APA updates guidelines for older adult patients
In February, the American Psychological Association (APA) updated its guidelines for treating older adults. The new recommendations include things like understanding what is normal cognitive aging as opposed to neurodegenerative conditions; recognizing and allowing for diversity in race and ethnicity, gender and gender identity, sexual orientation, and socioeconomic status; utilizing telehealth as a way for older patients to access care; and acknowledgement that psychologists should work with other healthcare professionals like pharmacists, primary physicians, or nurse practitioners as “healthcare teams” for their patients.
The U.S. population is getting older. According to the World Health Organization, one in six people will be over the age of 60 by 2030. Approximately 14 percent of older adults live with a mental disorder. And mental disorders account for more than 10 percent of the total years lived with a disability.
In a released statement, APA President Cynthia de las Fuentes, PhD, said, “With questions regarding age, memory, and competency much in the news lately, it’s important to note that psychologists play a vital role in supporting and maintaining the health and well-being of older patients.”
Consider the fact that older adults may also experience conditions simultaneously, like depression and anxiety along with chronic pain, reduced mobility, dementia, or other health problems caused by aging.
Another widespread problem with older adults is suicidal ideation. According to the CDC, adults aged 75 and older have one of the highest suicide rates, with men topping the list.
Juan Carlos Urizar, MD, director of clinical geriatric psychiatry at Brigham and Women’s Hospital in Boston, said older adults succeed in suicide by overdosing on medications or using guns and firearms.
“The problem is older adults are seen as at the end of their lives but it’s just the beginning of another stage of life,” he explained. “But if you consider it to be the end point of life, you can lose hope or isolate. We are talking more about loneliness.
“Older adults experience loss of peers and loved ones. There are co-morbidities, medical problems that are incapacitating, or limitations on income. And people often do not connect, especially if some of them are not technically savvy and that can create more isolation,” he added.
Richard Zweig, Ph.D, ABPP is professor of psychology at the Ferkauf Graduate School and the director of the Ferkauf Older Adult Program at Yeshiva University in New York.
One of the primary drafters of the new guidelines, Zweig said the guidelines are updated every 10 years, which happens to coincide with an aging population. He said many of the problems we see in older adults are like younger adults such as depression, anxiety, or substance abuse.
Zweig said certain issues are also on the rise that are of concern, citing alcohol, prescription drug, and opioid misuse.
“Misuse can range from excessive use to unwitting amounts where they don’t realize they are taking more than they should. Older adults have a slower metabolism, and one drink has a stronger effect than on a younger adult and may even interact with their medications. Many older adults are not aware of that,” he said.
Urizar agreed. “When you talk about misuse, there is a ‘use’ for those medications, but it becomes dangerous once you cross a certain threshold.”
Zweig added other problems include rising rates of insomnia, which responds to cognitive behavioral therapy or CBT-I, and chronic pain.
The guidelines point out other issues that highlight diversity. For example, older adults are often women, because they typically outlive men. But that longevity does not go without its associated problems.
Many women, for instance, may have fewer economic resources than older men and experience poverty at a higher rate.
Also, the older women get, the more likely they will live with a chronic condition or disability. In fact, twice as many older women than men become housebound.
When it comes to transgender individuals, many have experienced a lifetime of stigma, discrimination, and violence that may affect their mental health and their willingness to access care. Similarly, people of color have experienced racism and discrimination, or race-based trauma, which may manifest like PTSD.
A provision on telehealth was a welcome addition to the guidelines. Telehealth became necessary during the pandemic but has continued in this post-pandemic world. While some patients prefer in-person visits, many people enjoy the convenience of telehealth or live in an area in which telehealth is the only option.
But Zweig issued a caveat to that option. He said, “The big question for the future is for which patient with which problem with which life circumstance is telehealth most effective and needed?”
The bottom line is aging shouldn’t affect your ability to function and continue to be independent on a daily basis. Yet, there’s a wide range of functionality in older adults. One 75-year-old could be perfectly healthy and active while another 75-year-old has chronic pain and is disabled. They may have trouble finding words or remembering names, but they need the insight and awareness to determine when those things are a problem. In other words, functionality should exist without a connection to chronological age.