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Geropsychology, 1990 M. Powell Lawton, Ph.D. Philadelphia Geriatric Center One of my most vivid training experiences was 2 years of psychological test seminars with David Wechsler. Wechsler was in his 60s then and he delighted in drawing and redrawing his age curve of raw scores on the Wechsler-Bellevuse. He liked that curve because it was one of the all-time great illustrations of a major effect: a steep rise until age 22, a fairly flat shape through most of adulthood, and an accelerating decline beginning around age 60-65. He was proud to have generated such compelling He was pretty evidence of the rise and fall of intelligence. forgetful himself, which he enjoyed pointing out and blaming not on himself but on the built-in biology of age-related intellectual deterioration. C The geropsychology of the time was characterized by a number of similar oversimplifications, many of them reinforcing an ageism that saw older people as inevitably confused and debilitated. Another psychologist of the time was Irving Lorge '^- f^^-f (of the Thorndike-Lorge word list) who was a--pioneer i t f ^ aging. to teach a course based on empirical knowledge about Courses at TC Columbia at the time were coded with 3 Although Lorge was one of the pioneers digits and 2 letters. against ageism he couldn't resist giving his course the number Address delivered to the Philadelphia Society of Clinical Psychologists, June 2 f 1990. 207AK, which those of you who know the term "alte kaker11 will no doubt recognize. We've come a long way since then, much of the motive power for new research having come from the changing demography of age about which so much has been written. I'll give myself a quota of just 5 tidbits of litany to illustrate why aging is no longer A the coming thing but the arrived thing: As of the end of WWII people 65+ constituted every twelfth person in the country. Before the end of our century they will represent every eighth person During the same time period, years have continued to be added to the lives of people even after they have reached age 6 5 : Over those 40 years men have been benefited by more than 2 additional years, women by almost 4. The very old as a group are growing. In 1950 the 85+ By 2000, they constituted 4.7% of the 65+ population. will constitute 13.3% of all older people. More than 80% have one or more chronic diseases, including 4 to 6 percent who suffer from Alzheimers disease. Despite this general level of morbidity only 5% are institutionalized and only 10% of those living in the community have self-care problems marked enough to require the help of another person. These snippets portray the magnitude of the societal issues revolving around the older population in terms of its relative m a s s , its center of gravity moving into the old-old region, and its health status -- the bad news is age-related morbidity and the good news is that morbidity does not necessarily equal disability and dependence. With this prologue completed, I'd like to take the rest of my time for a few thoughts on the relevance of aging for the practice of clinical psychology. The Relevance of Age and Cohort Membership to the Practice of Clinical Psychology Over the past years several studies have appeared of the age distribution of people in treatment for psychological conditions. Various estimates have appeared: In 1978 3% of psychiatrist office visits were by people 65+ and over, exactly the percentage estimated by Eisdoi^ter in 1987 for all private-practice mental health services. For CMHCs the estimate of percentage of all These percentages are A Is visits made by those 65+ was 6% (1984). grossly lower than the population proportion of older people. fact of life is thus thatause rates for MH services, a f * low. ji it ageism in professional practice, a matter of older people's lower income, of very limited reimbursement capacity, or of reluctance by older people to seek psychological services? It is worth lingering on this question in order to plan for the future. Mental health services now being planned and individual practitioners looking ahead may benefit from some interesting data relevant to changing demand for mental health services by the elderly. When considering change over time we have 3 inextricably related phenomena to consider. First is chronological aging. Second is life experiences that are specific to the periods of one's life, the sol-called cohort effects common to people born at a particular time. The third is historical time changes to which all people are exposed, such as world war^s and economic ^depression. Probably most of you are aware how recognition of these influences has enabled us to characterize many effects once presumed to have been due to aging (for exaMple, performance on some intellectual tasks) as being due to differential educational experience associated with birth cohort membership, rather than chronological aging. Similar considerations apply to attitudes, expectations, and behaviors associated with mental health and its treatment. I'll quote at length some relatively neglected findings from a study that allowed us to partially separate the contributions of age, cohort, and period diffeierrees to what we might call "readiness to seek mental health services." This study by