Counseling Older People: Opportunities and Challenges

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

Counseling Older People

Opportunities and Challenges

Charlene M. Kampfe

American Counseling Association

6101 Stevenson Avenue, Suite 600 • Alexandria, VA 22304 • www.counseling.org

Copyright © 2015 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the written permission of the publisher.

10 9 8 7 6 5 4 3 2 1

American Counseling Association

6101 Stevenson Avenue, Suite 600 • Alexandria, VA 22304

Associate Publisher • Carolyn C. Baker

Digital and Print Development Editor • Nancy Driver

Production Manager • Bonny E. Gaston

Copy Editor • Kimberly W. Kinne

Cover design by Bonny E. Gaston

Library of Congress Cataloging-in-Publication Data

Kampfe, Charlene M.

Counseling older people: opportunities and challenges/Charlene M. Kampfe.

pages cm

Includes bibliographical references and index.

ISBN 978-1-55620-323-7 (pbk. : alk. paper)

1. Older people—Counseling of. 2. Older people—Psychology. 3. Older people—Social conditions. 4. Older people—Mental health. I. Title.

HV1451.K356 2015

362.6′6—dc23

2014038869

Preface

The older population is one of the fastest growing groups in the United States (Administration on Aging, 2007). The growth of this population can be both an opportunity and a challenge for professional counselors, including general counselors as well as those who specialize in group work, employment, rehabilitation, multicultural issues, gerontology, substance abuse, grief and loss, mental health, spirituality, assessment, military, family, and forensics.

With the growth of the older population, we counselors will have the exciting opportunity to carve a place for our profession in those systems that serve older people. Currently in those systems, older people are often disempowered, and there are few programs and resources that provide gerontological counseling. Although some counselors may not have worked with older consumers in the past, they already have many of the skills necessary to do so. Counselors understand and support the concept of empowerment. They know how to provide a safe, respectful, and challenging environment in which individuals can explore their thoughts, feelings, and behaviors. They have been trained to be good listeners, advocates, problem solvers, and case managers.

The challenge for counselors is to become informed about the characteristics of the older population, specific issues faced by this group and their families and friends, services and benefits available to them, advocacy issues associated with aging, vocational interests and concerns of older people, family dynamics that may influence older people and their adult children, assessment issues associated with older people, attitudes toward older people, death and dying perspectives, systems in which older people are served, laws and regulations that apply to the older population, and specific counseling techniques that are effective for individuals who are experiencing certain conditions associated with being older. Learning about these topics will extend the boundaries of counselors’ competence and will take them closer to meeting the recommendations of both the American Counseling Association (ACA) and the Council on Rehabilitation Education (CORE) codes of ethics that counselors practice in specialty areas only if they have appropriate education, training, and supervised experience.

The purpose of this book is to provide practical, anecdotal, and research-based information and perspectives to counselors who wish to work with the older population. Personal experiences, case studies, practical suggestions, and various exercises and activities are included to help the reader analyze, incorporate, and assimilate the material. The book is based on the concepts of personal power, personal choice, variability, and the dignity of older persons who counselors serve. In writing this book, I have relied on many resources: (a) my professional experience in working with older consumers and their families; (b) scholarly study of this population, including writing about this group; (c) membership in the Association for Adult Development and Aging; (d) consultation with agencies and programs that provide services to older people; (e) discussions with colleagues and professors who provided information, wisdom, perspective, practicality, and philosophy regarding aging; (f) presentations to various audiences regarding the aging process; (g) years of experience teaching about and being actively involved in advocacy issues; (h) experience with my own family members’ aging process; (i) interaction with agencies, programs, and individuals that have provided services to my older relatives; and (j) my own personal journey through the aging process.

About the Author

Charlene M. Kampfe, PhD, is a professor emeritus of rehabilitation counseling at the University of Arizona, Tucson, and has also taught in the School of Medicine at the University of North Carolina, Chapel Hill. She received her doctorate from the Department of Rehabilitation Counseling at the University of Arizona and is a national certified counselor, a nationally certified gerontological counselor, and a national certified rehabilitation counselor.

