Download chapter 1 the multicultural journey to cultural competence

CHAPTER 23
COUNSELING OLDER
ADULT CLIENTS
OLDER ADULTS
 The population of older individuals in the
United States is growing
 Individuals aged 65 and older are 16.2% of
the population
 Yet, mental health services specific to this
population are lacking
SPECIFIC CHALLENGES
FOR OLDER ADULTS
 Older
individuals are subject to negative
stereotypes and discrimination.
 Ageism, very common in our society, is
defined as negative attitudes toward the
process of aging or toward older individuals.
 Women who are older are even more likely to
be viewed negatively by society as a whole
and many internalize ageist norms.
SPECIFIC CHALLENGES
OF OLDER ADULTS
Stereotypes about older adults include:
thought to be rigid and inadaptable in their
thought processes,
 lacking in health, intelligence, and alertness,
and
 having either no sexual interest or, if they
were sexually active, as engaging in activity
inappropriate for their age.
SPECIFIC CHALLENGES
OF OLDER ADULTS
 Those with minority status face multiple
discrimination
 One in seven adults aged 71 or older have
dementia, including the 2.4 million in this
age group diagnosed with Alzheimer’s
Disease.
SPECIFIC CHALLENGES
OF OLDER ADULTS
 Older adults suffer from elder abuse and
neglect as well as from self-neglect
 Depression is more strongly associated with
feelings of “being old” than with actual age
or health status.
SPECIFIC CHALLENGES
OF OLDER ADULTS
 White males aged 85 and over have the
highest suicide rate of any group
 Numbers of older adults suffering from
substance abuse have increased; many cases
go undetected and untreated.
Implications for Clinical Practice



Obtain specific knowledge and skills in
counseling older adults. Critically evaluate
your own attitudes about aging and quality of
life
Be knowledgeable about legal and ethical
issues that arise when working with older
adults (e.g., competency issues)
Determine the reason for evaluation and the
social aspects related to the problem, such as
recent losses, financial stressors, and family
issues
Implications for Clinical Practice

Show older adults respect and give them
as much autonomy as possible
regardless of the issues involved or
mental status

Identify medical conditions and
prescription and over-the-counter
medications because mental conditions
are often a result of physical problems
or drug interactions or side effects
Implications for Clinical Practice



Presume competence in older adult
clients unless the contrary is obvious
If necessary, slow the pace of therapy to
accommodate cognitive slowing
Provide information in a manner that
approximates the client’s level of
reading and comprehension, using
alternative methods such as simplified
visuals or videotapes if necessary
Implications for Clinical Practice



Involve older adults in decisions as
much as possible
Use multiple assessments and include
relevant sources (client, family
members, significant others, and health
care providers)
Determine the role of family caregivers,
educate them about the disorder, and
help them develop strategies to reduce
burnout
Implications for Clinical Practice



When working with an older couple,
help negotiate issues regarding time
spent alone and together (especially
after retirement
Recognize that it is important to help
individuals who are alone establish
support systems in the community
Help the older adult develop a sense of
fulfillment in life by discussing the
positive aspects of their experiences
Implications for Clinical Practice



Determine the older adult’s views of the
problem, belief system, stage of life issues,
educational background, and social and ethnic
influences
Assist in interpreting the impact of cultural
issues such as ethnic group membership,
gender, and sexual orientation on their lives
For adults very close to the end of their lives,
help them deal with a sense of attachment to
familiar objects by having them decide how
heirlooms, keepsakes, and photo albums will
be distributed and cared for