This article focuses on the importance of a practitioner's awareness of ageism, motivation, and countertransference in working with elders with dementia. These factors have the capacity to significantly affect a professional's performance. Additionally, they may also affect the type and quality of services a memory-impaired client receives. Ageism is discussed at the micro, mezzo, and macro level, and practitioners are urged to develop an increased awareness of the effects of ageism on client/service options and as well as practitioner's beliefs. Monitoring professional motivation and being aware of countertransference are important considerations in practitioner-client relationships. Professionals are encouraged to incorporate personal introspection and consultation or supervision to ensure that clients receive the most appropriate service available. Case examples are provided to illustrate concepts.
Carmel S, Cwikel J, Galinsky D: Changes in knowledge, attitudes, and work preferences following courses in gerontology among medical, nursing, and social work students. Educ Gerontology. 1992; 18: 329-342.
2.
Geiger DL: How future professionals view the elderly: A comparative analysis of social work, law, and medical students’ perceptions. Gerontologist. 1978; 18(6): 591-594.
3.
Kane MN: Factors affecting social work students’ willingness to work with elders with Alzheimer's Disease. J Soc Work Educ.1999-A; 35(1): 71-85.
4.
Rohan EA, Berkman B, Walker S, Holmes W: The geriatric oncology patient: Ageism in social work practice. J Gerontological Soc Work. 1984; 23(1/2): 201-221.
Birenbaum A, Aronson M, Seiffer S: Training medical students to appreciate the special problems of the elderly. Gerontologist. 1979: 19(6): 575-579.
7.
Cyrus-Lutz C, Gaitz CM: Psychiatrists’ attitudes toward the aged and aging. Gerontologist. 1972; 12(2): 163-167.
8.
Green SK, Keith KJ, Pawlson LG: Medical students’ attitudes toward the elderly. J Am Geriatr Soc.1983; 31(5): 305-309.
9.
Intrieri RC, Kelly JA, Brown MM, Castilla C: Improving medical students’ attitudes toward and skills with the elderly. Gerontologist. 1993; 33(3): 373-378.
10.
Robins LS, Wolf FM: The effect of training on medical students’ responses to geriatric patient concerns: Results of a linguistic analysis. Gerontologist. 1989; 29(3): 341-344.
11.
Solomon K, Vickers R: Attitudes of health workers toward old people. J Am Geriatr Soc.1979; 27(4): 186-191.
12.
Wilderom CPM, Press EG, Perkins DV, et al.: Correlates of entering medical students’ attitudes toward geriatrics. Educ Gerontology. 1990; 16(5): 429-446.
13.
Gomez GE, Young EA, Gomez EA: Attitude toward the elderly, fear of death, and work preference of baccalaureate nursing students. Gerontology Geriatr Educ.1991; 11(4): 45-56.
14.
Rowland VT, Shoemake A: How experiences in a nursing home affect nursing students’ perceptions of the elderly. Educ Gerontology. 1995; 21: 735-748.
15.
Robinson AD: Attitudes toward the elderly among nursing home aides: A factor analytic study. Gerontology Geriatr Educ.1993; 14(2): 21-32.
16.
Weiler RM, Sarvela PD: The attitudes toward the elderly questionnaire. Home Health Care Services Q. 1993; 14(1): 113-122.
17.
Beall C, Baumhover LA, Novak DA, et al.: Educating about Alzheimer's disease: Curricular implications for health professionals. Gerontology Geriatr Educ.1992; 12(3): 93-107.
18.
Schwalb SJ, Sedlacek WE: Have college students’ attitudes toward older people changed?J College Student Dev.1990; 31(2): 127-132.
19.
Rosenbloom C, Whittington FJ, Wilson SL: A practicum in geriatric nutrition: Improving nutrition student attitudes toward elderly clients. J Nutr Elderly. 1987; 6(3): 41-45.
Kane MN: Ethnoculturally-sensitive practice and Alzheimer's Disease. Am J Alzheimer's Dis.2000; 15(2): 80-89.
22.
Baker FM: Psychiatric treatment of older African Americans. Hosp Community Psychiatry. 1994; 45(1): 32-37.
23.
Ballard EL, Nash F, Raiford K, Harrell LE: Recruitment of Black elderly for clinical research studies of dementia: The CERAD experience. Gerontologist. 1993; 33(4): 561-565.
24.
Biegel DE, Farkas KJ, Song L: Barriers to the use of mental health services by African Americans and Hispanic elderly persons. J Gerontological Soc Work. 1997; 29(1): 23-44.
