Helping Relationships With Older Adults. Adelle M. Williams

of aging. No longer so driven by the desires that shaped the first part of their lives, their lives become more about meaning than about ambition, more about intimacy than about achieving. They experience the second half of their life as a time of deepening creativity and ripening of the soul (Robbins, 2007).

      Leisure Activities

      Participation in challenging programs has a positive effect on physical health, mental health, and social functioning in older adults. Cognitively fit older adults benefit from participation in leisure activities. Among cognitive activities, reading, playing board games, and playing musical instruments were associated with a lower risk of dementia.

      Dancing is the only physical activity associated with a lower risk of dementia (Verghese et al., 2003). Senior participants in a Dancing Heart program reported better health, stating that the dance and movement improvisation activities improved their flexibility, coordination, balance, and endurance, and the shared reminiscence and discussion increased their memory and socialization skills (Tabourne & Lee, 2005–2006). Researchers found that long-term social dancing may be associated with better balance and gait in older adults (Verghese, 2006), and dancers reported slightly more improvement in sleep, mood, and the ability to participate in hobbies, do housework, and have sex than the others.

      Playing music, specifically taking group keyboard lessons, was found to increase human growth hormone (hGH) levels. Growth hormone levels decline during aging and contribute to unwelcomed effects of aging (Clements, 2010). Low hGH is implicated in such aging phenomena as osteoporosis, energy levels, wrinkling, sexual function, muscle mass, and aches and pains while controlling for differences in life events and social support. Boyer (2007) found that participants in music classes also showed a decrease in anxiety, depression, and perception of loneliness.

      Participating in the arts improves older adults’ quality of life as well, particularly for those who suffer from dementia. Participation in weekly sessions focused on objective and subjective indicators of affect, and self-esteem contributed to each individual’s sense of well-being (Rentz, 2002). An increase in quality of life was measured following music performances and wall murals, which can be effective for cueing residents away from situations that may evoke agitation as well as potential harm and litigation (Kincaid & Peacock, 2003). In older adults without dementia, creating visual art was found to alleviate boredom, loneliness, helplessness, and distraction from physical pain and stimulated cognitive faculties (National Assembly of State Arts Agencies, 2005).

      Research into the effects of exercising the body, mind, and social ability proves promising. Healthy adults who received 10 memory training sessions, reasoning training, and speed training did better than the control group (Willis et al., 2006). Researchers found that fitness training may also improve some mental processes, and physical exercise might slow the effects of aging and help people maintain cognitive abilities well into older age (Kramer, Colcombe, Erickson, & Paige, 2006). Such positive effects of leisure activities prove the importance of encouraging all older adults participate in them.

      Intimacy

      Older people desire and continue intimate relations, and they embrace the need for love, partnership, and physical intimacy (Aleman, 2005; Connidis, 2006). Sex, like love, is an important component of a close emotional relationship in old age (Connidis, 2006; Gott & Hinchliff, 2004; National Council on Aging, 2002). Most people with sexual partners consider sex at least somewhat important. Only those who face insurmountable barriers to sex, such as poor health, place no importance on it (Gott & Hinchliff, 2004).

      Nearly half of all Americans over the age of 60 have sexual relations at least once a month, and 40% would like to do so more often (Cutler, 2001). Sexual relations taper off with age, with 71% of men and 51% of women in their 60s having sex once a month or more and 27% of men and 18% of women in their 80s saying they do (Cutler & NCOA, 2001). Those who had sex at least once a month said it was important to their relationship. Women had sex less often in part because they are more likely to be widowed.

      Thirty-nine percent of people surveyed stated that they are happy with the amount of sexual relations they currently have—even if it is none—while another 39% would like to do so more often (Cutler & NCOA, 2001). Only 4% of people said that they would like to have sexual relations less frequently. The survey also found that 74% of men and 70% of women find their sex lives more emotionally satisfying now that they are older than when they were in their 40s. As to whether it is physically better, 43% say it is just as good, or better, than in their youth, while 43% say sex is less satisfying. When it comes to knowledge about sex, older people are not necessarily wiser than their children. A third of the respondents believed it was natural to lose interest in sex as they aged (Cutler & NCOA, 2001).

      Psychosocial factors have been identified as being very important determinants of sexual response. These factors include sexual attitudes and knowledge; previous sexual behavior and enjoyment; length and quality of relationship; physical and mental health; body image and self-esteem; stress; and partner availability, health, and sexual functioning (Avis & Stellato, 2001). However, women are much more likely to attribute declining sexual response to physical changes of menopause than to other factors. Case Illustration 3.4 is an example of intimacy between two older adults in a nursing facility. It demonstrates perceptions and reactions by staff and family members toward this subject. This case demonstrates that intimate acts do not cease to exist for all elders, and the subject of intimacy needs to be addressed at various levels (individual, family, and institutional).

      Case Illustration 3.4

      Ms. Jones and Mr. Waters are both in their 80s and have been residing in the local nursing home. They were admitted there from the hospital where it was decided that a nursing home would provide them with 24-hour care, including supervision of their medical problems, medication management, nutritious meals, and assistance with activities of daily living. Ms. Jones and Mr. Waters have developed an intimate relationship over time, which, at the outset, staff and family members thought was cute and harmless.

      However, over the next several months, family members became disturbed when they exhibited public displays of affection, kissing each other on the lips, holding hands, and caressing. Mr. Waters’s son also learned from his father that they had sex. His son was enraged and shared this information with Ms. Jones’s family members and also with the nursing home administrator and staff of the facility. The staff and administrator remained calm, and the staff did not seem to have a problem with their relationship. It was reported that they genuinely enjoyed each other’s company and were just happy to be with each other. This was unacceptable behavior for their adult children. Mr. Waters’s son moved his father into another facility, which has devastated Ms. Jones. Ms. Jones has deteriorated, is depressed, refuses all activities, and spends most of her time in her room, picking at her food.

      There are many life stressors facing older adults that challenge existing competencies. Their social networks will shrink and they must create new connections, they will lose loved ones and have to manage feelings of grief and chronic loneliness, and they must deal with declining health and financial resources. Each of these spheres (e.g., initiating social contacts, managing instrumental needs, coping with negative emotion, managing interpersonal conflict) requires various competencies. Counselors are in a pivotal position to assist older adults in acquiring and cultivating these competencies to continue to be effective and enjoy life. By developing resiliency, maintaining healthy lifestyles, remaining actively engaged, and having intimacy, older adults have the keys to successful aging.

      Counseling Older Adults

      As society continues to grow older, the issues concerning the elderly increasingly become issues for the community. There are already legislative changes being made that address Social Security, medical benefits, and retirement as the government is forced to address the needs of an aging society. Just as the government has been slow to act on behalf of senior citizens, so has the counseling community. Counselors have seemingly avoided actively seeking to help the elderly, possibly because of a lack of knowledge or experience (Karel, Gatz, & Smyer, 2012). For those not specializing in gerontological counseling, counselor training