Dr. Kampfe has served as a governing council member of the ACA, president of the Association for Adult Development and Aging (AADA), and board member for both the American Rehabilitation Counseling Association (ARCA) and the National Council on Rehabilitation Education (NCRE). She has served on and chaired many committees of these associations and has received numerous awards for her service (e.g., Outstanding Contributions in the Field of Government Relations from ARCA, Government Relations Award from AADA, Distinguished Service Award from the AADA, President’s Award from the Arizona AADA, and Outstanding Member Award from the Arizona Counselors Association). She has also been involved in international consultation and capacity building with Mexico, Kenya, and Afghanistan, and she has served on local advisory committees for various projects of the Tucson Botanical Gardens Horticulture Therapy program, which focuses on aging issues.

Dr. Kampfe has published 11 chapters, 65 journal articles, and one group-written book, The Aging Workforce, for which she was a group editor. She has given more than 100 presentations at the local, national, and international levels regarding various aspects of counseling and the human condition, and she has been a keynote speaker or panel facilitator of opening/closing sessions for 10 national meetings or conferences. She has served on numerous editorial review boards and received several national awards for her scholarship (e.g., Outstanding Research Award from the Counseling Academic and Professional Honor Society International, Outstanding JADARA Article from the American Deafness and Rehabilitation Association, Ralph F. Berdie Memorial Research Award from ACA, and Best Practices Faculty Research Award from ACA).

Acknowledged as an exceptional teacher and mentor, Dr. Kampfe has received numerous awards for this aspect of her professional life. Her awards include Honored Faculty Member at the First Annual Learning Disability Gala, University of North Carolina; Faculty in Models of Teaching Excellence, University of Arizona; Mentor of the Year Award, AADA; Outstanding Teacher, College of Education, University of Arizona; Outstanding Faculty Member, Disability Resource Center, University of Arizona; Sarah Folsom Memorial Award, Arizona Rehabilitation Counseling Association; Extraordinary Faculty Award, University of Arizona Alumni Association; Counselor Education Advocacy Award, ACA; and Rehabilitation Educator of the Year, NCRE. Furthermore, a student fund was established in her name by the ARCA Student Task Force. Since her retirement, she has continued to teach or act as a mentor with the Rehabilitation Counseling Program, Auburn University, Auburn, Alabama; and the Humanities Seminars Program, University of Arizona.

Dr. Kampfe is a creative dancer, singer, and drummer. She belongs to the International Association for Creative Dance and dances regularly at the Tucson Creative Dance Center and at national conferences. She has incorporated creative dance philosophy into the counseling process and has given several presentations at national conferences regarding the parallels between creative dance and creative counseling.

Acknowledgments

I wish to thank Carolyn Baker, Nancy Driver, Dr. S. Mae Smith, Dr. John Wadsworth, Dr. Jane Myers, Dr. Juliette Neihaus, Dr. Larry Burlew, Richard Helling, Dr. Phil Johnson, Dr. Manley Begay Jr., Dr. Linda Shaw, Art Terrazas, Dr. Will Stroble, Holly Clubb, Dr. Michelle Wade, Jennifer Fowler, Caroline Chilewski, Dr. Catherine Roland, Sandy Durazo, Kimberly Kinne, and all of my teachers, students, friends, and members of the AADA for their wisdom, practical advice, challenges, insights, and scholarship in the field of counseling with older adults. I want to thank all the older people with whom I have lived and worked for sharing their stories with me and for informing me of the potential life experiences and perspectives an older person can have.

