Psychological Geriatric Care - Essay Example

PSYCHOLOGICAL GERIATRIC CARE 2007 Introduction The current tendency toward the continued increase in the numbers of elderly in the US wasforecasted long time ago. Thus, according to the projections made in the 1980's the share of elderly population would reach 21 percent of the US population by 2030 (Kaiser, 1990). Modern demographics of the US population have fully confirmed and even surpassed these previously made projections (SOME). The increase of the elderly population - an inevitable outcome of the aging tendency - has considerable implications for the healthcare practices with care professionals increasingly involved in working with aging patients. Therefore, understanding of the differences that distinguish the elderly from the younger patients has turned vital in the modern care practices. While many of the differences relate to pharmacological and biological changes associated with aging, the psychological aspect of geriatric care can hardly be neglected too. Knowledge of the basic psychological characteristics of elder patients can contribute seriously to the provision of optimal geriatric care (Lyness, 2004). Over the last two decades, the role of professional psychological services involving elder patients has been increasing. Thus, while in 1986 psychological practice in nursing homes was almost non-existent, after only ten years psychological services became very common in those institutions. Simultaneously, practitioners and researchers started to accumulated specific knowledge related to the unique principles of psychological care of older adults (APA, 2003). The existing data in the field of geriatric care allows identifying the basic psychological principles and concepts understanding of which is critically important for care professionals to be effective in their work with elder patients. Main Body Elder patients have in common a special sensitivity to the psychological quality of care provided by health professionals. This sensitivity is largely due to the perceived biologic vulnerability and decreased ability to cope with stress observed in elder patients (Neugarten, 1984). Therefore, psychological geriatric care requires from care providers to observe several specific principles which help address the unique psychological needs of elder patients. The psychological view on the process of aging has transformed seriously over the course of the last century. In the past, growing old was predominantly viewed as a sad and negative experience " an ever-increasing slope, racing quickly toward death" (Sperry & Prosen, 1996: 5). Although such distorted perception of aging still persists in the modern culture, it is far from being as predominant as it was in the past. And what is especially important aging is viewed as a dynamic process that challenges the individual to make continuing behavioral adaptations rather than a static condition that leaves the individual no opportunity for better life (Diehl, Coyle, & Labouvie-Vief, 1996). However, while majority of modern theorists tend to view aging as a complex dynamic developmental process, the most essential difficulty is changing the traditional perceptions as for the nature of this process. This difficulty is perfectly summarized by Sperry and Prosen (1996): ".the elderly in general will be better served if theorists, clinicians, and researchers develop more positive images of aging. This amounts to a paradigm shift in our thinking about the older adult. To do so we must first confront the myths and misconceptions we have about aging and carefully consider the ever-increasing evidence that aging is in fact a development process" (Sperry & Prosen, 1996: 3). Such situation can be explained by the fact that absolute majority of theories and perspectives in the field of psychological development of human being focused almost exclusively on the earliest stages of life - infancy, childhood and adolescence. Although psychodynamic, cognitive, humanistic, and behaviorist theories viewed the process of human development differently lack of attention toward developmental processes which occur in adulthood and especially late adulthood is common for all of them. There are only a few valid scientific paradigms that attempt to address this shortcoming of the previous research. Eric Erickson's theory of life cycles is perhaps the most recognized among them. Eric Erickson represents the Neo-Freudian paradigm and his ideas are generally based on works of his ideological predecessors - Sigmund and Anna Freud (Evans, 1969). The essence of Erickson's concept is the social and emotional development of personality in ontogenesis, from birth till senility. Instead of focusing exclusively on childhood and adolescence, Erikson takes into consideration the whole life-cycle dividing it into eight phases. In particular, Erikson believes that psychological crises are common to all ages while Freud and other psychologists of the past perceived them as immanent to childhood and adolescence only (Sheehy, 1977). Erikson addresses his model of human development as 'epigenetic' (Greek "epi" - above; genesis - development). Every stage in his model has its specific goal and ends in crisis that lets a person to enter new life cycle. These crises are turning-points that allow the individual to obtain new skills and master new form