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Investigating Social WorkStudents' Perceptions of Elders'Vulnerability and ResilienceMichael N. Kane PhD MSW MDiv a , Debra Lacey PhDMSW MEd b & Diane Green PhD MSW aa School of Social Work , Florida Atlantic University ,Boca Raton, Floridab Social Work at Barry University , Miami Shores,FloridaPublished online: 28 Jan 2009.
To cite this article: Michael N. Kane PhD MSW MDiv , Debra Lacey PhD MSW MEd& Diane Green PhD MSW (2009) Investigating Social Work Students' Perceptions ofElders' Vulnerability and Resilience, Social Work in Mental Health, 7:4, 307-324, DOI:10.1080/15332980802052035
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Social Work in Mental Health, Vol. 7(4) 2009Copyright © Taylor & Francis Group, LLC.
doi:10.1080/15332980802052035 307
WSMH1533-29851533-2993Social Work in Mental Health, Vol. 7, No. 4, December 2008: pp. 1–31Social Work in Mental Health
Investigating Social Work Students’ Perceptions of Elders’ Vulnerability
and ResilienceKane, Lacey, and GreenSocial Work in Mental Health Michael N. Kane, PhD, MSW, MDiv
Debra Lacey, PhD, MSW, MEdDiane Green, PhD, MSW
ABSTRACT. The manner in which elders are perceived by future socialworkers may affect how social work services will be delivered to olderadults, especially older adults affected by substance abuse and/or mentalillness such as depression. Perceptions about resilience have importantimplications for practice and policy with elders, especially those affectedby depression and/or substance abuse. This study investigated perceptionsof elders’ resilience among social work students, and the variables thatinform those perceptions. The findings of this study suggest that the vari-ables influencing respondents’ perceptions of elders’ resilience included(a) perceptions of elders’ vulnerability, (b) perceptions of elders’ actions totreat themselves, (c) perceptions of elders’ seeking professional help, and(d) the respondents’ educational program. Respondents perceived elders asunlikely to seek professional help, vulnerable, marginalized, and as onlymoderately resilient in overcoming depression or substance abuse. Thesefour predictor variables were identified using a standard regression analy-sis that accounted for 22.3% of the model’s variance. Implications forsocial work practice and education are discussed.
Michael N. Kane and Diane Green are Associate Professors in the School ofSocial Work, Florida Atlantic University, Boca Raton, Florida.
Debra Lacey is Associate Professor of Social Work at Barry University,Miami Shores, Florida.
Address correspondence to: Michael N. Kane, School of Social Work, FloridaAtlantic University, 777 Glades Road, P.O. Box 3091, Boca Raton, FL 33431-0991 (E-mail: [email protected]).
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KEYWORDS. Elders, ageism, resilience, vulnerability, depression,oppression, substance abuse
INTRODUCTION
Ageism is an immense construct with multiple facets, layers, andtextures. Some ageist ascriptions are positive, whereas most attributionsare negative (Palmore, 1999; 2001). Negative attributions portray olderadults as vulnerable, incompetent, useless, inflexible, frail, and resourcepariahs who benefit little from professional services (Bowling, 1999;Cardinali & Gordon, 2002; Grant, 1996; Hummert, Garstka, Shaner, &Strahm, 1994; Kane, 1999a; 2002; 2004b; Palmore, 2001; Ragan &Bowen, 2001). Positive perceptions cast elders as dependable, kind, wise,and affluent (Palmore, 1999). This mixture of ageist attributions fre-quently steers professional helping disciplines, service providers, policy-makers, service-delivery organizations, and the general population as theyinteract with older persons.
No doubt some older adults are kind, wise, dependable, or affluent.Other older adults are incompetent, vulnerable, frail, inflexible, or willbenefit little from professional services. Professionals of all disciplinesmake assumptions about aging persons and increasingly need to under-stand that there is more health and socioeconomic diversity among eldersthan any other age group. Ageism is rampant because this diversityamong older adults is rarely acknowledged.