25.
Cox C: Comparing the experiences of black and white caregivers of dementia patients. Soc Work. 1995; 40(3): 343-350.
26.
Dungee-Anderson D, Beckett JO: Alzheimer's disease in African American and White families: A clinical analysis. Smith College Studies Soc Work. 1992; 62(2): 155-168.
27.
Lewis ID, Ausberry MSC: African American families: Managed of demented elders. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 167-174.
28.
Neighbors HW, Jackson JS: Mental health in Black America: Psychosocial problems and help-seeking behavior. In H. W. Neighbors and J. S. Jackson, eds., Mental health in Black America. Thousand Oaks, CA: Sage Publications, 1996, 1-13.
29.
Taylor RJ, Hardison CB, Chatters LM: Kin and non-kin as sources of informal assistance. In H. W. Neighbors and J. S. Jackson, eds., Mental health in Black America. Thousand Oaks, CA: Sage Publications, 1996, 130-145.
30.
Braun KL, Takamura JC, Forman SM, Sasaki PA, Meininger L: Developing and testing outreach materials on Alzheimer's disease for Asian and Pacific Islander Americans. Gerontologist. 1995; 35(1): 122-126.
31.
Elliott KS, Di Minno M, Lam D, Tu AM: Working with Chinese families in the context of dementia. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 89-108.
32.
Elo IT: Adult mortality among Asian Americans and Pacific Islanders: A review of the evidence. In K. S. Markides and M. R. Miranda, eds., Minorities, aging, and health. Thousand Oaks, CA: Sage Publications, 1997, 41-78.
33.
Kitano HH, Shibusawa T, Kitano KJ: Asian American elderly mental health. In K. S. Markides and M. R. Miranda, eds., Minorities, aging, and health. Thousand Oaks, CA: Sage Publications, 1997, 295-315.
34.
McBride MR, Parreno H: Filipino American families and caregiving. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 123-135.
35.
Takamura JC: Asian and Pacific Islander elderly. In N. Mokuau, ed., Handbook of social services for Asian and Pacific Islander Americans. New York: Greenwood Press, 1991, 185-202.
36.
Tempo PM, Saito A: Techniques of working with Japanese American families. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 109-122.
37.
Yeo G, Gallagher-Thompson D, Lieberman M: Variations in dementia characteristics by ethnic category. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 21-30.
38.
Aranda MP, Miranda MR: Hispanic aging, social support, and mental health: Does acculturation make a difference? In K. S. Markides and M. R. Miranda, eds., Minorities, aging, and health. Thousand Oaks, CA: Sage Publications, 1997, 271-294.
39.
Cox C, Monk A: Hispanic culture and family care of Alzheimer's patients. Health Soc Work. 1993; 18(2): 92-100.
40.
Cox C, Monk A: Minority caregivers of dementia victims: A comparison of Black and Hispanic families. J Appl. Gerontology. 1990; 9(3): 340-354.
41.
Gallagher-Thompson D, Talamantes M, Ramirez R, Valverde I: Service delivery issues and recommendations for working with Mexican American family caregivers. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 137-152.
42.
Henderson JN: Cultural dynamics of dementia in a Cuban and Puerto Rican population in the United States. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 153-166.
43.
Henderson JN, Gutierrez-Mayka M: Ethnocultural themes in caregiving to Alzheimer's disease patients in Hispanic families. Clin Gerontologist. 1992; 11(3/4): 59-74.
44.
Henderson JN, Gutierrez-Mayka M, Garcia J, Boyd S: A model for Alzheimer's disease support group development in African-American and Hispanic populations. Gerontologist. 1993; 33(3): 409-414.
45.
Henderson JN, Gutierrez-Mayka M: Ethnocultural themes in caregiving to Alzheimer's disease patients in Hispanic families. Clin Gerontologist. 1992; 2(3/4): 59-74.
46.
Lopez SR, Taussig IM: Cognitive-intellectual functioning of Spanish-speaking impaired and nonimpaired elderly: Implications for culturally sensitive assessment. Psychol Assessment: J Consult Clin Psychol. 1991; 3(3): 448-454.
47.
Valle R: Cultural and ethnic issues in Alzheimer's Disease family research. In E. Light and B. D. Lebowitz, eds., Alzheimer's Disease treatment and family stress: Directions for research. Rockville, MD: U.S. Department of Health and Human Services, 1989, 122-154.
