CHAPTER 23 COUNSELING OLDER ADULT CLIENTS

OLDER ADULTS The population of older individuals in the United States is growing Individuals aged 65 and older are 16.2% of the population Yet, mental health services specific to this population are lacking

SPECIFIC CHALLENGES FOR OLDER ADULTS Older individuals are subject to negative stereotypes and discrimination. Ageism, very common in our society, is defined as negative attitudes toward the process of aging or toward older individuals. Women who are older are even more likely to be viewed negatively by society as a whole and many internalize ageist norms.

SPECIFIC CHALLENGES OF OLDER ADULTS Stereotypes about older adults include: thought to be rigid and inadaptable in their thought processes, lacking in health, intelligence, and alertness, and having either no sexual interest or, if they were sexually active, as engaging in activity inappropriate for their age.

SPECIFIC CHALLENGES OF OLDER ADULTS Those with minority status face multiple discrimination One in seven adults aged 71 or older have dementia, including the 2.4 million in this age group diagnosed with Alzheimer’s Disease.

SPECIFIC CHALLENGES OF OLDER ADULTS Older adults suffer from elder abuse and neglect as well as from self-neglect Depression is more strongly associated with feelings of “being old” than with actual age or health status. Family circumstances most commonly associated with abuse and neglect include: (1) previous traumatic experiences and a pattern of violence in the family, (2) stress (including marital stress) resulting from accommodating an older parent or relative in the family home, (3) financial burdens, (4) overcrowded quarters and 5) low levels of social support.

SPECIFIC CHALLENGES OF OLDER ADULTS White males aged 85 and over have the highest suicide rate of any group Numbers of older adults suffering from substance abuse have increased; many cases go undetected and untreated. Family circumstances most commonly associated with abuse and neglect include: (1) previous traumatic experiences and a pattern of violence in the family, (2) stress (including marital stress) resulting from accommodating an older parent or relative in the family home, (3) financial burdens, (4) overcrowded quarters and 5) low levels of social support.

Implications for Clinical Practice Obtain specific knowledge and skills in counseling older adults. Critically evaluate your own attitudes about aging and quality of life Be knowledgeable about legal and ethical issues that arise when working with older adults (e.g., competency issues) Determine the reason for evaluation and the social aspects related to the problem, such as recent losses, financial stressors, and family issues

Implications for Clinical Practice Show older adults respect and give them as much autonomy as possible regardless of the issues involved or mental status Identify medical conditions and prescription and over-the-counter medications because mental conditions are often a result of physical problems or drug interactions or side effects

Implications for Clinical Practice Presume competence in older adult clients unless the contrary is obvious If necessary, slow the pace of therapy to accommodate cognitive slowing Provide information in a manner that approximates the client’s level of reading and comprehension, using alternative methods such as simplified visuals or videotapes if necessary

Implications for Clinical Practice Involve older adults in decisions as much as possible Use multiple assessments and include relevant sources (client, family members, significant others, and health care providers) Determine the role of family caregivers, educate them about the disorder, and help them develop strategies to reduce burnout

Implications for Clinical Practice When working with an older couple, help negotiate issues regarding time spent alone and together (especially after retirement Recognize that it is important to help individuals who are alone establish support systems in the community Help the older adult develop a sense of fulfillment in life by discussing the positive aspects of their experiences

Implications for Clinical Practice Determine the older adult’s views of the problem, belief system, stage of life issues, educational background, and social and ethnic influences Assist in interpreting the impact of cultural issues such as ethnic group membership, gender, and sexual orientation on their lives For adults very close to the end of their lives, help them deal with a sense of attachment to familiar objects by having them decide how heirlooms, keepsakes, and photo albums will be distributed and cared for