Veroff, Gurin, and others was one of the landmark efforts that launched the Community Mental Health movement. The study was commissioned by the Presidential Task Force on Mental Health and Mental Illness to understand the position of mental health among the American public. The book that appeared in 1957, Americans View Their Mental Health, reported the state of people's mental health, their attitudes toward psychological concepts, their receipt of various mental health services, and their expectations about what they would do should they need help. was repeated 2 decades later. Essentially the same survey It has now been 16 years since that followup survey and one hopes that there will be a third coming along soon. Such a repeated study offers 3 possibilities for understanding any given issue. Responses to a particular question may change over 20 years for the entire population, in which case one would infer that social-historical change had influenced everyone's behavior or attitude. A second change might look at people in 1957 and see howA20 (A years of continued A :/ / f living might have affected responses -- the effect of age. Finallyf differences between people of one age in 1957 and different people the same age in 1977 would reflect birth cohort differences. You'll no doubt recognize that one can't separate there are always 2 of them each of the 3 effects one at a time -- that are confounded -- but I'll just implicitly take that into account as I note the findings. From 1957 to 1976 there was a substantial increase in the proportion of people of all ages who actually used some professional mental health services, an increase that could have been due to both increasing acceptance of such services as a function of time or to the movement through the at-risk period of birth cohorts who warer increasingly socialized to accept mental 4 health services. Of particular interest is the fact that the percentage of people 65+ fusincj such.services showed an increase of 63% over the 2 decades* from 7.7% to 12.6% of the 65+ age group. Looking longitudinally at those in the age 40-59 range in A J Ln 1 9 5 7 , their percentage use increased from 12.6% to 15.4% in 197 9^*^^ They apparently maintained their original propensity for helpseeking as well as sharing in the nationwide increase in helpseeking across those 20 years. At the very least there was no decrease with age in rate of receiving mental health services.
Object Description
Title | Geropsychology |
Subject | geropsychology; clinical health psychology; mental health services; older people; aging; aged; clinical psychology; mental health |
Subject Keyword | geropsychology |
Subject LCSH | clinical health psychology; mental health services; older people; aging |
Subject MeSH | aged; clinical psychology; mental health |
Description | Address delivered to the Philadelphia Society of Clinical Psychologists (June 2, 1990) |
Abstract | While, historically, older adults have made up a very small proportion of those seeking mental health services, evidence suggests that clinical psychologists should prepare themselves for a growing number of patients over the age of 65. One study found that a willingness of a person to view their problems in psychological terms was the most important factor determining their use of mental health services. While older adults born prior to the advent of modern clinical psychology are less likely to seek professional mental health help, those born later are more receptive to this option, beginning a trend of increased acceptance of psychological services by the elderly. Clinical psychologists should immediately work to improve the quality of their services to older adults by emphasizing a lifespan perspective in credentialing and continuing education requirements. // This presentation includes some handwritten corrections. --AJL |
Creator | Lawton, M. Powell, 1923-2001 |
Publisher | Polisher Research Institute |
Contributors Principal Investigators | Rachel R. Resnick |
Contributors Research Assistants | Karen C. Kohn; Nicole Snyder; Amanda J. Lehning; Arthur Shum |
Contributors Reviewers | Philip D. Sloane; Maggie Calkins; Laura Gitlin; Jeanne Teresi; Patricia Parmelee |
Physical Description | 10 p. |
Date | 1990 |
Type | Text |
Original Format | Publications |
Digital Format | application/pdf |
Class Number LCC | RC451 |
Class Number NLMC | WT 105 |
Class Number DDC | 616.890084 |
Language | English |
Relation | Lawton, M.P. (1970). Gerontology in clinical psychology, and vice versa. Aging and Human Development, 1, 147-159. // Lawton, M.P., & Gottesman, L.E. (1974). Psychological services to the elderly. American Psychologist, 29, 689-693. // Lawton, M.P. (1976). Geropsychological knowledge as a background for psychotherapy with older people. Journal of Geriatric Psychiatry, 9, 221-233. // Kaye, J.M., Lawton, M.P., & Kaye, D. (1990). Attitudes of elderly people about clinical research on aging. The Gerontologist, 30, 100-106. |
Rights | http://rightsstatements.org/vocab/InC/1.0/ |
Contributing Institution | Polisher Research Institute |
Sponsorship | This Digital Object is provided in a collection that is included in POWER Library: Pennsylvania Photos and Documents, which is funded by the Office of Commonwealth Libraries of Pennsylvania/Pennsylvania Department of Education. |
