
d
el
iv
er
ed
A
SM
P

R
h
eu
m
at
o
id
ar
th
ri
ti
s
an
d
o
st
eo
ar
th
ri
-
ti
s
37
5

6
m
o
n
th
s
O
u
tc
o
m
es
ac
h
ie
v
ed
(e
.g
.,
d
ec
re
as

ed
p
ai
n
,
gl
o
b
al
v
it
al
it
y
in
cr
ea
se
d
,
jo
in
t
co
u
n

t
im
p
ro
v
ed
,
an
d
cl
in
ic
al
v
is
it
s
d
ec
re
as
ed
)
Se
lf

-m
an
ag
em
en
t
co
u
rs
es
ca
n
im
p
ro
v
e
th
e
h
ea
lt
h
o

f
th
e
el
d
er
ly
an
d
d
ec
re
as
e
co
st
s
o
f
cl
in
ic
al
ca
re

rv
e
d
.
Sh
ar
p
e
et
al
.
(1
99
7)
E
D
an
d
p
h
ys
ic
al

ac
ti
v
it
y
p
ro
gr
am
w
it
h
em
p
h
as
is
o
n
st
re
n
gt
h
,

b
al
an
ce
,
m
o
to
r-
co
o
rd
in
at
io
n
,
an
d
m
o
b
il
it
y

A
d
u
lt
s
in
ru
ra
l
co
n
gr
eg
at
e
n
u
tr
it
io
n
si
te
s
11
0—

tr
ea
tm
en
t
gr
o
u
p
(6
1)
an
d
co
m
p
ar
is
o
n
gr
o
u
p
(4
9)

12
m
o
n
th
s
(t
w
ic
e-
w
ee
k
ly
se
ss
io
n
s)
O
u
tc
o
m
es

ac
h
ie
v
ed
(e
.g
.,
gr
ea
te
r
im
p
ro
v
em
en
ts
in
p
h
ys
ic
al

fu
n
ct
io
n
in
g
o
v
er
th
e
p
re
v
io
u
s
ye
ar
th
an
th
e
co

m
p
ar
is
o
n
gr
o
u
p
)
L
o
w
-i
n
te
n
si
ty
ex
er
ci
se
ca
n

b
en
efi
t
th
e
o
v
er
al
l
h
ea
lt
h
an
d
p
h
ys
ic
al
fu
n
ct
io

n
al
it
y
o
f
el
d
er
ly
su
b
je
ct
s.
Sl
ae
ts
,
K
au
ff
m
an
n

,
D
u
iv
en
v
o
o
r-
d
en
,
P
el
em
an
s,
an
d
Sc
h
u
d
el
(1
99

7)
M
D
T
,
P
SY
G
te
am
,
C
B
T
,
an
d
SS
S
M
ed
ic
al
in
p

at
ie
n
ts
w
it
h
p
o
o
r
p
h
ys
ic
al
fu
n
ct
io
n
in
g
23
7—
tr

ea
tm
en
t
gr
o
u
p
(1
40
)
an
d
co
n
tr
o
l
gr
o
u
p
(9
7)
12

m
o
n
th
s
(f
o
ll
o
w
in
g
d
is
ch
ar
ge
)
O
u
tc
o
m
es
ac

h
ie
v
ed
(e
.g
.,
im
p
ro
v
em
en
t
in
th
e
p
h
ys
ic
al
fu
n
ct

io
n
in
g
o
f
th
e
tr
ea
tm
en
t
gr
o
u
p
p
ar
ti
ci
p
an
ts
)

