Social Work in Action

Background

In 2019, the number of older adults ages 65 years and older represented 18.4% of the population in Hawai‘i.¹ Hawai‘i's older adult population is expected to continue growing.^1,2 In 2015, Alzheimer disease (AD) ranked as the sixth leading cause of death in Hawai‘i. By 2025, there will be 35,000 individuals ages 65 and older with AD. This leads to high caregiving burdens and healthcare costs.³ The mean annual per-person Medicare spending for older adults without AD and other dementias is $7,561, whereas spending for those with AD and other dementias is more than triple ($24,598).⁴

Why is cognitive impairment a critical issue to the state of Hawai‘i? At an individual level, older adults are at risk of losing independence and quality of life. At a societal level, caregiving and economic burdens challenge us to identify the protective and risk factors of cognition. For instance, medical care costs for AD and other dementias are expected to exceed $1.1 trillion in 30 years (2050).⁵

Current Efforts in Hawai‘i

Responding to the societal impact of cognitive impairment in old age, stakeholders in Hawai‘i endeavor to promote cognitive health (eg, the ability to think, judge, learn, and remember)⁶ through initiatives in the following areas: education/research, community programs, and policies.

Interdisciplinary collaboration on campus is burgeoning and an exemplar is the Pacific Islands Geriatrics Workforce Enhancement Program (PI-GWEP), funded by the Health Resources and Services Administration (HRSA), led by investigators Dr. Aida Wen and Dr. Kamal Masaki, from the John A. Burns School of Medicine (JABSOM) at the University of Hawai‘i at Mānoa, PI-GWEP offers a unique educational experience training healthcare leaders from disciplines including medicine, nursing, pharmacy, and social work.⁷ Interdisciplinary assessment and didactic sessions are conducted to develop comprehensive care plans for older adults with dementia and other conditions. Gerontologists from MBTSSW at UH Mānoa continue to collaborate to improve the health and quality of life for Native Hawaiian older adults. As part of the Myron B. Thompson School of Social Work (MBTSSW) at UH Mānoa, the Center on Aging is leading the Hawai‘i Alzheimer's Disease Initiative (HADI). This initiative strengthens the capacity of Hawaii's community to support older adults with dementia and their caregivers through various activities. HADI offers online resources such as a dementia care coordination practice tool, a clinical provider practice tool, and a memory care navigator roadmap. The center is also working on expanding the number of memory care navigators and Staff Training in Assisted-living Residences - Caregivers (STAR-C; ie, intervention for caregivers and dementia-capable memory clinics).⁸

Hā Kūpuna is a National Resource Center for Native Hawaiian Elders, established in 2006, at UH Mānoa. One example of their innovative work related to cognitive health is the development of a short storybook, “Pomai and Her Papa.” This storybook provides reader-friendly information about the signs of dementia. Through visual illustrations and easy-to-understand language, the storybook offers a guide to support both older adults and young caregivers.^9,10 This storybook is a unique resource for families in Hawai‘i, as there are a good number of intergenerational families in the state.^9,10 Young caregivers may be the first to observe dementia symptoms in their older family members. Hā Kūpuna's work demonstrates educational and research efforts to disseminate cognitive health-related knowledge to the general public.

Community organizations in Hawai‘i provide resources not only for older adults with cognitive impairment but also for dementia caregivers. For instance, Catholic Charities Hawai‘i offers various workshops and coaching programs. The organization offers caregivers a workshop to train them in the Rosalynn Carter Institute for Caregiving (RCI) Resources for Enhancing Alzheimer's Caregivers Health (REACH) Program. This program is known to benefit the psychological well-being and quality of life of dementia caregivers by offering self-care and self-efficacy techniques. Starting in the summer of 2020, Catholic Charities Hawai‘i will offer a series of workshops in O?ahu that focus on a positive approach to dementia care.¹¹

The Executive Office on Aging (EOA) of the Hawai‘i State Department of Health (DOH) continues to support and fund programs and services to improve the health and well-being of older adults in Hawai‘i.2 The EOA of the DOH indicated that it is the state's priority to address cognitive health issues in the following areas by 2025: AD prevention and treatment, quality of care, support for older adults and caregivers, public awareness, and data tracking.¹²

In addition to current efforts to address cognitive health issues in Hawai‘i, there is an innovative theoretical framework that can inform cognitive health research, programs, and policies. Gerontologists utilize the productive aging framework to promote health in later life.