of relationships: crises in Erickson's theory are the moments of choice between progress or regress, integration or retarding (Erikson, 1963). The last eighth stage in Erickson's model is characterized by 'Integrity versus Despair' that takes place at old age. It's a contradictive stage as person understands her significance in the gone life and tends to compare it with the present ability. This time is the one for ego integration and realization of new life's roles. In case the preceding seven psychosocial crisis have been successfully resolved, the mature adult develops the peak of adjustment; integrity. This integration expresses in ability to the so-called "Post-Narcissus love" a person is proud of what he creates - his children, his work, or his hobbies (Sheehy, 1995). However, in case one or more of the earlier psychosocial crises have failed to be resolved an individual may treat himself and his life with disgust and despair. According to Erickson psychological development is a continuous dynamic process which encompassing the whole period of life though the specifics of this process is different at various stages of life. While childhood development revolves primarily around the formation of psychic structure, development of adults is focused around the continuing evolution of the existing psychic structure and with its real life application. Therefore, the developmental processes in adulthood are influenced by at least two major factors: the adult's recent past and the childhood experiences. Besides, development in adulthood also depends considerably upon the physical changes, cognitive transformations, recognition and acceptance of death. This range of factors should be taken into consideration in psychological care of elder patients. Although many psychological issues in late adulthood are similar to problems at earlier stages of life (e.g. life transitions, sexual difficulties, social discrimination, isolation, traumas, etc), late life is also characterized by some unique difficulties. Adaptation to age-related physiological changes, including health problems (Schulz & Heckhausen, 1996), meeting the need for integrating with the individual's achievements and failures (Butler, 1963) and the effects of social and cultural attitudes toward the elder people (Kite & Wagner, 2002) are the most common among them. Loss is one of the unique characteristic of the elderly patients. Loss of spouses, friends, relatives, animals, belongings, social roles, physical independence, mental capabilities, health, etc. often triggers problematic reactions, especially in people initially predisposed to depressive moods or/and other mental disorders (Sternberg & Lubart, 2001). However, despite the multiple potentially stressful factors associated with late adulthood, older adults have a lower incidence of psychological disorders than younger adults. Therefore, a psychologist working with elder patients should be aware of the following things: this group of people has much in common with younger adults; many old adults possess their own strengths and capabilities to cope with many of the emerging problems; and finally, what is very essential they have opportunities for effective application of skills developed over the lifespan for continued psychological growth in late stages of life (APA, 2003). Changes in perception of well-being represent another specific feature of late adulthood. For example, although people of all ages reminisce about the past, older adults are more likely to use reminiscence in psychologically intense ways to integrate experiences, to maintain intimacy and to prepare for death (Webster, 1995). Dimensions of well-being that are useful for psychologists to consider include self-acceptance, autonomy, and sense of purpose in life. Later-life family, intimate, friendship and other social relations as well as issues pertaining to relationship between generations should be considered adequately in psychological geriatric care (APA, 2003. One recent theoretical perspective postulates that aging normally results in a sharpened awareness of the limitations associated with the individual's remaining time and opportunities. This leads to heightened selectivity in the individual's social relationships, goals, coupled with increased concentration on those persons and relationships which bring the most emotional satisfaction (Carstensen, Isaacowitz, & Charles, 1999). As a result, the network of social contacts and relationships shrinks with age: often family and relatives remain the only members of this network and play critical role in the psychological care involving seniors (Antonucci, 2001). Psychologists should appraise the social support context in detail and try to find such solutions and interventions that strike a balance between respecting the dignity and autonomy of the elder patients and simultaneously recognize perspectives of the remaining social network members on the patient's needs for psychological care (APA, 2003). Diversity of the elder adults is another important principle to be considered in psychological geriatric care. The cultural, social, economic and demographic variations in the elder population are reported to surpass those observed in younger populations (Crowther & Zeiss, 2003). Consequently, the psychological issues and needs of seniors are likely to differ significantly