«WHAT PRACTITIONERS SHOULD KNOW ABOUT WORKING WITH OLDER ADULTS NORMAN ABELES, PHD President, American Psychological Association APA Working Group on ...»
WHAT PRACTITIONERS SHOULD KNOW ABOUT
WORKING WITH OLDER ADULTS
NORMAN ABELES, PHD
President, American Psychological Association
APA Working Group on the Older Adult Brochure
Susan Cooley, PhD
Irene M. Deitch, PhD
Mary S. Harper, RN, PhD
Gregory Hinrichsen, PhD
Martita A. Lopez, PhD
Victor A. Molinari, PhD
AMERICAN PSYCHOLOGICAL ASSOCIATION
WHAT PRACTITIONERS SHOULD KNOW ABOUT
WORKING WITH OLDER ADULTSNORMAN ABELES, PHD President, American Psychological Association APA Working Group on the Older Adult Brochure Susan Cooley, PhD Irene M. Deitch, PhD Mary S. Harper, RN, PhD Gregory Hinrichsen, PhD Martita A. Lopez, PhD Victor A. Molinari, PhD
AMERICAN PSYCHOLOGICAL ASSOCIATIONRevised and Reprinted 1998 Originally Published December 1997
Content of this publication was published in:
Professional Psychology: Research and Practice (1998), Vol. 29, No. 5, 413-427 —EXECUTIVE SUMMARY— This publication is designed to give psychologists and other health care providers important information to help guide their work with older adults.
Clinicians need to know more about this age group because the number and proportion of older adults in the population are increasing, and more psychologists will be called upon to deliver psychological services to them.
Older adults are defined as persons 65 years of age and older. The population of older Americans is itself getting older. The “oldest old” group, those 85 years and older, is increasing faster than any other age group. Unfortunately, there are numerous negative stereotypes about older people. The reality is that most older people live independently and maintain close relationships with family and friends. Personality remains relatively stable throughout the lifespan, and community dwelling older adults have lower rates of diagnosable depression than younger adults.
However, older adults do experience age-related changes—both physical and cognitive. Common age-related physical changes include hearing impairment, weakening vision, and the increasing probability of multiple chronic conditions such as arthritis, hypertension, heart disease, diabetes, and osteoporosis. While there is some degree of cognitive impairment, cognitive changes in older adults are highly variable from one person to another, but can include decline in information processing speed and memory problems. These changes do not typically interfere with daily living. Because a large number of older adults take several medications, drug interactions and drug side effects are more common than in younger age groups.
In assessing an older adult, the practitioner may have to modify the testing environment to assure optimal performance. Any assessment of an older adult should include the client’s current mental status, cognitive ability, social supports available to the client, the client’s medical status, and, if cognitive impairment is suspected, interviews with family members and close friends.
Research indicates that psychological interventions that historically have proven effective with younger and middle-aged adults are also effective for older adults. Specifically, cognitive-behavioral, brief psychodynamic, and Klerman and Weissman’s interpersonal psychotherapy have been shown to be effective in the treatment of one or more late-life mental disorders.
—CONTENTS— WHY PRACTITIONERS NEED INFORMATION ABOUT WORKING WITH OLDER ADULTS.............. 7
VI. APPROPRIATE PSYCHOLOGICAL INTERVENTIONS FOR OLDER ADULTS....................... 26
VII. BROAD PROFESSIONAL ISSUES OF CONCERN TO PSYCHOLOGISTS WORKING WITH OLDER ADULTS. 30
WHY PRACTITIONERS NEED INFORMATION
ABOUT WORKING WITH OLDER ADULTSOur society is being reshaped by a rising demographic tide. Never have so many people lived into the later stages of their lives so healthy and so productively. In the United States, those born between 1946 and 1964—the “baby boomers”—are now growing older, and the first wave of this demographic phenomenon will reach age 65 in less than 15 years. At the crest of the aging of the baby boomers, 20 percent of the population of the United States will be 65 years old or older.
Who is old? Specific chronological markers for old age are arbitrary. The definition of “older adult” varies, depending on different perspectives and purposes. For example, gerontologists traditionally focus on persons aged 60 years and older. The federal government uses age 65 as a marker for full Social Security and Medicare benefits. Researchers identify subgroups of “older adults” as “younger old” (ages 65-75), “older-old” (ages 75-85), and “oldest old” (ages 85+). Age ranges vary across studies.
Subjectively, though, many older adults don’t label themselves as “old,” even at advanced ages. A survey of 2,500 seniors in a Los Angeles community revealed that as the seniors aged, they continued to grow, create, and engage in activities linked with education and travel. Some older adults are late-life career bloomers; others become active in their families or proactive in their communities, volunteer their time, or enter the political arena.
Advocates of older adults, including Nobel laureate Elie Wiesel, feel that older adults as guardians of the world’s vital memories should be appreciated and respected. Yet, they are a neglected resource. As the 1997 APA Convention keynote speaker, Wiesel said, “an old person represents wisdom and the promise of living a full life…the worst curse is to make him or her feel worthless.” Psychologists are in a unique position to address the psychologically related issues older adults experience and enhance their intellectual, social, and emotional well-being.
In the face of the demographic changes, many psychologists who have never received formal instruction to work with older adults will choose to provide services to this growing population. Many of the skills psychologists use to aid younger adults are, for the most part, applicable to older adults. But, assessment and treatment must be informed by the impressive amount of geropsychological data now available. Armed with facts about the myths and realities of aging, knowledgeable about the problems older adults face, cognizant of how to assess and treat older persons, and familiar with broader professional issues in aging, psychologists can maximize their efforts to assist this large and diverse segment of our society.