Full Text | Geropsychology, 1990 M. Powell Lawton, Ph.D. Philadelphia Geriatric Center One of my most vivid training experiences was 2 years of psychological test seminars with David Wechsler. Wechsler was in his 60s then and he delighted in drawing and redrawing his age curve of raw scores on the Wechsler-Bellevuse. He liked that curve because it was one of the all-time great illustrations of a major effect: a steep rise until age 22, a fairly flat shape through most of adulthood, and an accelerating decline beginning around age 60-65. He was proud to have generated such compelling He was pretty evidence of the rise and fall of intelligence. forgetful himself, which he enjoyed pointing out and blaming not on himself but on the built-in biology of age-related intellectual deterioration. C The geropsychology of the time was characterized by a number of similar oversimplifications, many of them reinforcing an ageism that saw older people as inevitably confused and debilitated. Another psychologist of the time was Irving Lorge '^- f^^-f (of the Thorndike-Lorge word list) who was a--pioneer i t f ^ aging. to teach a course based on empirical knowledge about Courses at TC Columbia at the time were coded with 3 Although Lorge was one of the pioneers digits and 2 letters. against ageism he couldn't resist giving his course the number Address delivered to the Philadelphia Society of Clinical Psychologists, June 2 f 1990. 207AK, which those of you who know the term "alte kaker11 will no doubt recognize. We've come a long way since then, much of the motive power for new research having come from the changing demography of age about which so much has been written. I'll give myself a quota of just 5 tidbits of litany to illustrate why aging is no longer A the coming thing but the arrived thing: As of the end of WWII people 65+ constituted every twelfth person in the country. Before the end of our century they will represent every eighth person During the same time period, years have continued to be added to the lives of people even after they have reached age 6 5 : Over those 40 years men have been benefited by more than 2 additional years, women by almost 4. The very old as a group are growing. In 1950 the 85+ By 2000, they constituted 4.7% of the 65+ population. will constitute 13.3% of all older people. More than 80% have one or more chronic diseases, including 4 to 6 percent who suffer from Alzheimers disease. Despite this general level of morbidity only 5% are institutionalized and only 10% of those living in the community have self-care problems marked enough to require the help of another person. These snippets portray the magnitude of the societal issues revolving around the older population in terms of its relative m a s s , its center of gravity moving into the old-old region, and its health status -- the bad news is age-related morbidity and the good news is that morbidity does not necessarily equal disability and dependence. With this prologue completed, I'd like to take the rest of my time for a few thoughts on the relevance of aging for the practice of clinical psychology. The Relevance of Age and Cohort Membership to the Practice of Clinical Psychology Over the past years several studies have appeared of the age distribution of people in treatment for psychological conditions. Various estimates have appeared: In 1978 3% of psychiatrist office visits were by people 65+ and over, exactly the percentage estimated by Eisdoi^ter in 1987 for all private-practice mental health services. For CMHCs the estimate of percentage of all These percentages are A Is visits made by those 65+ was 6% (1984). grossly lower than the population proportion of older people. fact of life is thus thatause rates for MH services, a f * low. ji it ageism in professional practice, a matter of older people's lower income, of very limited reimbursement capacity, or of reluctance by older people to seek psychological services? It is worth lingering on this question in order to plan for the future. Mental health services now being planned and individual practitioners looking ahead may benefit from some interesting data relevant to changing demand for mental health services by the elderly. When considering change over time we have 3 inextricably related phenomena to consider. First is chronological aging. Second is life experiences that are specific to the periods of one's life, the sol-called cohort effects common to people born at a particular time. The third is historical time changes to which all people are exposed, such as world war^s and economic ^depression. Probably most of you are aware how recognition of these influences has enabled us to characterize many effects once presumed to have been due to aging (for exaMple, performance on some intellectual tasks) as being due to differential educational experience associated with birth cohort membership, rather than chronological aging. Similar considerations apply to attitudes, expectations, and behaviors associated with mental health and its treatment. I'll quote at length some relatively neglected findings from a study that allowed us to partially separate the contributions of age, cohort, and period diffeierrees to what we might call "readiness to seek mental health services." This study by Veroff, Gurin, and others was one of the landmark efforts