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12 Late Adulthood (Ages 61 to 75)
Old age is like everything else. To make a success of it you have to start young.
Late adulthood or “golden years” is not the period of dependency and deterioration that many people think it is. These are years to spend time with the family, grandchildren, and friends; putter in the garden; go fishing; or simply sip your coffee with no need to rush anywhere. These same late adulthood years can also be times of physical decline, mental challenge, and socioemotional loss. While the path experienced is clearly influenced by the conditions and context of one’s life, it is also a reflection of the developmental path that one has taken to this point.
Although many people maintain that old age is a state of mind, there are several life events that signal the beginning of late adulthood. These are tied to chronology, just as other life events are in previous stages of the lifespan. This stage of the lifespan is a dynamic period with unique challenges and problems that deserve the attention of the counseling profession.
This chapter will review the uniqueness of this developmental period. After reading and discussing this chapter the reader will be able to
describe the natural transition into late adulthood and how aging may heighten the need for a more specific type of therapeutic counseling,
understand the application of age-appropriate gerontological skills that will enhance the counseling process with older adults,
describe older adults’ lifespan events to be considered in their assessment and clinical counseling, and
explain the psychopathology and aging process in late adulthood.
Responding to the Counseling Needs of a Growing Aging Population
Photo 12.1 Intergenerational families have more support to offer to each other, and their quality of life is enhanced by their interaction.
The drastic increase of the aging population in the United States has created a shift in society that will more than double the number of persons in late adulthood by 2020; approximately 16.5% of the population will be 65 years of age or older. This percentage is expected to increase to 20.8% by 2060 (U.S. Census Bureau, 2002).
This demographic change has been labeled the “age wave,” fueled by the Baby Boomer generation. The age wave is estimated to reach our communities and family structures in an unprecedented manner that will impact almost all aspects of our existence, including family structure, health care provision, economy, and sociopolitical system. Although improved human longevity is a great success, which offers exciting opportunities, it causes tremendous challenges as well. Among these challenges are the growing threats of mental health issues and chronic diseases associated with changing patterns of aging and the need for support systems, including gerontological counseling and elderly-care (Dychtward & Flower, 1990).
Longer lifespan has created an emergent need for trained professionals who provide services to older adults to enhance their quality of life and maximize their potentials. As indicated in Chapter 13, the social phenomenon recognized as the “graying of America” changes the fabric of every aspect of society and highlights the diversity of older adults and their specific needs (Himes, 2001).
The field of counseling, as it relates to gerontological counseling, will soon be responsible for a large number of older adults among over 40% of the U.S. population, which comprises a generation of Baby Boomers (Morgan, 1998). The number of adults 65 years old and older has raised awareness about this population’s needs, challenging professionals in the human services and counseling fields to implement more effective therapeutic practices. These needs are evident within the counseling profession since the desire and growing demand for professional counseling services for older adults is experiencing a parallel increase. As indicated by Sinick (1976), unfortunately, the counseling profession has not been well-prepared to meet this demand because most counseling techniques, aids, and programs are designed for use with younger groups, covering a much shorter individual lifespan (pp.18–21). Taking into account this shift in demographics and human service needs, Myers (1981), concurs that currently there is a great need for the development of counseling services methods and aids specifically appropriate for use with older adults (p. 21).
Counseling older adults is not equivalent to counseling the general younger population. Specialized skills and knowledge, as well as sensitivity to the contexts in which older adults in late adulthood live and their lifespan experiences, are essential to working successfully with this population. For the counseling profession, it is important to acknowledge gerontological issues and what is referred to as the normal aging process in order to enhance counseling competencies. As indicated by the American Psychological Association (APA; 2009), as Baby Boomers continue their aging process over the next several years, one can expect both the needs and the demands for mental health services to increase. These needs may also be consequences of secondary chronic health conditions that are also likely to increase. Individuals in late adulthood have a higher prevalence of depression and other mental disorders when compare to other cohorts, like the GI Generation and Great Depression eras cohorts. In addition, clinical demands may change because this generation has typically been psychologically minded and relatively high consumers of mental health services, in spite of the notion of underutilization of these types of services by older adults.
The staggering increase of the late adulthood population presents a new challenge that generations before us have never experienced. This chapter provides an introduction to gerontological-based counseling, integrating the basic skills of working with older adults with counseling skills to address the multiple issues that are accumulated during this lifespan.
The Aging Process
Most theorists agree that there is no uniform aging process. In a broad sense, one might define that aging is “a total process that begins at conception,” but aging is normally identified with changes that come after maturity (Meiner, 2011; Moody & Sasser, 2012). Aging can also be defined as the time-dependent series of cumulative, progressive, intrinsic, and harmful changes that begin to manifest themselves at reproductive maturity and eventually end with the end of life (Arking, 1998).