48.
Chapleski EE: Long-term care among American Indians: A broad lens perspective on service preference and use. In K. S. Markides and M. R. Miranda, eds., Minorities, aging, and health. Thousand Oaks, CA: Sage Publications, 1997, 367-394.
49.
Cross A: Working with American Indian elders in the city: Reflections of an American Indian social worker. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 183-185.
50.
John R: Aging and mortality among American Indians: Concerns about the reliability of a crucial indicator of health status. In K. S. Markides and M. R. Miranda, eds., Minorities, aging, and health. Thousand Oaks, CA: Sage Publications, 1997, 79-104.
51.
John R, Hennessy CH, Roy LC, Salvini ML: Caring for cognitively impaired American Indian elders: Difficult situations, few options. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 187-203.
52.
Kramer BJ: Dementia and American Indian populations. In G. Yeo and D. Gallagher-Thompson, eds., Ethnicity and the dementias. Washington, DC: Taylor and Francis, 1996, 175-181.
53.
Manson SM: Provider assumptions about long-term care in American Indian communities. Gerontologist. 1989; 29(3): 355-358.
54.
Barker RL: The social work dictionary. 4th ed.Washington, DC: National Association of Social Workers, 1999.
55.
Gatz M, Pearson CG: Ageism revised and the provision of psychological services. Am Psychol. 1988; 43(3): 184-188.
56.
Laws G: Understanding ageism: Lessons from feminism and postmodernism. Gerontologist. 1995; 35(1): 112-118.
57.
Hepworth DH, Rooney RH, Larsen JA: Direct social work practice. 5th ed.Pacific Grove, CA: Brooks/Cole Publishing Company, 1997.
58.
Kane MN: Consent and competency in the elder with Alzheimer's disease. Am J Alzheimer's Dis.1998; 13(4): 179-188.
59.
Kane MN: Legal guardianship and other alternatives in the care of elders with Alzheimer's disease. Am J Alzheimer's Dis.2001; 16(2): 89-96.
60.
Kelly TB: Paternalism and the marginally competent: An ethical dilemma, no easy answers. J Gerontological Soc Work. 1994; 23(1/2): 67-84.
61.
Kapp MB: Geriatrics and the law. New York: Springer, 1999.
62.
Peters R, Schmidt WC, Miller KS: Guardianship of the elderly in Tallahassee, Florida. Gerontologist. 1985; 25(5): 532-538.
63.
Sabatino CP: Competency: Refining our legal fictions. In M. Smyer, K. Warner Schaie, and M. B. Kapp, eds., Older adults’ decisionmaking and the law. New York: Springer, 1996.
64.
Scogin F, Perry J: Guardianship proceedings with older adults: The role of functional assessment and gerontologists. Law Psychol. Rev.1986; 10(Spring): 123-128.
65.
Kapp MB: Alternatives to guardianship: Enhanced autonomy for diminished capacity. In M. Smyer, K. Warner Schaie, and M. B. Kapp, eds., Older adults’ decision-making and the law. New York: Springer, 1996.
66.
Houston-Vega MK, Nuehring EM, Daguio ER: Prudent practice: A guide for managing malpractice risk. Washington, DC: NASW Press, 1997.
67.
Madden RG: Legal issues in social work, counseling and mental health: Guidelines for clinical practice in psychotherapy. Thousand Oaks, CA: Sage Publications, 1998.
68.
Gatz M, Smyer MA: The mental health system and older adults in the 1990s. Am Psychol. 1992; 47(6): 741-751.
69.
Reamer FG: Ethical standards in social work: A critical review of the NASW Code of Ethics. Washington, DC: NASW Press, 1998.
70.
Jamal K. Bowie N: Theoretical considerations for a meaningful code of ethics. J Bus Ethics. 1995; 14: 703-714.
71.
Semel VG: Countertransference and ageism: Therapist reactions to the older patient. In C. M. Brody and V. G. Semel, eds., Strategies for therapy with the elderly: Living with hope and meaning. New York: Spencer, 1993, 130-138.
72.
Strean H: Psychoanalytic theory. In F. J. Turner, ed., Social work treatment: Interlocking theoretical approaches. New York: The Free Press, 1986, 19-45.
73.
Burlingame VS: Gerocounseling: Counseling elders and their families. New York: Springer, 1995.
74.
Kaplan HI, Sadock BJ: Synopsis of psychiatry. 8th ed.Baltimore: Williams and Wilkins, 1998.
