Mary Beth Morrissey

Forget Me Not: Dementia in Prison.

The number of older adults with dementia in U.S. prisons is rapidly rising. Yet, the vast majority of this marginalized subgroup of the aging population is left neglected behind bars without access to adequate medical and mental health care services. We assert that proactive, interdisciplinary collaborative efforts to improve practice, policy, and research and to develop a high-quality evidence-based continuum of care for this aging population are urgently needed. The overarching goals of this paper are to raise awareness of the life and experiences of persons with dementia in prison and to stimulate discussion, research, and advocacy efforts for this forgotten subgroup of older Americans. We describe the growing number of older adults with dementia in U.S. prisons, high-risk factors for dementia present in the prison population, and the life and experience of persons with dementia in the culture and environment of prison that is primarily not designed for them. We review the current state of services and programs for dementia in prison. We conclude by proposing practice, policy, and research-related priority areas and strategies for interdisciplinary gerontological responses.

The aftermath of childhood trauma on late life mental and physical health: a review of the literature

This article is an examination of the empirical literature published in peer-reviewed journals, which investigated samples of adults aged 50 and older, who had experienced trauma, in childhood with follow-up of the impact on later life mental and physical health. Articles were identified through searches of EBSCO host databases, such as PubMed, SocioIndex, and PsychoLit. Search terms such as childhood trauma and cumulative trauma were paired with the term older adults in varying combinations. The collective findings of 23 studies published between 1996 and 2001 suggested that trauma first documented as occurring in childhood is associated with later life mental and physical health. Methodological limitations and future directions as well as recommendations for practice, policy, and research with older adults and trauma are delineated. Language: en

Key Role of Social Work in Effective Communication and Conflict Resolution Process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and Shared Medical Decision Making at the End of Life

In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care.

Relationship Between Pain and Chronic Illness Among Seriously Ill Older Adults: Expanding Role for Palliative Social Work

Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed.

Phenomenology of Pain and Suffering at the End of Life: A Humanistic Perspective in Gerontological Health and Social Work

In this article, the author examines the phenomenology of pain and suffering and the fundamentally social nature of living with serious illness for older adults at lifes end. She focuses on three concerns in gerontological health and social work: developing a phenomenological account of lived experiences of pain and suffering; articulating a humanistic phenomenological perspective on the axiological and ethical dimensions of pain and suffering; and exploring a phenomenological approach to a more humanistic, person-centered social work practice with older adults in end-of-life and palliative care. The contribution that the author makes through this article is in elaborating a humanistic framework for understanding agency, obligation, and ethical choice in end-of-life decision making.

Health Care Costs in End-of-Life and Palliative Care: The Quest for Ethical Reform

Health reform in the United States must address both access to medical services and universal insurance coverage, as well as health care cost containment. Uncontrolled health care costs will undermine improvements in access and coverage in the long-run, and will also be detrimental to other important social programs and goals. Accordingly, the authors offer an ethical perspective on health care cost control in the context of end-of-life and palliative care, an area considered by many to be a principal candidate for cost containment. However, the policy and ethical challenges may be more difficult in end-of-life care than in other areas of medicine. Here we discuss barriers to developing high quality, cost effective, and beneficial end-of-life care, and barriers to maintaining a system of decision making that respects the wishes and values of dying patients, their families, and caregivers. The authors also consider improvements in present policy and practice—such as increased timely access and referral to hospice and palliative care; improved organizational incentives and cultural attitudes to reduce the use of ineffective treatments; and improved communication among health professionals, patients, and families in the end-of-life care planning and decision-making process.

Public Health Imperative of the 21st Century: Innovations in Palliative Care Systems, Services, and Supports to Improve Health and Well-Being of Older Americans

A primary aim of federal aging and health policy must be promoting innovations in palliative care systems, services, and supports that improve the experience of growing old in America. Older adults must contend today with increasing burden over the life course often as the result of life-limiting chronic pain and chronic illnesses as well as social and economic factors beyond their control. These burdens are frequently shared with unpaid family caregivers who provide significant uncompensated medical care and social support to their loved ones. Enjoyment of the highest attainable standard of physical and mental health, recognized as a fundamental human right under international law, remains a goal for all older adults and encompasses the right to palliative care. For many older Americans, especially vulnerable subgroups who face health and pain disparities, however, this goal remains elusive. A public health strategy for implementing palliative care policy interventions will help to build age-friendly environments, assure the availability and accessibility of palliative systems of care, essential medicines, and an adequate generalist-level workforce, and sustain diffusion of innovation across all levels of health and social provision. The 2015 White House Conference on Aging must make these realignments a policy priority in order to foster social and economic development for all older Americans.