that launched the Community Mental Health movement. The study was commissioned by the Presidential Task Force on Mental Health and Mental Illness to understand the position of mental health among the American public. The book that appeared in 1957, Americans View Their Mental Health, reported the state of people's mental health, their attitudes toward psychological concepts, their receipt of various mental health services, and their expectations about what they would do should they need help. was repeated 2 decades later. Essentially the same survey It has now been 16 years since that followup survey and one hopes that there will be a third coming along soon. Such a repeated study offers 3 possibilities for understanding any given issue. Responses to a particular question may change over 20 years for the entire population, in which case one would infer that social-historical change had influenced everyone's behavior or attitude. A second change might look at people in 1957 and see howA20 (A years of continued A :/ / f living might have affected responses -- the effect of age. Finallyf differences between people of one age in 1957 and different people the same age in 1977 would reflect birth cohort differences. You'll no doubt recognize that one can't separate there are always 2 of them each of the 3 effects one at a time -- that are confounded -- but I'll just implicitly take that into account as I note the findings. From 1957 to 1976 there was a substantial increase in the proportion of people of all ages who actually used some professional mental health services, an increase that could have been due to both increasing acceptance of such services as a function of time or to the movement through the at-risk period of birth cohorts who warer increasingly socialized to accept mental 4 health services. Of particular interest is the fact that the percentage of people 65+ fusincj such.services showed an increase of 63% over the 2 decades* from 7.7% to 12.6% of the 65+ age group. Looking longitudinally at those in the age 40-59 range in A J Ln 1 9 5 7 , their percentage use increased from 12.6% to 15.4% in 197 9^*^^ They apparently maintained their original propensity for helpseeking as well as sharing in the nationwide increase in helpseeking across those 20 years. At the very least there was no decrease with age in rate of receiving mental health services. A Similar changes were seen in the % who defined any of a series of personal problems in mental health terms and in the % who thought they would seek professional assistance if they should develop personal problems. When this expectancy of help- seeking was expressed as a percentage of all those who construed their problems in mental health terms, the absolute percentages were surprisingly high and the age difference almost obliterated: In 1976 67% of 65+ with acknowledged mental health problems would seek professional assistance, only 4 points less than the 71% of younger adults who would do so. The critical feature, thenf seems to be the willingness to formulate for oneself a view of problems in psychological terms. The combined effects of social change, cohort movement, and aging all show increased acceptance of psychotherapy and other personal interventions over time. As oldest cohorts die they are succeeded by the new aged who were in their twenties during World War II and have been more exposed to psychological ideology in the years that followed. Simply aging as social change moves toward increasing general acceptance of psychological processes and psychotherapy itself is accompanied by individual increase in acceptance despite growing older. One can reasonably infer that We trajectories have orrcnrcca^ since the 1976 survey. have not yet seen a boomeranging of/intrapsychic ideologies. Therefore I think it safe to say that we are at the beginning of an upward trend in acceptability of psychological treatment bythe elderly that may well last 40 years f offset somewhat only if psychological approaches to human problems lose disastrously in public acceptance in - f f e a decades. ffere ft So here they come, the largest aged cohorts ever, socialized to accept psychological interventions -- what will it mean and how will our profession greet this waiting crowd? Recent Changes That Have Occurred Probably the major thing on most of our minds at this point is the independent provider status accorded psychologists under Medicare. This was one of the great triumphs of organized psychology, one that the future will surely judge to have been the major marker of the coming of age of the clinical psychology of later life. If we are fortunate this achievement may also prove to have been the turning point in acceptance of psychology j f - a future national health plan. rt To many individual clinical psychologists participation in Medicare will mean considerable expansion of possibilities for private practice. With that fact taken for granted, I'd like to spend the rest of my time this evening speculating about some possible directions that organized psychology, including the Clinical Society, might take to foster the continued development of professional expertise in working with older people. Credentialing and continuing education are two mechanisms for quality enhancement. Credentialing Medicare legislation specifies no