Ch. #24 Counseling Older Adults

Older adults are also viewed as what?

"All alike," possessing characteristics such as being rigid, sickly, dependent, and depressed.

Family circumstances most commonly associated with abuse and neglect include:

(a) Previous traumatic experiences in a pattern of violence in the family, (b) stress - including marital stress - resulting from accommodating an older parent or relative in the family home, (c) financial burdens, (d) overcrowded quarters, and (e) low levels of social support.

What is Alzheimer's disease?

A form of dementia that generally strikes older adults and is currently incurable.

For older adults demonstrating significant cognitive decline and for those suspected of having a neurodegenerative conditions such as Alzheimer's disease, the traditional mental status exam can provide some indication of problem areas. However,

A more frequently used assessment is the Mini-Mental Status Examination (MMSE). This test takes about 5-10 minutes to administer and has normative and validity data. It comprises 11 items that assess orientation, attention and calculation, recall, language, and visual motor integrity.

Older adults often have physical impairments, such as hearing or vision loss or cardiovascular disease. Moreover,

About 30% of adults between the ages of 65 and 74 have some hearing impairment, and this increases to about half of those older than 75. Up to 25% of older adults have insomnia or difficulty falling asleep.

How are self-identity and autonomy important to older adults, including those with dementia?

Adult children may infantilize or dominate a parent with a cognitive decline, assuming interactions are in the best interest of the parent but failing to take the parents own preferences or values into consideration.

What is ageism?

Ageism, defined as negative attitudes toward the process of aging or toward older individuals, is common in our society and around the world.

How are depression and social isolation common complaints among older adults?

Although physical changes are associated with aging (e.g. vision or hearing loss or cardiovascular disease) can sometimes lead to depression, depression is not a normal consequence of aging. Depression is more strongly associated with feelings of "being old" than with actual age or health status.

The majority of older adults have good emotional stability and high levels of affective well-being. Thus,

Although they may have less control over their environment, many should flexibility in their ability to adjust to different situations. They also show greater facility in understanding and managing emotions than younger individuals.

Approximately one in seven adults age 71 or older has dementia (i.e. memory impairment and declining cognitive functioning), including the 5.2 million in this age group diagnosed with Alzheimer's disease. Moreover,

Alzheimer's disease is now the fifth leading cause of death among American adults aged 65 and older; the risk of Alzheimer's disease and other dementias increase with age.

A number of biological and psychological treatments are effective in treating depression in older adults. Therefore,

Antidepressants such as certain selective serotonin reuptake inhibitors (SSRIs) have comparatively few side effects and are more likely to be continued - an important consideration, since rate of non-compliance with medication is higher among older adults.

Emotional stressors (retirement, caregiving, and lifestyle changes) and physical changes can produce problems in sexual functioning. Thus,

As with younger adults, therapists should remain aware of possible sexual concerns. The mental health professional should determine the treason for any difficulties, encouraging the client to consult with medical professionals when appropriate.

Drugs that have abuse potential include:

Benzodiazepines, opiates, and muscle relaxant.

Why is it essential that counselors be familiar with best practice guidelines for treating older adults and the complex ethical and legal issues pertaining to defining and reporting elder abuse and neglect, including self-neglect?

Counselors may see signs of bruising or malnutrition in older clients or indications that they are suffering from emotional abuse. Assessment may be difficult, since the client may have feelings of shame or dependency on the caregiver.

Many older adults consider elderspeak to be...

Demeaning, and even though with severe dementia may react negatively to its use by showing behavioral resistance.

In recent studies, older adults who believed they were resilient - had the ability to deal with stressors - tended to display successful aging regardless of physical or cognitive impairments. In addition,

Despite physical health status, self-ratings of successful aging were highly dependent on attitudinal qualities such as belief in one's ability to cope with challenges.

Ethnic minority older Americans tend to have more chronic, debilitating diseases, such as:

Diabetes and heart disease.

What is elderspeak?

Elderspeak, such as "Are we ready for our bath?" or "You want to take your medicine now, don't you?" is often used with an exaggerated intonation and elevated pitch, along with terms such as "honey" or "good girl."

It is unclear whether this group has less resilience and fewer coping strategies or whether the high suicide rate is because life changes associated with advanced age (e.g. loss of employment, physical changes, loss of control) are a greater stressor for men. However,

Factors associated with suicide include being separated, divorced, or alone; suffering from depression; having an anxiety disorder; having physical or medical problems; and dealing with family conflict or loss of a relationship.

What steps can be taken to reduce the prevalence of elder abuse and neglect?

