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It begins with your first steps. Your first bike ride. Your first driving lesson. Your first job. The first time you buy a house. All these experiences in life eventually shape who we are and who we will become.
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With age come physical, social, and cognitive changes that make experiences once taken for granted more difficult to accomplish. In extreme cases, we might require assistance to complete even simple tasks like buying groceries or cleaning the house. Independence is a trait valued by many Americans, and is, unfortunately, often stripped from many who experience difficulties in old age.
Older adults approaching changes in life often find that these and other challenges related to aging cause unwanted mental strain and suffering. Physical disability and illness are common in the aging population, causing older adults to seek the professional expertise and advice of geriatric psychologists to address these issues.
Seeking guidance in times of confusion
Physical, mental, emotional, and social losses sometimes force older adults to rely on others or technologies for basic tasks that they were once able to accomplish themselves. Loss of independence induces a feeling of helplessness in the older adult, and sometimes leads to depression (see Depression) or anxiety (see Anxiety), or both.
Consider, for example, an older adult experiencing hearing loss. The National Council on Aging has found hearing loss to result in depression, anxiety, loss of social activity, and insecurity. Throughout his or her life, the older adult has lived without hearing loss, having developed a career, hobbies, and experiences based on the ability to hear.
Now, suddenly, the adult has difficulty hearing servers at restaurants, or is unable to have conversations with friends. Now the older adult needs the assistance of a hearing aid, which does not provide the same level of hearing the adult once enjoyed. Unable to fully accept the loss, the older adult turns to a geriatric psychologist to provide understanding and treatment for the emotional concerns he or she has about this physical loss.
Older adults also turn to geriatric psychologists to provide emotional and mental support for other physical and social issues. At some point, the body starts to change. Maybe stiff joints or a bad back prevents physical activity, or maybe an older adult isn’t so quick to remember dates or facts. Whatever the case, the mental assessments and psychological treatments provided by geriatric psychologists assist older adults, helping them to adjust to aging’s changes in healthy ways.
How do geriatric psychologists help older adults?
Assessing older adults to separate normal aging concerns from those that have led to more serious issues of depression or anxiety is the first step for geriatric psychologists. These professionals determine a correct diagnosis, and a correct therapeutic treatment.
Geriatric psychologists have several methods of assessment available for determining the mental state of older adults, including the possibility of depression and anxiety.
The principle assessment method is the Geriatric Depression Scale (GDS). This simple, 15-question yes-or-no survey provides geriatric psychologists with an initial view of the patient's mental health. Questions include: “Have you dropped many of your activities?” and, “Do you feel worthless the way you are now?” When a patient picks five or more negative answers, geriatric psychologists consider a diagnosis of depression.
Another depression assessment used by geriatric psychologists is Beck's Depression Inventory (BDI), a 21-question test where patients examine specific aspects of their lives. Questions range from feelings of guilt, to thoughts of suicide, energy levels, motivation, appetite, physical health, and interest in sex. Participants rate each question from 0 (e.g. “I make decisions as well as I could”) to 3 (e.g. “I can't make decisions at all anymore”).
The psychologist scores the test, placing the score along a continuum. For example, a score ranging from 1 to 10 signals to the psychologist that the older adult’s “ups and downs” are normal. However, a score in the 40+ range signals extreme depression.
After assessment and diagnosis, the geriatric psychologist determines the correct treatment method.
Treatment for older adults experiencing depression, anxiety, or other mental distress is highly situational, and rests on physical, emotional, and social factors. According to “Cognitive-Behavioral Psychotherapy in Older Adults,” by Psychologists Bob G. Knight and Derek Satre, the environment of the older adult is often a reinforcement for negative emotions.
For example, consider an older adult who moves into the home of his or her adult children because he or she is recently widowed. The older adult then adopts a sedentary lifestyle reinforced by the adult child, who does not wish to provide constant transportation for the older adult. The older adult, who does not wish to be a burden, loses social connections, eventually developing depression.
A geriatric psychologist hearing this patient’s story knows the depression experienced by this older adult is directly related to the loss of independence. The psychologist works with the adult to redevelop self-management skills, like using senior transportation services to reduce reliance on the caregiver. Oftentimes, this also means addressing physical inactivity by increasing mobility through exercise in addition to addressing the adult’s self-image.
Knight and Satre also indicate that all types of loss are an important focus of treatment in geriatric psychology. Loss of social situations, loss of loved ones, loss of independence, or loss of physical health all require different approaches to treatment. By addressing these specific situations, geriatric psychologists tailor treatments like cognitive behavioral therapy and interpersonal therapy to correctly treat older adults.
