Helping Relationships With Older Adults. Adelle M. Williams

my professional experiences, I stayed committed to working with older adults. I had the opportunity to work on inpatient and outpatient units, long-term care systems, health care systems, and in educational and consultant positions. The Benedum Geriatric Outpatient Center provided numerous opportunities for assessment and treatment for older adults and excellent supervision by personnel who specialized in gerontology, geriatrics, and geropsychiatry. This breadth of experience facilitated my completion of a master’s degree in business administration to better prepare me to understand the business aspects of the health care industry and its impact on aging services.

      Currently as a professor and Gerontology Coordinator at Slippery Rock University, I have developed courses, revised curricula, managed academic programs, developed and supervised internship placements, advised students, conducted research, published articles, engaged in university governance, and provided community service. Positions included Director of a Health Services Administration program, Assistant to the Dean of the College of Health, Environment, and Science, and Gerontology Coordinator, while maintaining faculty responsibilities. Courses taught in administration included the organization, delivery, management, and financing of the health care delivery system. Courses in health included personal health, community health, and international health. Aging courses include the aging process, death and dying process, senior aging seminar, women and aging, foundations of aging, counseling older adults, career development counseling, and internship supervision.

      In all of the various transitions within the university, I continue to focus on increasing awareness of aging issues and promoting the counseling and related health professions to enhance their ability to serve older clients. Elevating the status of aging as a specialty and increasing the numbers of gerontological specialists remains a high priority.

Section I Overview of the Aging Process, Aging Theories, Positive Aging, and the Helping Process

      Chapter 1 Introduction

       “There is a fountain of youth: it is your mind, your talents, the creativity you bring to your life and the lives of people you love. When you learn to tap this source, you will truly have defeated age.”

      —Sophia Loren

      Learning Objectives

      After reading this chapter, you will be able to

      1 Describe the basic changes that occur in the aging process

      2 Analyze the various biological theories that explain aging

      3 Examine the normative physical changes that accompany the aging process

      4 Explain the cognitive changes that accompany aging

      The aging of the population is one of the most profound and far-reaching changes affecting contemporary society. Between 2014 and 2060, the U.S. population is projected to increase from 319 million to 417 million, reaching 400 million in 2051 (Colby & Ortman, 2014). By 2030, one in five Americans is projected to be 65 and over (Colby & Ortman, 2014). In 2014, the 65 plus population is expected to grow from 15% gradually upwards to 24% by 2060 (Colby & Ortman, 2014). The baby boomers (individuals born between 1946 and 1964) largely account for the increase in this demographic, as they began turning 65 in 2011. By 2050, the surviving baby boomers will be over the age of 85.

      The aging of the population has wide-ranging implications for the country. By aging, demographers often mean that the proportion of the population in the older age range increases. As the United States ages over the next several decades, its older population will become more racially and ethnically diverse. The projected growth of the older U.S. population will present challenges to policymakers and programs. It will also affect families, businesses, and health care providers (Ortman, Velkoff, & Hogan, 2014). There is a clear need for health professionals with a thorough understanding and appreciation for the experiences of this older population. With so many individuals over age 65, mental health professionals with the expertise to assess and treat the problems of later life are sorely needed (Zarit & Zarit, 2011).

      People are not just living longer, but they are living better longer than ever before. Improvements in disease prevention and health promotion, the widespread availability of public and private pensions and other financial benefits, and increased educational opportunities for each successive generation have dramatically improved the lives of today’s society. The next generation of older people will have had better education and have taken better care of their health across the life span, so their prospects for successful old age are even greater (Zarit & Zarit, 2011).

      These demographic and social changes mean that an increasing number of older people are in need of psychological services. The mental health field, however, has been slow to respond with adequate numbers of trained professionals who have specialized training in geriatrics. For many years, geriatric practice was a backwater, a minor field viewed condescendingly by clinicians who felt that little could be done for anyone over age 50 (Zarit & Zarit, 2011). That viewpoint was a luxury of a society that had relatively few older people. The dramatic expansion of life expectancy and growth in the proportion of people over age 65, coupled with empirical findings of the effectiveness of treatment for many problems of later life, provides a solid foundation for geriatric mental health practice. The number of clinicians with geriatric expertise, however, falls far short of the need (Zarit & Zarit, 2011).

      Aging is a natural and inevitable process and a very complex one. Many changes occur in this process; however, no two persons experience these changes at the same time or at the same rate. It is a variable experience. Some elders accept the natural changes that occur as a positive experience, while others view these changes with disgust and frustration. The process of aging is also a time to explore hidden talents, engage in new activities, commit to new relationships, and express oneself in novel and creative ways. Aging is more than the physical, social, psychological, and environmental changes. It involves a renewed energy and appreciation for life, opportunities to explore, and an inner transformation that is unique to every aging individual.

      Aging

      Aging is characterized by a variety of changes. These changes can be social, physical, or cognitive. Constant adjustments and readjustments are required to maintain some sense of normalcy.

      Socially, a number of adjustments may occur, such as a change in the quantity and quality of relationships one has, a change in role from a caregiver to a care receiver, becoming single after being married for 50 years, and transitioning from utilizing informal supports (e.g., family, friends) to formal support systems (e.g., long-term care facilities, respite care services). Society’s perception of aging persons can change as well, with many perceiving older persons as less valued. Environmental modifications can be required if older adults live in environments that are inconsistent with their functional abilities. Changes in their residence, proximity to significant others, and driving status will impact their social situation.

      Physical changes are an inevitable consequence of the aging process. Gradual changes will occur in an older adult’s senses, appearance, balance, strength, and cognition, though most conditions can be addressed and corrected in the earlier stages. Sense of taste and smell will decline with age; however, there may exist other causes for impaired taste and smell that are treatable (e.g., dental problems, nasal/sinus problems). Vision will decline, but it can be corrected at earlier stages. Hearing will become impaired, though simple modifications can correct this issue. Balance, flexibility, and muscle strength will decrease, but with adequate exercise, including cardio, strength training, and yoga, these changes do not necessarily impair one’s routine activities.

      Cognition depends on a healthy, well-functioning brain. While the ability to learn, store, and retrieve information may require more time than for a younger person, barring any major disorders, older persons adapt well to changes in cognitive status. Older adults continue to have the capacity to learn new information; however, it may take longer and may require the use of more mnemonic devices to assist them.

      Healthy, highly functioning older adults have high self-esteem, are internally