1. Mona Mikael, M.A. Pepperdine University

2. What are some of your beliefs about aging?

3.  Individuals of advanced age are the fastest growing segment of the population (He et al., 2005)  The percentage of Americans 65 and older has tripled from 4.1% in 1900 to 12.4% (or 36.3 million) in 2005  Baby-boomers are also entering retirement in 2011, thereby increasing the population of elders to 20% or 72 million (He et al.) by 2030  partially because of the increase in life expectancy  Increase in the life in years and not just years in life

4.  Research focuses more heavily on losses and degeneration in people of advanced age than on strength and resilience (Hagestad & Dannefer, 2001; Kaufman, 1986)  Gerontology related research predominantly centers on medical disabilities and the functional losses of aging (Bengston et al., 1999)  Concept of loss is often associated with old age, e.g., loss of loved ones, mobility, independence, physical health

5.  Provided that older adults do not suffer from serious cognitive impairments, they can still evince heightened emotional intelligence, judgment, a greater sense of self, and relativistic/systematic thinking (Baltes, 2006; Cohen, 2005)  Older adult exhibit greater acceptance of life’s realities (Cohen, 2005)  As one ages, a greater sense of self emerges (Cohen, 2005)  Older adults expand their store of memories, experiences, and appreciation of the complexity and beauty of human experience (Ranzijn, 2002)

6.  With age, one is better equipped to think relativistically and view circumstances out of his/her own context (Cohen)  With age, one has an increased ability to moderate his/her emotions, leading to contentment of life (Strongman and Overton, 1999)  Through life experiences “…adults in their sixties and seventies often address problems requiring wisdom extremely well” (Baltes, p.34)

7.  Ethnicity/Race  Cultural values, beliefs, and behaviors  Gender  Cohort/historical effects  Language  SES  Religion  Urban/suburban/rural residence  Social support  Political, economic, and social climate

8.  Non-White minority elders tend to have lower levels of income and education so may be at risk for poorer access to health care (Haley et al., 1998)  African Americans who had experienced racism in earlier life, now tended to cope with illness through their unique “philosophy of illness;” their deep faith helped them maintain their sense of autonomy and helped them persevere despite life-threatening illnesses (Becker & Newsom, 2005)  Strong commitment to faith helped elderly African Americans accept their health challenges (Harvey, 2006; Harvey & Silverman, 2007)

9.  A study of 3,050 Mexican Americans (56% women) age 65 and over living in five U.S. states reported more symptoms of depression than their acculturated counterparts (Chiriboga, Jang, Banks, & Kim, 2007)  In a study of elder Taiwanese age 60 and older, women were more likely than men to experience negative health outcomes since they were often less educated and from a lower socioeconomic status (Hsu, 2005)

10.  Accommodate client’s family  Inquire how client would like to be addressed  Use familiar terminology rather than “educating” client on use of professional jargon  Provide services in culturally relevant locations such as in a church setting or home visits  Theoretical orientation  Be familiar with chronic illnesses and the impact on mood, interaction effects/side effects of medications  Flexibility in scheduling  Cope with feelings of disempowerment

11.  Medication compliance  Support negotiating the health care system  Take cultural expression of symptomatology into account when using standard assessments of measures  Understand the client’s code words when describing emotional issues  Self-disclosure

12.  Consider whether the psychological & cognitive tests are developed, normed, and validated for older adult (and older adults of diverse cultures)  Use appropriate norms for age and educational attainment  Integrate collateral information  Consider consequences of assessment data on client’s independence and ability to be self-reliant, e.g. if license is permanently revoked  Manage client’s potential reluctance to follow through with testing

13.  Philosophy about living with illness  Self-perception of health  Religiosity  Experiences with racism  Consider client’s culture and degree of acculturation  Age at time of immigration, level of acculturation, and acculturative stress  How mate was selected  Size of social network size here versus in native country  Subjective experience with control in family  Gender specific roles, caregiving expectations  Informal support already sought  Natural support networks

14.  Older adults more likely to go to general medical provider for help with a mental health problem  Stigma of psychotherapy in older generations  Lack of information  Physical frailty  Poverty  Lack of linguistic and cultural services  Psychological issues

15.  Receive support services (e.g., home meals, transportation, phone service  Decrease isolation; increased contact with family, friends, or others  Decrease risk of homelessness or premature higher level of care  Decrease suspiciousness  Decrease contact with governmental agencies  Increase limit-setting behavior (Yang et al., 2005)

16.  Ageism  Self-awareness of attitudes and beliefs about aging and older adults  The “Reluctant Therapist”  Recognizes differences between clinician and patient values, attitudes, assumptions, hopes and fears related to aging  PAY ATTENTION TO YOUR OWN JOURNEY & FEELINGS TOWARD AGING

17.  Consider caregiver burdens  Depression and coping classes  Stress reduction training  Family attitudes toward death and dying,  Preferences for coping directly or indirectly  Family interventions  Watch for Elder Abuse ** Neglect**  Pay attention to impact of abuse reporting