C
o
m
b
in
in
g
el
em
en
ts
fr
o
m
p
sy
ch
ia
tr
ic
,
so
ci
al
se

rv
ic
e,
an
d
ge
ri
at
ri
c
co
n
su
lt
at
io
n
w
it
h
el
em
en
ts

o
f
u
n
it
-d
ri
v
en
se
rv
ic
e
im
p
ro
v
es
p
h
ys
ic
al
fu
n
ct

io
n
in
g
am
o
n
g
th
e
el
d
er
ly
.
R
ic
h
,
G
ra
y,
B
ec
k

h
am
,
W
it
te
n
b
er
g,
an
d
L
u
th
er
(1
99
6)
R
C
T
,
M
D
T

,
N
T
,
E
D
,
an
d
SS
S
C
H
F
p
at
ie
n
ts
w
it
h
p
o
o

r
b
eh
av
io
ra
l
m
ed
ic
at
io
n
co
m
p
li
an
ce
15
6— in
te
rv
en

ti
o
n
gr
o
u
p
(8
0)
an
d
co
n
v
en
ti
o
n
al
ca
re
gr
o
u
p
(7
6)

30
d
ay
s
(f
o
ll
o
w
in
g
h
o
sp
it
al
d
is
ch
ar
ge
)
O
u
tc

o
m
es
ac
h
ie
v
ed
(e
.g
.,
m
ed
ic
at
io
n
co
m
p
li
an
ce
in
p

at
ie
n
ts
in
cr
ea
se
d
)
A
M
D
T
ca
n
im
p
ro
v
e
m
ed
ic
at

io
n
co
m
p
li
an
ce
d
u
ri
n
g
fi
rs
t
30
d
ay
s
fo
ll
o
w
in

g
d
is
ch
ar
ge
fr
o
m
th
e
h
o
sp
it
al
in
el
d
er
ly
p
at
ie
n

ts
w
it
h
C
H
F
.
M
ai
si
ak
,
A
u
st
in
,
an
d
H
ec
k
(1

99
6)
R
C
T
,
te
le
p
h
o
n
e
m
o
n
it
o
ri
n
g
an
d
co
u
n
se

li
n
g
R
h
eu
m
at
o
id
ar
th
ri
ti
s
an
d
o
st
eo
ar
th
ri
ti
s

40
5
9
m
o
n
th
s
O
u
tc
o
m
es
ac
h
ie
v
ed
(e
.g
.,
b
et
te

r
h
ea
lt
h
st
at
u
s
sc
o
re
s,
n
u
m
b
er
o
f
m
ed
ic
al
v

is
it
s
d
ec
re
as
ed
)
E
ld
er
ly
p
at
ie
n
ts
w
it
h
rh
eu
m

at
o
id
ar
th
ri
ti
s
an
d
o
st
eo
ar
th
ri
ti
s
ar
e
re
sp
o
n
si

v
e
to
te
le
p
h
o
n
e
co
u
n
se
li
n
g
an
d
su
p
p
o
rt
fo
r
p
ai

n
.
(c
on
ti
n
u
ed
ov
er
le
a
f)
217
D=1106529.
C
o
p
yr
ig
h
t

ll
ri
g
h
ts
r
e
se
rv
e
d
.
T
ab
le
8.
3
C
on
ti
n
u
ed
R
ef
er

en
ce
s
In
te
rv
en
ti
o
n
s
P
ro
v
id
ed
P
re
se
n
ti
n
g
P
ro

b
le
m
s
S
p
ec
ifi
ed
P
o
p
u
la
ti
o
n
s
D
u
ra
ti
o
n
o

f
In
te
rv
en
ti
o
n
s
T
ar
g
et
ed
O
u
tc
o
m
es
E
ff
ec
ti
v

en
es
s
o
f
In
te
rv