Suffering narratives of older adults : a phenomenological approach to serious illness, chronic pain, recovery and maternal care

Introduction 1. The Dialectics of Suffering and Maternal Care-Seeking in Serious Illness 2. The Narrative of Angelique: Maternal Affordances in Suffering 3. The Social Ecology of Suffering in Serious Illness: Loss of Maternal Foundations 4. Suffering and Care-Seeking as Moral Experience: The Movement Toward Self-Actualizing and Spiritual Well-Being 5. The Narrative of Camila: Enacting and Reenacting Cultural Meanings of Faith and Fidelity 6. Living in Community: The Gifts of Grapes and Maternal Grace 7. Seriously Ill Older Adult Men in Recovery: Maternal Care Facilities 8. A Call for Broader Social Care Provision: A Maternal Turn in Ethics of Care

Sexual Abuse Histories Among Incarcerated Older Adult Offenders: A Descriptive Study

In the United States today, there are over 2.2 million incarcerated adults held in custody in U.S. state or federal prisons or local jails (Glaze, 2010). Prison facilities are oftentimes filled to capacity or in some cases, so overcrowded that conditions violate the constitutional rights of adults in prison (Brown v. Plata, 2011; Sabol & West, 2009; West & Sabol, 2008). Official statistics paint a contemporary portrait of the 1.5 million adult sentenced prisoners under state or federal jurisdiction who are mostly male (93%) and from diverse racial and ethnic backgrounds including Black American (36%), Caucasian (31%), and Latino (20%)(West & Sabol, 2008). Black males continue to have the highest incarceration rates across all age categories compared to White or Latino males (Sabol & Couture, 2008). There is a growing number of older adults in both state and federal prisons, approaching nearly 5% of inmates 55 and older in custody of state prisons in 2007, and over 7% of inmates 56 and older in federal prison in 2009 (Cox & Lawrence, 2010; Sabol & Couture, 2008). This aging prisoner population, which is five times larger than in 1990, presents a significant public health challenge that the correctional system is not adequately equipped to address (Falter, 1999; Reimer, 2008). Moreover, the high prevalence of trauma among older adults in prison and psychological distress associated with trauma experiences raise serious concerns about the well-being of this population (Krause, 2004). Studies have shown that approximately 93% of juvenile and adult prisoners have had prior exposure to trauma, such as being a victim of and/or witness to sexual abuse (Harlow, 1999).

Guest editors' introduction to the special issue.

This special issue of the Journal of Social Work in End-of-Life & Palliative Care grows out of the November 2009 Conference of the Collaborative for Palliative Care of Westchester County and the New York State Southern Region (‘‘the Collaborative’’), ‘‘A Team of Partners in Palliative Care: Challenges and Choices in Ethics of Care at End of Life.’’ Contributions to the special issue have been made by conference speakers and Collaborative members who have participated in the Collaborative program planning or in the research process. We regret that not all of our speakers are represented in this issue, but we recognize their contributions to the Collaborative and to the November 2009 Conference. Therefore, we provide for your reference a full list of program speakers at the November Conference available for download from the publisher’s online edition of the journal. The development of the Collaborative and the critical role it has played in building community assets to improve palliative and end-of-life care in one region of New York State are described in the opening article of the issue. Dobrof and colleagues discuss the importance of grassroots leadership in the founding of the Collaborative and the defining of its mission. The strong transdisciplinary character of the project is highlighted, as well as the focus on bridging policy, practice and research. The authors also provide information about the diverse types of work in which the Collaborative is engaged, and report on results from an evaluation of the Collaborative’s development process. The members of the Collaborative have made a clear commitment to professional education and training to improve the quality of palliative and end-of-life care for persons who are seriously and terminally ill. The contributions to this special journal issue are in major areas in which the Collaborative is targeting professional education and training. The Collaborative has devoted considerable resources in its program planning to education and training on pain and pain management, an issue Journal of Social Work in End-of-Life & Palliative Care, 7:2–4, 2011 Copyright # Taylor & Francis Group, LLC ISSN: 1552-4256 print=1552-4264 online DOI: 10.1080/15524256.2010.548042