depending upon such factors as age cohort, culture, ethnicity, gender, residence, educational background, economic and social status, sexual orientation, etc. The picture of syndromes and symptoms in different members of this age group often reflect interactions among these factors and/or characteristics of the setting in which care is provided (APA, 2003). An important aspect of psychological care involving elder adults is the influence of so-called generational factor. Each generation of people is born to a unique set of historical circumstances which play the decisive role in shaping collective psychological perspectives of the whole generation throughout the lifespan. Thus, these days's population of US elder adults witnessed such major events as the economic depression of the 1930's and World War II during the early stages of their lives. This experience contributed to formation of a strong ethics of self-reliance (Elder, 1999). However, these people were also brought up in social and cultural environment characterized by openly negative attitudes toward issues associated with mental health. Consequently, this attitude is often extrapolated on the professionals whom provide psychological care: the current generation of American elder adults is likely to demonstrate more reluctance than their younger counterparts in relation to psychological services (APA, 2003). The ethnic and cultural aspects of aging are likely to play increasingly important role in psychological geriatric care. Although the population of seniors is largely white nowadays, the projections say that non-white older adults will constitute approximately 35 percent of this age group in the United States by 2050 (Gerontological Society of America Task Force on Minority Issues in Gerontology, 1994). This factor must be taken into account because earlier experiences of such elder adults are often affected by specific ethnic or racial identity. For example, some of them faced discrimination in various fields of their lives such as work, healthcare, or housing, etc. Consequently, these elder adults are likely to have more mental and physical health issues than the majority group (APA, 2003). The demographic data demonstrates that the number of women among the elder adult population exceeds the number of men: this is explained by greater average longevity of women. The prevalence of elder women has several important implications for a health care professional. Firstly, most elder women are likely to experience widowhood and be at increasing risk for dementia and other health conditions associated with late adulthood. Secondly, the current generation of elder women had not the opportunity to engage in competitive employment which the younger generation had. Consequently, these elder women tend to have less economic resources in late adulthood life than their male counterparts. Women's issues frequently arise as concerns to be dealt with throughout the processes of assessing and treating older adults. Consideration of special issues affecting older men is similarly germane, though many of these have not been sufficiently researched (APA, 2003). Residence is also reported to affect the experiences of late adulthood. Thus, elder adults from rural areas often have difficulties accessing major resources associated with late adulthood (e.g., transportation, meals programs, community care centers, etc.). These limitations result in largely negative experiences of social support and care, and much higher levels of isolation as compared with representatives of the same age group residing in urban areas (Guralnick et al, 2003). Urban seniors also take advantage of better access and quality of mental health services, while the professional level of mental health specialists in urban nursing homes is reported to be better too (Coburn & Bolda, 1999). And finally, representatives of sexual minorities are likely to possess very specific psychological images. Typically, these people faced harsh discrimination from the majority, including the mental health professionals, which previously labeled sexual variation as psychopathology and utilized psychological and biological treatments to try to alter sexual orientation (APA, 2003) Prior history of developmental disorders such as mental retardation, autism, brain injuries, seizure disorders, and other, coupled with the physical issues which typically develop at late adulthood such as deafness, blindness, cardiovascular and musculoskeletal issues, etc. also has serious implications for psychological care involving elder adults. Due to the recent advances in medicine life expectancy for people suffering from such conditions and disabilities almost equals with the average life expectancy of healthy population (Janicki & Dalton, 1999). Consequently, the share of such people increases in the late adult population of the US, and a care professional must be aware that their history of disabilities is likely to seriously affect psychological assessment and diagnosis of patients, and has serious implication for their treatment (APA, 2003). Serious cognitive changes associated with late adulthood represent another concern to be faced in psychological geriatric care. Various cognitive abilities demonstrate different patterns of change over the process of normal aging (Schaie, 1994). The most common changes occur to