I give special thanks to my parents (Royce and Vivian Chipps), my grandparents (Paul and Mattie Chipps, Fred and Eva Robinson), and my great-grandparents (Frank and Emma Chipps, Little Grandma Wilhemina Robinson) for all their lessons about love, honor, kindness, and follow-through and for sharing their experiences in the aging process. I also want to thank my husband (Ron Kampfe) and his family, my sister (Tami Jonak) and her family, my aunts and uncles (Mildred, Bernie, Bob, Doris, Jack) and their children, and my friends (from childhood to the present) who are, happily, too numerous to mention. I also want to express my admiration for the ancestors who I never knew. They have all shaped my life and my opinions about older people. I also want to thank my dog, Buddy, who sat under my chair as I wrote and occasionally reminded me that it is time to play.

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 that show devaluation, indirect and systemic messages of low value are given. For example, older people are sometimes excluded from various epidemiological studies, which may be a subtle and perhaps unconscious statement by researchers that the older population does not matter or is inappropriate for a particular study, simply by virtue of advanced age (Kampfe et al., 2005; Wadsworth et al., 2006). Other examples of devaluation can be seen in advertising and in television programming. One only needs to watch television to see the large number of devaluing statements that are made regarding older people or aging, especially for women (Choate, 2008). I invite you, the reader, to partake of the following exercise.

Media and Advertising Activity

At any time during the day or night, turn the television on for 1 to 4 hours.

List all items having to do with age (both positive and negative). Items may include physical appearance (e.g., hiding the gray, reducing wrinkles, etc.); depictions of older people as weak, slow, or with memory loss; portrayals of older people as wise; and depictions of interactions between younger and older people.

Tabulate the number of positive messages versus negative messages about aging.

After completing this list, consider how these messages (a) reflect the general population’s perceptions of aging and older people, (b) influence the general population’s perception of aging and older people, (c) influence counselors’ perceptions of aging and older people, and (d) influence your own perceptions of aging and older people.

Brainstorm strategies that you can use to counteract the potential negative attitudes that exist in the media, in the public, in older people (themselves), in the counseling profession, and in yourself.

Because counselors are a part of this society, they, themselves, may have fears, stereotypes, and general negative views of aging and older people. They may unconsciously associate aging with decline, disability, death, weakness, dependence, inability to make decisions, disinterest in learning new things, and inability to contribute to society (Kampfe et al., 2005; Kimmel, 2012; Shannonhouse & Myers, in press; Wadsworth et al., 2006). In contrast, believing that all older people are sweet, kind, or wise may also be a form of ageism because these views indicate the belief that all older people are the same and perhaps one-dimensional (Kampfe, 1990b). These thoughts and feelings may limit counselors’ openness, understanding, and expectations of older clients (J. E. Myers & Schwiebert, 1996; Shallcross, 2012c). Counselors will, therefore, need to examine their own attitudes about aging and challenge any negative perceptions that they have about older people.

Counselors’ self-evaluations of their attitudes toward aging and older people are likely to be a lifelong endeavor that will require considerable introspection, supervision, training, and perhaps personal counseling. Counselors can benefit by participating in training sessions or graduate courses regarding this issue (e.g., dignity vs. dehumanization training, values clarification workshops). They can join the AADA, attend AADA annual conferences, or attend AADA-sponsored training at the ACA World Conference. They can engage in personal exploration of their attitudes through individual or group counseling or discussions with colleagues or supervisors; they can refer to their professional code of ethics and professional philosophy, which promote the right to productivity, dignity, independence, and self-determination (Kampfe et al., 2005); and they can read information about ageism such as that provided by J. E. Myers and Shannonhouse (2013).

Individual Exercise: Counselors’ Perceptions of Aging

Make a list of all the descriptors of older people. When doing this, try to be as honest as you can with yourself about your current perceptions of this population. Start with physical descriptors then move to mental, spiritual, emotional, and other descriptors. Describe their energy levels, work tolerance, personal power, desire to work, level of independence, types of skills, and type of disabilities you are aware of. List both positive and negative attributes.

For each of these, reflect back to the source of these perceptions or attitudes. How accurate are these perceptions? What has contributed to your views of older people? What is there about you, personally, that has resulted in these views?

Discuss your answers with a group or with another person. These discussions may provide additional insight.