Definition

Understanding the productive aging framework provides strategies to promote healthy cognition in later life. According to gerontologists, productive activities are defined as paid or non-paid activities performed by older adults that contribute to the greater society. Productive activities include work, volunteering, and caregiving.^13,14 Due to the mixed findings on the caregiving-health association,^15,16 the following sections focus on work and volunteering, and its implications for healthy cognitive aging.^13,14

Work and Cognition

Previous studies found that work provides an opportunity for cognitive stimulation, resulting in better cognitive health outcomes.^17,18 Moreover, work that involves interaction with others, such as taking instructions or helping, is associated with reduced risk of AD.¹⁹ Despite the positive impact of work on cognitive health, not everyone has an equal opportunity to be engaged in the labor force. Thus, programs such as the Senior Community Service Employment Program (SCSEP), funded by the US Department of Labor, increase work opportunities for vulnerable older adults. The SCSEP started in 1965 and is an employment program for low-income older adults ages 55 and older. The program trains eligible older adults to develop the skills necessary for permanent employment.^20,21 The State of Hawai‘i Workforce Development Division (WDD) provides detailed information on the benefits of SCSEP and participant eligibility. The information is available at https://labor.hawaii.gov/wdd/home/job-seekers/scsep/benefitseligibility/.²² Promoting employment programs, offering resources, and options for flexible work can not only benefit society but also provide cognitive stimulation for older adults.

Volunteering and Cognition

Engagement in volunteering can promote cognitive health in later life.^23–26 When older adults engage in a community-based intergenerational volunteering program, there are positive health consequences. For instance, the Baltimore Experience Corps involved older volunteers in teaching and working with elementary school students. As a result of this program, the students benefited academically, while the older adults had positive health outcomes. The older adults experienced better cognitive health outcomes such as improved executive function, increased brain activity, and increased brain volume.^23–26

In Hawai‘i, there is an intergenerational program called Ka ‘Aha. It is an online-based program connecting and increasing bonding across different generations. For 8 weeks, a team of 2 to 4 from at least 2 different generations participate in activities provided by the program website. The activities include spending time together, using technology to communicate with each other, eating together, and participating in community events. The intention of this program is to facilitate intergenerational interactions and to share culture/traditions passing from older adults to children.²⁷ Similar to the Experience Corps model, the Ka ‘Aha program incorporates intergenerational activity with cognitive stimulation. The state of Hawai‘i can utilize the productive aging framework to develop more intergenerational volunteering programs for cognitive health promotion initiatives.

Social Work Implications

Social work as a profession strives to improve the lives of vulnerable populations and promote social justice. The employment of social workers is expected to rapidly increase 11%between 2018 and 2028, in part due to increased demand for healthcare.²⁸ Social workers are involved in various areas of social issues and there is a growing need for geriatric social workers due to the rapidly increasing number of older adults. Geriatric social workers work with individual clients and they also engage in policy-making.^29,30 They can also promote healthy aging for older adults with cognitive impairments. Addressing cognitive health issues can improve the quality of life of older adults and their families. According to the American Academy of Social Work and Social Welfare, one of the 12 social work grand challenges is to “advance long and productive lives.”³¹

MBTSSW at UH Mānoa offers training opportunities for geriatric social workers to serve older adults. For instance, MBTSSW offers courses on the topics of aging. The MBTSSW gerontology specialization is one of the first in the nation and remains the only advanced degree program in the state for social workers. For undergraduate students, “SW 477 Social Welfare Concepts and Issues in Gerontology” is offered to educate on aging issues at the micro, mezzo, and macro levels and the role of social work. For master's students, the program offers a gerontology specialization that was directed by Dr. Colette V. Browne. Social work students can take the following courses to enrich their experience and understanding of aging and society: “SW 639 Social and Cultural Aspects of Aging”, “SW 727 Seminar in Social Work with the Aged” and “SW 797 Advanced Social Welfare Policy and Change.” Additionally, at MBTSSW, social workers have the opportunity to leverage aging-related resources at the Center on Aging. There is a growing interest in productive and healthy aging among faculty and students.

Conclusion

One of the priorities in Hawai‘i is to address cognitive impairment in later life, especially with the demographic phenomenon of population aging. In addition to the ongoing initiatives, future research, intervention, and policy efforts can utilize productive activities to improve cognitive health. The application of a strength-based perspective on productive aging to promote cognitive health can enhance the state's ability to support our older adults. Additionally, educational efforts to train future geriatric social work leaders can prepare them to serve the needs of the individual, the family, and the community.