Counseling Older People

Opportunities and Challenges

Charlene M. Kampfe

• Publisher: American Counseling Association
• Year: 2015
• Print ISBN: 9781556203237
• eBook ISBN: 9781119027027
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

This book provides insight into the primary issues faced by older adults; the services and benefits available to them; and the knowledge base, techniques, and skills necessary to work effectively in a therapeutic relationship. Dr. Kampfe offers empirically and anecdotally based strategies and interventions for dealing with clients' personal concerns and describes ways counselors can advocate for older people on a systemic level. Individual and group exercises are incorporated throughout the book to enhance its practicality.

Topics covered include an overview of population demographics and characteristics; counseling considerations and empowering older clients; successful aging; mental health and wellness; common medical conditions; multiple losses and transitions; financial concerns; elder abuse; veterans' issues; sensory loss; changing family dynamics; managing Social Security and Medicare; working after retirement age; retirement transitions, losses, and gains; residential options; and death and dying.

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Chapter 1
The Increasing Older Population and Its Characteristics

The purpose of this chapter is to provide an overview of the aging population in the United States. The chapter includes discussions of the levels, classifications, and definitions of old age; the growth in the older population; the diversity among this group; and attitudes toward aging and older people. In addition, there is an acknowledgment that the older population is composed of the strong ones, that is, the ones who survived.

Levels, Classifications, and Definitions of Old Age

There are many classifications or categories of old age. Although these classifications may have little practical or meaningful significance to counselors or their clients, counselors should be aware of them in order to understand and evaluate the literature, research, laws, regulations, and attitudes that exist about aging. Counselors should also be aware that the classification systems can be confusing and should be viewed with caution. One problem with age classifications is that writers define them differently or provide different birth dates for the same classification title.

The most often used classification is chronological age (i.e., the number of years that a person has lived, such as age 65, age 85, age 105). This classification is typically used in literature, legislation, policies, research, and reports. Age 65 is the age by which the general public typically defines “old” (Wadsworth, Smith, & Kampfe, 2006). Examples of chronological age classifications include the young-old (age 65 to age 74 or 75), the old-old (age 75 to age 84), the oldest-old or very-old (approximately 85 years or older), the centenarians (age 100 years or older), and the super centenarians (age 110 years or older; Chatters & Zalaquett, 2013; Lehembre, 2012; Schaie & Willis, 2002; Whitbourne & Whitbourne, 2011). Yet another term for the very old is nonagenarians (Lehembre, 2012).

Other classifications are based on actual dates that individuals were born (age cohort). Age cohort is much different than chronological age and often reflects the experiences that a group of people have in common. People who were born in 1925 will have very different experiential backgrounds than people who were born in 1945. For example, the cohort of people born in 1925 likely experienced the Great Depression and thus learned to live in moderation. They may, therefore, have a different perspective of life than the cohort of people who were born in 1945 (Loe, 2011).

There is some danger in classification systems for older people because people vary widely within each age group and because the definition of “old” is evolving. Because of the variability among people who have reached a particular chronological age, gerontologists have encouraged the use of new classification systems that are based on functional age. Three of these classifications systems are biological age (based on quality of bodily systems), psychological age (based on memory, intelligence, and learning abilities), and social age (based on social roles; Whitbourne & Whitbourne, 2011).

Another term that has been used to refer to older people is the elderly. It has been suggested that this term is a subtle form of ageism because it connotes many images and behaviors that are thought to be common among older people (e.g., frailness, forgetfulness). Because the term the elderly broadly categorizes people as objects, the American Psychological Association (APA) has indicated in its popular style manual that it should not be used; instead, APA advocates using terms such as older adults. Therefore, counselors may want to avoid using the term the elderly in their work with older people (J. E. Myers & Shannonhouse, 2013).