First, continued public education can bring the problem out in the open and increase awareness of the risk factors for abuse. Second, respite care (e.g. family members, friends, or hired workers helping with caregiving) can help reduce caregiver burnout. Third, increasing social contact and support for caregivers can help keep stress more manageable.

It is also important to be alert for what client self-neglect?

For example, unsafe driving, failure to eat or take medications), another common concern that can have serious consequences.

Older adults who report a cognitive decline should undergo assessment to determine if their difficulties are associated with normal aging or due to pathological factors. Thus,

For those with a "normal" decline, reassurance and strategies to improve cognitive function and can be useful.

What changes do occur in sexual functioning in older women?

For women, aging is associated with a decline in estrogen, resulting in decreases in vaginal lubrication. however, sexual responsiveness of the clitoris is similar to that of younger women.

What changes do occur in sexual functioning in older men?

In men, erections occur more slowly and require continuous stimulation, although they can be maintained for longer periods without the need for ejaculation. The refractory period increases, so that it may take a day or two for the man to become sexually responsive again.

Why do women report significantly less sexual activity than men?

In part, this is due to a reduced likelihood of having a spousal or intimate relationship, as well as sexual problems such as low desire, difficulty with vaginal lubrication, and inability to reach orgasm.

Although dementia has a gradual progression, how can the effects of this condition quickly affect with the client and family members?

In the early stages, memory problems are often the primary concern. Delusions and hallucinations may develop as the dementia progresses.

Therapists should be sensitive to...

Intersectional considerations when working with older adults, and should comprehensively assess for potential problems with discrimination when working with those who have a disability, who come from a different ethnic or cultural group to the therapist's own, or who are members of a sexual minority.

The U.S. Department of Health and Human Services has published a comprehensive treatment manual for use by counselors that contains an evidence based cognitive behavioral group treatment for substance abuse in older adults. What does it include?

It includes modifications to therapy that incorporates physiological, cognitive, and social changes that are characteristic of this population. The manual is helpful in providing specific interventions in either a group or an individual format.

Why do many older adults, especially ethnic and minority group members, place a high value on religious beliefs?

It is a factor that contributes to a sense of hope and optimism, meaning and purpose in life, and better mental health.

Because of the frequency of physical illness (e.g. cardiovascular disease, hypertension)...

It is critical to work with medical providers to rule out the possibility that physical conditions, medications, or medication interactions are causing or contributing to emotional symptoms.

In many cases, major depression tends to be unrecognized in older adults and is a significant predictor of suicide. Therefore,

It is essential to assess for depression and suicidality when working with older adults. A popular instrument for screening for depression is the Geriatric Depression Scale, which was developed for older adults. It has age-related norms and emits somatic symptoms that may be associated with physical problems rather than depression.

How has there been a dramatic increase in substance abuse and the non-medical use of prescription medications among older adults?

It is estimated that 11% of older adults abuse alcohol or prescription drugs; some of the misuse of prescription drugs may involve misunderstandings of dosing instructions.

Research has found that cognitive decline in older adults can be delayed or reduced through...

Lifestyle changes such as the use of cognitive activities to stimulate the mind (e.g. chess, crossword puzzles, computer games, reading), engaging in physical activity, and better nutrition. These lifestyle interventions appear to improve neuroplasticity, increase neuronal connections in the brain, and increase cognitive reserve.

How is the maltreatment of older adults, including neglect and emotional, financial, physical, and sexual abuse, a significant public health concern?

Many cases of abuse or neglect go undetected, especially among those who are most vulnerable (e.g. individuals living with dementia, depression, or significant health concerns).

What is dementia?

Memory impairment and declining cognitive functioning as a result of brain disease.

How does ageism influence how both the general public and mental health professionals perceive older persons?

Negative stereotypes often result in older adults feeling invisible or less valued. Many older individuals come to accept ageist views and suffer from a less of self-esteem. In fact, many internalize negative societal beliefs.

Depression needs to be identified and treated, since it is also seen as an independent risk factor for cardiovascular and cerebrovascular disease. In addition,

Not only does late-life depression significantly affect older adults physical health, but it can also affect social connections and overall functioning, and increase the risk of suicide.

How are older individuals subject to negative stereotypes and discrimination?

Older people always experience ageism at the intersections of other identifies, such as those associated with race, ethnicity, and gender.

How do the resulting manifestations of ageism often differ?

Older women, for example, are likely to be viewed negatively by society as a whole, and may internalize ageist norms involving qualities such as beauty.

How are the majority of older individuals quite healthy and are able to live independent lives requiring only minimal assistance?

