People are living longer today, staying productive and independent well past the age when their grandparents became “the old folks.” Additionally, Baby Boomers ( those born post WWII and before 1965) are wealthier than their predecessors and, in general, have fewer financial worries. A 92 year-old nursing home resident told her visitor that she lived in the young-people’s hall. Another wing was reserved for those 100 and over. That brings a smile, but it also raises an issue. People who do have significant concerns in the aging process have many more years to deal with them. A woman in 1950 who was 65 probably had only another ten years to live. Today most 65-year-olds can expect to live another twenty years. Almost everyone will suffer some type of loss as they age. Of course, friends and family members pass away, but there is also hearing loss, memory loss, vision difficulties, cognitive and emotional impairment and other issues that may be minimal or quite pronounced. As resources for these individuals dwindle, they are left without support at a time when their need for help increases. Geriatric psychologists ( also known as geropsychologists) address this need.
Geriatrics refers to the study of the elderly, and this simple topic can encompass a number of different things. Those working in the geriatric psychology field typically handle the needs of aging patients and the problems they face. Many people find themselves upset with the idea of growing older, and suicide rates among the elderly are higher than the rates reported among younger people. Geriatric psychologists handle different needs than geriatric psychiatrists.
The Aging Process
While today’s seniors are staying productive longer, they still will face the changes associated with aging at some point. Typically, there is some lessening of vision acuity and hearing as well. Failing hearing and sight may lead to isolation that affects emotional health. Most older people face losing physical strength and gaining some aches and pains from arthritis and other age-related illnesses. It becomes harder to remember details and names. It is more difficult to walk where good balance is required. Learning new things takes more effort. All of these are parts of normal aging. They are also components of dementia and Alzheimer’s disease. In order to help older people, who are living longer live well, the field of geriatric psychology has evolved.
According to the American Psychological Association, by 2050 there will be almost 84 million people who are 65 and older in America. The rates of many types of mental illness are much lower for this age group than for younger people, but 25 percent of these older Americans will have some depression or anxiety. Additionally, the “Boomers” who are aging well in many areas are beginning to show an increase in drug use and alcoholism. The problem is that, for this age group, physical and psychological problems are closely related. Many older Americans are still sexually active and struggle with dysfunction. Sleep problems seem to increase as people age. Another issue for older people is that many are still in the workforce and deal with the demands of their jobs and the effects of ageism and the stress that causes.
Psychology vs. Psychiatry
While psychology and psychiatry are two related fields, the two are significantly different. Those with a simple Bachelor’s degree in Psychology can seek work after graduation in nursing homes, retirement homes and other facilities, but many students choose to attend graduate programs. Psychiatrists study Pre-Med or Medicine, and these students must finish a medical degree that involves working in the field. One of the other big differences between the two professions is that psychiatrists can legally prescribe medications to patients, while psychologists usually can’t prescribe medications.
Geriatric psychologists study Psychology and Social Work as an undergraduate. Social work programs often include a number of classes on death, dying and the aging process. After finishing the undergraduate program, the student has the chance to attend graduate school. Most jobs in the geriatric psychology field require at least a Master’s degree and some programs look for those who completed a doctorate program. These students often work among the elderly and complete internships in nursing homes and other facilities.
It is important to remember that, although the issues of older adults are complicated by the inter-relation between conditions, the elderly still experience non-age-related conditions. Students will study different types of therapy, addictions, developmental issues and all the “regular” courses in psychology degrees. Psychology is an exciting field, and all the opportunities that exist within other specializations are available with geriatric psychology. These psychologists use research techniques, conduct and analyze tests, diagnose and intervene in many types of psychological disorders and even work as private clinicians.
Geriatric psychologists can work in either the research field or the counseling field. Researchers meet with patients, perform tests and examine evidence to reach conclusions and determine how aging affects different people. They can use that research to learn how Alzheimer’s attacks the body, what happens to those dealing with psychological conditions and potentially find cures for some of the more common diseases that attack the elderly. Counselors meet directly with patients and help those patients understand the changes they notice. Elderly people often deal with depression and anxiety, but some older patients might also suffer from mood swings and more serious conditions. Counselors can provide therapy, suggest changes patients can make and help patients feel better about themselves.
The Greatest Need
While geriatric psychologists are needed in many settings, the most pressing need, according to the APA is in integrated health teams. Because physical and psychological issues are so interrelated, treating one thing is often dependent upon addressing the other. The best outcome for older patients is derived from a team approach consisting of primary-care physicians, social work case managers, housing or long-term care administrators, psychologists and others.
The Four “M’s”
Part of the difficulty in working with the elderly is that, while they may have impaired cognition or emotional illnesses, they are still adults. One initiative among the integrated health teams is toward an “age friendly health system.” The Institute for Healthcare Improvement presents the concept in terms of “the four m’s.”
