March/April 2023

Education: Raising the Bar in Gerontological Social Work Education
By Josh Hildebrand
Today’s Geriatric Medicine
Vol. 16 No. 2 P. 6

A gap in clinical social work education in gerontology leaves an aging population without adequate care. Simulation training can help.

It’s well documented that people are living longer than in previous generations. According to a study published in 2009, there’s been a roughly 30-year increase in lifespan in western Europe, the United States, Canada, Australia, and New Zealand, and larger increases in Japan, Spain, and Italy1—changes that may be attributable to healthier habits such as less smoking, more exercising, and improved diets.

While older adults in places such as the United States are trending healthier, with age may come weakness, increased fragility, a greater likelihood of developing chronic conditions and diseases such as Alzheimer’s or Parkinson’s, and a higher risk of injuries from falls and other accidents. Physicians can diagnose and treat these conditions, but what happens afterward? What options are available for continued support and aid?

The answer? Social workers. Or that should be the answer—if it weren’t for a shortage of social workers interested in working with older adults and a lack of training for those who are interested.

Barriers to the Practice of Gerontological Social Work
A shortage of social workers specializing in gerontology has been a pressing issue since as early as the 1970s, according to a study from that year which is referenced in a 2006 article in The Journal of Gerontological Social Work.2 The study author pointed to a “lack of responsiveness” to the field of gerontological social work that, if left unattended, would create a larger issue in the future. Authors of the 2006 article state that in 1998, the John A. Hartford Foundation created numerous programs designed to address obstacles to the progression of interest in the specialty. Many of these highlighted the existence of gerontological education programs for social work students and touted a key benefit of the profession—the satisfaction of enhancing the well-being of a burgeoning population of older adults.

One of the chief aims of the Hartford Foundation initiatives was to pique the interest of social work students and faculty in the field by adding more gerontological content to social work curricula through the GeroRich program, designed to infuse social work course offerings with gerontological content.2 Results demonstrated numerous areas of improvement in schools that employed the program. Because the scope of the study was limited, with only 67 colleges and universities receiving funding to participate, the authors called for programs such as GeroRich to be implemented in a wider array of colleges and universities, not only to increase gerontological curricula but also to improve faculty engagement, seeking gerontological social workers to foster connections with students, and facilitate ongoing faculty research in gerontology.

Despite such consistent efforts to raise awareness of the importance of the practice and address the dearth of gerontological social workers, the problem has persisted. Many social work students are still unaware of gerontological programs offered by colleges and universities, and innovative education remains lacking.

Zvi Gellis, PhD, director of Penn Center for Mental Health & Aging Research, cites a Bureau of Labor Statistics’ prediction that between 2019 and 2029, there will be a 14% increase in demand for gerontological social workers.3 Thus, further efforts to interest social work students in gerontology and prepare them for practice are crucial. But a number of obstacles stand in the way.

Gellis identifies several of the barriers. Limited faculty training and/or expertise in gerontology content, limited funding for gerontology in social work schools and beyond, and a lack of interest or exposure by incoming graduate social work students are all factors leading to a lack of trained social workers equipped to deal with the needs of older adults.

“Delivering care to older adults and their families is frequently a complex and demanding task,” he says. “Negative bias by students of unrewarding or not sufficiently challenging work with older adults can dissuade them from pursuing gerontological social work. Additionally, many incoming social work students likely have a greater interest in child welfare instead of gerontology.”

The authors of a 2014 study echo Gellis’s observations, citing several studies from the early 2000s that point to social work students’ interest in working with younger patients, one noting that only about 3% of social workers specialized in gerontology.4 A 2011 study surveyed a group of 237 social work students to determine if they had heard of a gerontological specialty and/or if they knew what the word meant. Forty percent of the students were unaware their colleges or universities offered such a course and lacked an understanding of the word.5

“There is a lack of required innovative geriatric curricula,” Gellis says. “The chasm between academic coursework and field internship performance remains challenging.” One way to bridge that gap is through simulation training. “Clinical teaching through hi-fidelity simulations of real-world practice can challenge students to greater levels of clinical competency and confidence without the threat of patient harm.”