As you read the book and as you do further study of the older population, return to your list and examine any changes you make regarding your opinions.

Group Exercise: Influence of Stereotypes

The purpose of this group exercise is to encourage counselors to consider how stereotypes or prejudices can interfere with the counseling process (Kampfe et al., 2007). It can also be used with family members and community service providers.

Two people sit or stand facing each other approximately 15 feet apart. One of these people will be the counselor, and the other will be an older consumer.

One at a time, the group members will call out negative stereotypes that society may have about older people.

As each stereotype is called out, that person stands between the counselor and the consumer. Continue this process until at least four or five people are standing between the counselor and the consumer.

At the end of the process, the question is raised, Can the counselor see the consumer?

Discuss the implications of this exercise in the counseling process.

This exercise can be repeated, with the counselor being an older person and the consumer being the younger person. Again, stereotypes about older people are called out, and people stand between the younger consumer and the older counselor. The question can be asked, Can the consumer be open to the older counselor? As typically happens, it becomes clear that negative stereotypes and attitudes about older people may impede the counseling process.

Older people, themselves, may have internalized societal ageist concepts. They may demonstrate these concepts by avoiding other older people, developing low self-concepts or self-efficacy, feeling vulnerable, questioning their abilities and worth, lying about their age, and getting facelifts or makeup to disguise their age. Furthermore, they may believe that older people should behave in certain ways and therefore restrict their activities to what they consider to be age-appropriate behaviors. In other words, internalized societal ageist concepts may affect their thoughts, feelings, and behaviors. Counselors need to be alert to these ageist attitudes, challenge them, and help clients work through negative self-perceptions associated with aging (Edmondson & Kondratowitz, 2009; J. E. Myers & Schwiebert, 1996).

Counselors can do much to change the attitudes of the community, family members, other service providers, and older people themselves. One of the most effective strategies in changing attitudes is to model appropriate behaviors and language. For example, when a counselor observes family members or others making decisions for the client, the counselor can stop the conversation and ask the client what he or she wants. If someone asks a family member or the counselor what they want to do about the client, the counselor can say, Let’s ask him. When a client is present but someone speaks about that client rather than to that client, the counselor can face the client and speak directly to him or her about the topic. When a service worker speaks to the client with the sticky sweet voice, as if speaking to a child, the counselor can model direct adult-to-adult communication with the client. Counselors can also provide training to family members and service providers regarding attitudes and behaviors. For example, they can use the above exercises with these individuals or other training resources described throughout this book. In addition, counselors may benefit by having more detailed information about healthy aging. An entire chapter focuses on this topic.

They Are the Survivors: The Strong Ones

An important point for counselors to remember is that older people are the survivors. Regardless of their current physical and mental functioning, they are the strong ones. They are the ones who lived to be older people. They are the ones who learned to adjust and to make it beyond age 65 or age 85 or age 100, when others did not. I have found that when older people hear that I perceive that they are the strong ones (e.g., that they have survived when others have not) and that they have wisdom and information to impart, their eyes brighten because this seems to be a new concept (even a revelation) to them. They sometimes indicate surprise that anyone has thought this. Such communication often leads to very strong counseling relationships that can support the counseling process. I do not remember which wise friend, teacher, or scholar taught me this concept, but it has stayed with me, and it has become my own. I have assimilated it. I own it. I hope that you, the reader, can also make it your own belief.

A relatively recent movement has been underway to recognize the strengths of older individuals (Choate, 2008). Various positive characteristics have been associated with people who have had long and successful lives. These attributes include optimism, adaptability, resilience, a sense of responsibility for oneself, belief in personal power, healthy self-esteem, involvement in meaningful relationships and projects, a history of work habits and skills, and potential for leadership and mentoring (Borman & Henderson, 2001; Institute on Rehabilitation Issues, 2009; Kampfe, Wadsworth, Mamboleo, & Schonbrun, 2008).

