Counseling

Older Adults
Cloudette Williams 20 April 2016

Valuable Contributors
Older Adults comprise a growing proportion of the global population. They make valuable
contributions and serve as essential resources to their communities. The younger
generation can benefit from their wealth of knowledge and experiences.

Having lived so many years, they are filled with wisdom. Our seniors have experience,
which is the best teacher in life. They know firsthand what it s like to live through
tragedies and triumphs. They are living testament that people survive through good and
bad times
(Sue &
Sue,
2016).

If you are
fortunate
to reach
old age,
the
important
battles
have been
waged and
decisions
made. You
no longer
have to do
the
pushing, the striving, and the struggle.

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 Values & Norms
Many elders exhibit a sense of calm. Because
they have lived through so many events, both
historical and personal. Older people realize
that life goes on despite adversities. For many,
fears about what could happen have been
replaced with a sense of acceptance, and, with
acceptance comes peace.

Family - At the top of their list is family. Family provide a setting for much of the
growth they experience in life. Through family they experience and exercise love,
joy and sorrows. Families serve, teach, and learn from each other. Although family
can bring difficult challenges, they also give strength an account for some of the
greatest happiness.

Respect, Support & Patience - Older adults want to be respected. Respect is

important because it shows that one values another as an individual, and that he
honors the personal rights and dignity of the person. They expect support from
families and friends.

Friendship - friendships are viewed as the most common source of joy. Having close
friends positively affects the emotional well-being of older adults.

Acceptance & Accomplishment - Successful

aging is accepting what they are at this time. Not
dwelling on what have been or forgot to do or
couldn t do or things they want to do that are no
longer capable of doing. Just being content, satised
with where they are.

Appreciation - They want to feel recognized for their contribution in life. Not being
ignored but celebrated.

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Love & Happiness - Although sexual activities decreases, older adults still
experience sexual desires. Companionship keeps their minds healthy along with love
and support from family members.

Faith & Spirituality - Developing a trusting relationship with God and prayers are
very self comforting.

Justice & Peace - availability of facilities including social security benets, health
care and nursing homes for those older people living alone and with difculty.

Independence - they want to be treated with with independence and not

handicapped.

IMPACT ON THE COUNSELING PROCESS

As counselor we recognize that each client is unique, likewise counseling this

population. Although majority of older adults share similar values, it is always
important for the counselor to do background research, be aware of what is important
to them, their beliefs and values. Counselor can use these values and strengths to
administer appropriate treatments and interventions.

Older adult clients are looking for trust, commitment, and respect from the counselor.
They feel happier when they are in the company of friends and family than when they
are alone. (Larson and Bradney, 1988). These values inuence a positive health
outcomes, such as lower mortality rates and a relatively long life. As individuals grow
older, many lose their spouses through either death or divorce, particularly women,
and this also creates a greater call for close ties with family and friends.

Older adults may be prone to serious health problems. They may experience physical
limitations, minimal income and reduced transportation, which can
limit their social activities. Counselors should ensure the counseling
environment is appropriate: eliminating environmental barriers such
as extraneous noise, adequate lighting that can help the client to feel
secure. The counselor can also provide assistance in terms of eye
glasses or hearing aid if the client requires one. (Sue & Sue, 2016).

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 Historical Experiences

1914 1918 World War I - Claimed the lives of 115,516 Americans.

1920 - The Civil Retirement Act provided a retired system for many governmental

employees.

1929 - 1945 World War II - Claimed the lives of 400,000 military soldiers.

1935 - Social Security Act passed; provides for Old Age Assistance and Old Age
Survivors Insurance.

1950 President Truman initiated the first Nation Conference on Aging, sponsored
by the Federal Security Act to consider the range of problems presented by the
changing age distribution of the American population.

1952 First Federal Funds appropriate for Social Service programs for older
persons under the Social Security Act.

1959 Housing Act authorized a direct loan program for non-profit rental projects,
for the elderly at low interests rates and lowered eligibility ages for public-low-rent
housing, for low-income women to age 62.

1960 Social Security eliminated age 50 as minimum for qualifying for disability
benefits, and liberalized the retirement test and the requirement for fully insured status.

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 1963 - President Kennedy first celebrated older Americans by designating May as
Senior Citizens Month.

1967 - The Age Discrimination of Employment Act prohibits age discrimination in

employment against persons 40 years of age or older. This law promotes employment of
older persons based on their ability rather than age; prohibits arbitrary age discrimination
in employment.