Ageist attributions have many implications for aging populations. Atthe level of direct practice, for example, depression and substance abuseare areas of critical concern. Depression in older adults is regularlyundiagnosed (Bartels & Smyer, 2002; Sadock & Sadock, 2003) andsubstance abuse is frequently considered less serious in older persons(Blow, Oslin, & Barry, 2002). Health, mental health, and social serviceprofessionals neither assess nor intervene appropriately with an elderaffected by depression or substance abuse because of their assumptionsand beliefs about aging, older clients and their resilience, ageism, orresource availability. Similar ageist assumptions are common in serviceorganizations, governmental agencies, among professional service pro-viders, policymakers, and within the general population.
On the other hand, some policymakers portray elders as critically illand in need of expensive health care services in order to obtain a largershare of the limited resource-pie (Hendricks, 2005). Special interest
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groups and lobbying groups for older adults tacitly condone these percep-tions when they portray elders as having significant unmet needs inpromotional material or advisement. Although the goal may be toincrease service availability, funding, and resource development, theseportrayals of older adults encourage ageist perceptions of elders beingvulnerable and debilitated (Hendricks, 2005). Rarely are elders depictedas more than their vulnerability or as resilient and possessing strengths.
There are many instruments that measure attitudes toward elders andageism. Few instruments measure perceptions of the resilience of olderadults. This study investigated the perceptions of social work studentsregarding the resilience of elders and the factors that influence thoseperceptions. Although thoughts about aging and elders are not geographi-cally limited to the United States, this study focused on attitudes towardelder resilience among a diverse group of Florida social work students.
ELDERS AS VULNERABLE
Vulnerable populations are groups who have a greater probability ofbeing harmed by social, health, or environmental problems than thegeneral population (Barker, 1999). As a result of increased health risks,environmental pressures, and economic stresses associated with advancedage and the aging process, the population of older persons is viewed asvulnerable. Even though elders possess diverse strengths, the aging pro-cess affects physical functions and abilities, psychological strengths, andthe spiritual resources of elders. Collectively, these may have profoundimplications for social and environmental options available to olderadults. Older individuals may be most vulnerable when they are affectedby physical or cognitive deficits, and/or possess limited personalresources. The gross amount of an elder’s personal resources will man-date the quality and type of care accessible to him or her; often withoutregard to his or her physical and/or psychological needs.
As a result of media attention, Americans are becoming increasinglyaware that access to retirement benefits, Social Security, and Medicare areno longer as certain as they once were (Stanford & Usita, 2002). Thisadds to accurate perceptions of vulnerability among elders. Many elderslive in poverty and remain active in the work force beyond minimumretirement ages (Stanford & Usita, 2002). More elders will move towardpoverty as retirement plans vanish, as benefits are reduced, and asdefined-benefit pension plans are replaced with personal retirement
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accounts subject to the vagaries of the market, and personal assets areexhausted. Older women and minority elders face the greatest risks forliving in poverty (Stanford & Usita, 2002). Compounding poverty andother types of economic vulnerability, women and members of racial,ethnic, cultural, religious, and sexual minorities may have experienced alifetime of oppression and marginalization. This experience may leavesome members of these groups facing old age with greater resilience,whereas others will find it necessary to cope with economic vulnerability,marginalization because of minority status, as well as the prejudicesdirected toward older persons.
While health needs may increase as people age, interventions for theirrelief may be affected by the ageist attitudes of service professionals;thereby increasing the vulnerability of older persons. Ageism and socialpolicy have significant impacts on the types of intervention offered andthe manner in which they are delivered to older persons. For example,some literature points to ageism as the reason some physicians limit thenumber of older clients in their practices while not limiting other types ofclients. This same body of literature suggests physicians are more likelyto use aggressive intervention strategies with younger persons more thanwith elders; even when both would benefit equally and with similar levelsof risk (Bowling, 1999; Cardinali & Gordon, 2002; Damiano, Momany,Willard, & Jorgerst, 1997). Elders with few resources who rely solely onMedicare or Medicaid may be severely limited in their service options.
PERCEPTIONS OF ELDERS AS MARGINALIZED
Marginalized and oppressed groups of people have little power(Barker, 1999). Although older adults are perceived as marginalized,some older persons do have access to power as a result of their personalresources. However, most elders are perceived as confused, frail, ill, unre-liable, and unimportant (Cardinali & Gordon, 2002; Grant, 1996; Kane,2002; Palmore, 2001; Ragan & Bowen, 2001).
