1. Counseling Older
Adults
By: Sasha Albrecht, Molly Corrigan, Kelly Creech, Hannah
Nimmer, Kierrin Viall

2. Outline
 United States Demographics
 Wisconsin Demographics
 Ageism and Elder Abuse/ Neglect
 Vocation
 Mental Deterioration
 Sexuality and Common Issues
 Substance Abuse/ Depression
 Resources

3. Demographic Information
• Older adults comprise 16.2 % of the U.S.
population
• 85-and-older age group, fastest growing adult
group
• Healthy males at 65- 28% chance of living to
90
• Healthy females at 65- 40% chance of living to
90
• 2030
• Will comprise 20% of population
• Graying of the population
• Baby Boomers
• Seek therapy at a much lesser rate
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice. (6th ed.). Hoboken: John Wiley & Sons.
https://www.census.gov/newsroom/releases/archives/aging_population/cb14-64.html

4. Wisconsin’s Adult
Population
 2010 Census Counts:
57.3%19.2%
13.7%
6.6%
2.1%
18-
25
60+
65+
75+
85+
- Wisconsin Department of Health Services
59

5. Wisconsin’s Older Adult
Population
 Between 2010-2035,
 < 65 population will grow by 4%
 > 65 population will grow by 90%
(doubles)
 number of people < 65 will decrease
for the first time
- Wisconsin Department of Health Services, 2013

6. Ageism
• Definition:
 Negative attitudes toward the process of
aging or toward older individuals
• Worse for women
• Stereotypes
• Bias from mental health professionals
• Multiple Discrimination
• Technology
• Individualist culture

7. Elder Abuse and
Neglect
 Sue & Sue (2013):
 Maltreatment of older adults, including
neglect and emotional, financial, physical,
and sexual abuse.
 Mickey Rooney
https://www.youtube.com/watch?v=ST_7kf7UCqw
- Associated Press, 2011

8. Elder Abuse and
Neglect Perpetrator is most often a family member
 Family situations: previous trauma, pattern of violence,
stress from living situations, financial burdens, low social
support
 Physical abuse
 Lack of necessary equipment, bruises or welts,
dehydration or malnourishment, inappropriate
administration or lack of medication, frequent ER visits
 Financial exploitation
 Missing personal items, will or checks changed/signed
when person is incapable, refusal of care by power or
attorney

9. Elder Abuse
(continued) Self-Neglect
 Not likely to report due to shame, intimidation, or fear of
institutionalization
 Wisconsin Department of Health Services
 Division of Quality Assurance
 Nursing homes, assisted living facilities, home health and
hospice, caregiver misconduct
 Greater Wisconsin Agency on Aging Resources
- goMilwaukee, WI Department of Health Services, Greater WI Agency on Aging
Resources

10. Implications
1) Individual, unique treatment for client
2) Continued public education and increased
awareness
3) Respite care to reduce caregiver burnout
4) Increased social contact and social support

11. Vocation and Older Adults
 Sample Counseling Session of an older adult at the end
of his career
 As shown by Roger Sterling of Mad Men
 https://www.youtube.com/watch?v=13mHndt7db0

12. Workforce Statistics
 More than half (55%) of the US Workforce is between 40
and 75 years old
 The 55-75 year old segment of the workforce is
excepted to grow by 11 million over the next 10 years
 US Bureau and Labor Statistics, 2010
12

13. Stereotypes of Older Workers
 Older Workers Cost More
 Older Workers are less able to learn
 Older workers are less adaptable and flexible
 Older Workers are less motivated
 Older works are old fashioned and conservative
 Older workers are mentally and physically impaired
 Viewed all alike (homogeneous)
 Ageism 13

14. Ageism in the Workplace
 Effects of Ageism on the Workplace
 Ideas not heard
 Overlooked for promotion
 Termination
 Influence motivation and performance
 Self-defeating cycles
 None of these attitudes have any empirical evidence!
14

15. When in Reality.. Strengths
 Based on a meta-anlaysis study from NG and Feldman
(2012)
 Summarized Findings:
 Higher reliability
 Productive
 Less supervision
 Stability
 Less distracted by outside interests
 Strong work ethic
 Willing to work part time or flexible hours
 The only findings consistent with empirical evidence is older
workers are less likely to participate in training and career
development activities
15

16. 16

17. Retirement
 Misconception: People ages 65 and older
will retire
 The average retirement age is still 61,
up from 57 in 1991
 According to a Gallup Poll in 2010
retirement at age 65 is no longer the goal
for most working Americans
 One third of workers say they expect
to retire after 65 which is up 14% from
1995

18. Gallup 2010 Retirement Statistics/
Trends
 76% of employees report they will continue
working past retirement age
 40% because they want to
 35% because they have to
 Part time work is preferred to full time
 Trend: People with higher wages want to
continue working, those with lower wages
do so to maintain standard of living

