Demand grows for geropsychologists



Erlene Rosowsky, Psy.D., of Needham Psychotherapy Associates, LLC in Massachusetts, cites a need for more psychologists to treat the elderly. (photo by Tom Croke)

By Jennifer Chase Esposito

The work is very exciting," says Erlene Rosowsky, Psy.D., of Needham Psychotherapy Associates, LLC. "It's very broad, it's not insular, and it gets broader, sometimes, when people get more complicated with age."

If Rosowsky sounds like she's trying to convince others to join her team, she almost is ... and she needs to. Geropsychologists and psychologists who treat the elderly are a dying breed. By 2030, older adults will comprise about 20 percent of the U.S. population, according to the Department of Health and Human Services. And the Institute of Aging in a study a few years ago said that an estimated 5,000 doctoral geropsychologists will be needed by 2020. That's 4,300 more than currently are trained.

Rosowksy is a clinical geropsychologist who has treated the elderly. An assistant clinical professor of psychology at Harvard, she is director of the Center for Mental Health and Aging at Massachusetts School of Professional Psychology and part of the national traveling faculty for the American Society on Aging. In addition to writing books and talking on the subject of geropsychology, she's integral in helping train those who wish to become geropsychologists to treat aging clients.

Typical older-adult clients range from 65-100+. Their situations vary from individuals who need many things done for them to others who are capable of maintaining a certain lifestyle regardless of age. They include people worrying about their adult children's problems and veterans who were in the Korean War. They are men dealing with divorce after 43 years of marriage, and they are women who worked all their lives that at 60-something are only now beginning to identify as an individual and not as a wife or mother.

"At this point, [with] the abundance of older people, there's not going to be a way to do a lot of one-on-one treatment," says Rosowsky. "The boomers - the rising cohorts - have used therapy; there are going to be a lot of them and not a lot of people to do [the work]."

Today, says Rosowsky, it's more acceptable for psychologists to take courses and gain more education to provide the services to older adults. In spite of the lacking number of geropsychologists, "I think people are working very, very hard in this field to educate and train."

Fred White, Ph.D. falls into that category. A general practitioner in Maine, White for five years was the psychologist serving at the VA Medical and Regional Office Center at Togus. It's his business, in rural Maine, to treat all ages but he has made himself knowledgeable in the ways of geriatrics with past research that included studying speech communication in the elderly.

"There's a whole lot of need for specialists and experts in the area" of the elderly, says White. "In this region, there's a shortage of specialists of many kinds."

In those cases, White refers out to whom he calls his "go-to guy" if he doesn't have the answer to a particular geriatric question. Philip Pierce, Ph.D., ABPP, has been involved in geropsychology since 1978. He is the staff geropsychologist at the Togus Veterans Medical & Regional Office Center.

In 1989, Pierce created an adult behavioral scale that studies 14 areas of daily activity and is used to help treat geriatric patients. The scale, called the Adult Functional Adaptive Behavior Scale (AFABS), was published in 1992 and is now used nationwide. "Often my test results go to probate courts," says Pierce. It tests the ableness of a person's executive functions and cognitive functions. "Ninety percent of people I assess wind up with guardians."

If stats are correct, the country will need to find more psychologists interested in treating the elderly. Even according to people in the field, that appears to be the difficult part.

"There are so many healthcare professionals out there who don't have a lot of experience with mental health problems in the elderly," says Eric Margolies, Psy.D. Margolies is partner of the Connecticut Resource Group, LLC. His private practice comprises adult and geriatric patients: the day of this interview his clients were 68, 74, 80 and 81."It is a serious concern that a lot of psychologists tend to go into childhood and general practices - and I'm a general practitioner - but we're going to need more training than ever because of the baby boomers."

The personal and professional toolbox of psychologists who treat the elderly is not very different from what they use to treat other patients: patience, empathy, absolute respect, and flexibility.

"Personality is definitely a crucial part of working with the elderly … trying to meet the client where they're at," says Margolies. Margolies uses humor to make his elderly clients feel at home and comfortable. It's something for which they've praised him.

But it seems to be even more personal. "I think if you interviewed all [people who treat the elderly], you'd find a couple of common things: in our hearts, we hold an image of beloved grandparents and a love of stories," says Rosowsky, who was very close with her maternal grandmother. "I also have a high regard for the wisdom of older adults and I don't mean just older or smarter....I love the sense of survival an 80-year-old brings to us, [which is] very different from a young person."

Long before White entered psychology, people would tell him their stories. For Margolies, it was his grandparents. With Pierce, it was his childhood neighbor Miss Elliott. "She raised flowers: I worked in her gardens, I put her storm windows in. That woman affected my whole life, and [was] basically why I went into geropsychology," he said.

Psychologists treating the elderly have a good idea of what they're likely to see in a client. "Depressive disorders," says White without missing a beat. "And sometimes substance problems, alcoholism and prescription-medications-gone-bad. I think there's a lot of substance abuse in the elderly population that gets overlooked."

Older clients also present fear of dementive processes and there's considerable bereavement trauma that accompanies the loss of a partner. According to White, depressive issues need to be ruled out before dementia can stand as a diagnosis. "Looking at a 75-year-old man with gray hair, foggy eyes and not really paying attention, it looks like and sounds like dementia. But it could just be because they're good and depressed."

Rosowsky has three patients in their 90s. These issues are common.

"These are real situations a lot of older adults worry about - their middle aged kids who are having a hard time making it," says Rosowsky. "Things go 'bump' in the night [and] it's very difficult to be worrying about [them]."

According to Margolies, it's not always the parents worrying about the kids, but also kids worrying about their parents. Often called the "sandwich generation," there's concern for the adult caregivers in the middle of caring for their aging parents and their own young children. Sadly, the cycle never ends.

One of the things about working with clients ages 70 and above is knowing that while you're working on quality of life issues, you're doing so against a ticking clock, says Rosowsky. "Sometimes, we consider success as slowing an inexorable decline," she says.

In Pierce's experience, it's been easier treating his elderly clients because many are committed to taking it seriously. "In assessing an elderly person, you really need to look at their cognition, executive function and functions of adaptive behavior…..They have a lot of life experience and if they're 'into' therapy, they really value it."

Conversely, says Margolies, "Some elderly patients may not be open to revealing their feelings, because of the stigma of having mental health problems," especially, he says, if they grew up in an era that evoked a "Why would you want to put your problems out to a stranger" mentality.

White says that older clients may get deeper into distress before they actually present for evaluation and treatment. "It may not be convenient for an elderly client not driving anymore," for example. "Socially, they get a little more isolated."

What about getting accused of "not being able to understand" because the client is older than the doctor? "It's not a question of being accused,'' says Rosowsky. "As you work with individuals, the age difference doesn't matter."

"I found that happened more with my younger clients, but not with the elderly," said White.

But maybe that's because Rosowsky is in her 60s. Margolies is 35 and has a different story.

"Sure, that's certainly happened," he says. "I've had a couple [of patients] say to me, 'How do you relate?' And I'll say, 'That's right: I'll never know exactly what's going on in your shoes.' But once they hear me explain my background, about myself and hear me really explain my research," that changes.

If Rosowsky knew Margolies, she'd probably like his sincere attitude toward treating the elderly, largely because he answers the call she'd make to all young psychologists entering the field. "If I could, I would want to encourage my younger colleagues and people who are beginning to study [psychology] to consider [working with the elderly], and be open to it."

Demand grows for geropsychologists (December 2005 Issue)

Demand grows for geropsychologists
(December 2005 Issue)