en
ti
o
n
s
R
ic
h
et
al
.
(1
99
5)
P
R

T
,
N
u
rs
e-
d
ir
ec
te
d
M
D
T
,
N
T
,
E
D
,
an
d
SS
S

C
H
F
p
at
ie
n
ts
w
it
h
p
o
o
r
b
eh
av
io
ra
l
co
m
p
li
an

ce
to
tr
ea
tm
en
t
w
h
o
w
er
e
at
ri
sk
fo
r
re
-
ad
m
it
ta

n
ce
to
h
o
sp
it
al
fo
ll
o
w
in
g
d
is
ch
ar
ge
28
2— tr
ea
tm
en
t

gr
o
u
p
(1
42
)
an
d
co
n
tr
o
l
gr
o
u
p
(1
40
)
90
d
ay
s

(f
o
ll
o
w
in
g
h
o
sp
it
al
d
is
ch
ar
ge
)
O
u
tc
o
m
es
ac

h
ie
v
ed
(e
.g
.,
h
o
sp
it
al
re
ad
m
is
si
o
n
w
as
si
gn
ifi
ca

n
tl
y
re
d
u
ce
d
)
N
u
rs
e-
d
ir
ec
te
d
M
D
T
ca
n
im
p
ro

v
e
th
e
q
u
al
it
y
o
f
li
fe
an
d
re
d
u
ce
b
o
th
h
o
sp
it

al
u
se
an
d
m
ed
ic
al
co
st
s
fo
r
el
d
er
ly
p
at
ie
n
ts
w
it

h
C
H
F
.
B
ai
ll
y
an
d
D
eP
o
y
(1
99
5)
A
D
E
,
E
C

G
C
li
en
ts
at
a
fa
m
il
y
m
ed
ic
al
ca
re
p
ra
ct
ic
e
in
ru

ra
l
ar
ea
10
2
w
ee
k
s
St
at
is
ti
ca
ll
y
si
gn
ifi
ca
n
t
in

cr
ea
se
in
k
n
o
w
le
d
ge
o
f
A
D
E
w
as
n
o
t
re
p
o
rt
ed

A
u
th
o
rs
su
gg
es
t
th
at
A
D
E
m
ay
b
e
a
fa
m
il
y
is
su

e
ra
th
er
th
an
so
le
ly
an
in
d
iv
id
u
al
is
su
e.
A
D
E
=
A
d

v
an
ce
d
ir
ec
ti
v
e
ed
u
ca
ti
o
n
;
A
SM
P
=
A
rt
h
ri
ti
s

se
lf
-m
an
ag
em
en
t
p
ro
gr
am
;
C
B
P
=
C
o
m
m
u
n
it
y-
b

as
ed
gr
o
u
p
;
C
B
T
=
C
o
gn
it
iv
e
b
eh
av
io
ra
l
th
er
ap

y;
C
C
M
=
C
o
ll
ab
o
ra
ti
v
e
ca
re
m
an
ag
em
en
t;
C
C

T
=
C
o
n
tr
o
ll
ed
cl
in
ic
al
tr
ia
l;
C
D
S
=
C
o
m
m
u
n

it
y-
d
w
el
li
n
g
se
n
io
rs
;
C
G
A
=
C
o
m
p
re
h
en
si
v

e
ge
ri
at
ri
c
as
se
ss
m
en
t;
C
H
F
=
C
o
n
ge
st
iv
e
h
ea

rt
fa
il
u
re
;
D
E
E
D
II
=
D
is
ch
ar
ge
o
f
el
d
er
ly
fr
o

m
th
e
em
er
ge
n
cy
d
ep
ar
tm
en
t
p
ro
gr
am
;
D
P
A
H
C

=
D
u
ra
b
le
p
o
w
er
o
f
at
to
rn
ey
fo
r
h
ea
lt
h
ca
re
;