When service providers assess and/or intervene with elders, they maypaternalistically interact with older persons as though they were children whoare unable to make decisions and for whom they have little patience(Hummert et al., 1994). Treating older adults as though they were childrenwho are incapable of reasoning, expressing preference, or making a rationaldecision is a profound method to marginalize and discount an individual.This infantilizing method of interaction with elders is based on the pervasive
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notion that aging is a journey ending in depression, incompetence, and for-getfulness (Gatz & Pearson, 1988; Kane, 2001; Kane, Lacey, & Green, 2006;Laws, 1995). If a professional believes that the older adult is headed towardincompetence, paternalistic intervention may be viewed as a benevolent ges-ture (Kane, 1998). For social workers, paternalistic intervention must beweighed against the primary social work value of client self-determination.
In spite of the almost universal misperceptions among professionalsregarding the incompetence of elders (Becker, Schonfeld, & Stiles, 2002;Dunkelman & Dressel, 1994; Gatz & Pearson, 1988; Kane, 1999a, 2001;2003; Laws, 1995; Palmore, 2001; Ragan & Bowen, 2001), epidemiologistsestimate that only 5% of people over 65 years have severe dementia and15% have mild dementia (Sadock & Sadock, 2003). When professionalsassume that all elders are incompetent, many conclude that interventionfor elders is futile or unnecessary (Kane, 2002; Mezey, Mitty, Bottrell,Ramsey, & Fisher, 2000). This attitude has been termed therapeutic nihilism(Dunkelman & Dressel, 1994). Through an insidious generalization ofeffects, therapeutic nihilism spreads to professionals’ perceptions of manyconditions effecting elders and to a reluctance to provide service.
PERCEPTIONS OF ELDERS AS RESILIENT
Resilience is the ability to recover after stresses, challenges, or prob-lems (Barker, 1999). Service providers consistently underestimate thestrengths and resilience of older adults (Gatz & Pearson, 1988; Kane,1999a, 2001; 2003; Laws, 1995; Palmore, 2001; Ragan & Bowen, 2001).Some of the most powerful examples of professionals’ perceptions of theresilience possessed by elders involve depression and substance abuse.
Depression is one of the most significant mental health concerns foraging adults. Epidemiologists estimate that 16% of women and 10% ofmen aged 65–69 exhibit symptoms of depression. The estimates increaseat age 85 with 22% of women and 15% of men exhibiting depressivesymptoms (Federal Interagency Forum on Aging Related Statistics,2004). Although depressed mood and many other symptoms may bepresent, it is often somatic complaints that are the primary indicators ofdepression in older adults (Mays & Croake, 1997). Depression in olderadults frequently coexists with medical illnesses and effects health out-comes and mortality (Weintraub, Furlan, & Katz, 2002). Pharmacologicalinterventions alone may reduce the severity of symptoms of depression inolder adults by 50–60% (Bartels, Haley, & Dums, 2002; Zarit & Zarit,
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1998). When coupled with psychosocial therapies, even greater reductionsin depression are evidenced (Bartels et al., 2002). However, depression inolder persons generally remains undiagnosed and untreated (Bartels &Smyer, 2002; Butler, Lewis & Sunderland, 1998). While depressed indi-viduals may suffer tremendously and experience decreases in their qualityof life, untreated depression increases health care utilization and costs, aswell as mortality and disability rates (Bartels & Smyer, 2002).
Because service providers do not recognize the symptoms of this mooddisorder, they do not provide intervention. As noted, depression is treatable.Frequently depressive symptoms in older adults may be attributed tocognitive impairment or normalized as a result of multiple losses over thelifespan (Kane, 1999b). As a result of this lack of diagnosis and intervention,the suicide rate among elders is higher than other groups; with the highest rateof suicide held by elderly males (Bartels & Smyer, 2002; Butler et al., 1998).
