 |
Aging Today/June Epstein Blum and Marcella Bakur Weiner |
| Marketing 101/Ofer Zur | |
| How Therapists Can Coach Virtual Groups/Ben Dean |
| June Epstein Blum, Ph.D., ABPP,
and Marcella Bakur Weiner, Ed.D., Ph.D. |
Aging Today
The Changing of Our Population One thing you can count on in life is change. This is graphically noted in the changing face of our older populations. On the cusp of a new century, our population of 65-plus is over 37 million, with a projection of 68 million by 2030. This includes the first born baby boomers who will reach 65 in just eleven years. The aging of today, however, are not the aging of yesterday. The newcomers to this group are healthier, better educated, and know that sexuality is not the exclusive province of the young. They are economically more secure, psychologically more sophisticated and are not strangers to the therapeutic process. Indeed, despite popular misconceptions, there is a lower incidence of new depression in the older population than in almost any other age group. Not only are we aging, but we are doing it well and staying active and productive. There are still, however, many cohorts that view speaking of their problems as demeaning and are not familiar with the benefits of psychotherapy. They can be reached by our expansion of community psychoeducational involvement which can relax their resistances to seeking the help we psychologists can provide. Cross-sectional studies show that the meaning of adverse life events, rather than the objective characteristics of adverse events, is the most important factor determining the impact of adverse events. The key to successful aging lies with how people “make sense” of the course of their lives and maintain a coherent sense of self. The use of the “key” may be handicapped by a person’s life span maladaptive personality patterns which are complicated by the vicissitudes of the aging process. It is here that psychological practice and research come to the fore and destroy the myth that older people are untreatable and cannot change. Clearly, this is an expanding field of practice for psychologists. Basic Issues in the Lives of the Older Adult In the later years, everyone, to varying degrees, is faced with stresses that are part of this stage of life. There are ego assaults, narcissistic losses, social isolation and loneliness, personal loss and sensory changes and physical fragility. Symptoms may include depression, anxiety and somatic complaints. The most vulnerable are those who have struggled with lifelong unresolved conflicts. Retirement Eexperience Retirement creates many life changes for older adults. An increase in free time along with a decrease in income is the most dramatic. The effect depends upon whether work was an identity badge, whether the retirement was voluntary, and their degree of psychological preparedness. Retired men (aging career women will not be exempt) have a greater number of psychological symptoms and score higher on depression, anxiety, somatization, phobic anxiety and obsession/compulsion scales. The four personal characteristics which have been linked to retirement satisfaction are: health, income, attitude, and preparedness. Each of these, when dealt with in depth, are the keys to helping a person adjust to the new phase of life. Three stresses are found to be most significant: loss of income, loss of friends and marital difficulties. The retired male has to face new intimacy with his wife. He is suddenly home with her seven days a week which involves new patterns of interpersonal behavior. Changes can become threatening. The loss of role becomes a narcissistic injury which contributes to depression, the stress of which can revive underlying conflicts. Since the link between retirement and life satisfaction is moderated by the degree to which a retiree’s expectations concerning retirement are met, the therapeutic process can offer relief and assurance that life after retirement can be a rewarding experience. Sharing research results with retirees can also decrease anxiety. Despite age discrimination, a surprising number of people get post retirement work, start new careers, or participate in programs for “senior learners” or retired professionals. Still others find fulfillment in performing community service, traveling, or engaging in a much-loved hobby. The need for engagement is the key. Working with the retiree’s individual dynamics–and exploring options with the older about-to-be retired person–can lead to a sense of meaning in this stage of life. Many baby boomers are not interested in retiring. We may speculate on how they will be affected psychologically by the pushing up of the younger generation. In this context, psychological preparation can be a proactive intervention. Transition: Bereavement Though the divorce revolution has also affected older couples, divorce is a transition that tends to occur relatively early in life. Widowhood remains the primary change in marriage that people can expect in their later years. Contrary to divorce, this transition tends to be a female event due to women’s longer life expectancy and their tendency to marry older men. In either case, loss of a spouse in the later years can create a crisis with the ensuing adjustment demands. Loss of spouse, for both men and women, means mourning the loss of a life companion. Remaking an identity whose central focus was on “being married” tilts the family structure. Often, an older woman has to learn to function in areas that were her husband’s province such as taxes and finance while the older man is thrust into what has been perceived as the feminine domain–cooking, laundry, and shopping. Patience and understanding along with concrete suggestions are aids in this process. Then, there are the underlying psychodynamic adaptations of the older depressed woman who devoted herself to her husband’s career, basked in his glory, and now finds herself alone and ignored after his death. Older widowers, in turn, are bereft for they are now confronted with being alone. It is here that depression, anxiety, and somatic complaints are presented and our expertise as psychologists comes into the fore. The problems present an opportunity to help patients with working through unresolved conflicts to Pollack’s “mourning