special licensure for psychologist providers. It is unlikely that the regulations will introduce such an idea and I've heard little interest with'APA, N I M H , or elsewhere in geropsychologist licensure or other forms of restrictiveCCrtification. The dominant conviction is that it is desirable for most psychologists to develop broad expertise to work with people of all ages. In many ways we are beginning to appreciate the value of a lifespan perspective, as contrasted with one that is age-specific. The reactionary so-called "generational equity" political movement is an example of extreme age segmentation. To some extent this perspective on generational competition for resources %^? fueled by over-zealous advocacy for the aged subpopulation. At the present time, this divisive position is being counteracted by joint efforts in behalf of families as a whole by organizations such as the Childrens Defense League and the Gerontological Society of America. Their alternative position is that interdependence and supportive behavior across generations are much stronger^ and more productive than age competition. I feel that the anology to the practice of geropsychology works quite well: One can be more effective in treating one generation if one has at least a minimum level of expertise in dealing with other generations. Another argument against restrictive credentialing is that it would in fact limit the supply of an already scarce resource. Even as the critical mass of people with some training in geropsychology increases in the future I hope we can resist any move toward closing ranks. I am convinced that older patients will benefit from a free market and the greater diversity and choice that such openness would afford. Concurrently however there is a major immediate need for training in both general gerontology and the age-specific facets of clinical psychology. Over the long range this goal can be accomplished only through complete integration of such content 8 into university clinical psychology programs. In 1981 APA sponsored a conference on training in geropsychology, the "Older Boulder Conference," where a series of recommendations were made regarding the need to fortify undergraduate psychology and graduate clinical psychology programs with content appropriate to the full adult lifespan. Many recommendations were made regarding the content of such training and the need for analogous opportunities at the internship and continuing education level. For the most part progress in this direction has been disappointing. The Medicare participation victory came unexpectedly early and we have some substantial catching up to do at the university level. In the meantime continuing education is clearly where concentrated effort will be well placed. The burden is-&?xmm$ey on organizations like PSCP and PPA to step up their activities by providing short training experiences in limited areas such as behavioral methods for older people and their families; depression in the eldely; counseling caregivers of dementia patients; neuropsychological assessment of older people; multilevel assessment of older people. PSCP will sponsor a session on group psychotherapy with the aged this fall. I think it would be worth the effort by PSCP to lay out a ^CiW?wJr~ii*JLfl_ plan Uvp^^gf^fg^ffilff^ when periodic CE sessions of this type could be offered so as to cover several of the highest-priority areas that could elevate level of expertise in working with older people. The big problem is whether enough participants can be 9 attracted to such training sessions. Continuing education requirements for licensure do wonders for enrollment, and we shall probably see 5 o f e of that. T!T In addition, however f I'd like to see the professional organizations evolve some formal educational criteria for awarding certificates of purely incremental, rather than restrictive, significance. If the size and consumer demand of the older adult population become as great as I predict, a certificate tfiQaffking educational attainment in the psychology of adult development ought to constitute an effective appeal for the older patient. Therefore, I'll end these remarks by suggesting that PSCP continue its concern with upgrading the skill level of its members in geropsychology. I have great confidence that it will Both the aged and be an investment well worth the effort. clinical psychology will be better off if a large number of good psychologists learn about aging than if a small number become good geropsychologists. Age-specialized clinicians will have plenty to do being the resource and training nucleus for generalized gerontologizing activity. But let me thank this group as a whole and all the individual members over the years for their expressions of appreciation of the place the older person holds in our Society. Your record in this respect is really extraordinary. You honored one of our great Philadelphians, Maggie Kuhn 15 years ago and Sam Granick, unquestionably the first clinician in Phila. to identify himself with aging, 10 years ago. thriving. Both of them are still I hope that PSCP and geropsychology will do the same. 10 |
Contributors Authors | M. Powell Lawton |
Access Rights | fair use rights |
Description
Title | Geropsychology (pages 1-5) |