Often, mental health practitioners perceive elders as incapable oftherapeutic improvement, resistant to intervention, and unsuitable fortherapy (Ivey, Wieling, & Harris, 2000; Reekie & Hanson, 1992). Whileunwillingness to work with the mental health concerns of older adults per-sists among practitioners (Ivey et al., 2000; Kane, 1999a; 2004b; Kane,Hamlin, & Hawkins, 2004; Reekie & Hanson, 1992), epidemiologistsindicate that by the year 2030 there will be more older-adult mental healthconsumers than any other age group (Bartels & Smyer, 2002).
Similar to the case of depression and resilience is the case for substanceabuse among elders and resilience. Families as well as professionals arewilling to overlook, excuse, or deny the abuse of alcohol or other sub-stances among older adults, believing it problematic primarily of youngerpersons and best left untreated in older adults (Blow, Oslin & Barry, 2002;Sadock & Sadock, 2003). Practitioners view recovery from substanceabuse in older persons as unnecessary or impossible (Blow et al., 2002).While ignoring the problems, as many as 15% of older adults abuse alcohol(Blow et al., 2002). Other substance concerns are largely ignored amongaging persons too. The intentional and accidental misuse/abuse of over-the-counter medications and prescription drugs by elders is a commonoccurrence that has far reaching health and mental health implications(Sadock & Sadock, 2003). In the future, substances will continue to beadded to this list of concerns, especially illicit street drugs. As theboomers retire, many will have had long histories of substance abuse anddependence resulting in adverse health consequences. These same indi-viduals may continue using substances as well as experiment with others.Although their bodies may have endured these challenges relatively well
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while in their twenties and thirties, these substances will provide greaterchallenges for aging bodies (Blow et al., 2002; Sadock & Sadock, 2003).
The literature suggests that social work students and practitioners artic-ulate little willingness to work with older adults, possess limited knowl-edge of aging, and possess attitudes that are in the neutral to negative endof the attitude continuum (Carmel, Cwikel, & Galinsky, 1992; Kane,1999a; 2002; 2004a; Kane et al., 2004; Rohan, Berkman, Walker, &Holmes, 1994). Kane (1999a) found that few social work students werewilling to work with elders or elders diagnosed with Alzheimer’s diseaseor other types of dementia. Of a list of 15 vulnerable groups, elders withAlzheimer’s disease were rated the group of lowest interest. Healthyelders were ranked as the sixth choice of 15 groups. Students were moreinterested in working with families and children, survivors of domesticviolence, HIV/AIDS clients, mental health consumers, and persons withdisabilities more than with aging populations. In another study, Kane(2004b) found that social work students were less optimistic in theirbeliefs and attitudes about the recovery of older persons from health ormental health concerns than younger persons. Specially, respondentsbelieved that younger persons were more likely to recover from healthissues than older persons, that younger persons benefit from psychotherapymore than older persons, and that social workers should prepare olderpersons for death when they are ill because they had lived a sufficientlylong life. In general, social workers and social work students did not possessoverwhelming confidence in their abilities to work with elders or elderswith special needs (Carmel et al., 1992; Kane, 1999a; 2002; 2004a;2004b; Kane et al., 2004; Rohan et al., 1994). Similar findings have beendocumented among nurses, nursing students, physicians, medical students,and other health and mental-health providers.
As with many groups of professionals, depression and substance misuseamong older adults appear to be two areas in which social work practitio-ners show little interest (Kane et al., 2006). While ignorance of depres-sion and substance abuse among older adults and appropriateinterventions may be contributory causes, the failure or unwillingness tointervene seems to originate in therapeutic nihilism (Dunkelman &Dressel, 1994). As with other professional groups, these ageist attitudesand professional unwillingness to work with older adults suggest that socialworkers may believe that older adults are not capable of rebounding fromillness, injury, trouble, or any other adversity. But, in truth, adversity doesnot necessarily end in vulnerability, even for older persons. Saleeby (2002)suggests that resilience is a process for “continuing growth and articulation
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of capacities, knowledge, insight, and virtue derived from meeting thedemands of one’s world, however chastening” (p. 11).
Professionals who are capable of perceiving elders as resilient and whocan appreciate their diversity will be valuable assets in the care of agingpopulations. These individuals will be able to serve older persons in manycapacities. Developing the knowledge to recognize and the skill to inter-vene in the presence of the various indicators of depression and substanceabuse are two areas that will have important implications for older adultsand the profession of social work. These social workers will affect healthoutcomes and mortality among depressed and substance abusing peopleand will assist in decreasing health care utilization and costs.