Knight and Satre recommend that while developing treatment plans for loss, geriatric psychologists follow guidelines set forth by a specific model, the Contextual, Cohort-based, Maturity, Specific Challenges (CCMSC) model. The CCMSC model identifies four areas that psychologists must understand to effectively adopt therapy for older adults. This model specifies that psychotherapy is adapted based on the following:
Contextual, or environmental situations, focus on the older adult's living arrangement and social environment. This could include adults who are retired, widowed, in nursing homes, or any older adults defined by social circumstances. In adopting therapy for older adults, the psychologist must take into account what it is like for an older adult to live in an age-segregated environment – a key aspect in working with older adults.
Age-segregated environments often reinforce conditions like depression. For example, an older adult living in a nursing home might feel less independent, which leads to depression. So the psychologist works on developing independence skills within the context of the nursing home, such as self-feeding, changing clothes without aid, and using the bathroom.
Cohort differences between patients constitute the time periods or generational eras of older adults. Individuals grouped by cohort share certain abilities, lifestyles, beliefs, attitudes, and personalities that distinguish them from other groups.
In order to correctly adjust treatment for different cohorts, geriatric psychologists must understand sociocultural differences between cohorts. Take, for instance, older adults experiencing anxiety. If they older grew up during the Great Depression, understanding the hardships they experienced would provide insights into how they tackle problems, like finances or housing concerns. With this knowledge, the psychologist adjusts and specializes therapy, such as focusing on underlying fears related to finances.
And for those older adults born before World War II, understanding that formal education has steadily increased with each successive cohort since that time changes therapy. For example, this cohort is the oldest of all living cohorts, and has less education and therefore less reasoning abilities. Psychologists must conduct therapy at a slower pace, as well as present concepts more simply in order to produce effective outcomes.
Maturational effects are the developmental changes the adult experiences throughout life. This includes worsening memory, changing physical abilities, and shifting skill sets. In order for therapy to be effective, geriatric psychologists need to talk more slowly and clearly, present new ideas one at a time, and adjust to challenges of hearing, sight, and mobility.
Specific challenges, similar to maturational effects, relate to the more frequent incidences of chronic illness, disease, grief, and caregiving associated with old age. In the case of chronic illness, the geriatric psychologist would focus on teaching the older adult to learn to control pain, and adjust to disabilities that frequently accompany disease.
Geriatric psychologists also teach alternative approaches to pain management. They introduce relaxation techniques, music therapy, and aroma therapy. They also employ a therapeutic framework called cognitive behavioral therapy (CBT), an empirically based, proven method for managing pain.
In the journal article “Cognitive Behavioral Therapy Managing Pain,” Psychologist Francis J. Keefe lists three basic components for treating those afflicted with chronic pain. First, the patient is informed of how cognitions, or thoughts, directly affect the pain experience. Second, training is provided for coping techniques like relaxation to decrease muscle tension, and other methods to distract the patient from pain. Third, the patient applies the learned techniques and learns problem-solving techniques to deal with pain flare ups.
How do I become a Geriatric Psychologist?
Becoming a geriatric psychologist requires a doctorate in psychology, as well as a compassionate personality and desire to help others. In addition to coursework, future geriatric psychologists should attempt to spend as much time around older adults as possible. This is accomplished through internships or volunteer opportunities at locations like hospitals, senior centers, nursing homes, and private practices.
For more information on working as a geriatric psychologist, request information from schools offering degree programs in psychology.
Minority Groups and Geriatric Psychology
The cultural landscape of America is changing. In 2011, the older U.S. population is predominately white, but by 2030, over 25% of the older U.S. population will consist of ethnic and racial minority groups, according to the Corsini Encyclopedia of Psychology. This significant portion of the population will require new approaches to psychology, as differences in traditions, cultures, and economic backgrounds will contribute in different ways to varying mental health needs.
The American Psychological Association (APA) indicates that interventions will need to be developed and provided in culturally sensitive and appropriate ways. In “Instilling Skills for Treating Minority Elders,” published in the November 2005 APA Monitor, author Bridget M. Law relates the story of a Chinese man in his 60s who complained of back pains, headaches, and nightmares. During the China-Vietnam war, the man saw many friends and family members die, and the past haunts him. The man wants peace, but does not have social support in the U.S., and wishes he were in China to visit a traditional healer.
A psychologist treating this Chinese man without taking into account his traditional upbringing and culture might not be able to adequately provide treatment. For instance, the usual interventions and medications for post traumatic stress disorder wouldn't necessarily take into account the spiritual needs of the man. Recommending regular psychotherapeutic treatments, however, in addition to spiritual healing from local Buddhist priests, or combining Eastern and Western treatments, would probably ensure a better therapeutic outcome.
This is just one example of how geriatric psychologists must be prepared to adjust treatment for minority populations. Minority groups are also more likely to experience mental health concerns and not seek treatment for a number of cultural and economic reasons. According to the APA, minorities are more likely to live in poverty, in segregated and disorganized communities, receive a poor education, and face stereotyping and discrimination.
The APA notes that more multicultural training is needed for geriatric psychologists in order to effectively meet the rising demands of the aging minority population.