Subject | geropsychology; clinical health psychology; mental health services; older people; aging; aged; clinical psychology; mental health |
Subject Keyword | geropsychology |
Subject LCSH | clinical health psychology; mental health services; older people; aging |
Subject MeSH | aged; clinical psychology; mental health |
Description | Address delivered to the Philadelphia Society of Clinical Psychologists (June 2, 1990) |
Abstract | While, historically, older adults have made up a very small proportion of those seeking mental health services, evidence suggests that clinical psychologists should prepare themselves for a growing number of patients over the age of 65. One study found that a willingness of a person to view their problems in psychological terms was the most important factor determining their use of mental health services. While older adults born prior to the advent of modern clinical psychology are less likely to seek professional mental health help, those born later are more receptive to this option, beginning a trend of increased acceptance of psychological services by the elderly. Clinical psychologists should immediately work to improve the quality of their services to older adults by emphasizing a lifespan perspective in credentialing and continuing education requirements. // This presentation includes some handwritten corrections. --AJL |
Creator | Lawton, M. Powell, 1923-2001 |
Publisher | Polisher Research Institute |
Contributors Principal Investigators | Rachel R. Resnick |
Contributors Research Assistants | Karen C. Kohn; Nicole Snyder; Amanda J. Lehning; Arthur Shum |
Contributors Reviewers | Philip D. Sloane; Maggie Calkins; Laura Gitlin; Jeanne Teresi; Patricia Parmelee |
Physical Description | 5 p. |
Date | 1990 |
Type | Text |
Original Format | Publications |
Digital Format | application/pdf |
Identifier | 1990Ger1.pdf |
Class Number LCC | RC451 |
Class Number NLMC | WT 105 |
Class Number DDC | 616.890084 |
Language | English |
Relation | Lawton, M.P. (1970). Gerontology in clinical psychology, and vice versa. Aging and Human Development, 1, 147-159. // Lawton, M.P., & Gottesman, L.E. (1974). Psychological services to the elderly. American Psychologist, 29, 689-693. // Lawton, M.P. (1976). Geropsychological knowledge as a background for psychotherapy with older people. Journal of Geriatric Psychiatry, 9, 221-233. // Kaye, J.M., Lawton, M.P., & Kaye, D. (1990). Attitudes of elderly people about clinical research on aging. The Gerontologist, 30, 100-106. |
Rights | http://rightsstatements.org/vocab/InC/1.0/ |
Contributing Institution | Polisher Research Institute |
Sponsorship | This Digital Object is provided in a collection that is included in POWER Library: Pennsylvania Photos and Documents, which is funded by the Office of Commonwealth Libraries of Pennsylvania/Pennsylvania Department of Education. |
Full Text | Geropsychology, 1990 M. Powell Lawton, Ph.D. Philadelphia Geriatric Center One of my most vivid training experiences was 2 years of psychological test seminars with David Wechsler. Wechsler was in his 60s then and he delighted in drawing and redrawing his age curve of raw scores on the Wechsler-Bellevuse. He liked that curve because it was one of the all-time great illustrations of a major effect: a steep rise until age 22, a fairly flat shape through most of adulthood, and an accelerating decline beginning around age 60-65. He was proud to have generated such compelling He was pretty evidence of the rise and fall of intelligence. forgetful himself, which he enjoyed pointing out and blaming not on himself but on the built-in biology of age-related intellectual deterioration. C The geropsychology of the time was characterized by a number of similar oversimplifications, many of them reinforcing an ageism that saw older people as inevitably confused and debilitated. Another psychologist of the time was Irving Lorge '^- f^^-f (of the Thorndike-Lorge word list) who was a--pioneer i t f ^ aging. to teach a course based on empirical knowledge about Courses at TC Columbia at the time were coded with 3 Although Lorge was one of the pioneers digits and 2 letters. against ageism he couldn't resist giving his course the number Address delivered to the Philadelphia Society of Clinical Psychologists, June 2 f 1990. 207AK, which those of you who know the term "alte kaker11 will no doubt recognize. We've come a long way since then, much of the motive power for new research having come from the changing demography of age about which so much has been written. I'll give myself a quota of just 5 tidbits of litany to illustrate why aging is no longer A the coming thing but the arrived thing: As of the end of WWII people 65+ constituted every twelfth person in the country. Before the end of our century they will represent every eighth person During the same time period, years have continued to be added to the lives of people even after they have reached age 6 5 : Over those 40 years men have been benefited by more than 2 additional years, women by almost 4. The very old as a group are growing. In 1950 the 85+ By 2000, they constituted 4.7% of the 65+ population. will constitute 13.3% of all older people. More than 80% have one or more chronic diseases, including 4 to 6 percent who suffer from Alzheimers disease. Despite this general level of morbidity only 5% are institutionalized and only 10% of those