This study investigated social work students’ perceptions of resiliencein older adults; particularly as related to perceptions of the vulnerability ofelders, perceptions about elders’ willingness to seek help, and perceptionsregarding elders and substance abuse. Professionals, as a result of theirattitudes and perceptions, may influentially communicate information toan older person that encourages or discourages clients and affects theirtreatment outcome (Sadock & Sadock, 2003). This communication mayhave some lasting consequences for older individuals, long-term care,caregivers, and developers of social policy.
METHODOLOGY
Sampling and Data Collection
BSW (n = 72) and MSW (n = 84) student respondents with a mean ageof 33.85 years (Min. = 19, Max. = 69) participated in an anonymous, self-administered, in-class survey. The sample included Florida’s diverseracial and cultural groups: European American = 55.2% (n = 85), AfricanAmerican = 14.9% (n = 22), Caribbean American = 11.0% (n = 17), andLatino = 17.5% (n = 27). Data gathered specifically for this study wasattached to an instrument which investigated social work students’ per-ceptions regarding depression in elders (Kane et al., 2006).
Instrumentation
Based on a literature review, 15 items were developed to investigaterespondents’ perceptions about resilience, vulnerability, marginalization,help-seeking behaviors, and substance abuse in older populations.Agreement was reached for face validity by researchers, social work
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educators and practitioners. A five point Likert-type scale (1= stronglyagree, 2 = agree, 3 = not sure—neither agree nor disagree, 4 = disagree,5 = strongly disagree) was adopted as response options for each item.
The items for two independent variables used in this study were devel-oped by Kane et al. (2006) to investigate perceptions of elders’ actions totreat themselves and their willingness to seek help. The independent vari-able “perceptions of elders’ actions to treat themselves” used four itemsthat sought information about perceptions regarding elders’ use of alco-hol, abusing street drugs, and using substances to self-medicate feelings ofsadness. Actual scores ranged from a minimum of 9 to a maximum of 20,with a mean of 15.5641 (SD = 2.2438). The mean score suggests thatrespondents did not perceive older adults as self-medicating or self-treating.
The independent variable of “perceptions of elders seeking help”included two items (Elders seek psychotherapeutic services, elders aretreatment compliant). With a minimum score of 3 and a maximum score of10, the mean score for respondents was calculated at 7.0897 (SD = 1.4068).The higher scores from these respondents suggest that they possessedslightly more than moderately negative perceptions of elders’ willingnessto seek professional help. These two variables were analyzed and thefindings of that analysis are reported in Kane et al. (2006).
For the remaining variables, inter-item correlations were calculated forall items prior to forming variable groups. Items which were uncorrelatedwith any other items at 0.3 or higher were removed from further analysisas suggested by Hedderson and Fisher (1993), because unrelated itemsmay form inefficient factors in principal components analysis (Hutcheson &Sofronious, 1999).
To determine the adequacy of the sample for forming variable factors,the Kaiser-Meyer-Olkin (KMO) statistic for both individual and multiplevariables was executed. These statistics for both individual and multiplevariables range from zero to one. Higher scores are more desirable. Forthis sample, the KMO statistic for multiple variables was computed at0.674; well above the required value. The scores for each item were alsocomputed and found to range from .6 to .8. Scores above .5 are requiredfor analysis (Hutcheson & Sofronious, 1999). The KMO analysis suggeststhat the sample meets the requirements for principal components analysis.
These ten correlated items were analyzed using principal componentsanalysis with varimax rotation to form three factor variables. The three fac-tor variables had eigenvalues greater than 1.0 and a cumulative variance of57.373%. All items had factor loadings at .6 or higher. The three variablefactors were labeled (a) perceptions of elders as vulnerable (eigenvalue = 2.415,
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% of variance = 24.151), (b) perceptions of elders as resilient (eigenvalue= 2.102, % of variance = 21.017), and (c) perceptions of elders as oppressedand marginalized (eigenvalue = 1. 221, % of variance = 12.205).
