Geriatric counseling

Prepared by
Basma Abd ElMoniem Mohamed

Under supervision
Assist. Prof Dr. Mawaheb Mahmoud Zaki

Assistant professor of psychiatric nursing department

Faculty of Nursing

Benha University

2022-2023
 Outlines

 Introduction
 Definition
 Importance Of Geriatric Counseling
 Principles of Geriatric Counseling
 Types of Geriatric Counseling
 Process of Geriatric Counseling
 Geriatric Counseling Techniques
 Issues in the counseling perspective
 Overcoming geriatric mental issues
 Factors affecting Aging and Geriatric Counseling
 References .
  Objective

At the end of this lecture each post graduate student

will be able to:

Define Geriatric Counseling

List importance Of Geriatric Counseling
List benefits of Geriatric Counseling
Discuss principles of Geriatric Counseling
Enumerate types of Geriatric Counseling
Discuss process of Geriatric Counseling
Enumerate Geriatric Counseling Techniques
Discuss issues in the counseling perspective
Enumerate Overcoming geriatric mental issues
List factors affecting Aging and Geriatric Counseling

 Introduction
 Geriatric is an adjective that describes something related to old age
and the elderly. The word geriatrics, however, refers specifically to
a branch of medicine focused on treating conditions in older adults.
Geriatric counseling is an important service that many elderly people
need. It can provide comfort and support to those who are
experiencing difficulties in their day-to-day lives. The elderly
population is growing, so it’s important for geriatric counselors to
.help meet the needs of these individuals

 Definition of Geriatric counseling

Geriatric counseling is a specialty of psychology that focuses on the
challenges aging adults face. The geriatric counselor will work with
people in their 50s, 60s, and 70s to help them adjust to the life
changes they experience as they age. It’s important for seniors who
are struggling with depression or other mental health issues to get
treatment before it worsens into something more serious like
.dementia or another form of cognitive impairment

 Importance Of Geriatric Counseling

We can promote awareness among people about Geriatric Counseling
in many ways, such as:

 It is important to educate people about what geriatric counseling

entails.
 Older adults should know that it provides a way for them to
adjust and cope with the many changes they experience in their
daily lives, such as decreased vision and mobility.
 People who don’t find relief from symptoms like anxiety or
depression through medication may benefit from Geriatric
counseling .
 They can also learn coping strategies that will help them stay
healthy and active, reduce feelings of isolation, and manage
negative emotions more effectively.

5ways counseling is beneficial for elderly

Mental health issues can arise for the first time in the senior years
when older adults face new challenges. Your aging loved one
might already have a diagnosed mental health condition that
presents new symptoms. Professional counselors are available
to help elderly through the changes in their lives, and providing
them with a counselor can help him or her enjoy a better quality
.of life

Motivate them to make positive changes-1

Apathy is a common issue for seniors, and your loved one may
sometimes take the stance that negative health issues just happen.
Counseling empowers seniors to do what they can to address
their overall wellbeing. Instead of simply claiming life has
to be difficult, your loved one may begin to be more(proactive)
.about maintaining independence

If your aging loved one needs help managing everyday tasks or

encouragement to adopt healthier lifestyle choices, turn to home
.care assistance, a leading provider of in-home care
Richmond home care assistance provides professional in-home
caregivers around the clock to help seniors live longer, happier,
.and healthier lives

Learn to accept a new health diagnosis-2

There are times when seniors need to reach a point of acceptance

regarding things that cannot be changed. Your loved one might
be in denial about a health diagnosis, such as Alzheimer's, and a
counselor can teach him or her how to accept it. Learning ways to
manage their emotional reactions to health conditions puts
seniors in a better position to take care of themselves. Counseling
can also help seniors overcome stress that often occurs with a
new health diagnosis, and counselors have techniques for stress
.relief that benefit people who live with chronic pain

If your senior loved one has been diagnosed with a serious

condition and needs help with tasks like meal prep,
transportation, bathing, and grooming, reach out to home care
assistance, a leading provider of home care families can trust. We
also offer comprehensive care for seniors with dementia,
.Alzheimer's, and Parkinson's
Work through the stages of grief & loss-3

Elderly people often experience multiple losses in a short time.