This publication delivers information to dispel myths about older adults and raise practitioners’ awareness of facts about aging. The information is presented in seven sections. Section I, Demographic Realities of the Increasing Older Population, presents demographic information, such as gender and ethnicity, of the older population. Section II, Commonly Held Myths About Older Adults, lists facts as opposed to the myths. Section III, Realities of Aging for Older Americans, discusses productivity, economic well-being, social circumstances, and other general information about the older adult population. Section IV, Psychological Problems Some Older Adults Experience, is an alphabetical listing of common psychological problems and how they present in older adults. Section V, Assessment of Older Adults, gives information about basic principles and unique features for assessing older adults. Section VI, Appropriate Psychological Interventions for Older Adults, discusses unique problems of late life and the needed adaptation of psychological interventions. Section VII, Broad Professional Issues of Concern to Psychologists Working With Older Adults, presents practical issues in providing services, such as sources of reimbursement, ethical challenges, and unique realities of ethnic minority older adults. The publication concludes with a list of professional resources in geropsychology and a bibliography.
I. DEMOGRAPHIC REALITIES OF THE INCREASING OLDER POPULATIONSince 1900 the percentage of Americans 65 years and older has more than tripled.
The older population itself is getting older. In 1994 the 65-74 age group was 8 times larger than in 1900.
The 75-84 age group was 14 times larger. The 85 and older age group was 28 times larger.
The “oldest old” group (those over 85 years) is increasing faster than any other age group.
The ethnic racial minority population over 65 years old is growing faster than the older adults group as a whole, at a 2:3 ratio. Minority persons are projected to represent up to 25 percent of older adults by the year 2030.
In 1994 there were nearly 8.6 million veterans 65 years or older (32 percent of the total veteran population), about 4 percent of whom were women. Because of the aging of World War II veterans, the number is expected to peak by the year 2000, when there will be about 9.3 million elderly veterans (38 percent of the total veteran population). In 1996, 76 percent of civilian males aged 70-74 years were veterans, reflecting U.S. participation in World War II.
III. REALITIES OF AGING FOR OLDER AMERICANSWhat is aging America really like? What are Americans’ patterns of aging, education, productivity, economic well-being, social circumstances, leisure interests, cognitive abilities, physical well-being, etc.? The answers to the questions below give a broad picture.
Over one-third of older adults are involved in formal or informal volunteer work.
WHAT IS THE ECONOMIC WELL-BEING OF TODAY’S OLDER ADULTS?
The overall economic picture of older adults has improved significantly since the 1970s, and, in general, they now have more assets than younger adults. In 1992, 13 percent of older adults as a group were poor (compared to nearly 15 percent of those under 65 years), although poverty rates were higher for older African Americans (33 percent), Hispanics (22 percent), and persons aged 85 or more (20 percent). The median income for older men was $15,276, and $8,579 for older women. Social Security benefits are the primary source of money income. Interestingly, a survey conducted by the APA Committee on Older Women found that older female psychologists were as financially secure in their later years as older male psychologists.
WHAT ARE THE SOCIAL CIRCUMSTANCES AND THE SOCIAL WELL-BEING OF OLDER PEOPLE?
Family and friends are key social supports for many older adults. The following data refer to noninstitutionalized older persons, except where noted.
In 1993, 64 percent of those aged 65 to 74 were married and living with a spouse. Among those aged 85 years and older, 24 percent lived with their spouse and 48 percent lived alone. Older men were nearly twice as likely as older women to be married and living with their spouse. Half the women over the age of 65 are widows. Older women are more likely to live alone than are older men.
Of those older adults with living children in 1984, nearly half (48 percent) had daily contact, and 86 percent had at least weekly contact with their children.
Many older adults provide assistance to younger family members, including giving emotional support, caring for grandchildren or disabled children, providing a place to live, or making monetary gifts or loans.
About four of five older adults report having one or more confidants. Generally, women have more interaction with friends than do men.
Salient risk factors for institutionalization include: age over 75 years, living alone, immobile, demented, and recently hospitalized.
WHAT ARE THE SOCIAL AND LEISURE INTERESTS OF OLDER ADULTS?
Although older adults vary widely in their specific interests and pastimes, there is continuity in leisure pursuits across the life course. Most leisure time is not spent in activity programs developed especially for older persons.
Religious affiliation is the most common form of organizational participation among older adults, with 50 percent attending religious services weekly.
Older adults are active in politics, with about two-thirds reporting voting in the 1992 Presidential election (compared with about half of younger adults).
With advancing age, older adults tend to pursue more sedentary and solitary activities, such as visiting family and friends, watching television, and reading.
WHAT ARE COMMON AGE-ASSOCIATED PHYSICAL CHANGES?
Normal age-associated changes typically occur gradually over time.
Hearing impairment in older adults is often mild or moderate, but it is widespread. In 1990, 48 percent of men 75 years and over and 37 percent of women (noninstitutionalized) had problems with hearing.
Visual changes include problems with reading speed, seeing in dim light, reading scrolling or other externally paced displays, reading small print, and locating objects visually.
Reaction time is typically slower among older adults, particularly for more complex tasks.
The probability of having multiple chronic conditions increases with age. Common comorbidities include arthritis, hypertension, cataracts, heart disease, diabetes, and osteoporosis.
Although estimates vary, the proportion of older adults needing personal assistance with everyday activities increases with age (e.g., 9 percent of those aged 65-69 and up to 50 percent of those aged 85 or older).
After age 65, a greater proportion of women than men become disabled.