Helping Relationships With Older Adults

From Theory to Practice

Adelle M. (McCollum) Williams

• Publisher: SAGE Publications, Inc
• Year: 2016
• ISBN:
  9781483344577
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

"A definite read for students in counseling programs for improving the lives of older adults!" –Amy Gray-Graves, Webster University Helping Relationships with Older Adults: From Theory to Practice examines the fundamental theoretical perspectives of the aging process with an emphasis on the healthy aspects of aging. Taking a comprehensive approach, the text addresses various therapeutic methods as it highlights the strengths and resiliency of the older population. Exercises and case studies demonstrate key concepts and promote skill development by allowing students to experience the various challenges in the lives of older clients. Helping Relationships with Older Adults: From Theory to Practice is part of theCounseling and Professional Identity Series. To learn more about each text in the Series, please visit www.sagepub.com/cpiseries.

Chapter 1 Introduction

“There is a fountain of youth: it is your mind, your talents, the creativity you bring to your life and the lives of people you love. When you learn to tap this source, you will truly have defeated age.”

—Sophia Loren

Learning Objectives

After reading this chapter, you will be able to

1. Describe the basic changes that occur in the aging process
2. Analyze the various biological theories that explain aging
3. Examine the normative physical changes that accompany the aging process
4. Explain the cognitive changes that accompany aging

The aging of the population is one of the most profound and far-reaching changes affecting contemporary society. Between 2014 and 2060, the U.S. population is projected to increase from 319 million to 417 million, reaching 400 million in 2051 (Colby & Ortman, 2014). By 2030, one in five Americans is projected to be 65 and over (Colby & Ortman, 2014). In 2014, the 65 plus population is expected to grow from 15% gradually upwards to 24% by 2060 (Colby & Ortman, 2014). The baby boomers (individuals born between 1946 and 1964) largely account for the increase in this demographic, as they began turning 65 in 2011. By 2050, the surviving baby boomers will be over the age of 85.

The aging of the population has wide-ranging implications for the country. By aging, demographers often mean that the proportion of the population in the older age range increases. As the United States ages over the next several decades, its older population will become more racially and ethnically diverse. The projected growth of the older U.S. population will present challenges to policymakers and programs. It will also affect families, businesses, and health care providers (Ortman, Velkoff, & Hogan, 2014). There is a clear need for health professionals with a thorough understanding and appreciation for the experiences of this older population. With so many individuals over age 65, mental health professionals with the expertise to assess and treat the problems of later life are sorely needed (Zarit & Zarit, 2011).

People are not just living longer, but they are living better longer than ever before. Improvements in disease prevention and health promotion, the widespread availability of public and private pensions and other financial benefits, and increased educational opportunities for each successive generation have dramatically improved the lives of today’s society. The next generation of older people will have had better education and have taken better care of their health across the life span, so their prospects for successful old age are even greater (Zarit & Zarit, 2011).

These demographic and social changes mean that an increasing number of older people are in need of psychological services. The mental health field, however, has been slow to respond with adequate numbers of trained professionals who have specialized training in geriatrics. For many years, geriatric practice was a backwater, a minor field viewed condescendingly by clinicians who felt that little could be done for anyone over age 50 (Zarit & Zarit, 2011). That viewpoint was a luxury of a society that had relatively few older people. The dramatic expansion of life expectancy and growth in the proportion of people over age 65, coupled with empirical findings of the effectiveness of treatment for many problems of later life, provides a solid foundation for geriatric mental health practice. The number of clinicians with geriatric expertise, however, falls far short of the need (Zarit & Zarit, 2011).

Aging is a natural and inevitable process and a very complex one. Many changes occur in this process; however, no two persons experience these changes at the same time or at the same rate. It is a variable experience. Some elders accept the natural changes that occur as a positive experience, while others view these changes with disgust and frustration. The process of aging is also a time to explore hidden talents, engage in new activities, commit to new relationships, and express oneself in novel and creative ways. Aging is more than the physical, social, psychological, and environmental changes. It involves a renewed energy and appreciation for life, opportunities to explore, and an inner transformation that is unique to every aging individual.

Aging

Aging is characterized by a variety of changes. These changes can be social, physical, or cognitive. Constant adjustments and readjustments are required to maintain some sense of normalcy.