They can also experience tragedies such as losing adult children
or life partners. Professional counseling gives seniors tools that
help them work through these losses. While you cannot bring
your loved one's friends and family members back, you can
.provide a way to move forward

Address unresolved issues from the past-4

In a perfect world, conflicts from the past would all be resolved

by the time a person reaches the golden years. However, many
seniors are still grappling with issues that happened long ago.
Long-standing family conflicts could reduce your loved one's
network of support. Memories of traumatic events can cause
seniors to isolate themselves from others. Your loved one may
not be ready to explore some of these issues with close family
members, but he or she is likely to open up to a counselor
.who can help him or her begin to take steps toward healing

Practice accepting assistance-5

Seniors sometimes feel as though they're being forced to accept

help from others. Older adults who have worked hard to be
independent are the most likely to resist having caregivers.
Talking to counselors can help seniors see that accepting help is
a good thing. Your loved one's counselor can guide him or her
toward ways to let people help. The counselor can also help your
loved one develop communication skills that enhance the benefits
.he or she receives from having care provided at home

Principles of Geriatric Counseling;

 Principle of Universality
There is no single characteristic that accurately describes older
adults, as this cohort encompasses an array of different life
experiences, personality traits, and goals for counseling. Thus,
counseling the elderly must begin with basic knowledge of the
aging process, such as normal versus pathological aging, fact
 versus fiction, and stereotypes. Counselors should be well
versed in the physical, mental, and emotional aspects of older
clients that are built upon a foundation of respect, empathy, and
support.
 Principle of Adaptation
Once an elderly client shows the need for counseling, several
adaptations have to be made in the traditional counseling
format. Counselors need to be aware of the social context in
which their older adult clients exist and the challenges of
navigating an aging world. For many older adults, entering into
counseling is a new and possibly intimidating experience.
Education about the counseling process may assist in rapport
building and setting appropriate expectations. By outlining the
logistics of the sessions (e.g., how long each meeting will last,
the cost, and duration of therapy) and describing the process of
therapy, the counselor can potentially alleviate concerns,
allowing older clients to be active participants in the course of
treatment.

 Principle of Client Conceptualization

 Social Conceptualization

The counselor should try to understand the broad historical timeline of

events that may have influenced an elderly person‘s perspective on life
A general awareness of these events and their consecutive effect on
elderly life may help the counselor, in identifying and understanding
client‘s current stage in life.

 Physical Conceptualization
An example would be, older clients exhibiting physical declines like
difficulty in hearing, the counselor speaking louder in a deeper voice
and possibly more slowly. If clients have decreased eye sight, the
written materials should be in large prints; if older clients experience
physical limitations, preventing them from completing paperwork or
providing a signature is important.

 Cognitive Conceptualization
In those elderly with changes in memory functioning, counselors may
need to use more repetition, provide hands-on material, and focus on
events and emotions that are more easily recalled. Complex and jargon
filled interpretations will not likely to be successful, as many older
adults may be more receptive to pragmatic and problem-solving
techniques.

 Principle of Applicability
Elderly confined to self and family, to alleviate their worry of
becoming a care burden to their family, requires inclusion of
spouse/family members/caregivers in the counseling process.
Older adults, who live independently in the community,
experience different challenges than those living with
family/with the help of a caregiver/in an assisted living facility
or in a long-term care facility. Counselors need to understand
the system in which the client lives, so that they can recognize
better and appreciate the corresponding challenges, which may
arise.

 Types
Supportive Counseling
It is most often used with elderly, who have difficulty facing their
problems alone. In supportive counseling, the goal is not to create a
chronic dependency upon the counselor, but to give temporary
support and help the elderly to gain strength and the resources to
cope.