Only 3.3% of adults 65-74 years need help with personal care from other persons; this percentage increases to 10.5% for those 75 and older.

In our youth-oriented society, older adults are not expected to be interested in sex. Some consider sexual activity among older persons to be rare or even inappropriate. However,

Sexual interest and activity continue well into the 80s and 90s for many individuals. Among people 70 and older, 80% of men and 39% of women indicated that a satisfying sexual relationship is an important part of the quality of life.

Older adults rarely seek treatment for substance abuse problems because of...

Shame and perhaps because they feel uncomfortable in programs that deal with "street" drugs, such as heroin and cocaine.

Poverty, unemployment, poor living conditions, discrimination, and lack of receptivity among health care providers can...

Significantly contribute to mental health concerns among older adults and may need to be addressed.

Family members may not understand that individuals with dementia do not always recall what they are told. They may become frustrated when the affected individual is forgetful or needs extra assistance following through with tasks. Additionally,

Some may believe the behavior is willful or may try to assume responsibility over all aspects of the older person's life, even when he or she can perform effectively in some areas.

What can increase the risk of depression in older adults?

Stressful life changes, such as the deaths of friends and relatives, increasing social isolation, or financial distress, can increase the risk of depression. Social isolation is related not only to depression but also to other mental health conditions and physical complaints.

In a review of negative attitudes toward older individuals, what did Palmore (2005) find?

That older adults were thought to be inflexile in their thought processes; lacking in health, intelliegene, and alertness; and either lacking in sexual interest or, if they were secually active, engaging in activity inappropriate for their age.

What is especially problematic is that aging produces physiological changes that may increase the potency of drugs and other interactions. Thus,

The National Institute of Alcohol Abuse and Alcoholism recommends that men 65 or older do not have more than one drink daily, and a maximum of two drinks on any occasion; lower limits are recommended for women. The misuse of drugs can produce conditions resembling organic or mental health conditions.

Late-onset alcohol and drug abuse problems seem to be related to stressors such as what?

The death of a spouse, family member, or friend; retirement issues; family conflicts; physical health problems; or financial concerns. Many of these structures are typical issues faced later in life.

Because depression often co-occurs with physical illnesses, such as cardiovascular disease, stroke, diabetes, and cancer, health providers often believe that the mood disturbance is a normal consequence of these problems, so they are less likely to refer for mental health treatment. Thus,

There is an urgent need to detect and adequately treat depression in order to reduce suicide among older individuals.

A common view of older persons is that they are mentally incompetent. Although,

There is some cognitive slowing associated with normal aging (e.g. periodic minor memory difficulties such as forgetting names or phone numbers or misplacing objects), the majority of older adults do not demonstrate significant mental decline.

Because of the deleterious effects of social isolation on older adults, early assessment and intervention to prevent further isolation is important. How can encouraging older adults to participate in senior centers or other social activities in their community decrease social isolation?

There is some evidence that the impact of loneliness and depression can be counteracted by helping older adults focus on positive emotions such as happiness, optimism, and resilience; in other words, happiness has been found to "undo" or negate the negative effects of loneliness and depression in older adults.

Meta-analysis of evidence-based therapies, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and interpersonal therapy, indicate that...

These therapies are effective in reducing depression in dealing with issues such as loss, transition, and cognitive decline in older individuals. Interpersonal therapy has been demonstrated to reduce suicidal ideation.

Unfortunately, how do mental health professionals also display age bias?

They express a reluctance to work with older adults, perceiving this populations as having a poorer prognosis, and viewing older people as less interesting, more set in their ways, and less likely to benefit from therapy. Additionally, mental health problems in older adults may be accurately attributed to aging. Such beliefs can limit referrals for necessary services.

Individuals aged 65 and older currently constitute 16.2% of the U.S. population. However,

This group is growing, and is expected to constitute more than 20% of the population by 2030. During the past decade, the age‐85‐and‐older group, the fastest‐growing segment of the adult population, has increased by 38%.

Baby Boomers - those born in the 1950s and 60s - have shown a dramatic spike in suicides, especially among White, Native American, and Alaskan men. Why?

This increase may be the result of coming from a youth-oriented an optimistic generation, and an associated inability to deal with the signs of aging or a perceived lack of achievement.

When providing mental health services for older adults, why should counselors consider the possibility that some will have physical limitations?

To ensure that the counseling environment is appropriate for older clients, rooms should have adequate light and be free from extraneous noise, as well as any limiting environmental barriers. If the client uses eyeglasses or hearing aids, make sure these are present during the session.

Early detection of cognitive decline allows for what?

Treatment and advanced planning involving legal matters or potential problems such as driving.