1969 - Robert N. Butler (Gerontologist) Founder of National Institute on Aging. He

coined the term ageism and became a political activist who decided his lifes work to
advocating for the needs and rights of elderly persons. He worked tirelessly for decades to
raise societal awareness of issues surround population aging.

1973 - Area Agencies on Aging (AAAs) were established under the Older
Americans Act (OAA) to respond to the needs of American aged 65 and over in every
local Community.

2004 - Negotiated Settlement of Federal Age Discrimination complaints totaled

$69 million.

2009 - President Obama appointed Kathy Greenlee as 4th Assistant Secretary for
Aging.

2011 First of the nations baby boomers turn 65

Commonly recognized older adults generation today in the United States are those
associated with World War II, the Great Depression, the cold war, the Vietnam War and
the Summer of Love. These dramatic events can have long lasting impact on the elderly
population. Family members and/or friends might have been involve in these events
and their death could have a significant impact on their lives.

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 The population age 65 years or older numbered 44.7 million in 2013. They
represent ted 14.1% of the U.S. population.

In 2013, there were 25.1 million older women and 19.6 million older men, or a sex
ratio of 128.1 women for every 100 men. At age 85 and over, this ratio increases to
195.9 women for every 100 men.

Between 2012 and 2050, the United States will experience considerable growth in
its older population. In 2050, the population aged 65 and over is projected to be
83.7 million.

By 2050, the surviving baby boomers will be over the age of 85. (U.S. Department
of Heath and Human Services)

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The number of people aged 65 and over in Massachusetts in 2010 was 902,724. This
represents an increase of 42,562 seniors, compared with the population aged 65+ from
the 2000 Census. Residents 65 and over represent 13.8% of the total population of the
Commonwealth, slightly higher than the U.S. average of 13.0%.

The projected number of people aged 65 and over in Massachusetts in 2030 is 1.5
million. This represents 21% of the total projected population for 2030.

The number of women aged 65 and over in

Massachusetts in 2010 was 526,299. Women
account for 58% of the 65 and over age
group. The number of women aged 85 and
over was 100,174, representing 69% of
Massachusetts residents aged 85 or
more (which totals 145,199 people).

Fourteen percentage of people aged

65 and over in Massachusetts is
foreign-born. This represents an
estimated foreign born population of
129,000 seniors (U.S. Census Bureau,
2010 )

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 Latest Population Figures

Income

The median income of older persons in 2013 was $29,327 for males and
$16,301 for females.

From 2012 to 2013, median money income of all households headed by older
people rose 3.7% which was statistically significant.

Households containing families headed by persons 65+ reported a median

income in 2013 of $51,486.

About 6% of family households with an older adult householder had

incomes less than $15,000 and 70% had incomes of $35,000 or more.

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 Education

The educational level of the older population is increasing. Between 1970 and 2014,
the percentage of older persons who had completed high school rose from 28% to 84%.

About 26% in 2014 had a bachelor's degree or higher.

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 Challenges
Ageism negative attitude and unfair treatment
of old people

Mandatory Retirement

Asexual- no sexual feelings or associations

Societal Norms: comedian jokes,

advertisements

Negative Stereotypes and discrimination.

Elderly Abuse (Nursing Homes/Caregivers) - intentional, or negligent causing harm

or a serious risk of harm to a vulnerable adult.

Cognitive Challenges - Aging results in normal changes in cognition: reduced

processing speed, greater tendency to be distracted, and reduced capacity to process and
remember new information (working memory).

Visual Challenges - Many older adults have problems with vision. About 2/3 of adults
with vision problems are older than 65.

Hearing Challenges - Hearing loss is common in older

adults, affecting 1 in 3 people older than 60 and half of
those older than 85.

Disease ( Diabetes, Hypertension, etc)

Medical Expense & Economic insecurity Older

Adults are outliving their finances and cost of living is
expensive, medications are expensive.

Mobility decreases their ability to move independently

and safely from one place to another.

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Social Isolation/loneliness lacking participation and contribution to their
communities can result in reduced social skills, develop depression, social anxiety,
alcoholism, etc.

Retirement - transition faced by the elderly effects on physical and mental health
depending on attitude toward and reason for retiring. About one third of retirees have
difficulty adjusting to certain aspects of retirement, such as reduced income and altered
social role and entitlements. Some people choose to retire, having looked forward to
quitting work; others are forced to retire because of health problems or job loss.

