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

This article explores the common attitudes and assumptions about aging, highlighting the forgotten minority group of individuals of advanced age. It discusses the need for a more optimistic view of older adults and the contextual factors to consider in working with seniors. Additionally, it addresses sociocultural factors, aging, and health, as well as considerations for working clinically with the elderly.

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

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  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

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