Confrontational Counseling
It seeks to point out to the client his or her negative actions. The
counselor guides the counselee into seeing, what misdeeds were
committed and to realize the hurt that might have been caused to
others. The idea is that hiding one‘s immoral actions only creates
guilt, frustration, and anxiety.

Educative Counseling
It focuses on teaching the client. Undesirable learned behavior may
have to be unlearned. The counselor in this case is a teacher and
people may come to the counselor with questions on physical issues,
 mental issues, social issues, spiritual issues, or even with adjustment
issues. Often elderly clients may need help in making certain critical
decisions.

Preventive Counseling
It is used to stop problems before they start or to prevent things
from getting worse. Areas like
―How to keep health in old age
-How to prepare for retirement, or sessions to adjust with frailty are
examples of preventive counseling.

Spirituality Counseling
It is a great necessity, as the elderly often seeks for an opportunity
to get on to the way to *Almighty‘. Sometimes there will be persons,
who want to find spiritual answers and may be seeking for a purpose
in life. Through spirituality counseling the counselor can discover
some psychological issues that need immediate intervention.
Depth Counseling
It is a long-term relationship in which deep-seated problems of the
elderly are uncovered and dealt with in detail. The counseling
process is extended and demands the skills of a counseling
professional, requires multiple sessions and constant adherence to
the therapy

Informal Counseling
It takes place in a casual setting. Perhaps on a hospital visit, or
during an informal home visit, the counselor may be drawn into a
conversation, where his/her help might be asked for. Informal
counseling at times is also considered as incidental counseling, but it
may not be of therapeutic purpose always

 Process of Geriatric Counseling

The method of counseling will help in considering the resource
requirements, client expectations and the specific counseling
procedures to be initiated. However, there is a general geriatric
counseling process, which is outlined below:
Step 1: Preparing for Counseling Sessions;

The counselor and the client should schedule a mutually convenient

date, time and location for a counseling session. Counselors should
reach the counseling site about 10 min early to make ensure that
everything is in order and to greet the clients when they arrive.

Step 2: Opening

Introduce yourself to the elderly. Address the client in the manner

they prefer. Open the session with a brief introduction,
summarizing your role as a counselor and the mission and scope
expected of the process. Explain how you can help the elderly by
providing objective information to enable him or her to reach well-
informed decisions.

Step 3: Elderly Contact Form

The name of the elderly, date, basic demographic information, type

of assistance needed, and amount of time spent on counseling, and
the counselor's name should be recorded on the contact form.
Following the contact form is a good way to keep the counseling
session focused and on track. If a spouse, relative, friend or other
representative is seeking help on the elderly‘s behalf, record that
contact person‘s information also.

Step 4: Problem Identification

At this stage, ask elderly to summarize his or her reasons for

meeting with the counselor. This is the counseling need or reason
for contact and should be indicated on the contact form. If multiple
concerns are expressed, all that are presented to the counselor
should be identified on the form. If during counseling process, it is
identified that the client has a different or more serious
physical/mental/social problem than the one(s) the client has
presented, that information too has to be included or recorded as a
narrative or summary section on the contact form. During this
phase, counselor will collaborate with the elderly in order to
discover, what specific goals are to be set and work towards. This
stage entails planning therapy, based on what the counselee is
seeking and to understand from his/her viewpoint, what life would
be like without the existing problem(s).

Step 5: Action Plan

The counselor and the counselee should discuss and agree upon a
course of action to be taken to resolve the client‘s most pressing
problem. Encourage clients to act on their own behalf. Keep the
counselee an involved participant in the process of resolving his or
her health problems. It may be more time consuming initially, but
the effect will be longer lasting. A simple checklist included with
counseling materials and used to remind the client of the actions
they need to take after the counseling session is over, will be
helpful.