Socially, a number of adjustments may occur, such as a change in the quantity and quality of relationships one has, a change in role from a caregiver to a care receiver, becoming single after being married for 50 years, and transitioning from utilizing informal supports (e.g., family, friends) to formal support systems (e.g., long-term care facilities, respite care services). Society’s perception of aging persons can change as well, with many perceiving older persons as less valued. Environmental modifications can be required if older adults live in environments that are inconsistent with their functional abilities. Changes in their residence, proximity to significant others, and driving status will impact their social situation.

Physical changes are an inevitable consequence of the aging process. Gradual changes will occur in an older adult’s senses, appearance, balance, strength, and cognition, though most conditions can be addressed and corrected in the earlier stages. Sense of taste and smell will decline with age; however, there may exist other causes for impaired taste and smell that are treatable (e.g., dental problems, nasal/sinus problems). Vision will decline, but it can be corrected at earlier stages. Hearing will become impaired, though simple modifications can correct this issue. Balance, flexibility, and muscle strength will decrease, but with adequate exercise, including cardio, strength training, and yoga, these changes do not necessarily impair one’s routine activities.

Cognition depends on a healthy, well-functioning brain. While the ability to learn, store, and retrieve information may require more time than for a younger person, barring any major disorders, older persons adapt well to changes in cognitive status. Older adults continue to have the capacity to learn new information; however, it may take longer and may require the use of more mnemonic devices to assist them.

Healthy, highly functioning older adults have high self-esteem, are internally controlled, maintain balance in their lives, minimize stressful situations, and are actively engaged in a variety of activities. They have a belief system that allows them to handle life’s ups and downs. When confronted with losses, such as that of a spouse, residence, physical and cognitive health, or relationships, they grieve but readjust to the loss and continue pursuing their goals and aspirations. However, even under the best circumstances, there are older persons who respond to losses in such a manner that necessitates the interventions of a professional. Their self-esteem and self-worth may be jeopardized, and therefore, outside support is required. This constant cycle of adjustment and re-establishment is an ongoing process for older adults and can affect their psychological well-being.

Older adults are wise, resilient, and spend most of their lives free of disabilities. However, many physical and mental conditions can accompany the aging process. With a comprehensive geriatric assessment and maintenance of a healthy lifestyle, these conditions are managed so that older persons can continue with their daily activities. Later life provides many opportunities for social interaction, participation in activities, continued employment, volunteerism, and leisure pursuits. These opportunities are different for each person because resources vary. There are older persons who will have the ability to retire, while others will continue to work. Time, income, interest, and health will determine the extent to which each older person is able to take advantage of various opportunities. Promotion and adherence to a healthy lifestyle that includes a good diet, adequate rest, exercise, engagement in meaningful activities, and a connection to others is critical at all stages of the life cycle.

Many transitions occur throughout the life course. Most are managed with little effort, while others require the assistance of professionals. Professional counselors have an opportunity to position themselves to provide advocacy, referral, counseling, and educational services to a growing older population.

Biological Theories Associated With Aging

Numerous theories have been identified to explain why the human body ages, as there is no single theory that can do so. Each theory provides insight into certain aspects of aging, and a firm grasp of these concepts will help mental health professionals better understand their older clients and the aging process.

Neuroendocrine Theory

The neuroendocrine theory of aging focuses on the neuroendocrine system, which is a complicated network of biochemicals that govern the release of hormones altered by the hypothalamus located in the brain. The hypothalamus controls various chain reactions to instruct other organs and glands to release their hormones. The hypothalamus also responds to the body hormone levels as a guide to the overall normal activity, and as we grow older, the hypothalamus loses its precision regulatory ability, and the receptors that uptake individual hormones become less sensitive to them. Additionally, as we age, the secretion of many hormones decline, and their effectiveness is also reduced (Ramaswamy, 2012). As the body ages, it produces lower levels of hormones that are vital for well-being. Dehydroepiandrosterone (DHEA) is a hormone that comes from the adrenal gland and also made in the brain. DHEA leads to the production of male and female sex hormones. DHEA levels begin to decrease after age 30 and levels decrease more quickly in women. Lower DHEA levels are found in people with hormonal disorders, HIV/AIDS, Alzheimer’s disease, heart disease, depression, diabetes inflammation, immune disorders, and osteoporosis (Mayo Clinic, 2015). DHEA may cause side effects related to other hormones, and women may experience symptoms such as increased unnatural hair growth and deep voice, and men may experience urinary urgency and aggression, among other symptoms. Other side effects that ma...