reaction time, the overall speed of information processing, and reduction in visuospatial and motor control abilities, memory, and attention, particularly the ability to divide one's attention, to shift focus rapidly, and to deal with complex situations (APA, 2003). Cognitive functions that are better preserved with age include learning, language and vocabulary skills, reasoning, and other skills that rely primarily on stored information and knowledge. Typically, seniors remain capable of new learning though slower than people at younger age. Any observable changes in executive abilities are commonly predictive of functional disability (Royall, Chiodo, & Polk, 2000). A range of factors influence both lifetime levels of cognitive achievement and patterns of maintenance or decline in intellectual performance in late adulthood, including genetic, constitutional, health, sensory, affective and other variables. Sensory impairments, especially those related to hearing and vision, often substantially limit elder adults' intellectual functioning and ability to interact with their environments (Baltes & Lindenberger, 1997). Many of the illnesses and chronic physical conditions that are common in late adulthood tend to have substantial impacts on particular aspects of cognition, as do many of the medications used to treat them. Accumulation of these factors may produce a noticeable decline that elder adults experience in intellectual functioning, as opposed to the normal process of growing old. In addition to sensory integrity and physical health, psychological factors such as affective state, sense of control and self-efficacy, coupled with active use of information processing strategies and continued practice of existing mental skills may influence elder adults' level of cognitive performance (APA, 2003). The incidence of serious cognitive disorders is higher among elder adults than in other age groups. Therefore, late adulthood is commonly associated with increased risk of cognitive disabilities and impairment, in various forms and degrees. Population-based research has found that the prevalence of dementia increases dramatically with age, with various estimates indicating that as many as 25% to 50% of all those over age 85 suffer from this condition (Bachman et al., 1992). Although Alzheimer's disease and dementia are reported to be the most prevalent in the elder population, milder forms of cognitive impairments, which are not inevitably progressive and for which the etiology may not be clearly definable, are also common in this group. Depression or anxiety sometimes may trigger reversible cognitive impairments in seniors without the history of cognitive impairments or disabilities. These impairments can also be triggered by medical conditions or side effects of medications. Acute confusional states (delirium) often signal underlying physical conditions or illness processes, which generally deserve prompt medical attention and sometimes may even be life-threatening (APA, 2003). Conclusion Psychological services involving elder population represent a serious challenge for health care professionals. The stable tendency toward higher longevity of life suggests the share of elder adults will steadily increase over the next decades. Therefore, expertise in elderly care is likely to continue to be essential for health care professionals. Several specific requirements have to be mentioned in this regard. Firstly, fighting the effect of obsolete age-related stereotypes and biases is crucial for a psychologist working with seniors. A qualified professional must be aware of the negative consequences of prejudiced attitude toward the patient simply because he is socially and culturally defined as 'old' otherwise effectiveness of care will be seriously undermined. Secondly, qualified psychological care of elder patients should be firmly based upon the notion that aging is an ongoing, dynamic process, not a static condition or downhill slope inevitably characterized by poor qualify of life. Apparently, the process of mental development of elder adults differs in many ways from the same process in childhood and adolescence, but both processes are dynamic and positive. These major requirements have serious implications for unique aspects of psychological care associated with elder population: Physiological and health-related aspects of aging differ from those in younger age groups; Importance of social support networks; Greater influence of such factors as age cohort, culture, ethnicity, gender, residence, educational background, economic and social status and sexual orientation; Specific cognitive changes and disorders associated with late adulthood; However, despite these and other health related consideration, the main conclusion that can be drawn in relation to elder population is that though growing older is commonly associated with health care problems, the process of ageing is highly individual: it is absolutely wrong to assume that all seniors share common needs and suffer from common disease. References American Psychological Association (2003). Guidelines for Psychological Practice with Older Adults. Antonucci, T. C. (2001). 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Webster (Eds.), The art and science of reminiscing: Theory, research methods, and applications. Bristol, PA: Taylor & Francis. Read More