As you prepare for your ASWB exam, know that issues surrounding aging adults are likely to show up in one form or another on your test. The ASWB is assessing not only that you know how to appropriately respond to scenario questions with aging adults, but also that you know symptoms for common diagnoses such as Dementia, Parkinson’s Disease, and Alzheimer's. Additionally-and this is an important one-they want to make sure you aren’t answering based on any underlying assumptions or stereotypes you have about aging adults.
Like our work with any client population, we want to ensure we are honoring and promoting self-determination with our aging adult clients. Challenging dynamics can arise when the adult children of our aging clients want different actions or outcomes than what our aging clients want. Unless a client has been deemed unable to make decisions for themselves and someone has medical Power of Attorney over them, we must promote client self-determination. Age does not negate a client’s right to decision making authority over their lives.
Don’t Make Assumptions-Especially Negative Ones
Sometimes the ASWB will throw a question in there to ensure you aren’t making assumptions about a client based on their age. For example, you don’t want to automatically choose an answer like ‘conduct a Mental Status Exam’ just because you are working with an older client. You would only do so if there were a reason to conduct a mental status exam (beyond just the client’s age) in the question stem.
A reason to conduct a Mental Status Exam would be if someone is having loose associations or not making sense in their speech or is experiencing tangential thoughts. But without a reason to do so, you don’t want to choose that answer solely based on someone’s age. Similarly, you don’t want to assume that an older client has memory problems if nothing in the question stem indicates this. Lastly, do not assume a client is unfit to live independently just based on their age.
As we should do with all of our clients, we must be aware of how countertransference impacts our work with aging adults. Or, for purposes of the exam, how it impacts the way we answer these questions. Some of us have aging parents ourselves, and we may find ourselves answering a question based not on client self-determination, but what we would want for our own parents. So we want to make sure we are checking our own biases and personal beliefs when it comes to these questions. The ASWB questions on aging adults are just as much about what we shouldn’t do as what we should do. Let's see how you do on a practice question about aging adults!
ASWB Practice Question:
An 82-year-old client was admitted to a hospital after experiencing a fall down the stairs. The client is ready to be discharged from the hospital and wishes to return home where she lives independently despite the fact that she is still recovering physically from her injuries. Both the client’s doctors and her adult children want the client to move into an assisted living facility where she can be better supported during her recovery, but the client is adamant about living independently. What should the social worker do?
A. Work with the client to determine ways she can support her independence while maintaining safety
B. Schedule a competency hearing
C. Explain the benefits of assisted living to the client
D. Schedule the client’s discharge to an assisted living facility for the duration of her recovery
(scroll down for answer)
The correct answer is A, to work with the client to determine ways she can support her independence while maintaining safety. There is nothing in the question stem that indicates a need for a competency hearing (B). The client has already expressed her desire to live at home, so C and D are both going against the client’s self-determination. Answer option A honors the client’s self-determination while also addressing potential safety concerns that may arise during her recovery.
ASWB Masters and Clinical Exam Preparation
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