Psychotherapy Termination Practices with Older Adults: Impact of Patient and Therapist Characteristics.

OBJECTIVES: The aims of this study were to survey clinicians' opinions regarding psychotherapy practices in mutual termination with a specified population (depressed older adult outpatients) and to examine the patient and therapist characteristics that may influence such practices. METHODS: We surveyed psychologists' (N = 96) psychotherapy termination practices, using a hypothetical depressed older adult as a referent, to assess consensus on the appropriateness of various guidelines to termination and to examine whether these differ as a function of patient and therapist characteristics. RESULTS: Several practices were generally agreed to be "extremely appropriate" when terminating psychotherapy with older adults, including collaborating to determine the end date of treatment and discussing patient growth. Data also indicate that patient factors, such as personality pathology, and therapist factors, such as having an Integrative theoretical orientation were associated with differential endorsement of termination practices. Identification as a geropsychologist or working regularly with older adults were associated with a more cautious approach to termination. CONCLUSIONS: There is substantial consensus regarding many approaches to termination, but modifications might be appropriate depending on patient characteristics. CLINICAL IMPLICATIONS: Clinicians agree on a set of fundamental termination practices when working with older adults, but modify these based on orientation and diagnosis.

Health and social adjustment of homeless older adults with a mental illness.

OBJECTIVE: To better inform treatment strategies, this study compared mental health, substance use, physical health, and social support among young, middle-aged, and older homeless adults before and after participation in intensive case management services. METHODS: Data were obtained from the Access to Community Care and Effective Services and Supports (ACCESS) public database. Young (age 18 to 34; N=2,469), middle-aged (age 35 to 54; N=4,358), and older (age 55 or older; N=408) homeless adults with a mental illness were compared on the basis of demographic characteristics and measures of substance use, mental and general medical health, and social support at baseline by using Kruskal-Wallis and chi square tests and at three-month and 12-month follow-ups by using mixed-model analysis. RESULTS: Older adults had fewer severe mental health and substance abuse problems than the two groups of younger adults at baseline. At 12-month follow-up, all age groups had improvements in housing, substance use, and psychiatric symptoms, but rates of psychiatric symptoms had improved the most among young adults, and their scores for psychiatric symptoms were the lowest on average of any group. Compared with older adults, adults in the younger groups showed greater decreases in substance use. CONCLUSIONS: Older homeless adults appeared to follow a different treatment trajectory than their younger counterparts, possibly because of lower severity of mental illness at baseline, and may need specific interventions to address their unique pathways to homelessness.

Learning From The Past and Planning For The Future: The Challenges Of And Solutions For Integrating Aging Into Doctoral Psychology Training.

The long forecast "elder boom" has begun. Beginning in 2011, ten thousand members of the "baby boom" generation began turning 65 each day. This demographic shift in our society mandates that pre-doctoral programs in clinical psychology incorporate aging as an integral component of their core and elective training. While fully supporting the concept of broad and general training for predoctoral professional psychology programs, we maintain that the infusion of aging into doctoral psychology training curricula has been inadequate. In this manuscript we provide an overview of geropsychology training models and discuss the challenges involved in incorporating aging to the curriculum of pre-doctoral training in clinical psychology. Potential solutions and examples for accelerating infusion of aging knowledge base are discussed in the context of different geropsychology training models. We conclude that providing services to this rapidly growing segment of our population presents both an employment opportunity to broaden the reach of our profession as well as an ethical responsibility to train future professionals who will practice within their area of knowledge and expertise.

Medical and psychology students' knowledge and attitudes regarding aging and sexuality.

The current study surveys medical and doctoral psychology students (N = 100) from an urban northeastern university regarding knowledge and attitudes toward elderly sexuality and aging using the Facts on Aging Quiz, the Aging Sexuality Knowledge and Attitudes Scale, and measures of interest in gerontology, academic/clinical exposure to aging and sexuality, and contact with elders. The current study found that psychology students demonstrated greater aging knowledge than medical students; however, both groups showed gaps in knowledge about sexuality. Married students had greater academic/clinical exposure and greater knowledge about aging but less permissive attitudes toward elderly sexuality. Generally, knowledge about aging was the strongest correlate of knowledge about sexuality. Level of knowledge about sexuality was not associated with attitudes. Attitudes toward sexuality and aging may be more strongly tied to demographic variables reflective of religious beliefs or adherence to sociocultural norms.

The social adjustment scale-self-report: psychometric properties for older adults.

To assess the reliability and validity of the Social Adjustment Scale-Self-Report for older adults, 129 community dwelling elderly ranging in age from 63 to 87 years (M=72.3 yr., SD=5.0) were surveyed using a modified version of the scale. The average internal consistency of subscales was satisfactory (mean coefficient alpha=.62). Overall social functioning impairment (total score) was associated with measures of depression (Beck Depression Inventory, r =.58) and global psychiatric symptoms (Brief Symptom Inventory, r = .55). Older adults scored higher on Marital role, Family Unit role, and overall social functioning impairment compared to mixed-age adults assessed in previous research, and higher on marital role impairment but similarly on overall social functioning when compared with a mixed-age sample from primary care. The modified Social Adjustment Scale-Self-Report has acceptable psychometric characteristics for research use with older adults, and select subscales may account for findings of age-related differences.

Doctoral clinical geropsychology training in a primary care setting.

Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.