Elderly Clients & the Competent Counselor

When working with elderly....

What type of specialized training might counselors need to address the clinical needs of elderly clients?

Counselors who chose to work with the elderly population must have significant knowledge of their specific issues, experiences, and concerns. Often times, when the elderly are referred to a professional in the human services field, they are struggling with emotional, psychological, or physical issues. Depression is of major concern among this age group. “Community studies have shown that 25% of elderly persons report having depressive symptoms” (Raj, para.3), additionally confirmed by Shirmbeck (2006), with high rates of occurrence (36% to 46%) among those hospitalized (Teresi & Holmes, 2001). According to Erik Erikson’s seven stages of human development, elderly individuals would find themselves dealing with the psychosocial crisis of ego integrity vs. despair. It is during this stage that the individual evaluates his or her life, accomplishments, and fears. Individuals who fear their own death, feel abandoned or lost due to the loss of loved ones, are experiencing chronic or terminal illness, or feel they have lost the ability to be self-sufficient can find themselves engulfed in a state of despair. For these individuals, it could be helpful to complete a life review. As, Lewis (2001) finds, “The life review is one counseling intervention which has been empirically shown to be useful with older adults” (234).

There are many facets to the life review, each which could provide positive results to the individual, especially so when the review is focused on the relationship to spirituality. During the life review process, the individual recalls, evaluates, and then reintegrates their memories developing a holistic view of their self-concept. “The life review has the primary purpose of helping the older client find integrity” (Lewis, 234).

Pervin, Cervone and Oliver (2005) find that through the progression of Erikson’s stages, some individuals are capable of developing a “sense of intimacy, an acceptance of life’s successes and disappointments, and a sense of continuity throughout the life cycle,” (p. 111) a progression that leads to integrity stage in later life. However, “other people remain isolates from family and friends, appear to survive on a fixed daily routine, and focus on both past disappointments and future death,” (p. 111) and are likely to find themselves rooted in despair. Pervin, Cervone and Oliver (2005) further suggests that the resulting personality, and final stage, may have it’s roots in a childhood conflict, “this is not always the case and that they have a significance of their own,” (p.112). In either case, it would be beneficial if the counselor were prepared to work through a life review with the elder client in an attempt to resolve the psychosocial crisis’ that might be preventing them from entering into the integrity stage.

What specific clinical skill sets may be needed?

Those who chose to work with the elderly population will likely be presented with a plethora of issues outside of that which brought the client initially into treatment. Due to the age of the client, the counselor will need to be aware not only of mental and emotional conditions but also those which may be of physical concern. Additionally, issues related to cognition may make the therapeutic process more difficult. There are two main forms of cognition, crystallized and fluid intelligence. Crystallized intelligence is one area of cognition that is often found to increase with age. Crystallized intelligence is defined by VanderZanden, Crandell & Crandell (2007) as “the ability to use knowledge that was acquired earlier in life on later occasions. Crystallized intelligence often shows an increase with age” (p. G-3). Furthermore, it has been shown that one’s knowledge base not only remains intact but also continues to grow throughout most of adulthood, only to start declining after age 65 (Cavanuagh & Blanchard-Fields, 2006). A second area of cognition is classified as Fluid Intelligence, which is defined as our "on-the-spot reasoning ability, a skill not basically dependent on our experience." (Belsky, 1990, p. 125). And unlike crystallized intelligence, fluid intelligence tends to peak in young adulthood, only to begin declining if not regularly used and practiced (Cavanaugh and Blanchard-Fields , 2006). Given this understanding of intelligence process, it is likely that elderly clients will have difficulty processing new concepts, and therefore the counselor will have to maintain patience and understanding when working with this population.

Unfortunately, this learner has little hands-on experience with the elderly population. Her only direct contact with individuals over the age of 65 is that of her husband’s grandmother, as her own grandparents are no longer living. Additionally, her future career goals tend to isolate this population, i.e. working with children and adolscents, and therefore she has failed to give this population much consideration throughout her research process, until now. She does look forward though to gaining a better understanding of this type of client, regardless if she never ends up working directly with the elderly in a professional setting.

Stephanie Lowrance-Henckel

References

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Cavanaugh, J. & Blanchard-Fields, F. (2006). Adult development and aging (5th ed.) Belmont, CA: Wadsworth Publishing/Thomson Learning.
Krebs-Carter, M. (2007). Ages in stages: An exploration of the life cycle based on erik erikson’s eight stages of human development. Yale-New Haven Teachers Institute. Retrieved on February 12, 2009, from http://www.yale.edu/ynhti/curriculum/units/1980/1/80.01.04.x.html#d
Lewis, M. (2001). Spirituality, counseling, and elderly: An introduction to the spiritual life review. Journal of Adult Development. 8(4). 231-240
Myers, R. (2007). Stages of social-emotional development in children and teenagers. Child Development Institute. Retrieved on February 12, 2009, from http://www.childdevelopmentinfo.com/development/erickson.shtml
Niolon, R. (2007). Erickon's Psychosocial Stages of Development. Resources for students and professionals. Retrieved on February 12, 2009, from http://www.psychpage.com/learning/library/person/erikson.html
Pervin, L., Cervone, D., & Oliver, J. (2005). Theories of Personality (9th ed.). New Jersey: John Wiley & Sons.
Raj, A. (2004). Depression in the elderly: Tailoring medical therapy to their special needs. Postgraduate Medicine Online. 115(6). Retrieved on February 12, 2009, from http://www.postgradmed.com/issues/2004/06_04/raj.htm
Shirmbeck, P. (Speaker). (2006). Elder Issues [Podcast Recording No. CAS038]. Kent, OH: CounselorAudioSource.net. Retrieved February 12, 2009, from http://www.counseloraudiosource.net/feeds/cas038.mp3.
Teresi, J., Abrams, R. (2001). Prevalence of depression and depression recognition in nursing homes. Social Psychiatry. 36(12). 613-620.
Vander Zanden, J. W., Crandell, T.L., & Crandell, C.H. (2007). Human Development (8th ed.). Boston; Mcgraw-Hill.