A variable that will strengthen the shift toward positive attitudes about older people is the aging of the Baby Boomers. This group is bringing a new definition to the terms older and aging. Furthermore, the shift in improved health among the older population appears to have resulted in a concomitant positive shift in attitudes toward aging (J. E. Myers & Degges-White, 2007). This change in attitudes is reflected in the terms healthy aging, resourceful aging, positive aging, and successful aging (Angus & Reeve, 2006). These terms are examples of how attitudes can change the language being used to describe someone as well as how changing the language can be used to change attitudes.

Although attitudes are beginning to shift from negative to positive, stereotypical views of older people and dehumanizing behaviors are still displayed throughout our culture. Fortunately, counselors, at their basic core, have been trained to support the independence, respect the opinions, and promote the integrity of the people they serve; therefore, they are well-suited to serve people who are older (Doyle et al., 2003; Finch & Robinson, 2003; Kampfe, 1994; Kampfe et al., 2005).

Summary

The older population is one of the fastest growing groups in the United States. This group is widely diverse; consequently, counselors cannot expect that one older person will be the same as another. Our society has traditionally had an ageist attitude. Counselors will need to examine their own attitudes toward aging and older people and take steps to ensure that these attitudes are appropriate. They can also encourage older clients and their communities to develop and maintain positive attitudes toward aging. An underlying belief that can support counselors in this process is that older people are the strong ones. They are the survivors.

Chapter 2

Counselor Considerations When Working With Older People

The purpose of this chapter is to provide information that is specific to gerontological counselors. Topics include counselor education program standards; other professionals who work with older people; responsibilities mandated by the Health Insurance Portability and Accountability Act (HIPAA); evidence-based practice and programming; the dangers of transference; the concepts of autonomy, personal control, independence, and empowerment; multicultural issues associated with aging and the need for counselor cultural competency; therapies used with older people; case management; assessment; and assistive technology.

Counselor Education Program Standards

The ACA Code of Ethics (ACA, 2014) reiterates the importance of appropriate training for and competence of counselors who work with special populations (Standards A.11.b., C.2.a., C.2.b., and E.2.a.). Individuals who wish to become gerontological counselors must seek appropriate graduate counselor training (i.e., from an accredited counselor education program) to ensure both that they have basic counseling skills and that they will be able to obtain certification and licensure to practice. At the present time, there are three important bodies or organizations from which counselor education programs can obtain accreditation: the Council for Accreditation of Counseling and Related Educational Programs (CACREP), the Council on Rehabilitation Education (CORE), and the Master’s in Psychology and Counseling Accreditation Council (MPCAC). Furthermore, as of 2013, CACREP and CORE offer dual CACREP/CORE accreditation standards (i.e., Clinical Rehabilitation Counseling Standards).

Counselors need to engage in ongoing professional development regarding current topics (ACA, 2014, Introduction) associated with the older population in order to keep themselves up-to-date regarding this diverse population and to ensure the competence of their work and protect others from possible harm (ACA, 2014, Standard C.2.b.; also see Standard C.2.f.). With knowledge, counselors will be likely to have an accurate understanding of their clients’ experiences and an arsenal of resources to help them deal with these experiences. To gain knowledge, counselors can read textbooks and journal articles about counseling older people, contact the resources suggested in this book, partake in continuing education options that focus on aging, seek supervision to evaluate their efficacy, obtain an additional gerontology certificate from a college or university, study the newer concepts about human growth and development, and do an internship in a program that serves older people (ACA, 2014; Shallcross, 2012c).

A major concern is that the term gerontological counselor currently has varying definitions. For example, a general term used for many types of professionals who specialize in working with older people is gerontologist. According to some sources, one group of gerontologists is composed of gerontological counselors, broadly defined as applied gerontologists, who work directly with older people and their families to provide materials and education. Requirements for gerontological counselors can range from a bachelor’s degree with special training in counseling, to professional counseling certification plus training in gerontological issues, to a master’s degree in mental health counseling, to a doctorate in psychology. Furthermore, the definition for gerontological counselor varies from state to state. Such broad and varying definitions of gerontological counselor are of great concern because there is no guarantee of specific, consistent training or skills in counseling or in working with older people. In order to maintain control over the qualifications for gerontological counselors, the counseling profession may wish to advocate for national certification and educational program accreditation for this specialty, similar to that which existed in the past (see J. E. Myers & Schwiebert, 1996).