Projections of Growth of the Older Population

The older population is one of the fastest growing groups in the United States (Dixon, Richard, & Rollins, 2003). In 2000, at least 35 million U.S. citizens were age 65 or older (U.S. Census Bureau, 2000). It has been projected that by 2030, 71 million Americans will be age 65 or older, and by 2040, 80 million Americans will be this age. The increase in the older population is primarily attributable to increased life expectancy and the large number of Baby Boomers who are aging (Administration on Aging, 2007).

Life expectancy in the United States has increased in recent years. According to the Administration on Aging (2007), life expectancy increased by 2.5 years from 1900 to 1960 and by 4.3 years from 1960 to 2004. Persons who were age 65 in 2007 were expected to live another 18 years, and those who were age 85 were expected to live an additional 6 to 7 years (Federal Interagency Forum on Aging, 2006). Increased life expectancy is primarily attributable to improvements in health care practices for the general public (Devino, Petrucci, & Snider, 2004; Hogg, Lucchino, Wang, & Janicki, 2001) and preventive practices with regard to onset or progression of disabling conditions among older people (Fried & Guralnik, 1997). Life expectancy has also increased for people who have had lifelong disabling conditions (Mitchell, Adkins, & Kemp, 2006), such as amputations (Briggs, 2006), traumatic brain injury (Weintraub & Ashley, 2004), multiple sclerosis (DeVivo, 2004), and developmental disabilities (Hogg et al., 2001).

Baby Boomers are those people who were born from 1946 through 1964, and there are approximately 72 to 79 million of them (Haaga, 2011). The first of these individuals reached age 65 in 2011; over the next two decades, the remainder of the group will reach this age (U.S. Census Bureau, 2006). Many of these individuals are considered to lead more productive lives and to be healthier than earlier groups at their age (Institute on Rehabilitation Issues, 2009).

This growing population provides an opportunity for counselors to infuse themselves into the systems that serve older people. Counselors have the basic and important skills to assist this group. They are good listeners, facilitators of empowerment and problem solving, and advocates who provide a respectful, safe, yet challenging environment that encourages clients to explore their thoughts, feelings, and behaviors and to effectively cope with the multiple issues that older people face.

Diversity of the Older Population

The older population is very heterogeneous. Indeed, the term diversity has been used in discussions of their characteristics (Larkin, Alston, Middleton, & Wilson, 2003). Although members of this population share the descriptive term older, they vary widely with regard to gender, race, ethnicity, culture, education, employment, occupation, socioeconomic status, religion, immigration and migration patterns, personality development, life experiences, family constellation, health status, disability status, and functional level (Kampfe, Harley, Wadsworth, & Smith, 2007; Middleton, 2005; S. M. Smith & Kampfe, 2000). This diversity is expected to increase in coming years as the current younger population becomes older (Dixon et al., 2003). One of the core professional values of the ACA Code of Ethics (ACA, 2014) is to honor and embrace “a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts” (Preamble). This value certainly applies to the widely diverse group of older people.

The older population is composed of a large percentage of females. In 2007, the overall ratio of men to women among older people was approximately 100 to 138. This ratio continues to change with age. For example, the ratio of men to women among the population age 65 to 69 was 100 to 114, whereas the ratio among the population age 85 or older was 100 to 213 (Administration on Aging, 2007). Because older women outnumber older men, counselors will need to become aware of the situations faced by women and develop effective counseling strategies to work with them (Choate, 2008). Counselors also need to be aware that males are, essentially, a minority group among the older population and may require unique counseling strategies designed for them.

The fastest growing subgroup of older people is composed of those from minority backgrounds. In 2000, the minority subgroup represented 16.4% of the older population, but this proportion is projected to rise to 23.6% by 2020 (Administration on Aging, 2007). Older individuals from minority groups have been reported to have low economic status and limited access to health care, both of which interact to result in the highest incidence of chronic disabling conditions among that older population (Larkin et al., 2003). Counselors should be familiar with health care and rehabilitation services that are available to this population and determine the degree to which individuals need or want assistance in identifying and accessing these services. Counselors should be mindful of the type of services that older minority clients may prefer. For example, they may wish to use indigenous healers or informal networks rather than the systems used by the current majority population (Harley, 2005; Kampfe, Wadsworth, Smith, & Harley, 2005).