19. Vocation and Older Adults
Early retirement might not be as realistic of an option for
people today as it was 30-40 years ago
 Factors:
 Finances: cost of living, medical costs, savings
 Enjoy Work!
 Medicare Eligibility
 Higher Social Security Retirement Age

20. Implications
 Do not make assumptions of work or
retirement of any client
 Understand the stressors that happen at
the end of a career and planning
retirement
 Keep educated on the changing trends
and any shifts in laws for medicare, social
security, or retirement age
 Be ready to advocate for a client in the
workplace
 Know your own biases

21. Economic Health
 Poverty
 Unemployment
 Poor living conditions
 Discrimination
 All contribute to mental & physical health problems

22. Physical Health
 Hearing and/or vision loss, cardiovascular disease,
insomnia
 Ethnic minorities: more chronic, debilitating
diseases (e.g. diabetes)
 Majority are quite healthy & able to live independent
lives with minimal or no assistance
 Decreasing percentage of older adults in nursing
homes

23. Implications for
Counseling:
 Awareness of possibility of physical limitations
 Counseling environment:
 Adequate light
 Free from extraneous noise
 Limit environmental barriers
 Communicate with other medical providers to rule
out possibility that physical conditions, medications,
or medication interactions are causing or
contributing to medical symptoms

24. Mental Deterioration
 Misconceptions:
 Mentally incompetent
 Reality:
 Some cognitive slowing associated with normal
aging
 Periodic memory difficulties (e.g. forgetting names)
 Difficulty multitasking
 Majority of older adults do not demonstrate
significant mental decline

26. Video games?

27. Significant Mental
Deterioration
 1 in 7 adults aged 71 or older have dementia
 2.4 million diagnosed with Alzheimer’s disease
 5th leading cause of death for Americans over the age
of 65
 Risk increases with age
 Women, on average, live longer than men and thus,
have higher prevalence

28. Implications for
Counseling
 Mini-Mental State Examination (MMSE)
 5-10 minutes
 Assesses orientation, registration, attention and calculation, recall,
language, and visual motor integrity
 Obtain reports from client, as well as other family members or
caregivers
 Coordinate with other medical professionals
 Evaluate for depression
 Misdiagnosing
 High comorbidity with dementia
 Psychoeducation with other family members
 Misconceptions about dementia
 Elderspeak

29. Sexuality and Aging
 Stats
 10% of all new cases of AIDS occur in people over 50
 53% of people 65-74 are sexually active
 26% of people 75-85 were sexually active
 Changes in sexual functioning
 Men: erections occur more slowly, refractory period increases,
impotence (vascular disease, diabetes, and medication)
 Women: decrease in lubrication
 Positive Changes
 Men can generally maintain erections for longer
 Sexual response is often unchanged
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice. (6th ed.). Hoboken: John Wiley & Sons.

30. Sexuality- Strengths
 Intimacy and affective well-being is strong in older adults
 More emotional stability and maturity
 Confident about sexual identity and preferences
 Romantic relationships can provide
 Companionship
 Physical affection
 Closeness
 Spiritual ties to another
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice. (6th ed.). Hoboken: John Wiley & Sons.

31. In Session
 Slower pace & clear voice
 Remove “therapy murmur”
 Introduction to therapy
 Encourage questions
 Goals of Therapy
 Enlightenment vs. practical interventions
 Memory aids (notecards or recordings, handouts)
 Review previous sessions
 Address cohort differences
 Communication styles
 Shame/fear associated with therapy
 Doubt about process/effectiveness
 Mindful of limitations and strengths
 Individuality
Bienenfeld, D. (2009). Cognitive therapy with older adults. Psychiatric Annals, 39(9), 828-8

32. Therapy Format
 Group Therapy
 Create sense of community
 Work against isolation/loneliness
 ‘study’ together
 Be heard and understood
 Intergenerational Care
 Children
 Preschoolers reported to be
 More empathetic and patient
 Exhibit better manners and self-control
 Older adults
 Feelings of usefulness, pride, accomplishment
 Increased focus and happiness
Bienenfeld, D. (2009). Cognitive therapy with older adults. Psychiatric Annals, 39(9), 828-
832.
Berrigan, F. (2013). How children and the elderly enrich each other’s lives. Retrieved from
http://www.huffingtonpost.com/frida-berrigan/how-children-and-the-elderly-enrich-each-

33. Substance Abuse
 Some Statistics
 17% adults aged 60 and older abuse alcohol or
prescription drugs
 Average of 5 prescription drugs per day
 Number of individuals needing treatment for substance
abuse will increase from 1.7million in 2001 to 4.4 million in
2020
 In recent years…
 Heroin abuse doubled from 7.2% to 16%
 Cocaine from 2.9% to 11.4%
 Prescription medications from 0.7% to 3.5%
 Marijuana from 0.6% to 2.9%