Other Professionals Who Work With the Older Population

According to the ACA Code of Ethics, counselors work to become knowledgeable about colleagues within and outside the field of counseling . . . and develop positive working relationships and systems of communications with colleagues to enhance services to clients (ACA, 2014, Section D, Introduction). Hence, counselors should be aware of the many specialists who are qualified to work with older people.

Professionals who specialize in mental health and aging include psychologists who focus on the older population (geropsychologists), social workers who focus on gerontological issues, and horticultural therapists who focus on aging issues (Casciani, 2012a, 2012b; Crawford & Walker, 2004; J. Neihause, personal communication, December 8, 2013; Weinstein, 2008). Counselors may find that working as a team member with these professionals can enhance services for their older clients.

Physicians who specialize in aging issues are called geriatricians. These individuals have skills and knowledge to recognize and treat the multiple physical conditions associated with aging; be aware of the unique effects, side effects, and interactions of medications on older people; understand how older bodies differ from younger bodies; and be familiar with other geriatric issues and needs. Unfortunately, there is a shortage in geriatricians, and this shortage is projected to increase as the Baby Boomers continue to reach age 65. Furthermore, in many cases, medical students have not had clinical rotations in geriatrics and therefore have not received even the basics in geriatrics during their training (Butterfield, 2007; Kimmel, 2012). Other medical specialists who may treat older people are neurologists, who focus on nerves and the brain; physiatrists, who focus on physical medicine and rehabilitation; and geriatric psychiatrists, who focus on mental disorders. Because of the unique nature of medical issues associated with older people, general doctors may miss important diagnostic clues, prescribe inappropriate or excessive medications, and have limited knowledge of cutting-edge medical treatments for older people. Counselors need to be aware of these potential problems and encourage older people and their families to seek medical advice and treatment from geriatricians if possible. Counselors can help clients find geriatricians or other medical specialists using the websites of the following organizations: the American Medical Association (https://apps.ama-assn.org/doctorfinder/html/patient.jsp), WebMD (http://doctor.webmd.com/), Find a Doc (http://www.findadoc.com/), and the American Geriatric Society (http://www.americangeriatrics.org).

Geriatric care managers (GCMs) provide geriatric care management and case management regarding a variety of topics (e.g., banking, accounting, trust departments, elder law, senior real estate, assisted living, medical care systems). GCMs represent a wide range of educational backgrounds (e.g., nursing, social work, gerontology, occupational therapy, and physical therapy) and a synthesis of theory and knowledge from each of these professions. Geriatric care management has become a professional business field with its own certificates and academic degrees. GCMs help older people and their families solve problems using client assessment, service coordination, nursing and social work tools, care planning, referral, monitoring, and help in time of crisis. In other words, they are case managers who provide a personal, individualized service on a 24-hour-a-day, 7-days-a-week basis. Furthermore, they act as surrogate family members who develop a long-term relationship with the older people they serve (Cress, 2007). Although counselors have not traditionally been listed as potential GCMs, they are very appropriate candidates because they often function as case managers (L. Shaw, personal communication, November 3, 2013). It might, therefore, be helpful for counselors to explore the certification, licensure, and training process for GCMs in their states.

HIPAA

Counselors who are working with clients of any age must be knowledgeable about HIPAA, which is designed to protect the privacy of their clients. Because counselors often work with various professionals, programs, family members, and friends of older people, it is vital that they are totally familiar with the HIPAA rules and that they follow them carefully. A discussion of these rules is beyond the scope of this book; however, counselors should find ways to update themselves regarding HIPAA and how to apply it to the type of work that they are doing.

