The Age Wave – Understanding the Diversity and Needs of Older Clients

Me work with older adults? Not if I can help it! That is frequently the attitude of students I encounter who think of the elderly as a boring and debilitated population residing in nursing homes or other institutional settings. While not saying so in such blunt terms, many clinicians in practice secretly share the same perceptions. The reality is that whether one has planned to or not, working with older adults is an increasing likelihood for all clinicians unless they limit their practice to children and adolescents. Even marriage and family therapists will find more of their caseloads taken up with adult children confronting problem parents (Should they be driving? Can they safely stay in the family home? Are they making bad financial decisions?) rather than problem children. Demographic data tell us that the fastest growing segment of the population is adults over the age of 75, with the over-85 group increasing more than six fold. As Baby Boomers age, the number of adults living well into their 80s and 90s will jump exponentially. Identification and classification of the aging population has proved challenging. For example, gerontologists traditionally identify persons aged 60 years and above as older adults. Researchers, however, often break old age into three categories: the young old (ages 65-75), the old (ages 75—85), and the oldest old (age 85+). Others have argued that health not age should be the criterion so that the young old are all those who are over 65 and healthy while the oldest old are those over 65 who are I’ll or disabled. Much of this confusion in terminology is related to the changing character of aging in this country. Current generations of older adults are healthier and better educated than past cohorts. They enter old age with more old_resources and different expectations from those of earlier cohorts. The consequence is that as Baby Boomers age, they will be more psychologically minded and open to psychotherapy as a helpful process than were their parents and grandparents.

*Barriers to Working with older Adults* Unfortunately, the average counselor usually has had little direct contact or experience working with a large number of older adults. This lack of experience can limit the counselors interest in or comfort with this population. As a consequence, it is easy for societal myths about older people and inappropriate stereotypes to Impact the mental health professionals attitudes toward older clients. For example, a common misperception is that most older adults live in nursing homes or other institutional settings. However, the reality is that less than 5% of the elderly population reside in nursing homes. The majority of older adults never spend any time in a nursing home but rather live independently, successfully coping with their life situations. Another barrier to services is the myth that older people do not change or benefit from counseling. Multiple studies have consistently documented that psychotherapy is effective in overcoming depression and other mental health disorders in older adults. In fact, rates of Improvement and the extent of gains are often similar to those found among younger groups. In addition, interventions that focus on family members or on hospital or nursing home staff can result in significant Improvements even for patients who are unable to participate in traditional psychotherapy (such as dementia patients). Counselors must examine and challenge the stereotypes and misconceptions that limit their understanding and willingness to serve this population.

The reality is that older adults experience the same broad array of psychological issues and disorders that affect younger adults. To be helpful, counselors need to better understand the diversity of situations and needs of the hase clients and the wide range of issues and concerns confronting them. This is not a homogenous population. Often the only commonality among them is that they are over the age of 65. Differences in education, health status, economic status, and life experiences are often greater in this group than in younger clients and must be recognized and evaluated if effective treatment is to be provided. Working with older clients presents a challenge to mental health practitioners and demands that they acquire specific knowledge and skills needed to work creatively and effectively with this population. (Unfortunately, few have had even minimal academic or clinical training to prepare them to work competently with older adults.)

*Successful Aging* One of the most Important new trends in working with older populations is a de-emphasis on only negative aspects of aging and a growing emphasis on successful aging. Prevention and early intervention are playing larger roles in helping to optimize life satisfaction and quality of life in old age. There appears to be some truth to the wry observation of the elderly gentleman who commented, If Id known I was going to live this long, Id have taken better care of myself. A multidimensional approach is needed to achieve optimal quality of life for the elderly. It has been suggested that positive aging is associated with: avoidance of disease and disability; maintenance of high physical and cognitive function; and sustained engagement in social and productive activities. One of the most striking aspects of working with older adults is the need to go beyond an individual focus to develop a multidisciplinary approach that involves the medical, family, and social systems of the client. Christian counselors have a unique opportunity to enhance the hase multidimensional goals by providing an additional focus on clients spiritual and religious old_resources as well as drawing on the church community for support and care. A finding often ignored by mental health professionals is that religion plays a significant role in the lives of older adults. In fact, it has been reported that religious affiliation is the most common form of organizational participation among older adults, with 50% attending religious services weekly.

*What Mental Health Professionals Should Know about older Adults* The majority of older adults manage to face problems and overcome them effectively, but others will need help facing the challenges of aging. Depression and anxiety should not be considered normal conditions of the elderly. The hase are treatable disorders. In fact, older people evidence fewer diagnosable psychiatric disorders than younger persons. Only cognitive Impairment (dementia, delirium) shows a definite age-associated increase in incidence. What information, then, should counselors have to provide useful and competent help to older clients?

