What practitioners should know about working with older adults

Rapid population growth among older adults means an increased need for psychologists prepared to provide mental health services to this population. A representative survey of 1,227 practitioner members of the American Psychological Association yielded information about current patterns of practice with older adults, sources of training in geropsychology, perceived need for continuing education (CE) in geropsychology, and preferred CE formats. Most respondents provided some services to older adults, but typically very little. The services provided are inadequate to meet projected demand. Most respondents lacked formal training in geropsychology and perceived themselves as needing additional training. CE workshops at the regional level and distance education were the most popular formats. These data serve as a call to the field to expand training opportunities at all levels of training, with an emphasis on the need for empirically based, broadly accessible CE offerings.

Psychologists in Practice With Older Adults: Current Patterns, Sources of Training, and Need for Continuing Education

The aging of the population will increase demand for psychological services for older adults, which challenges the profession of psychology to provide those services. In response to that challenge, professional geropsychology has been developing over the past few decades to meet current and prepare for anticipated future demand. The development of a range of training opportunities is important to enable psychologists to work effectively with older adults. This article describes the Pikes Peak model for training in professional geropsychology. The model is an aspirational, competencies-based approach to training professional geropsychologists that allows for entry points at multiple levels of professional development.

Pikes Peak model for training in professional geropsychology.

SUMMARY Objectives Quality of life in long-term care settings is a multidimensional construct that includes functional, cognitive, behavioral, and psychological variables. Quality of life variables have been found to be related to one another, but directional influences have not been tested. Methods The purpose of this study was to develop and compare two competing path models composed of quality of life variables, including dementia, pain, behavioral disturbances, and ADLs. Results Path analytic results revealed that cognitive, emotional, and behavioral variables interact with one another to predict patients’ activities of daily living. Pain levels did not influence activities of daily living directly, but rather influenced behavioral disturbances and depression, which in turn influenced activities of daily living. Conclusions These preliminary findings suggest that in order to assist long-term care residents in improving their activities of daily living, decreasing pain is likely to yield the greatest overall improvements. Future research on the relationships between quality of life variables is recommended to further develop multidimensional treatment models for healthcare providers in long-term care. Copyright # 2004 John Wiley & Sons, Ltd. Variables composing quality of life are routinely assessed in long-term care settings in order to track the status of the resident and the effectiveness of care.

Dementia, pain, depression, behavioral disturbances, and ADLs: toward a comprehensive conceptualization of quality of life in long-term care.

In recent years, professional psychology practice with older adults has been increasing, due both to the changing demography of our population and changes in service settings and market forces. For instance, federal legislation contained in the 1987 Omnibus Budget and Reconciliation Act (OBRA, 1987) has led to increased accountability for some mental health issues. Psychologists’ inclusion in Medicare has expanded reimbursement opportunities. For example, whereas in 1986 psychological practice in nursing homes was rare, by 1996 as many as a dozen large companies and numerous smaller organizations were providing psychological services in nursing homes. As well, clinicians and researchers have made impressive strides toward identifying the unique aspects of knowledge that facilitate the accurate psychological assessment and effective treatment of older adults, and the psychological literature in this area has been burgeoning. Unquestionably, the demand for psychologists with a substantial understanding of the clinical issues pertaining to older adults will expand in future years as the older population grows and service demands increase, and as cohorts of middle-aged and younger individuals who are attuned to psychological services move into old age (Gatz & Finkel, 1995; Koenig, George, & Schneider, 1994). General practice psychologists as well as those specifically identified as geropsychologists are interested in this area of practice. Relatively few psychologists, however, have received formal training in the psychology of aging as part of their generic training in psychology. A recent survey of American Psychological Association (APA)-member practicing psychologists indicated that the vast majority (69%) conduct some clinical work with older adults, at least occasionally, but that fewer than 30% report having had any graduate coursework in geropsychology, and fewer than 20% any supervised practicum or internship experience with older adults (Qualls, Segal, Norman, Niederehe, & Gallagher-Thompson, 2002). Many psychologists may be reluctant to work with older adults, feeling ill prepared in knowledge and skills. In the above practitioner survey (Qualls et al., 2002), a high proportion of the respondents (58%) reported that they needed further training as a basis for their work with older adults, and 70% said that they were interested in attending specialized education programs in clinical geropsychology. In other research, over half of the psychology externs and interns studied desired further education and training in this area, and 90% expressed interest in providing clinical services to older adults (Hinrichsen, 2000). As another indication of the perceived need for psychologists to acquire increased preparation for this area of practice, recent legislation in California has made graduate or continuing education coursework in aging and long-term care a prerequisite for psychology licensure (California State Senate Bill 953, 2002). In addition, the 2003 Congressional appropriation for the Graduate Psychology Education (GPE) program in

Guidelines for psychological practice with older adults

Psychologists in Long-Term Care (PLTC), a national network established in 1983, has developed, with input from colleagues and consumers, standards for psychological practice in long-term care facilities. These standards address provider characteristics, methods of referral, assessment practices, treatment, and ethical issues. This article describes the document's development and offers suggestions for its use.

/pdf/standards-for-psychological-services-in-long-term-care-4t0xmhupq1.pdf

Deborah Frazer

Papers

Standards for Psychological Services in Long-Term Care Facilities