Step 6: Processing

Once the counselor and elderly have agreed upon a plan of action,
the next step is to implement it. Generally, there are three distinct
categories in the processing step of any counseling session. They
include the elderly‘s need for information, claims for assistance and
advocacy. Some cases will require more than one approach and in
that situation, it is better to focus on the most serious, pressing
problem.

Step 7: Closing

At the close of the session, summarize the information reviewed

and procedures followed during the session. Review (provide a
written list, or a predefined checklist) of any follow-up activities to
be taken, either by the counselee or counselor as a result of the
counseling session. Indicate whether and when another counseling
session is needed, and what procedures should be followed to make
another appointment, if necessary.

Step 8: Documentation
 Provide an evaluation form to the elderly, where they can state their
honest opinion regarding the quality of the counseling services
received. While the client is completing the evaluation form, the
counselor should complete the rest of the client contact form,
including the decisions and resolutions made under mutual
agreement.

 Geriatric Counseling Techniques

GC therapists work with clients to change unhelpful thoughts and
behaviors. This can help reduce negative emotions and improve the
quality of life. There are some techniques that GC therapists may use,
such as:

The Use of Questions

Too many narrow questions may leave gaps in information.
Improperly framed leading questions at best can distort the facts, and
may confuse the client about what the counselor believe is important.
Too many detailed questions may cause anxiety that inhibits, rather
than enhance your client‘s ability to recall key points.
There are four primary categories of questions: open-ended, yes-or-no,
limited focus, and leading. Each has advantages and disadvantages to
securing an accurate account of the client‘s situation. Open-ended
questions allow the greatest latitude as to subject matter and details.
Leading questions are the opposite: they leave little room for the client
to improvise and, in fact, generally suggest the answer. Yes-or-no
questions and limited focus questions lie somewhere in between and
are used to channel the discussion and fill in gaps.

Paraphrasing Paraphrasing
is a key tool for checking accuracy of communication. By
paraphrasing back to the client, what the client has said;
1) the counselor can find out if the message that was heard is what
was intended by the speaker
2) keeps counselor's opinions out of the way, while giving the
older person a chance to explore problems and needs in his or
her own way
3) tends to reduce aimless repetition, as the older client knows that
the counselor has understood the message
4) gives the older person a feeling of support, a chance to hear and
examine
Checking Credibility
one must also investigate factors affecting older client‘s ability to
perceive, what he or she reported and to remember and recount it
accurately, on a later date. There is likelihood of encountering
conflicting reports. Checking the following factors which influence
elderly will tell counselor, whether he/she needs to probe elderly
memory in greater depth.

Significance of the Event

If the event was personally important to elderly or occurred when
little else was happening, former will likely have paid greater attention
to it and to the details surrounding it.

Emotional Factors
If client was concerned about his or her own safety or well-being,
he/she may not have observed details around the event. Also, client
may have been thinking about something else at the moment, when the
event occurred. Assess the amount of stress that the client experienced
at the time, caused either by the event or by other factors in client‘s
life.

Physical Factors
Age, health, intoxication, fatigue, vision problems, and defects in
hearing all contribute to the manner in which the experience was
observed and retained.

Expectations
All people have biases and prejudices, through which they view
events and the people around them. Perceptual distortion caused by
stereotyping may be unconscious, but has a very real effect.

Environmental Factors
Ask about time of the day, street lighting, room lighting, weather
conditions, location of the sun, noise level, distance from the event,
and other activities taking place near the event.

 Issues in the Counseling Perspective

Ageism
 Our attitudes to the elderly may be complex and dependent on our
own experiences. To a degree, the elderly are stereotyped as a
cohesive group, who are generally ill, rigid in thinking, and failing
mentally. However, they are actually a diverse group, still largely
active members of society. The relationship between the elderly
patient and counselor may be tainted by these stereotypes, as they
deal largely with the afflicted aged. Here counselor must attempt to
see the individual patient, beyond the elderly façade.