liberation.” Age itself may call forth new strengths and new capabilities that weren’t available at previous stages. What greater satisfaction can a psychologist receive? Tasks of Mourning What are some of the benchmarks, or tasks, of mourning? One is to accept the reality of the death. Helping the bereaved to understand that death is a reality can ease the mourning process, helping the bereaved to feel and accept the pain as a natural aspect of life. This assistance can also facilitate the mourning process as the loss is integrated into the full fabric of life. Finally, to recover emotionally, it is important to reconnect to others. It is critical to know that bereavement does not come in neat orderly stages as was once thought. People can experience conflicting emotions and behaviors at the same time. Signs of early shock, disbelief and denial may also appear with signs of recovery. Understanding how feelings intermingle can help the adult through the mourning process. Depression-Anxiety Everyone is confronted in various degrees with stresses of later years. Loss and grief are the most prominent. They result in depressive reactions which affect from 10% to 45% of the older population. Even those who have coped successfully during their early years can be affected. The reactions are akin to the mourning process. Thus, the patients are not only responsive to therapy, but are proactively strengthened for any ensuing losses. The rates for major depression for the elderly are only between 2% and 5%. This is due to the fact that the elderly, instead of complaining of depression focus on physical complaints, worries of family, and financial problems. They present cognitive dysfunction that is too quickly ascribed to a dementia. The assessment and diagnostic skills of the psychologist are valuable as approximately 12% of the elderly who are diagnosed as suffering from a dementia, are thought to be actually suffering from undiagnosed and untreated depression (pseudo dementia). Coping Aids To age successfully, people have to use coping styles that were effective in the past, or learn to develop new mechanisms for adapting to stressful situations. We psychologists can help those depressed individuals to:
We psychologists can assess the patient’s ego strength and determine his/her character defenses (injustice collecting, self-fulfilling projections, controlling others through expectations) in a noncritical manner, and work dynamically. The results can be positive and rewarding as the patient’s self-esteem improves and interpersonal relationships expand. Dementia: A Family Affair Approximately five to seven percent of those over the age of 65 succumb to some form of dementia such as Alzheimer’s Disease. Women are more at risk than men. The effect of this ongoing, insidious disease on the family is numbing. Family members experience acute traumas as they see a host of multiple cognitive deficits and loss of language skills (aphasias) consume their loved one. Caregivers’ Dilemnas Most often, one or more of the adult children of the patient seek help. Feeling helpless and hopeless about the disease, they may resort to warring factionalism in the family. Caring about the safety of the suffering parent becomes paramount but old, unresolved issues can surface to cloud problem solving. Who will be the official care giver? How will money be handled? Can the older person survive living at home, with in-house services supplied by outside agencies? Must he or she be placed is a supportive environment with round-the-clock care? And the most burning question of all, “Will this too be my destiny?’ During regular meetings with family members there is an opportunity, under the guidance of a psychologist to:
Here, the group process is one of listening, mediating, and educating. Treatment Because of the greater variability of our older population, the range of therapeutic interventions is a broad one. As in the case of a person of any age, the treatment is determined by the assessment. The treatment modalities–or variations of them–may include:
Included in the above treatment modalities is the holistic approach of interdisciplinary collaboration. Our function, as advocates with a positive outlook, is to improve the quality of our patients’ lives. There is hope at every stage. We have noted many of the overt concerns presented by older adults. Our training alerts us to be aware of unspoken problems such as alcoholism, drug abuse (which can involve misuse of prescribed medications) and suicide potential. In particular, we must be alert to the not so silent phenomena concerning the fragile and vulnerable elderly–Elder Abuse. We, as psychologists, have the opportunity and should advocate for them as we have done for child abuse. In addition, but certainly not least, we have the opportunity to strengthen our services to the expanding older populations in minority groups–recognizing their heterogeneity, their cultures, and their values. In the later years there is a great intermingling of bio-psycho-social impact on the integrity of the older person. Here we have an open window of opportunity to provide the needed coordinated services of an interdisciplinary team. We have much to contribute with our clinical expertise and continued openness to hone our knowledge. Here, too, we have new research opportunities. The expanding horizon of the aging population creates a win/win situation for us as psychologists. Not only do we gain the satisfaction of seeing the therapeutic process work, but in so doing have prepared for our own issues of adaption to, and coping with later life issues. We recognize that we, too, are part of the growing process–The Aging Process.
June Epstein Blum, Ph.D., ABPP, is Clinical Assistant Professor of Psychology in the Department of Psychiatry of Weill Cornell Medical College and maintains a private practice in Manhattan and Rhinebeck. She can be reached at 179 East 79th St., New York, NY 10021, 212-249-7998, E-mail: jblum@aol.com. Marcella Bakur Weiner, Ed.D, Ph.D., is Adjunct Professor of Psychology at Marymount Manhattan College and maintains a private practice in Manhattan and Brooklyn. She can be reached at 383 Ocean Parkway, Brooklyn, NY 11218-4701; 718-941-0381, FAX 718-856-5797. |
|||||
| Return to Top | ||||||