Academic journal article New Zealand Journal of Psychology

Developments in Clinical Interventions for Older Adults: A Review

Academic journal article New Zealand Journal of Psychology

Developments in Clinical Interventions for Older Adults: A Review

Article excerpt

Older adults are increasing as a percentage of the population in many nations, including New Zealand (Statistics New Zealand, 1995). In response to this trend, world-wide research in health care has increased its focus on successful ageing as well as disorders occurring later in life. Clinical psychology is not exempt from this upsurge in gerontological research, and our knowledge of many aspects of the psychology of ageing has grown exponentially in recent years. Yet to a certain extent, the psychology of later life; continues to be overshadowed by the more; established literature on younger adults Diagnostic categories and treatment approaches which are well-validated for younger populations remain under-researched or even wholly unexamined in older adults. Also, biases and assumptions about older adults can help instil a false sense of security in clinical work with older patients.

What follows is an attempt to highlight selected areas of new research as well as recent attempts to consolidate theoretical knowledge about diagnosis and treatment of older adults. Such a review cannot hope to be comprehensive in such a limited space. Topics were chosen to illustrate areas of new and innovative study (e.g. substance abuse, family therapy), areas in which much has been written but perhaps popular biases remain (e.g. bereavement, caregiving) and areas in which psychologists still have much to contribute (e.g. combined psychological and pharmacological approaches, dementia care).

Recent Empirical Research on Therapeutic Interventions

Treatment Protocols for Older Adults

Specific, empirically-validated treatment protocols have been developed for a range of psychiatric disorders, but the vast majority of these were developed either in adult populations or have only limited validation on older populations. In many instances, similar psychotherapeutic treatment approaches may be utilised with older adults as have been proven effective with younger adults. Several researchers, however, have suggested that therapists may wish to make minor modifications in assessing older adults for treatment, and in applying such treatments to older adults.

Sadavoy (1994) stresses the importance of gathering a thorough developmental history to gain insight into past behaviour patterns and coping styles, and to identify therapeutic issues. Bortz & O'Brien (1997) point out that the process of gathering such a developmental history helps to develop rapport and a productive therapeutic alliance. Cultural and cohort-based factors, along with the individual history and expectations of the older adult, should be taken into account, as these may affect later treatment decisions. Because older adults present with a rich history of psychiatric, medical, and social symptoms, patterns, relationships and beliefs, time spent gaining a solid understanding of how these interrelate will be time well spent by the clinician. In fact, in tapping into the rich experience of older adults, therapy may involve a "rediscovery" of skills by the patient rather than the teaching of new skills (Knight & Satre, 1999).

Interactive and integrative treatment strategies work particularly well with older adults (Sadavoy, 1994). In writing about interventions for late-life depression, Gallagher and Thompson (1983) offer specific suggestions to this end. The assumption of an active role by the therapist in socializing the older adult into treatment, the use of strategies in therapy to maximize learning and understanding by the patient, and the careful preparation for termination by a gradual tapering of sessions are described as means to therapeutic success. The adoption of a relatively prescriptive, directive approach to therapy may be useful in working with older adults, who may expect the therapist to fill a role similar to that of their medical doctor. Such an approach may allay fears triggered by the therapy situation (Hersen & Ammerman, 1994). …

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