34. Trends in WI
 .
30-Day Binge Drinking Among Older Wisconsinites- Gender

35. Substance Abuse
 Possible causes
 Death of a loved one
 Retirement issues
 Family conflicts
 Physical health problems
 Financial concerns
 Warning signs
 Behavior change
 Implications for counseling:
 Rarely seeks treatment
 But, when they do…
 Respond better to structure program policies
 Prefer flexible discharge rules
 Expect a comprehensive assessment
 Rely on outpatient mental health aftercare

36. Depression
 One of the most common psychiatric complaints
among older adults
 Affects physical health, social connections, and overall
functioning
 Is it depression?
 Rate increases with age for males
 But, rate of depression in women decreases after age
60
 Role of medications
 Co-occurrence

37. Suicide
 Contributing factors:
 Being alone
 Depression
 Anxiety disorders
 Physical/mental health problems
 Loss of relationship
 Among older women, suicide is most prevalent among
Asian females
 Suicide rates extremely high among older men
 Specifically, White males

38. Implications
 Extremely important to remember that depression is NOT a
normal consequence of aging
 Unfortunately, major depression tends to be unrecognized
 Predictor of suicide
 Geriatric Depression Scale
 Health providers often DO NOT refer older adults for mental health
counseling
 No-one can treat clinical depression on their own!
 Treatment of depression in older adults
 Approximately 80% overcome it with appropriate treatment
 SSRIs
 Evidence-based therapies
 Support groups

39. Resources (MKE area)
 Aging Resource Center (ARC) of Milwaukee County
1220 W. Vliet Street, Suite 300 Milwaukee, WI 53205. (414) 289-6874
http://county.milwaukee.gov/aging/resourcecenter
 Milwaukee County Area Agency on Aging
1220 W. Vliet Street Milwaukee, WI 53205. (414) 289-6874
www.milwaukeecounty.com
 Coalition of Wisconsin Aging Groups
2850 Dairy Drive, Ste 100 Madison, WI 53718. (608) 224-0606
http://www.cwag.org/
 Interfaith Older Adult Programs
600 W. Virginia Avenue - Suite 300, Milwaukee, WI 53204. (414)-291-7500
 Various local senior centers
 Mission specific organizations and programs
 Arthritis Foundation
 Affordable Care Act and older adults
http://www.hhs.gov/healthcare/rights/index.html

41. References
 American Business and Older Employees. AARP. Washington DC: 2000; Bureau of Labor Statistics
 Associated Press. [AssociatedPress]. (2011, March 2). Mickey Rooney: Elder Abuse ‘Emotional Blackmail’ [video file].
Retrieved from https://www.youtube.com/watch?v=ST_7kf7UCqw
 Berrigan, F. (2013). How children and the elderly enrich each other’s lives. Retrieved from
http://www.huffingtonpost.com/frida-berrigan/how-children-and-the-elderly-enrich-each-others-lives_b_4005310.html?ir=Fifty
 Brandon, E. (2013). The Ideal Retirement Age. US News & World Report. Retrieved from
http://money.usnews.com/money/retirement/articles/2013/06/10/the-ideal-retirement-age
 Bienenfeld, D. (2009). Cognitive therapy with older adults. Psychiatric Annals, 39(9), 828-832
 Centers for Disease Control and Prevention. (2012). Depression is Not a Normal Part of Growing Older. Retrieved from:
http://www.cdc.gov/aging/mentalhealth/depression.htm
 Center for Substance Abuse Treatment. (1998). Substance abuse among older adults: An invisible epidemic. Retrieved from:
 http://www.ncbi.nlm.nih.gov/books/NBK64422/
 Finn, L. The Effects of Discrimination in the Workplace. Retrieved from http://everydaylife.globalpost.com/effects-
discrimination-workplace-2727.html
 GoMilwaukee: Milwaukee County. (n.d.) Elder Abuse Reporting. Retrieved from http://county.milwaukee.gov/ElderAbuse
 Greater Wisconsin Agency on Aging Resources. (n.d.) Elderly Abuse. Retrieved from http://www.gwaar.org/for-seniors-and-
families/elderly-abuse-for-seniors.html
 Newsytech. (2013, March 7). Video games good for seniors’ health? [Video file]. Retrieved from
https://www.youtube.com/watch?v=3qEVCqEoPas.
 NG, T, & Feldman, D. (2012). Evaluating Six Common Stereotypes About Older Workers with Meta-Analytic Data. Personnel
Psychology, 65, 821–858
 NIH Senior Health. (2012). Prescription And Illicit Drug Abuse: Recognizing Substance Abuse. Retrieved from:
http://nihseniorhealth.gov/drugabuse/recognizingsubstanceabuse/01.html
 NIH Senior Health. (2012). Alcohol Use and Older Adults. Retrieved from:
 http://nihseniorhealth.gov/alcoholuse/ifyoudrink/01.html
 Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice. (6th ed.). Hoboken: John Wiley & Sons.
 Wisconsin Department of Health Services. (2014, February 20). Retrieved from http://www.dhs.wisconsin.gov/aps/index.htm
and http://www.dhs.wisconsin.gov/publications/p0/p00373.pdf