The first component is the one upon which the others hinge. In working with older adults, it is vital to let them make many of their own decisions. Geriatric psychology, recognizing the importance of self-determination, has to assess what matters the most to the client. Sometimes that is best understood by asking the person, and other times it must be discovered by interviewing family members or friends.
During the nursing-home lockdowns of the Covid-19 pandemic, many residents of long-term facilities told the administrators, the government and sometimes the media that they understood the isolation was to protect their lives, but that being with family was more important to them than living longer. What mattered to them was touching and being touched by loved ones.
Many older adults love to hike, and staying mobile is important to them. Others are artists for whom the ability to create matters most. What matters is different for different people, and loss of the ability to determine that for oneself can cause many other problems.
The idea here is to use medications that will not interfere with the patient’s ability to achieve what matters.
This is the prevention, identification and treatment of delusions, depressions, dementia and other psychological conditions that could impair the patient’s ability to function.
Medications, physical confinements and other treatments should be used in the least restrictive manner possible in accordance with patient safety and considering “what matters.”
Caring for Caregivers
Geriatric psychologists also provide interventions for caregivers. People who take care of the elderly at home do so for many reasons, not the least of which is financial need. More than a third of the caregivers are 65 or older, and often are the spouse of the patient. That means they are part of that demographic as well, and they suffer from depression, suicidal thoughts, substance abuse and other issues made more difficult because they are forced into those patterns by being the only support of the person for whom they care. Part of the responsibilities of a geriatric psychologist is providing care for the caregivers and for family members who must reconcile themselves that “what matters” to their loved one might not be what they perceive as important.
Insert after text: the stresses and emotional changes that aging brings.
Geriatric Psychology Shortage
People would certainly think that any professional field with a giant shortage in practitioners would offer great potential for employment. That doesn’t seem to be the case in this field. True, it is relatively new, and
Part of the problem in the shortage of geriatric psychologists is that there is a stigma on becoming old and a stereotype of what an elderly person looks like. That doesn’t necessarily mean physically, though many young people have a fear of getting wrinkles and gray hair. It isn’t any wonder they feel that way; the anti-aging industry probably grosses billions of dollars. No, the stigma is that it is hard to communicate with older people and that they are one step away from death, according to an article in Psychology Today Magazine. Working with the elderly is seen as not challenging because once a person is old, he doesn’t change. “It is all downhill from there.” People do change as they get older, but they also become “more the same.” That is, their personalities are stronger and they may be even more interesting than they were when they were younger. So, with the fact that the percentage of aging Americans continues to grow, and that this segment of the population is active and healthy far longer than their grandparents or even their parents were, it would seem that ageism would disappear. It hasn’t. Society is becoming more and more youth oriented. So, fewer students choose the geriatric specialization in their psychology programs. Today, the percentage of psychology students specializing in geriatrics is 1.2 percent, according to the American Psychological Association. While that is dismal news for the clients, it is a field of opportunity for psychology graduates.
Another factor that restricts the number of people going into this specialty is reimbursement. The perception is that psychological care for older people is reimbursed by Medicare at a lower rate than younger insured clients or private pay. While that may be true for someone who works at a long-term care facility or hospital that depends upon Medicare for the bulk of operating expenses, most psychologists in geriatrics make slightly higher than average salaries. Of course, like most other professions, what you make depends upon where you work. People in metropolitan areas will earn more than those in small rural communities.
On the Rise
The need for those trained in the field of geriatrics is on the rise. According to the American Association for Geriatric Psychiatry, the number of people reaching advanced ages will increase in years while the number of trained psychiatrists remains stable, meaning that patients won’t have access to the help they need. The number of students enrolling in geriatric psychology programs increased in recent years just as the average salaries of those working in the field increased. As more people grow older, the world needs more people prepared and trained to help those patients handle the stresses and emotional changes that aging brings.
Geriatric psychology is essentially the study of aging and its effects on the elderly. Those working in the field can research the impact that aging has on the human body or focus on helping patients deal with the struggles they face. As the number of people growing older increases, the demand for those capable of working in the field will increase as well.
Additionally, the field of gerontology studies is ballooning because of the increase in the percentage of the population that is 65 or older. However, the stigma of aging is still there, as if the twenty-somethings would never have to deal with it. Marketing companies are certainly targeting young people with car and insurance ads, real estate marketing and other advertisements, but they are beginning to look towards the older Americans too. As a writer for the ST. Cloud Times said, “ Older Americans have more money, more education and better health than any previous generation of older Americans. We deserve a little respect from the advertising industry.” They deserve respect from the field of psychology as well, and students who go into geriatric psychology will see a bright and well-paying future.
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