Disabilities
Elderly patients may have visual or hearing disabilities that
hamper their ability to communicate. Sometimes many of them
may have a long-term disability or handicap, which may affect their
ability to access the counselor or needed services appropriately. At
times, the elderly may feel frustrated and irritated with other‘s
attitudes and may react aggressively or uncooperatively.
The counseling materials and procedures or therapies, should be
adapted to assist elderly to see, hear and understand information. It
is important to allow adequate time for disabled elderly to see, hear,
move and understand.

Memory and Mental Deterioration

In most cases, counselor may be the first person to identify that an
elderly is having difficulty with memory and mental functioning.. It
may be difficult to approach the elderly directly about this, and
should be done with tact. They may make excuses or deny any
problems. If possible, family members and/or significant care
providers should be notified of their concerns.

Learning Style and Time

Difficulty in registering new information and retrieving information
can be accommodated by simple format (i.e. short lists) and
uncomplicated content. More reinforcement is needed to learn new
coping strategies; appropriate and acceptable behaviors should be
reinforced regularly. Problem-solving ability can be assisted by
providing simple, well-organized materials and relating the same to
where it can be possibly implemented

 Overcoming Geriatric mental issue

Increasing Awareness
 Awareness needs to be spread regarding mental health problems,
specific needs of the geriatric population and services available in
this regard. The existing framework should allow for positive
engagement between clinicians, researchers, caregivers and elderly
people with mental illness.

Training and Manpower Development

There is a felt need to expand the teaching curriculum across all
the disciplines, to include geriatric care components including
general physicians, psychiatrists, psychologists, psychiatric nursing
and psychiatric social work. Also, there is a need to increase the
seats in geriatric medicine specialty and geriatric psychiatry super-
specialty courses and developing programs for sensitizing general
physicians and health workers for screening and appropriate
referral. There is an urgent need to establish geriatric centers of
excellence catering to a multidisciplinary approach

Home Based Care Programs

In the current scenario, where training a health professional is a
time and resource-consuming affair, countries can develop
adequate training programs for family members, the major current
task force in the service of the elderly in the country. Supporting,
educating and advising family caregivers is a cost effective strategy
for developing countries, as it requires only one tenth of resources
investment in residential care

Rehabilitation Services
Adequate services for establishing continuity of care beyond
hospitals to the community level, in the form of day care centers,
respite care facilities, half way homes, and old age homes to
encompass long-term support and chronic disease management.

Need for research

The paucity of population-based research calls for more good

quality epidemiological and health services research, which will
help to generate awareness, shape health and social policy and
encourage the development of better services for patients and
.their caregivers
 Factors affecting Aging and Geriatric Counseling
There are many factors that affect the aging process, such as:

 Diet
 Genetics
 Lifestyle choices
 Health care
Many medical conditions people develop as they get an older result
from poor habits or other preventable causes such as smoking or lack
of exercise.

 References
 Atiq R,(2006); Common Themes and Issues in Geriatric
Psychotherapy.. [Online] Available from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990651.
 HIICAP NOTEBOOK. Counselling Techniques. 2010. [Online]
Available from http://www. op.nysed.gov/surveys/mhpsw/sofa-
att3.pdf
 American Bar Association,(2020); Effective Counselling of
Older Clients. Commission on Legal Problems of the Elderly of
the American Bar Association and Legal Counsel for the
Elderly, Inc.; 2020. [Online] Available from
https://www.americanbar.org/groups/law_aging/
 Department of Family and Community Medicine,
(2005);Faculty of Medicine, University of Toronto. Types of
Counselling in Family Medicine; Presented at the Rosser
Academic Day; Toronto, Ont. Apr 9, 2005.
 Knight, BG,(2004);Psychotherapy with Older Adults. 3rd Edn.
London: Sage; 2004
 Canada‘s Aging Population,(2013);. Report Prepared by
Health Canada in Collaboration with Interdepartmental
Committee on Aging and Seniors Issues. 2013. [Online]
Available from
www.hc-gc.ca/seniors.aines/pubs/fed_paper/pdfs/fedpager_e.pd
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