An Effective Strategy
Gellis is coauthor of a recent University of Pennsylvania study of a program involving integrated simulation in teaching clinical social work skills. Published in the Journal of Social Work Education, it highlights the importance of clinical education in social work curricula, not only to provide students with actual clinical experience but also to bring awareness to the field of gerontology and the important role social workers play in aiding the older adult population.3 The study program was designed by faculty at the School of Social Work, with scenarios based on information and encounters that occur in clinical practice. Students were assigned to engage with older adult patients, portrayed by actors, who presented with a range of chronic health and mental health conditions, such as depression.3 Students would then counsel the patients to improve their well-being.

Sessions with patients were 30 minutes long and recorded for later viewing by faculty and students. Following each session, students met once more with their respective patients for 15 minutes to discuss the outcomes of the simulation; the actor patients assessed the students’ interpersonal skills and shared feedback.

Results indicate that students reacted positively to the training, with many reporting feeling more confident about counseling and putting into practice the content they’d previously been learning only through coursework. Additionally, students remarked on the importance and relevance of simulations, stating that they provided a safe and productive learning environment.

“Simulation-based learning offers students the opportunity to practice social work assessment, problem-solving, decision-making, and treatment skills in a realistic environment,” Gellis says. “Simulations guide our understanding of the educational process in developing social work counseling skills at the cognitive, emotional, and behavioral levels of learning.”

Gerontological Social Workers Are Essential
COVID-19 exacerbated the lack of access to care and, at the same time, underscored the importance of social work for older adults.

“With the COVID-19 pandemic, we saw an increase in retirement of older social workers,” Gellis says. “This has been especially problematic in rural areas in the US suffering from a serious shortage of social workers, which was exacerbated by the pandemic.”

Other factors also contributed to the lack of access to social work care at the onset of the pandemic in 2020. Facilities such as nursing homes were forced to forego social work intervention because of a shortage of personal protective equipment, leading to significantly worse outcomes among residents.6

While telehealth options have expanded since the start of the pandemic, older adults, who were at greater risk, were more fearful of contracting the disease than were their younger counterparts and were worse off while being isolated from family and friends.7 This issue was further compounded by a lack of understanding of and access to smartphones and other such devices allowing digital communication during quarantine.

The ability of social workers to assist older adults has a profound impact on their health outcomes, as demonstrated by the consequences of their decreased presence when COVID-19 emerged.6 But their importance exists outside of such extenuating circumstances as well. Studies show that gerontological social workers improve patient morale and positively influence their mental well-being. Additionally, gerontological social workers have been proven to improve recovery times post surgeries.8

Because older adults may find it difficult to advocate for themselves and their treatment, they depend on social workers’ advice, advocation, psychotherapeutic support, and knowledge.8

“Social workers assist in ensuring older adults live in their own home to maintain their independence,” Gellis says. “They also provide comprehensive biopsychosocial assessment of older persons, managing chronic conditions for those who are medically frail and provide psychological interventions for stress, anxiety, isolation, and depression.”

The role of gerontological social workers cannot be understated. It is imperative that social work schools and other institutions promote gerontological programs—such as Gellis’ simulation training—to pique student interest and equip them with the necessary skills to ensure that older adults will not go without the essential care and support of social workers.

— Josh Hildebrand is an editorial assistant at Great Valley Publishing.

References
1. Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet. 2009;374(9696):1196-208.

2. Sanders S, Dorfman LT, Ingram JG. Geriatric enrichment in social work education: lessons learned from the GeroRich projects. J Gerontol Soc Work. 2009;52(4):354-376.

3. Gellis ZD, Gregory C, LaMarra D, et al. Effectiveness of an integrated simulation in teaching clinical social work skills: geriatric mental health proficiency [published online July 11, 2022]. J Soc Work Educ. doi: 10.1080/10437797.2022.2089304.

4. Cummings SM, Adler G, DeCoster VA. Factors influencing graduate-social-work students’ interest in working with elders. Educ Gerontol. 2005;31(8):643-655.

5. Ball E. Ageism in Social Work Education: a Factor in the Shortage of Geriatric Social Workers [MSW thesis]. California State University, Long Beach ProQuest Dissertations Publishing; 2018. 10751740.

6. Bern-Klug M, Beaulieu E. COVID-19 highlights the need for trained social workers in nursing homes. J Am Med Dir Assoc. 2020;21(7):970-972.

7. Banerjee D. The impact of Covid-19 pandemic on elderly mental health. Int J Geriatr Psychiatry. 2020;35(12):1466-1467.

8. Ray M, Milne A, Beech C, et al. Gerontological social work: reflections on its role, purpose and value. Br J Soc Work. 2014;45(4):1296-1312.