As aging increases, geriatric health expectations and needs for social work profession and its services increase. Current social work engage in geriatric health services still focuses on micro-level changes for clients, but macro-level services such as promoting environmental change and advocating for policies are insufficient, that is the research from macro social work perspective is weak.

We explore the model and practice of macro social work in the field of geriatric health and provide a scientific basis and analysis for its engagement in geriatric health services through doctrinal analysis and field research.

From March to July 2021, the researcher entered the J social work professional organisation in Shanghai to conduct a field study, and the empirical data were mainly collected through two methods: participatory observation and semi-structured interview. The research subjects were selected based on the principle of purposive sampling. A total of 21 research participants were interviewed, including 5 agency administrators and social workers, 16 cognitive disorder patients in Shanghai. The interview outline was formulated based on the theory of development of social policy and welfare social division of labor. The typology method was used to categorise the clinical and macro practices of social workers in geriatric health services. NVivo 11 software was used to code and classify the interview contents, combining theoretical and empirical data to explore macro social work practices in geriatric health services.

A total of 21 people with cognitive disorders were interviewed, including both providers and users of geriatric health services. Understanding the values of macro social work, understanding the issues and service populations, promoting change in the community as a field, and changing the systems approach with health policy and welfare can provide accurate systems services for the elderly, enrich macro social work services, and contribute to changes in the geriatric health service environment.

Macro social work can promote and change the environment to provide better well-being for elderly health. The development of health social work requires the synergistic development of various sectors, such as the National Health Commission and the National Ministry of Civil Affairs, and the convergence of the wisdom of clinical social work and macro social work in geriatric health services. This will jointly promote the quality development of geriatric health services.

随着社会老龄化的加剧，老年健康对社会工作专业及其服务的期待与需求增多，当前社会工作参与老年健康服务仍聚焦在微观层面——对服务对象的改变，在促进环境改变和倡导政策等宏观层面的服务不足，即宏观社会工作视角的研究较弱。

通过学理分析和实地调研，探索宏观社会工作在老年健康领域的模式与实务，为其参与老年健康服务提供科学依据。

于2021年3—7月研究者进入上海市J社会工作专业机构进行田野调研，实证资料的收集主要通过参与式观察与半结构访谈2种方式进行。研究对象的抽取以立意抽样为原则，通过对包括5名机构管理者和社会工作者，16名上海市的认知障碍患者家属共21名研究对象展开访谈，基于发展型社会政策与福利分工理论制定访谈提纲。采用类型法将社会工作者在老年健康服务领域的临床与宏观实务进行分类，并运用NVivo 11软件对访谈内容进行编码与归类，结合理论与实证数据，探索老年健康服务中的宏观社会工作实务。

本研究共访谈21名认知障碍相关的人员，涵盖了老年健康服务的提供者与使用者。结果表明理解宏观社会工作的价值观、理解问题和服务人群、推进改变作为场域的社区、改变系统方法、健康政策与福利等，能够为老年群体提供精准的系统服务，丰富宏观社会工作的服务内容，促进老年健康服务环境的变化。

宏观社会工作能够促进和改变环境，为老年健康提供更好的福祉。健康社会工作的发展需要卫健委、民政部等多部门的协同发展，并将临床社会工作与宏观社会工作智慧汇聚于老年健康服务，共同推进老年健康服务的高质量发展。