The older population is also diverse because of the multiple age cohorts it represents (i.e., ages ranging from 65 to 105+ years). These ages represent at least four decades and several generations. People from each age cohort will have experienced unique life events and environmental conditions that have shaped their perceptions of the world, sense of autonomy, sense of security, views of spending and saving, values, spirituality, definitions of oldness, and other aspects of their lives (Kampfe et al., 2007). Counselors should not, therefore, assume that all older people belong to one group of individuals with similar histories, values, and behaviors.

There is also broad variation within each age cohort. Variables such as urban versus rural lifestyles; geographical location (e.g., East, Midwest, West, South); natural surroundings (e.g., mountains, flatlands); personal, racial, ethnic, and cultural backgrounds; past and current cultures experienced as an outsider; family composition and atmosphere; socioeconomic status; gender; religious background; disability status; and individual personality styles will all contribute to the variation among people within each age cohort (Institute on Rehabilitation Issues, 2009; Kampfe & Dennis, 2000).

Because each person will have his or her own broad combination of group or cultural backgrounds that may influence thoughts, feelings, and behaviors, counselors cannot assume that individuals from a particular age cohort or cultural group will share all the same beliefs and practices of that particular group. In other words, counselors will need to be open to a variety of individual client styles and needs while being sensitive to the specific cultures that are important to each consumer. It is particularly important for counselors to be aware of and respectful of the various views of aging that individuals have and to take these into account when considering therapeutic interventions and client decisions (Kampfe et al., 2007). The implication of the wide diversity among the older population is that counselors must continue to develop cultural competency.

Negative Attitudes Toward Aging and Older People

Unfortunately, our society has typically devalued older people. This devaluation has been characterized by negative stereotypes about this population (i.e., ageism/prejudice against older people), fear of aging (gerontophobia), and misconceptions about what it means to be old (Saucier, 2004; Shmotkin & Eyal, 2003; Wadsworth et al., 2006). Furthermore, our society typically holds negative attitudes toward disability (Gordon, Feldman, Tantillo, & Perrone, 2004). Because older people are likely to have one or more disabling conditions, they may have two risk factors for being devalued.

Negative attitudes can, and do, influence behaviors toward an individual or a group of people (McCarthy & Light, 2005). For example, older people have often been discouraged from making their own life decisions or doing things for themselves, forced to make unnecessary residential relocations, and discriminated against in the workplace. They are sometimes spoken to disrespectfully or as if they were children; they are called “honey”; they are addressed using the “royal we,” as in “How are we today?”; and they are spoken “about” in front of them, as in “Has he taken his meds today?” Other inappropriate behaviors include ignoring older people’s perspective or concerns and using degrading body language (e.g., rolling eyes, knowing smiles; Doyle, Dixon, & Moore, 2003; Kampfe et al., 2005; J. E. Myers & Schwiebert, 1996).

In addition to direct behaviors ...

Table of contents

• Cover
• Title Page
• Copyright
• Preface
• About the Author
• Acknowledgments
• Chapter 1: The Increasing Older Population and Its Characteristics
• Chapter 2: Counselor Considerations When Working With Older People
• Chapter 3: Advocacy and Aging Issues
• Chapter 4: Aging Well/ Successful Aging
• Chapter 5: Health Issues Associated With Aging
• Chapter 6: Mental Health Issues Among Older People
• Chapter 7: Special Issues Associated With Aging
• Chapter 8: Sensory Loss Among the Older Population
• Chapter 9: Maintaining and Managing Interpersonal Relationships
• Chapter 10: Social Security and Medicare-Related Programs: Sorting Through the Maze
• Chapter 11: Retirement and the Need or Desire to Work
• Chapter 12: Residential Issues for Older People
• Chapter 13: End of Life, Death and Dying, Grief and Loss
• References
• Index
• Technical Support
• End User License Agreement