The independent variable of “perceptions of elders as vulnerable” usedfour items (older persons are vulnerable, being old means being vulnerable,to grow old is to become vulnerable, and older people live in poverty) withscores ranging from 4 to 19. The mean score was calculated at 10.0449(SD = 3.00396) suggesting that respondents perceived elders as vulnerable.
The independent variable of “perceptions of elders as marginalized andoppressed” used three items (older people are marginalized, oppressed,etc.) to investigate these perceptions, with scores ranging from a mini-mum of 3 to a maximum of 15. The mean score of 6.8824 (SD = 2.21223)suggests that respondents perceived elders as a marginalized group.
The dependent variable for this study was “Perceptions of Elders’Resilience.” This variable consisted of three items which tapped intoperceptions regarding elders’ abilities to overcome mental illness such asdepression, and substance abuse. With a minimum score of 3 and a maxi-mum score of 15, the mean score was 10.1871. Because higher scoressuggest that respondents perceived elders to be more resilient, theserespondents perceived elders as moderately capable of overcoming issuessurrounding depression or substance abuse.
Table 1 lists the univariate statistics for the dependent and predictivevariables.
RESULTS
Bivariate Analysis
Correlation coefficients were computed for demographic variables(gender, educational program, ethno-cultural identification) and all
TABLE 1. Univariate statistics for the dependent and predictive variables
Variable M SD Min. Max.
Perceptions of elders’ resilience 10.1871 2.2354 3.00 15.00Perceptions of elders’ vulnerability 10.0449 3.0039 4.00 19.00Perceptions of elders’ marginalization 6.8824 2.2122 3.00 15.00Perceptions of elders’ actions to treat themselves 15.5641 2.2438 9.00 20.00Perceptions of elders’ seeking professional help 7.0897 1.4068 3.00 10.00
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independent variables (Perceptions of Elders’ Vulnerability, Perceptionsof Elders’ Actions to Treat Themselves, Perceptions of Elders’ SeekingProfessional Help, and Perceptions of Elders’ as Oppressed and Marginalized)with the dependent variable (Perceptions of Elders’ Resilience). Severalof the variables were significantly correlated with the dependent variable:Perceptions of Elders’ Actions to Treat Themselves (r2 = .302, p = .000),Perceptions of Elders’ Seeking Professional Help (r2 = .293, p = .000),and Educational Program (r2 = .345, p = .000). Three other variablesapproached significance with p-values nearing significance (Perceptionsof Elders’ Vulnerability, r2 = .138, p = .086; Perceptions of Elders’Marginalization, r2 = –.140, p = .084; and Ethno-cultural Identification,r2 = .146, p = .072). Table 2 lists the correlation values between thedependent and the independent variables.
Multiple Regression Analysis
Initially, a standard regression analysis was performed that incorporatedall the variables that were significantly correlated with the dependentvariable. In order to avoid a Type II error, those variables which werenearing significance were incorporated in the preliminary model building.The initial model summary accounted for 21.7% of the variance (F = 6.619,p = .000).
In further model building, all non-significant contributors wereexcluded. A final model was selected that accounted for 22.3% of thevariance (F = 10.665, p = .000) using four predictor variables. These predic-tor variables included: (a) Perceptions of Elders’ Vulnerability (B = .117,Beta = .158, t = 2.182, p = .031), (b) Perceptions of Elders’ Actions to
TABLE 2. Bivariate correlations with the dependent variable (perceptions of elders’ resilience)
Independent variable Correlation p-value
Perceptions of elders’ vulnerability .138 .086Perceptions of elders’ marginalization –.140 .084Perceptions of elders’ actions to treat themselves .302 .000**Perceptions of elders’ seeking professional help .293 .000**Gender –.003 .969Education program .345 .000**Ethno-cultural identification .146 .072
**p < .001.
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Treat Themselves (B = .201, Beta = .202, t = 2.645, p = .009), (c) Perceptionsof Elders’ Seeking Professional Help (B = .275, Beta = .172, t = 2.231,p = .027) and (d) Educational Program (B = 1.155, Beta = .257, t = 3.391,p = .001). Table 3 contains a summary of these predictor variables.