Accepting One’s Life
One of the challenges in late adulthood is to accept life on its own terms. This challenge is also an accumulation of life events and the ability to resolve or accept issues affecting one’s life, and, in many cases, the lives of others. Accepting one’s life, particularly during late adulthood, is directly related to age and happiness. Some studies of adults have indicated that happiness increases with age (Rodgers, 1982); others demonstrate no differences in happiness for adults of different ages (Ingelhart, 2002); and yet others have found a U-shaped result with the lowest happiness occurring at 30 to 40 years of age (Mroczek & Kolarz, 1998). In addition, research findings suggest that, at least in the United States, adults ages 18 to 88 are happier as they age; therefore, accepting life throughout their lifespan can bring happiness in later life (Ehrlich & Isaacowitz, 2002; Reynolds, & Gatz, 2001; Yang, 2008).
Erik Erikson’s theory of psychosocial development is highly regarded and a meaningful concept that is very useful in counseling assessment and application techniques. Erikson’s (1950, 1982) final psychosocial development theory, as indicated in stage eight, ego integrity versus despair, ages 65 and older, involves a possible conflict of coming to terms with one’s life, and it is related to accepting one’s life (see Table 2.2, Chapter 2). As indicated in previous chapters, Erikson’s theory explains eight developmental stages in which physical, cognitive, instinctual, and sexual changes combine to trigger an internal crisis, whose resolution results in either psychosocial regression or growth and the development of specific virtues or “inherent strength,” which translates into wisdom.
13 Oldest-Old Elderhood (Ages 75 and Over)
Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.
Aging takes place in sequential, environmental, and societal contexts, and it is shaped by these contexts (Wahl & Oswald, 2010). One of the best known examples for contextual influences on aging is the increase in longevity, which began to rise in Western countries and parts of Asia around the turn of the 20th century. Over time, rapid increases in life expectancy have made it possible to live up to 100 years old, currently a reality for more people worldwide. Today, we identify this diverse population of the oldest-old (often referred to as the very old) as individuals from age 75 to 100 and over. The counseling field has been awakened by the rapid growth of this sector of the aging population, and it considers this as a serious issue to improve counseling services for this population. Early on, Blake and Kaplan (1975) referred to older persons as “the forgotten and ignored” of the counseling profession (p. 136). Myers and Blake (1986; Myers 1995) have argued for the need to train counseling professionals to meet the needs of older adult clients. A strong point of this awareness has been that if counselors are to prepare with training to meet the needs of older adult clients, an infusion of gerontological issues into counselor preparation courses and curricula is and will be necessary for years to come (Blake & Kaplan, 1975; Myers, 1995).
This chapter highlights the importance of acquiring gerontological-based counseling knowledge in order to work with individuals through their advanced lifespan and the type of information and skills that are valuable for this endeavor. After reading and discussing this chapter the reader will be able to
understand the challenges and implications of quality of life and life satisfaction during the adjustment to advanced age,
apply gerontological-based counseling skills to effectively work with advanced aged clients and their family members,
understand the counseling skills needed to manage the psychosocial crises and challenges faced by the oldest-old population, and
analyze major issues and contextual influences such as culture related to aging.
Understanding Quality of Life and Life Satisfaction in Old Age
In previous chapters, we have discussed that aging is commonly understood as the process of maturing or becoming older; in fact, aging is a broad term that includes several processes: (a) those changes happening along the lifespan, (b) individual differences attributed to age and environmental issues, and (c) the aging process of the older to oldest adults in comparison with younger adults (Birren, 1996). As researchers have pointed out, across one’s lifespan there is a continuous balance among stability, gains, and declines, especially after the individual reaches the third decade of life (Baltes, 1987). It is important to distinguish between biophysical and psychosocial changes that are part of this continuous balance of the aging process across a lifespan. According to Briggs (1990), biophysical systems are those that lose efficiency, psychological characteristics maintain stability, and show gains and declines depending not only on the biological organism but also on the sociocultural context, and on the control individuals exert through their behaviors; in other words, as Bandura (1997) pointed out, the organism, the person and his or her behavior, and the sociocultural context interact continuously.
Conceptions of quality of life and life satisfaction are diverse and unique to each situation. Currently, the term quality of life denotes two meanings: (a) the presence of conditions deemed necessary for a good life and (b) the practice of good living as such. Life satisfaction is based on the individual’s interpretation of his or her life. When used at the societal level, only the former meaning applies (Myers & Diener, 1996). For the use of clinical counseling interventions, both meanings may be applied. In counseling practice, it is important to be aware of what definition will be used or attached to the uniqueness of the client.
The contents and specific measures of quality of life, however, vary between and within disciplines (Farquhar, 1995). The emphasis ranges from standards of living in the discipline of economy to perceived health status in the discipline of medicine. There have been more than 1,000 identified indicators that measure various aspects of quality of life (Hughes & Hwang, 1996) and more than 100 definitions of quality of life have been proposed (Cummins, 1997). Despite the lack of a widely accepted definition, most definitions of quality of life include a multidimensional functional status aspect and a subjectivity aspect (Muldoon, Barger, Flory, & Manuck, 1998; Pukrop, 2003). Multidimensional functional status incorporates physical well-being, functional ability, emotional well-being, and social well-being, while subjectivity refers to the individual’s own perception of his or her quality of life (Muldoon et al., 1998). Therefore, while the subjectivity aspect of quality of life resembles life satisfaction, there is a multidimensional functional status dimension of the quality of life concept that life satisfaction clearly excludes.
