What are the scopes and limits of your role as a social worker in assessing the differences among the diagnoses of dementia, delirium and depression in an older adult before making referral for appropriate intervention.

 

Social workers have a variety of roles in health care settings and often they become part of interdisciplinary health care teams. Social workers often demonstrate and apply a complex skillset that complements other treatment providers and enhances coordination of patient care. Interdisciplinary geriatric health care teams may consist of various specialists such as geriatricians, internal medicine physicians, neuropsychologists, geriatric psychiatrists, neurologists, geriatric cardiologists, geriatric social workers, geriatric nurse practitioners, geriatric nurses, ophthalmologists, urologists, audiologists, physical therapists, pharmacists, and medical assistants.

Through use of a geriatric program with geriatricians usually in a leadership position, the social worker's role is integrated with other disciplines and is somewhat flexible where activities overlap with supporting overall team effort. Which is why social workers are an important aspect of the patients' experience from the time of initial contact throughout their future clinic visits. In other words, social workers are direct care providers, patient advocates, and liaisons with other professionals of the team.

A common aspect of geriatric assessment teams is a specialty in dementia, delirium, and depression diagnosis and treatment. Medications are evaluated to assess possible side effects of drug interactions and identify medication management issues such as lack of adherence to instructions for taking medications, lack of understanding, or limitations in access to medication. Social workers contribute to this process through assessment questions and diagnostic tools targeting problem areas. However, when a psychiatric evaluation is included, neurocognitive screening or testing is only done by a neurologist or neuropsychologist, not by a social worker.

A typical format for communication between the patient, caregivers, and the health care team is through a family summary conference, which is done after completing a thorough physical exam, and accounting for the results of all diagnostics, including neurocognitive testing. This meeting is usually attended by physicians, neuropsychologists, social workers, and sometimes nurse practitioners who talk with the patient and family members directly to review and discuss findings and allow the patient and family members to weigh in. After which patients are given a written report of the assessment, which includes recommendations for treatment and follow-up and educational and resource information from social workers related to diagnosis and plan of care. Literature about dementia, delirium, or depression, caregiver respite, housing options, communication and behavior problems management strategies, home safety, and caregiver stress reduction is commonly provided.