DISCUSSION AND IMPLICATIONS
Findings in this study were consistent with previous research in thatrespondents did not perceive older adults as a resilient group in areas ofmental illness (e. g., Gatz & Pearson, 1988; Kane, 1999a, 2001; 2003;2004b; Laws, 1995; Palmore, 2001; Ragan & Bowen, 2001) or substanceabuse (e.g., Blow et al., 2002). In the model building portions of thisstudy, four predictive variables were identified to explain perceptionsregarding the resilience of older adults. These variables included:(a) Perceptions of Elders’ Vulnerability, (b) Perceptions of Elders’ Actionsto Treat Themselves, (c) Perceptions of Elders’ Seeking Professional Help,and (d) Educational Program.
“Perceptions of Elders’ Vulnerability” statistically and logically makesa contribution to the explanation of the dependent variable. Respondentsidentified older adults as potentially vulnerable; that is, they have agreater probability of being harmed by social, health, or environmentalproblems than other members of the general population (Barker, 1999).Respondents who perceived elders as less resilient perceived elders asmore vulnerable. This is consistent with research that suggests that eldersare perceived as vulnerable for social, economic, and health reasons.As noted, the literature indicates that some elders live in poverty and mustremain active in the work force (Stanford & Usita, 2002). Other researchsuggests that students perceive elders as less capable of recovery fromphysical illness (Kane, 2004b). These perceptions of vulnerability may
TABLE 3. Regression summary table: Final model with the dependent variable (perceptions of elders’ resilience)
Predictor variable B Beta t p-value
Perceptions of elders’ vulnerability .117 .158 2.182 .031Perceptions of elders’ actions to treat themselves .201 .202 2.645 .009Perceptions of elders’ seeking professional help .275 .172 20231 .027Education program 1.155 .257 3.391 .001
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have significant implications for the types of intervention offered and themanner in which they are delivered to older persons. Although some liter-ature suggests that health care practitioners prefer offering service toyounger persons rather than older persons and that they provide moreaggressive types of services to younger persons than older persons (Bowling,1999; Cardinali & Gordon, 2002; Damiano et al., 1997), there is someliterature that suggests similar attitudes and behaviors among social work-ers and social work students (Carmel et al., 1992; Kane, 1999a; 2004a;Kane, et al., 2004; Rohan et al., 1994). These forms of ageist thought andbehavior may encourage perceptions of vulnerability and may inhibit per-ceptions of elder resilience.
Respondents’ Perceptions of Elders’ Actions to Treat Themselves wassimilar to previous research in that respondents did not generally perceiveolder adults as heavy substance abusers or as self-medicating (e. g., Blowet al., 2002). This is a concern for social work educators. Many socialwork students have an interest in substance abuse, but apparently mostperceive these as concerns that affect younger adults primarily. Clearlythis is not accurate. With the impending retirement of the baby boomers,substance abuse concerns in families and among older persons willincrease (Blow et al., 2002). Social workers with specialized knowledgeand skill will be needed for assessment and intervention. Educators willneed to increasingly address the issues of substance abuse among middle-aged and older persons in their content areas.
As in other research (e.g., Ivey et al., 2000; Kane, 2004b; Kane et al.,2004; Reekie & Hanson, 1992), respondents in this study were less likelyto perceive elders as willing to seek psychotherapeutic services. Appar-ently, perceptions of unwillingness to seek service contributed to morenegative perceptions of elders’ resilience. Previous research has suggestedthat social work students were less optimistic in their beliefs that olderadults were able to benefit from psychotherapeutic services and that thesestudent respondents’ attitudes about the recovery prognosis of older per-sons from health or mental health concerns was significantly less positivethan for the prognosis of younger persons (Kane, 2004b). Similar findingshave been documented among other mental health professionals (Ivey et al.,2000; Reekie & Hanson, 1992).
Not surprisingly, the level of social work education increased percep-tions of elders’ resilience; with MSW students possessing more positiveperceptions of elders’ resilience than BSW students. This finding seemslogical in that graduate study allows social work students to develop pro-fessional knowledge and skill that is deeper and broader. However, the
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topics of resilience, oppression, vulnerability, and diversity are the funda-mentals of social work education. The logical question that may arisewould consider whether ageism is sufficiently addressed in social workeducation. Although MSW students were better able to consider resil-ience and vulnerability among older adults than BSW students, neithergroup perceived elders as a resilient group. The amount of content that isrequired in both BSW and MSW education is enormous and growing, yetseemingly ageist thought and behavior has been insufficiently addressedin diversity content (Kane & Houston-Vega, 2004), at least for thisresponse cohort.
One of the more surprising, and confusing, findings in this study was thelack of contribution to the final model from the variable of “Perceptions ofElders as Oppressed and Marginalized.” While respondents perceivedelders as marginalized, this variable did not provide any significant expla-nation for the dependent variable of perceptions of elders’ resilience.Respondents appeared not to connect social marginalization and oppressionwith an individual’s ability to be resilient. This is confusing because theliterature suggests that professionals are paternalistic, employ infantilizingbehaviors, and consider elders incapable of articulating rational thoughtor choice (Cardinali & Gordon, 2002; Grant, 1996; Hummert et al., 1994;Kane, 1998; 2002; Palmore, 2001; Ragan & Bowen, 2001). These behaviorsand attitudes contribute to an immense disempowerment of older adultsthat disallows the perception of elder resilience. An alternative explanationmay simply be related to the general perception among respondents thatelders possess limited resilience regardless of marginalization or oppression.This variable will need further investigation.
There are implications in this study especially for social work educators.While respondents in this study perceived elders as vulnerable, oppressed,and marginalized, perceptions of elders’ resilience were moderately low.Educators may need to consider strategies that encourage understandingof resilience as a factor that is not reduced or deteriorated by age. Rather,it may be helpful to understand aging as a journey that allows persons togather experience that engenders resilience. This shift in focus may bekey to increasing students’ perceptions of the resilience and capability ofolder adults (Kane & Houston-Vega, 2004).
Social work students may display a lack of interest in gerontologicalpractice and an unwillingness to work with elders as a result of their per-ceptions regarding an elder’s lack of resilience. Believing that an individuallacks the ability to grow, improve, and change logically reduces most prac-titioners’ interest and willingness to provide service to that individual.
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Students in social work programs have clearly identified older adults asvulnerable and members of a marginalized group, but perhaps they havenot adequately considered the diversity of older persons, the life-longcoping histories of older adults, and the life-time experience that olderpersons possess for growth and change. The leap may be as simple ashelping students understand and appreciate that older persons were onceyounger persons, who now possess a vast amount of experience; ratherthan the victims of infirmity or catastrophe.
Although this study did not compare perceptual differences of respon-dents for younger and older persons with depression or substance abuseconcerns, respondents need more information to help them understandthat depression is a treatable condition for older adults. Older adults withdepression can be treated with both talk therapies and medication; andimprove (Bartels & Smyer, 2002; Butler, Lewis & Sunderland, 1998;Sadock & Sadock, 2003). Similarly, respondents need increased exposureto content that provides information regarding substance abuse diagnosis,treatment, and recovery among older adults (Blow et al.,2002; Sadock &Sadock, 2003). Like many areas relating to ageist thought and behaviorsamong professionals, exposure to information and older persons remainscritically important. Social work education will need to invest resources inthese content areas and methods of exposure if they hope to change stu-dents’ perceptions of older adults and their capabilities.
Finally, while students are capable of understanding the policy impli-cations that impact oppression and marginalization, they may need someassistance to understand the connection between marginalization andresilience.
SUGGESTIONS FOR FUTURE RESEARCH/LIMITATIONS
This study used anonymous responses from a convenience sample.Although few students opted not to participate, there is no way in whichto determine if perceptions of respondents differed from non-respondents.Additionally, instructors who offered access to students may have beenmore interested in this research topic than instructors with little interest.
Another limitation surrounds the study’s instrumentation, as it reliedon original instrumentation developed for this particular study. Caution ininterpretation of the findings must be exercised in all cases where aninstrument’s reliability and validity have not been established and docu-mented over time. Finally, the sample was obtained from one geographic
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area that possessed unique ethno-cultural characteristics. This may furtherlimit generalizability.
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