There are indications of concepts and concerns related to quality of life expressed by cohorts of the oldest-old population that are different from the general population. Important to counselors is to understand that quality of life is described often with both objective and subjective dimensions based on individuals’ life experiences during their lifespan.
Most people have an opinion about what is quality of life; however, there is disagreement on precisely what it means in general terms that can be applied to all individuals. Quality of life is highly individualistic and might even be an idiosyncratic mystery due to the high levels of variability between individuals, making it unsuitable for decision making. According to Brown, Bowling, and Flynn (2004), older adults, in particular the oldest-old population, have unique characteristics accumulated through a lifespan of experiences. Perhaps the perception that the oldest-old are particularly vulnerable is due to circumstances related to (a) the aging process, including declining physical and mental capabilities; (b) disengagement from active life; (c) greater dependence on others for financial and social supports; (d) decrease of extended family members and social networks; and (e) isolation due to death of loved ones, especially that of a spouse or partner and acquaintances of the same age group.
The term satisfaction is perceived as a state of mind. It is also understood as an evaluative appraisal of something. The term refers to both contentment and enjoyment, and it covers cognitive, as well as affective, appraisals. Life satisfaction is a major issue for counseling needs during the oldest-old life stage. Satisfaction can be both temporary and stable through time and lifespan (Karatafl, 2005). A review of the literature indicates a consensus on the definition stating that life satisfaction is the degree to which a person positively evaluates the overall quality of his or her life as a whole. In other words, how much the person likes the life he or she leads (Myers & Diener, 1996).
Life satisfaction of an individual during the oldest-old lifespan is very much influenced by various factors, such as the ability to function independently, taking pleasure in participating in daily activities, meaningfulness in life, acceptance of desired and achieved goals, perceived health, financial security, and social contact. Because the oldest-old are especially susceptible to numerous potential threats to life satisfaction, such as the loss of a spouse, changes in social network, changes in housing/living arrangements, and age-related diseases and comorbidity, the consideration of life satisfaction is particularly important for working with this group. In addition, other factors that took place during earlier developmental stages of an individual’s lifespan, such as the type of family he or she had, his or her relationships maintained with family members, availability of resources in the family, and the extent of participation in social and religious activities, might also affect life satisfaction in very old age. Individuals in advanced oldest-old age often have a decline in their daily routines, assuming that they are deprived of power by internal and external forces. In some cases, oldest-old individuals may feel worthless and powerless, and consider aging as a significant obstacle in obtaining satisfaction from life. All of the above aging issues are important variables that need to be taken into consideration not only to understand the oldest-old client but also to be able to provide counseling in the most effective manner. Most helping professionals subscribe to the notion that health is more than the absence of illness, and if there is health, there should also be quality of life. The presence or absence of disease, therefore, may not be a source of great concern to the oldest-old adult. The inability to perform activities of daily living is the greatest concern, which also interferes with quality of life (Haber, 2013).
In summary, in facing the challenges and rewards of working with an aging population, life satisfaction is an important factor that must be considered by counselors at all times. In spite of this fact, two main problematic issues have emerged: from a biomedical perspective, quality of life and life satisfaction are mainly reduced to health, and several health measures have been taken as quality-of-life measures. When several domains are considered, quality of life and life satisfaction are reduced to the individual’s subjective appraisal of those domains (Fernández-Ballesteros & Santacreu,2010). This view determines the existence of a variety of self-report methods assessing quality of life combined with a minority of rating-by-other scales from different disciplines. With some exceptions, quality-of-life measures as they relate to aging can be placed in an undeveloped state. The focus here is to emphasize the multidimensionality of quality of life and the strong need to use both subjective and objective components of those dimensions during counseling assessments and counseling interventions.
Adjustment to Advanced Aging
Adjustment to advanced aging is how the individual perceives himself or herself in reference to health concerns in later life such as chronic conditions, disability, and dependency. Believing that advanced age is equal to lost vigor and decreasing strength, followed by a gradual decline in health, generally frightens everyone. The epidemiology of aging is concerned with diseases that cause morbidity and mortality and also with the causes of disability and the effect on functional independence. This often means marked revisions in the roles the oldest-old individual plays in the home and in the open environment. But the changes that accompany advanced aging are more than just changes in health. As people age, they are often faced with events that can dramatically alter their lives. For example, they may lose decision-making power on individual and family affairs or on their living arrangements (Ailshire & Crimmins, 2011). These changes may become an impediment to a progressive adjustment to advanced aging and have the potential of affecting the well-being of the individual.
A number of inevitable physiological changes occur as we grow older that can also affect how an older individual adjusts to the continuing process of aging. Some of the common changes that appear to be related to aging can be the result of long-term diseases or, perhaps, lifestyles and exposure to hazardous environmental elements. Most of the