Where or from Whom do Older Adults Seek Help?

As people get older, we tend to ignore them and shut them away when we should
celebrate their wisdom and allow them to share their gifts with us and our children. Older
adults have experience complex emotions and tragedies in their lives. There is
considerable interest in how older adults manage severe negative life circumstances.

Some adults beliefs can interfere with seeking counseling services-namely, the beliefs that
older adults are less valued than other segments of the population. They belief that it is
more important to take care of others than of oneself. (R.S. Haight, 2005).

They therefore focus on more emotionally close relationship to get them through. They
often seek advise from older relatives and spiritual leaders.

One specific issue to keep in mind regarding counseling older adults is the fact that many
older adults are referred to counseling by a loved one or physician, because of this, it is
important for counselors to explore with their older adult clients, their understanding of
why they are seeing a counselor and their expectations and motivations.

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 Local Community/Agencies

Friendship Works
105 Chauncy Street
Boston, MA 02111
Program Name: Friendly Visiting and Medical Escort
Contact: Lois Lord Walker (617) 482-1510
www.fw4elders.org

Many elders face loneliness every day. Social networks that they have spent their
lifetimes building may have diminished and family, if it exists, may live far away or be
otherwise absent.

It is FriendshipWorkss ongoing mission to reduce social isolation and replace it with the
warmth and comfort that only a caring and dedicated friend can provide.
FriendshipWorks volunteers are there 52 weeks per year providing assistance and
companionship to those who need it most.

Mission: to promote the emotional, physical and economic well being of older
adults and to encourage their participation in all aspects of the community life.

Director: Lorraine Carrozza

10 Wally Krueger Way
Bridgewater
508-697-0929
http://www.bridgewaterma.org?Government/Depts/VeteransServices

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Services Include:
Assistance with bathing and dressing
Meal Planning and Preparation
Errands & Shopping
Medication Reminders
Hobbies, Arts & Craft
Social Events
24 Hour Care Line
Light Housekeeping

Boston Medical Center

Elders Living at Home Program
Yawkey Ambulatory Care Center
850 Harrison Avenue
Boston, MA 02118

Boston Medical Center, all are welcome and treated equally. They have the best and
brightest physicians. It is a non-profit organization committed to the community in
providing accessible health care to everyone. Through its commitment to serve everyone,.
Everyone is committed to providing quality care to every patient and family member with
respect, warmth and compassion. BMC offers numerous outreach programs and services
such as:
Health Screenings
Smoking Cessation
Preventive Food Pantry

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 Counseling Intervention

Acquire Specific knowledge and skills in counseling older adults and critically evaluate
your own attitudes and beliefs regarding aging and older adults.

Remain knowledgeable about legal and ethical issues when working with older adults.

Involve clients in decisions as much as possible

Older adults may be less receptive to counseling and may identify counseling as
stigmatizing, so it is important for counselors to address this issue directly.

Given many older adults lack of familiarity with counseling, a counselor may wish to
provide information to the client about how counseling functions, how it is structured
and its rationale.

Many older adults suffer with various sensory impairments (hearing, visual or
mobility), so counselors should be active in compensating for the particular
impairment(s) of the client.

Counselors should consider coordinating clients treatment with a physician and/or

other health care professionals to rule out physical conditions and medication that may
contribute to emotional symptoms.

Give full attention to our client

Treat the Client as an adult (Sue & Sue, 2016).

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 Don't Assume you know ASK
Don't underestimate their abilities
Dont talk about, rather to the Client.
Dont Speak Fast and/or low
Don't assume that the client cannot be an active participant in the counseling process

(Sue & Sue, 2016).

Counseling can significantly improve the quality of life for adults nearing the end of life

and help them resolve late life issues. Ageism influences how both the general public and

mental health professionals perceive older adults. As counselors, it is important to be self-

aware of ones negative perceptions of aging and of older adults, as a negative perceptions

will adversely affect ones ability to successfully counsel.

Counselors should anticipate complex and subtle emotions when working with clients in

later life. They must understand what are their expected norms, the clients actual

experiences and what the differences between expectations and reality are. It is essential

that counselors who work with older adults become informed about the social systems in

which their clients function. (Knight & Satre, 1999).

Counselors should presume competence in their client unless the contrary is obvious.

Show respect and give them as much autonomy as possible when communicating with

them. They should include relevant sources like family members, significant other or

health care providers. Their concerns should be taken seriously. Counselor should help

clients who are alone establish support systems in the community and help them develop

a sense of fulfillment in life.