Normal vs. Pathological Changes of Aging It is critical to be able to differentiate the normal changes of aging from those that are indicators of pathological conditions. For example, normal physical changes in aging include mild to moderate hearing Impairment, visual changes such as slowed reading speed, difficulty seeing in dim light or reading small print, slower reaction time, high likelihood of having multiple chronic conditions such as arthritis, hypertension, cataracts, heart disease, and osteoporosis. In addition, the likelihood of needing personal assistance with normal activities of daily living increases with age (up to 50% of those aged 85 and older need some form of assistance). Cognitive changes in aging are highly variable from one person to another. In some older people, general patterns of normal cognitive change include: slowed information processing speed (which results in a slower learning rate and greater need for repetition of new information); decrease in ability to sustain attention; some decline in long-term memory (but often benefits from cueing); decline in word-finding or naming ability; decrease in visuo-spatial ability; and some decline in abstraction and mental flexibility.1 Little or no change is found in short-term memory, language ability (including verbal comprehension, vocabulary), and continued accumulation of practical expertise (or wisdom).

*Specific Challenges for Late Life Clients* The challenges facing older adults, such as chronic Illness, disability, and the death of a loved one, can occur at any time but are likely to pile up with greater frequency in the latter part of life. Loss is a common theme, but it will not necessarily be experienced in the same way by all clients. The counselor must explore the meaning of the experience for each individual client before rushing to provide an intervention. As with younger clients, older adults have vastly different psychological, social, and spiritual old_resources available for coping with the hase challenges. Respecting those differences and drawing on the unique strengths of each individual will best promote resiliency in the face of the multiple stressors of late life. One caution is that it is Imperative to assess suicide potential in depressed elderly clients. The highest rate of completed suicides is in the over-65 age group. In addition, marriage and family counselors need to be aware of the Impact of chronic Illness, disability, or change in work status (e.g., retirement) on marital and family systems. The hase changes can trigger crises for an individual or the family. For example, as adult children become aware of changes in their parents functioning, they must shift roles to become parents to their parents. Some of the stresses on the family system may be unexpected, such as the reappearance of sibling rivalries as adult children are forced to work together to make decisions about a parents care. In fact, the hase types of conflict are often more difficult to manage than the actual parent care itself. In addition, long term successful marital systems can be thrown into chaos when one spouse becomes disabled due to Illness or injury, thus disrupting set patterns of functioning. Another specific challenge of later life counselees is elder abuse. This includes physical abuse, neglect, and chronic verbal aggression, most commonly at the hands of a spouse, adult child, grandchild, or professional caregiver. It occurs at all economic levels and among all age groups in later adulthood. Abuse is much more likely to occur when the older person is experiencing physical, emotional, or cognitive problems. Persons with Alzheimers disease and other dementia disorders are at greater risk than others for elder abuse. Because medical practitioners may overlook signs of physical abuse, such as bruises or other injuries, or assume they are because of falls, it is Important for the mental health professional to question the cause of physical injuries. Christian counselors may find this a particularly sensitive area to assess due to the shame associated with acknowledging anger or resentment by Christian family members and caregivers. Helping caregivers including family members to recognize their negative feelings and develop appropriate coping responses is critical in preventing further abuse. Many states require reporting by health care, social service, or other professionals if abuse is suspected in the home. All states require reporting when abuse occurs in an institution.

*Knowledge of Community Resources and Services for Older Adults* One of the most unique aspects of working with older adults is the need to tap into the larger network of aging services available in the community. The difficulties facing older adults that threaten their quality of life and well-being frequently result from medical, physical, or economic circumstances that limit independence and functioning. Often, there are community old_resources that can meet some of thesis needs and thus enhance the quality of life for the client. At a minimum, the counselor should be familiar with the Area Agency on Aging, a federally mandated agency available in every city, county, or region of the United States that acts as a clearing house for all senior services available in that area.

*Conclusion* Counseling older adults presents a complex and challenging array of issues and circumstances with which the mental health practitioner must work. This can be rewarding for counselors who are willing to set aside negative societal stereotypes and engage thesis clients in the process of growth and healing. In addition, the experience of counseling older adults can also deepen counselors awareness of their own aging and, hopefully, generate a voice of care, compassion, and advocacy for the needs of this special population.

About The Author


Counselor Directory is available for your help. is the leading provider of online counseling and telephone counseling technologies, and exists to connect people who hurt with people who help, 24 hours a day, 365 days a year. was created by counselors who perceived a need for better online counseling methods. now boasts a full range of distance and in-person counseling capabilities in video and text chat, HIPAA-compliant secure email, and fully searchable counselor listings, all organized strategically around the top 40 most commonly seen counseling issues. Its directors include Dr. Peter San, who practices therapy at Thrive Boston Counseling.


Article Source:

Article Source:

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

  • LAAAC is managed by St. Barnabas Senior Services; Funded, in part, by Archstone Foundation.
  • St. Barnabas Senior Services

%d bloggers like this: