Getting To Know The Advanced Age: An Often Overlooked Feature of Diversity

1. Getting To Know The Advanced Age: An Often Overlooked Feature of Diversity Mona Mikael, M.A. Pepperdine University

2. COMMON ATTITUDES/ASSUMPTIONS ON AGING What are some of your beliefs about aging?

3. A Forgotten Minority Group • Individuals of advanced age are the fastest growing segment of the population (He et al., 2005) • The percentage of Americans 65 and older has tripled from 4.1% in 1900 to 12.4% (or 36.3 million) in 2005 • Baby-boomers are also entering retirement in 2011, thereby increasing the population of elders to 20% or 72 million (He et al.) by 2030 • partially because of the increase in life expectancy • Increase in the life in years and not just years in life

4. The Common Emphasis of Gero-Research • Research focuses more heavily on losses and degeneration in people of advanced age than on strength and resilience (Hagestad & Dannefer, 2001; Kaufman, 1986) • Gerontology related research predominantly centers on medical disabilities and the functional losses of aging (Bengston et al., 1999) • Concept of loss is often associated with old age, e.g., loss of loved ones, mobility, independence, physical health

5. A More Optimistic View of Older Adults • Provided that older adults do not suffer from serious cognitive impairments, they can still evince heightened emotional intelligence, judgment, a greater sense of self, and relativistic/systematic thinking (Baltes, 2006; Cohen, 2005) • Older adult exhibit greater acceptance of life’s realities (Cohen, 2005) • As one ages, a greater sense of self emerges (Cohen, 2005) • Older adults expand their store of memories, experiences, and appreciation of the complexity and beauty of human experience (Ranzijn, 2002)

6. A More Optimistic View of Older Adults (cont.) • With age, one is better equipped to think relativistically and view circumstances out of his/her own context (Cohen) • With age, one has an increased ability to moderate his/her emotions, leading to contentment of life (Strongman and Overton, 1999) • Through life experiences “…adults in their sixties and seventies often address problems requiring wisdom extremely well” (Baltes, p.34)

7. Contextual Factors to Consider in Working with Seniors • Ethnicity/Race • Cultural values, beliefs, and behaviors • Gender • Cohort/historical effects • Language • SES • Religion • Urban/suburban/rural residence • Social support • Political, economic, and social climate

8. Sociocultural Factors, Aging, and Health • Non-White minority elders tend to have lower levels of income and education so may be at risk for poorer access to health care (Haley et al., 1998) • African Americans who had experienced racism in earlier life, now tended to cope with illness through their unique “philosophy of illness;” their deep faith helped them maintain their sense of autonomy and helped them persevere despite life-threatening illnesses (Becker & Newsom, 2005) • Strong commitment to faith helped elderly African Americans accept their health challenges (Harvey, 2006; Harvey & Silverman, 2007)

9. Sociocultural Factors, Aging, and Health (cont.) • A study of 3,050 Mexican Americans (56% women) age 65 and over living in five U.S. states reported more symptoms of depression than their acculturated counterparts (Chiriboga, Jang, Banks, & Kim, 2007) • In a study of elder Taiwanese age 60 and older, women were more likely than men to experience negative health outcomes since they were often less educated and from a lower socioeconomic status (Hsu, 2005)

10. Considerations in Working Clinically with the Elderly • Accommodate client’s family • Inquire how client would like to be addressed • Use familiar terminology rather than “educating” client on use of professional jargon • Provide services in culturally relevant locations such as in a church setting or home visits • Theoretical orientation • Be familiar with chronic illnesses and the impact on mood, interaction effects/side effects of medications • Flexibility in scheduling • Cope with feelings of disempowerment

11. Considerations in Working Clinically with the Elderly (cont.) • Medication compliance • Support negotiating the health care system • Take cultural expression of symptomatology into account when using standard assessments of measures • Understand the client’s code wordswhen describing emotional issues • Self-disclosure

12. Adaption of Assessment Methods in Working with Older Persons • Consider whether the psychological & cognitive tests are developed, normed, and validated for older adult (and older adults of diverse cultures) • Use appropriate norms for age and educational attainment • Integrate collateral information • Consider consequences of assessment data on client’s independence and ability to be self-reliant, e.g. if license is permanently revoked • Manage client’s potential reluctance to follow through with testing

13. Others Issues of Clinical Value • Philosophy about living with illness • Self-perception of health • Religiosity • Experiences with racism • Consider client’s culture and degree of acculturation • Age at time of immigration, level of acculturation, and acculturative stress • How mate was selected • Size of social network size here versus in native country • Subjective experience with control in family • Gender specific roles, caregiving expectations • Informal support already sought • Natural support networks

14. Barriers to Treatment • Older adults more likely to go to general medical provider for help with a mental health problem • Stigma of psychotherapy in older generations • Lack of information • Physical frailty • Poverty • Lack of linguistic and cultural services • Psychological issues

15. Other Considerations& Potential TreatmentGoals • Receive support services (e.g., home meals, transportation, phone service • Decrease isolation; increased contact with family, friends, or others • Decrease risk of homelessness or premature higher level of care • Decrease suspiciousness • Decrease contact with governmental agencies • Increase limit-setting behavior (Yang et al., 2005)

16. Countertransference • Ageism • Self-awareness of attitudes and beliefs about aging and older adults • The “Reluctant Therapist” • Recognizes differences between clinician and patient values, attitudes, assumptions, hopes and fears related to aging • PAY ATTENTION TO YOUR OWN JOURNEY & FEELINGS TOWARD AGING

17. Caregivers • Consider caregiver burdens • Depression and coping classes • Stress reduction training • Family attitudes toward death and dying, • Preferences for coping directly or indirectly • Family interventions • Watch for Elder Abuse ** Neglect** • Pay attention to impact of abuse reporting