Helping Relationships With Older Adults. Adelle M. Williams

related to a diagnosis of depression.

      The professional counselor greets Ms. Timmons using her first name. She proceeds by speaking loudly to Ms. Timmons in a childlike manner. She then escorts Ms. Timmons to her office, placing her arm around Ms. Timmons’ arm, despite the fact that Ms. Timmons is fully ambulatory. During the initial intake assessment, the counselor is interrupted several times with incoming phone calls. The counselor was very directive in her approach and used a depressive screening instrument to determine the extent of the symptoms and level of severity. This instrument was not normed on older adults, but one she typically uses with adult clients. Ms. Timmons did not complete the assessment, as she felt rushed and was given little opportunity to express other issues she was experiencing. Ms. Timmons had just experienced the loss of her pet of 12 years, foreclosure of her home, relocation of her major support system (her daughter moved out of state), and loss of her driver’s license. These areas were not addressed, and Ms. Timmons did not return for her follow-up session.

      Prejudice

      Age prejudice is a human rights violation that is exhibited in health care, employment, and the media. Prejudice is a state of mind and entails feelings and attitudes, including stereotypes and discrimination, that lead to the unfair or unequal treatment of members of a minority group (Oxford Dictionary, 2015; Merriam-Webster, 2015). For instance, discrimination exists in the definition of who is considered poor in the United States, as people ages 65 and older must be poorer than younger adults in order to be counted as poor by the U.S. Census Bureau (Estrine, Nyberg, & Muller, 2001). There exists a great deal of misinformation and a lack of accurate facts about the aging process and older people, both in society as a whole and among practitioners. Some of the myths about older adults include that they cannot change; like to live in the past; cannot learn new information; are grouchy all of the time; are childish; are cute; live in nursing homes; lose interest in life; are sick most of the time; become children to their adult children; and are sick, senseless, and sexless (Hogstel, 2001). However, older adults are not only more mature, but also more independent and often more assertive in expressing their thoughts and ideas because they are not subject to peer pressure or employment status.

      Guided Practice Exercise 2.3 provides the opportunity to explore personal perceptions of older adults.

      Guided Practice Exercise 2.3

      What are your views regarding older adults, and what experiences or events led to the views you currently hold? Remember to examine various aspects as they pertain to older adults, which include, but are not limited to, finances, relationships, values, religion/spirituality, and work. Do you perceive your views as promoting or impeding your ability to working constructively with older adults? Are any of your views modifiable, and how would you modify them?

      Individuals may cling to these myths and stereotypes because they have not interacted with an older adult. Children and young people growing up today often do not have personal contact with an older family member such as a grandparent. They therefore may feel uncomfortable around older people. Increased contact with healthy, happy, and active older adults may change the perception of older adults as clients (Hogstel, 2001).

      There are a number of common misconceptions about aging, as seen in Table 2.1. Some of the myths include lack of productivity, inflexibility, senility, and loss of sexuality (National Academy on an Aging Society, 2001). This is beginning to slowly change as more attention is being paid to the productive capabilities of older people and a better understanding that older persons have desires, capabilities, and satisfaction with regard to sexual activities. The “write-off” of older persons as senile because of memory problems, for example, is being replaced by an understanding of the profound and most common forms of what is popularly referred to as “senility,” namely Alzheimer’s disease. Senility is no longer seen as inevitable with age. Rather, it is understood to be a disease or group of diseases. When means of effectively treating dementia are available, ageism will also decline.

      The underlying psychological mechanism of ageism makes it possible for individuals to avoid dealing with the realities of aging, at least for a time. It also becomes possible to ignore the social and economic plight of some older persons. Ageism is manifested in a wide range of phenomena (on both individual and institutional levels), including stereotypes and myths, outright disdain and dislike, or simply subtle avoidance of contact; discriminatory practices in housing, employment, and services of all kinds; and epithets, cartoons, and jokes. At times, ageism becomes an expedient method by which society promotes viewpoints about the aged to relieve itself from the responsibility toward them, while other times it serves a highly personal objective, protecting younger (usually middle-aged individuals) from thinking about things they fear (aging, illness, and death).

Table 2.1

      Ageism can apply to stages of life other than old age. Older persons have prejudices against younger people and the attractiveness and vigor of youth. Angry and ambivalent feelings may flow, too, between older and middle-aged people. Middle-aged people often bear many of the pressures of both younger and older people, and they may experience anger toward both groups. Some older people refuse to identify with their peers and may dress and behave inappropriately in an attempt to appear young. Others may underestimate or deny their age.

      Case Illustration 2.2 is representative of an older woman who is grieving over the loss of her spouse. This case provides the opportunity to reexamine perceptions of older clients and knowledge of the grieving process as well as explore ways in which a more favorable outcome could be achieved.

      Case Illustration 2.2

      Mrs. Denver is a highly functional 72-year-old female referred for counseling services at an outpatient mental health facility. Mrs. Denver is resistant, stating, “I’m not mentally ill.” However, she made the appointment and attends her initial session. Mrs. Denver is assigned to a professional counselor who has been employed for approximately 5 years, but works primarily with young and middle-aged clients. This counselor has a license and certifications in numerous areas, which are displayed on her office walls. Mrs. Denver was referred for counseling services because her daughter feels that she is still grieving (6 months later) for her deceased spouse. Mrs. Denver has agreed to see a counselor to comply with her daughter’s request.

      Mrs. Denver was married for 45 years and really misses her husband. She describes her relationship as a good wholesome one—“not like the marriages of today.” She tries to convey to the counselor the pain she has been experiencing that just sweeps over her unexpectedly when engaging in activities they once did together. She attempts to share her feelings for having cared for her husband for 5 years prior to his death. He died of end-stage renal disease, but prior to that, she escorted him to and from all dialysis treatments three times per week for several years. Mrs. Denver cries intermittently throughout the session and speaks of how lonely she is without him. Her counselor tries to console her by saying, “everything is going to be okay” and “unfortunately as we grow older, death becomes a part of life.”

      The counselor appears uncomfortable during the session, distances herself, and begins investigating another referral for Mrs. Denver. Mrs. Denver does not feel that her counselor understands what she has been experiencing, but accepts the referral to a psychiatrist and thanks her for her time. Her counselor expresses to Mrs. Denver that she is depressed and would benefit from an antidepressant and follow-up sessions. Mrs. Denver did not return for her follow-up sessions, nor did she follow through with the referral to the psychiatrist.

      Historical Aspects of Aging

      National interest in aging and gerontology has resulted in major milestones and contributions to the well-being of older adults through a proliferation of research and dissemination of research findings. The federal government began in 1935 to acknowledge and support the needs of the older population, which served as an impetus to changing the landscape for older persons. Such milestones include the establishment of the Social Security Administration in 1935 and the National Institute on