A post-master's program in gerontological social work: fulfilling a practice need in health care.

This paper details an innovative Fellowship Program which provides intensive Post-Master's training in gerontological social work. The paper addresses the implications for social work education and practice for the growing number of elders in today's health care environment and in the future. The paper outlines the philosophy, design and implementation of the Program, suggesting ways in which a Fellowship can be modified for other settings. The authors discuss the evolution of the Program over six years, including funding challenges, overall benefits to such an undertaking, as well as future directions.

To drive or not to drive: preliminary results from road testing of patients with dementia.

There has been considerable debate about whether driving privileges should be revoked from patients with a diagnosis of dementia and whether highway safety policies should come under closer scrutiny for all elderly. Two case studies are reported of patients with a diagnosis of probable Alzheimer's disease who participated in a pilot project to assess driving. Subjects underwent neurologic and neuropsychological evaluation. Caregivers were included in psychosocial assessments. Patients participated in a specially designed driving evaluation, including an actual road test. Although both patients had mild-to-moderate cognitive impairment on standard tests, one of the patients was deemed safe to drive on the road test while the other was not. These preliminary results suggest that driving skill may not be predictable solely on the basis of the office examination. A road competency test provides a more objective and direct measure on which to base a decision of such important consequence. Implications for public policy and the role for healthcare providers in this process are discussed.

Professional and family collaboration in case management: a hospital-based replication of a community-based study.

This paper presents the results of research on a program that trains family members to serve as case managers for their elderly relatives. The effectiveness of the training program was evaluated using a randomized experimental design. Data were collected in an urban hospital setting about two groups of elderly patients: those with dementia and those needing hemodialysis. Family members of both types of patients were assigned randomly to an experimental group, which received systematic training in performing case management activities, or to a control group, which received only the services ordinarily provided by the hospital social work department. Post-test comparisons revealed that the experimental group family members performed significantly more case management tasks on behalf of their elderly relatives than did family members in the control group. Although trained family members assumed more responsibility for case management, there was no increase in the level of their subjective or objective caregiving burden. Implications for social work practice are presented.

Empowering families of the chronically ill: a partnership experience in a hospital setting.

An intervention model has been developed which teaches family members, in partnership with social workers, to obtain and monitor services for their chronically ill elderly relatives. The research site is a Boston teaching hospital with a patient population that is ethnically and racially diverse. Initial results of the study reveal that case management is easily accepted by most families, and the partnership between the family member and social worker enhances the delivery of needed services.

Temporal lobe epilepsy: social and psychological considerations.

The diagnosis of temporal lobe epilepsy (TLE) holds significant psychosocial ramifications for the patient and family. TLE is a type of seizure disorder which challenges the usual notions of epilepsy. Patients with TLE may never experience the stereotypical convulsion; rather, TLE seizures are more likely to take the form of changes in behavior and deepened emotionality. The symptoms are confusing and often frightening for the patient, his family and the larger community. This article explores the patient's and the family's reactions to TLE--myths that influence them, the practical and emotional dilemmas that confront them, and the benefits of social work intervention.

Living with dementia: the ongoing funeral.

Dementia is an illness profoundly affecting the patient's physical and emotional well-being. The impact of the disease extends far beyond the patient himself, touching each family member involved in the patient's care. Social workers and other mental health professionals can offer valuable assistance to the family as they experience each stage of the patient's illness. Several theoretical constructs aid in understanding the grieving process of the family. Clinical case examples are used to highlight individual and group therapeutic interventions.