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 Four Forces Applied to Older Adults
Several specific approaches to counseling and therapy have been
applied to work with older adults.

Existential-Humanistic

Elderly face some of the hardest challenges life presents. The

therapeutic process aims to help elderly clients cope with life

occurrences: death of a love one, depression, delusion, etc.

This approach is ideal for older adults since its concerned

with the overall care and treatment of the clients mind, body

and spirit. A valuable tools available to the therapist is

presence. Older adult clients seek companionship and

listening ears. The client needs the counselor to give them

undivided attention, listen intently and follow their story. It

is very important to understand a person's subjective or conscious experience without any

judgment, bias, expectation, or comparison. It is only then that a humanistic therapist can

assist clients deal with their own issues (Corey, G. 2013)

Cognitive-Behavioral Therapy (CBT)

CBT has been proven to be effective in

treating a wide range of mental disorders,

including depression, anxiety, bipolar

disorder, substance use disorders, eating

disorders, insomnia, and personality

disorders (Butler, Chapman, Forman, & Beck, 2006). Due to its focus on health and

strength, it is therefore an appropriate fit for older adults who suffer from late life anxiety,

pain and other disorders (Corey, G. 2013).

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Multicultural Therapy
Multicultural Approach - Focuses on

recognizing the cultural norms and

differences among clients. Older adults

are diverse in many ways. Their

demographics greatly affect family

structures, health, work, retirement

patterns, and financial security. Counselors need to view client as a member of a group

and look at how family and cultural factors affect their world views. Culturally

competent counselors need to understand the unique values, beliefs, traditions and

customs of their client and use that knowledge to deliver respectful and professional

counseling services. This approach is also a goof fit as counselors can collaborate with

older adults in creating and advocating for age-friendly policies and programs to provide

culturally competent services to older adults.

Psychodynamic Therapy

This approach is primarily concern with the

emotional conflicts and defense mechanisms

of the client. In older adults the threat of

death generates powerful defensive

reactions which prohibit them from effectively coping with the death crisis. The refusal to

accept the reality of death makes it impossible for older adults to prepare themselves and

their families adequately for it. Psychodynamic therapy is a good fit since its designed to

help patients explore the full range of their emotions, including feelings they may not be

aware of. By making the unconscious elements of their life a part of their present

experience, psychodynamic therapy helps them understand how their behavior and mood

are affected by unresolved issues and unconscious feelings (Corey, G. 2013).

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 Client's Voice
My Interviewee was Dr. Barbara Balboni, 75 years, a former professor at
Bridgewater State University. She was very resourceful and shared
several important experiences she encountered in her life journey which
are similar to numerous elderly experiences. She reiterated several times
in her interview, the important job of a counselor. Counselors need to
adapt their approaches in working with clients based on clients
developmental changes in life, their particular generation to which they
belong and the social context in which they live. Older adults belong to a particular
generation with a collection of experiences, memories and norms that differ from those of
the present. Older adults are more mature in many ways and a lot face particular
challenges that are relatively unique in later life. Ethical and legal issues may arise while
counseling older adults (e.g., issues of confidentiality within families and facilities). It is
important that counselors strive to ensure their clients right is maintained and therefore,
important for counselors to be very knowledgeable in counseling this population.

My interviewee believes she has lived a full life and has a lot to offer in terms of
experiences, wisdom and knowledge. Although she did not have any children of her
own, she values family a lot. Family becomes more and more important for elders as the
need for support increases. Older people often rely on family members for help. They may
need help with the demands of everyday life because of a chronic illness, crisis or social
support.

She also shared that her time with friends were very important. Because of physical
changes, loss and retirement, friendship is very important for older people. In many cases,
friends are as important as families. Many people turn to their friends first when they
encounter crisis because of the distance of their family. Studies have shown the benefits of
friendship on positive social, emotional and physical well-being. Having a strong circle of
friends can be a good boost for aging hearts and can help the bodys autoimmune system
resist disease. People who have good friends are in better health than those who have only
casual friends or no friends (Matthews, W. 1993).

She keeps herself very busy in her church, charity organizations and her favorite was her
books. As a professor, she came in contact with numerous individuals with crisis and has
lend a listening ear and offered advice since she was a Sister of Mercy for some years. The
older generation is excellent when it comes to giving advice because of their lifetime of
experiences. They volunteer and are involve in their communities and share their wealth
of skills and experiences, since they have lived through situations others can only
imagine.