living in the community have self-care problems marked enough to require the help of another person. These snippets portray the magnitude of the societal issues revolving around the older population in terms of its relative m a s s , its center of gravity moving into the old-old region, and its health status -- the bad news is age-related morbidity and the good news is that morbidity does not necessarily equal disability and dependence. With this prologue completed, I'd like to take the rest of my time for a few thoughts on the relevance of aging for the practice of clinical psychology. The Relevance of Age and Cohort Membership to the Practice of Clinical Psychology Over the past years several studies have appeared of the age distribution of people in treatment for psychological conditions. Various estimates have appeared: In 1978 3% of psychiatrist office visits were by people 65+ and over, exactly the percentage estimated by Eisdoi^ter in 1987 for all private-practice mental health services. For CMHCs the estimate of percentage of all These percentages are A Is visits made by those 65+ was 6% (1984). grossly lower than the population proportion of older people. fact of life is thus thatause rates for MH services, a f * low. ji it ageism in professional practice, a matter of older people's lower income, of very limited reimbursement capacity, or of reluctance by older people to seek psychological services? It is worth lingering on this question in order to plan for the future. Mental health services now being planned and individual practitioners looking ahead may benefit from some interesting data relevant to changing demand for mental health services by the elderly. When considering change over time we have 3 inextricably related phenomena to consider. First is chronological aging. Second is life experiences that are specific to the periods of one's life, the sol-called cohort effects common to people born at a particular time. The third is historical time changes to which all people are exposed, such as world war^s and economic ^depression. Probably most of you are aware how recognition of these influences has enabled us to characterize many effects once presumed to have been due to aging (for exaMple, performance on some intellectual tasks) as being due to differential educational experience associated with birth cohort membership, rather than chronological aging. Similar considerations apply to attitudes, expectations, and behaviors associated with mental health and its treatment. I'll quote at length some relatively neglected findings from a study that allowed us to partially separate the contributions of age, cohort, and period diffeierrees to what we might call "readiness to seek mental health services." This study by Veroff, Gurin, and others was one of the landmark efforts that launched the Community Mental Health movement. The study was commissioned by the Presidential Task Force on Mental Health and Mental Illness to understand the position of mental health among the American public. The book that appeared in 1957, Americans View Their Mental Health, reported the state of people's mental health, their attitudes toward psychological concepts, their receipt of various mental health services, and their expectations about what they would do should they need help. was repeated 2 decades later. Essentially the same survey It has now been 16 years since that followup survey and one hopes that there will be a third coming along soon. Such a repeated study offers 3 possibilities for understanding any given issue. Responses to a particular question may change over 20 years for the entire population, in which case one would infer that social-historical change had influenced everyone's behavior or attitude. A second change might look at people in 1957 and see howA20 (A years of continued A :/ / f living might have affected responses -- the effect of age. Finallyf differences between people of one age in 1957 and different people the same age in 1977 would reflect birth cohort differences. You'll no doubt recognize that one can't separate there are always 2 of them each of the 3 effects one at a time -- that are confounded -- but I'll just implicitly take that into account as I note the findings. From 1957 to 1976 there was a substantial increase in the proportion of people of all ages who actually used some professional mental health services, an increase that could have been due to both increasing acceptance of such services as a function of time or to the movement through the at-risk period of birth cohorts who warer increasingly socialized to accept mental 4 health services. Of particular interest is the fact that the percentage of people 65+ fusincj such.services showed an increase of 63% over the 2 decades* from 7.7% to 12.6% of the 65+ age group. Looking longitudinally at those in the age 40-59 range in A J Ln 1 9 5 7 , their percentage use increased from 12.6% to 15.4% in 197 9^*^^ They apparently maintained their original propensity for helpseeking as well as sharing in the nationwide increase in helpseeking across those 20 years. At the very least there was no decrease with age in rate of receiving mental health services. |
Contributors Authors | M. Powell Lawton |
Access Rights | fair use rights |
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