E
C
G
=
E
d
u
ca
ti
o
n
al
co
n
tr
o
l
gr
o
u
p
;
E
D
=
E
d
u
ca

ti
o
n
;
F
T
F
G
=
F
ac
e
to
fa
ce
gr
o
u
p
;
G
E
M
=
G
er

ia
tr
ic
ev
al
u
at
io
n
an
d
m
an
ag
em
en
t
p
ro
gr
am
;
G
E

T
SM
A
R
T
=
G
er
ia
tr
ic
ev
al
u
at
io
n
te
am
:
su
b
st
an

ce
m
is
u
se
/a
b
u
se
re
co
gn
it
io
n
an
d
tr
ea
tm
en
t
p
ro
gr

am
;
G
T
=
G
ro
u
p
th
er
ap
y;
H
D
S
=
H
ie
ra
rc
h
ic
al

d
em
en
ti
a
sc
al
e;
L
W
=
L
iv
in
g
w
il
l;
M
D
T
=
M
u
lt
id

is
ci
p
li
n
ar
y
te
am
;
M
M
SE
=
M
in
i-
m
en
ta
l-
st
at
e
ex
am

in
at
io
n
;
N
T
=
N
u
tr
it
io
n
al
tr
ai
n
in
g;
P
C
C
B
T

=
P
at
ie
n
t-
ce
n
te
re
d
co
gn
it
iv
e
b
eh
av
io
ra
l
th
er
ap

y;
P
R
T
=
P
ro
sp
ec
ti
v
e
ra
n
d
o
m
iz
ed
tr
ia
l;
P
ST
=
P
ro

b
le
m
so
lv
in
g
th
er
ap
y;
P
SY
G
=
P
sy
ch
o
ge
ri
at
ri
c;

P
T
=
P
h
ys
io
th
er
ap
y;
R
B
M
T
=
R
iv
er
m
ea
d
b
eh
av

io
ra
l
m
em
o
ry
te
st
;
R
C
T
=
R
an
d
o
m
cl
in
ic
al
tr
ia

l;
SS
S
=
So
ci
al
se
rv
ic
e
su
p
p
o
rt
;
SS
W
=
Se
ss
io
n
w

it
h
so
ci
al
w
o
rk
er
;
V
A
=
V
et
er
an
s
A
d
m
in
is
tr
at

They employed a range of practitioners including professionals,
semiprofes-
sionals, health-care agents, and family members of the subjects
examined.
Additionally, interventions were offered in clinical and
nonclinical loca-
tions and in an array of social settings, including urban,
suburban, and
rural, both in the United States and abroad.
The collective interventional framework of the studies in Cohort
3 can be generalized into two overlapping spheres, mental
health and
physical health. This may be due to the fact, in part, that the
presenting
problems of many elderly patients/clients are diametrically
related to the
unique transitions of later life, for example, declining health,
chronic and
acute pain, increased limitations in physical performance, loss
of social
connections and relationships, sociocultural isolation, cognitive
changes,
the escalating cost of health care, and anxiety and depressive
disorders.
And many of these are interrelated. As the unprecedented
increase in the
number of elderly continues to proliferate and the life
expectancy of older
adults extends, empirical evidence-based research on
efficacious interven-

tions will continue to be an essential tool to the social work
practitioner
(Cummings & Kropf, 2009). Curiously, of the hundreds of
studies reviewed
here, most of the discipline-specific social work publications
failed to meet
the stringent intervention-outcome identified criteria in Table
8.3.
Many of these study designs included interdisciplinary, and/or
multi-
interventional strategies to address presenting problems
(Caplan, Williams,
Daly & Abraham, 2004; Poon, Hui, Dai, Kwok, & Woo, 2005;
Rich, Gray,
Beckham, Wittenberg, & Luther, 1996; Slaets, Kauffmann,
Duivenvoor-
den, Pelemans, & Schudel, 1997). Multidisciplinary teamwork
in treating
the elderly is the norm and appears to be the most effective
interven-
tional stratagem. Perhaps this is due in part to the complexities
that are
concurrent to later-life experiences and its respective host of
challenges.
Among the uniqueness of gerontological practice is the
biopsychosocial
holistic approach to using interventions with the client. Using a
multidisci-
plinary approach is one way of addressing the whole person in
his or her
environment.
Cohort 3 studies clearly reveal an eclectic methodological range
in
their interventions. These interventions range in duration from 2

weeks
to 48 months and every possibility in between. Some
synthesized phar-
macological and therapeutic stratagems to address presenting
problems of
severe depression in the elderly subjects (Enguidanos, Davis, &
Katz, 2005;
Hunkeler et al., 2006). Others utilized a collaborative approach
of tech-
nology and therapy to address presenting problems ranging from
cognitive
impairment to chronic pain, from depression to arthritis, and
from urinary
incontinence to dementia (Dougherty et al., 2002; Poon et al.,
2005; Tse
et al., 2005).
Since the 1950s, the ubiquitous modality for treating the elderly
is
group work (Husaini et al., 2004). This approach continues to
be apparent,
having success in both achieving desired outcomes (Ball et al.,
2002) and
D=1106529.
C
o
p
yr

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