Her advice to counselors is to be flexible, open, honest, treat clients with respect and to
remember that there is a young person in them always. They must belief in the clients
ability to change and commit to helping them change.

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 Older Adults Strengths

Family is a major source of strength and support system for older adults. Being part of
the community and having positive contact with family members are important. It
enhances their self-esteem and life satisfaction. Counselors should determine the role of
family caregivers, educate them and help them develop strategies to reduce burnouts and
help keep stress more manageable (Sue & Sue, 2106).

Older adults like to feel they are independent and want to be treated with respect.
Counselors should treat them as an adult, presume competence unless the contrary is
obvious and as much as possible involve them in decisions making. If there are cognitive
limitations, it may be necessary to use legally recognized individuals to assist with
decision-making. Volunteering and sharing their expertise help increase their
independence and reduce loneliness and social isolation (Wood, J. 2001).

Older adults have wisdom which they can share with the younger generation. Erikson
called the final stage of life: ego integrity, a tendency to more readily accept oneself and
others, to enhanced life satisfaction and to begin to experience life completion. At the final
stage in life, older view their whole life with satisfaction and contentment (Corey, G.
2013). Counselors can help clients develop a sense of fulfillment in life by discussing
positives aspects of their experiences, having done their best, met and survived
challenges. A life review is often helpful for client to feel they have live a successful life

Spirituality is another strength and fertile area in working

with the elderly. Many older adults view religion as an
important factor seeking a relationship with the creative

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power of the universe in an attempt to find meaning in life and to develop their
uniqueness as a human. Religion helps them to have a hopeful, positive attitude about
life and keeps them motivated. Counselors can use this strength in counseling their
clients. They can seek advice from their spiritual leaders because they put a lot of trust in
them. This helps them to cope with physical health problems and life stresses. Plus their
religious beliefs put them in a better physical and mental state, with a positive and
hopeful attitude of life (Wood, J. 2001).

Relationships are important as they get older and retire. They do not have quite as
many opportunities to socialize as they did when they were younger. Social interaction
helps them to stay sharp, healthy, and maybe even ward off dementia. Social interaction
offers older adults many benefits. Staying socially active and maintaining interpersonal
relationships can help them maintain good physical and emotional health and cognitive
function. People who continue to maintain close friendships and find other ways to
interact socially live longer than those who become isolated. Relationships and social
interactions even help protect against illness by boosting their immune system. Counselor
can implement intervention that will reduce risk of feeling lonely and depressed. They can
be asked to volunteer in their communities, visit a senior centre and participate in
activities with other seniors which is a great way to make new friends. The counselor can
invite them to join a group, focused on activities they enjoy, such as playing cards, a book
club, join a gym or fitness group, etc. Staying socially active and maintaining relationships
are an important part of healthy aging. Counselors should help them reach out to their
loved ones, neighbors, friends, family members in order to keep them vibrant and active
(Wood, J. 2001).

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 References
Sue, D. W., & Sue, D. (2016). Counseling the Culturally Diverse: Theory and Practice (7th ed.).
New Jersey, NJ: John Wiley & Sons, Inc., Hoboken,.

Corey, G. (2013). Theory and Practice of counseling and Psychotherapy (ninth ed.). USA,
CA: American Counseling Association.

Schaie, W. K., & Elder, Jr., G. H. (2005). Historical Influence on Lives and Aging. New
York: Springer Publishing Company, Inc.

Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014, May). An Aging Nation: The Older
Population in the United States. U.S. Department of Commerce.

Centers for Disease Control and Prevention, (August 2011)

Achenbaum, A. W. (2015, October 19). A History of Ageism 1969. American Society on

Aging.

Gerontology Institute at the University of Massachusetts Boston: http://www.umb.edu/

gerontologyinstitute/research/demography/

Thomas, Day. Understanding the Issues facing Aging Seniors, (June, 2014)

(U.S. Census Bureau, 2010 )

Blando, John 2011: Counseling Older Adults

Wood, J. (2001, February). 'Productive Aging' Highlights Strengths.

Gamst, C., Glenn, Der-Karabetian, Aghop, Dana, H., Richard (2008).

Readings in Multicultural Practice

Nelson, D., Todd, (2004). Stereotyping and Prejudice Against Older Persons

American Psychological Association (2014). Guidelines for psychological practice with

older adults.

Alterkruse, K., Michael & Ray, Dee (1998). Counseling Older Adults: A Special Issue

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