Evidence-Based Programming and Practice

Evidenced-based programming and counseling practices are important in providing optimal services to clients. In other words, counselors should use programming and techniques that have been shown to be effective via well-designed research (ACA, 2014, Standard C.7.a.). Counselors would do well to read data-based, refereed articles to determine whether the counseling strategies or specific programming they use have been studied for their effectiveness with older populations (ACA, 2014, Standard C.7.a.). Thus, counselors need to have the ability to judge the quality of the research being described. As mentioned elsewhere in this book, the National Council on Aging’s Center for Healthy Aging (see http://www.ncoa.org/improve-health/center-for-healthy-aging) helps community organizations identify and put into place evidence-based practices; however, they focus only on depression, physical activity, and fall prevention. This center and perhaps other similar organizations would likely be good resources for information regarding successful counseling strategies and programs. Furthermore, counselors can contribute to the development of evidence-based practice by collaborating with researchers who are conducting studies of this nature.

Unfortunately, many of the programs and practices designed for older people have yet to be examined for their effectiveness using data-based research designs; therefore, many of the suggestions made in this current book are anecdotal rather than data-based. It will be important for current and future researchers to apply rigorous methodology to study any and all techniques and concepts suggested in the literature and in this book.

Potential Dangers of Transference Among Counselors and Older People

Counselors must be cautious about interacting with older clients in a manner that could lead to transference (e.g., older clients remind them of relatives and situations that may or may not have been resolved in their own lives; Kimmel, 2012; J. E. Myers & Shannonhouse, 2013). This potential transference may influence their interactions with, understanding of, and openness to older clients. Counselors may remember their elders as strong or weak, kind or irritable, supportive or demanding, loving or cold, involved or uninvolved. They may have feelings of pity, deference, love, guilt, worship, anger, or sadness associated with their elders. These old memories and feelings may influence their thoughts and feelings about their current clients. Thus, it is important that counselors understand themselves and work through any old issues associated with their own elders or with societal ageist perspectives to ensure that these issues do not influence their current interactions with older clients. If counselors are unable to work through their unresolved thoughts or feelings about older people, they should probably not work with this population until these issues are resolved (Shallcross, 2012c).

Autonomy, Personal Control, Independence, and Empowerment

The concepts of autonomy, personal control, independence, and self-determination are often used interchangeably and are rooted deeply in our counselor codes of ethics, beliefs, and practices (ACA, 2014; Kampfe et al., 2007). A sense of personal autonomy (i.e., the perception that one has control over his or her environment and choices) has been shown to be positively related to physical well-being, psychological well-being, and health-promoting coping strategies. Conversely, lack of personal control has been found to relate negatively to psychological well-being (Kampfe, 1994, 1995, 1999, 2002; Kampfe & Mitchell, 1991; Trouillet, Gana, Lourel, & Fort, 2009). An AARP survey (L. L. Fisher, 2010) provided strong support for this notion. Among respondents age 60–69, 99% of men and 98% of women stated that independence was important to their quality of life. Among those age 70 or older, 99% of the men and 93% of the women indicated it was important.

The concept of empowerment is closely related to autonomy. Perhaps the best definitions of empowerment are those of J. E. Myers and Shannonhouse (2013) and Sales (2007). According to J. E. Myers and Shannonhouse (2013), Empowerment refers to actions intended to help people help themselves or to create personal power (p. 159). According to Sales (2007), Empowerment is the process of supporting an individual in learning how to and becoming able to gain more control over himself or herself in the environment (p. 81). Both of these definitions focus on the power of the person rather than the counselor’s ability to give them power (a very important distinction). E. B. Waters and Goodman (1990) also focused on the power of the client rather than the ability of the counselor to give power. The following books can provide in-depth considerations of the concepts and practices associated with empowerment: Empowering Older Adults: Practical Strategies for Counselors (E. B. Waters & Goodman, 1990); Rehabilitation Counseling: An Empowerment Perspective (Sales, 2007); and Empowerment for