Abstract
Based on their education and training, clinicians have a general knowledge of assessment and treatment. However, with each population they work with, they need to understand the intricacies of that population in order to effectively provide care. This often requires additional knowledge or training specific to that population. As the older adult population continues to rise and the possibility that a clinician will be working with an older adult increases, it is timely to have a guide for clinicians working with older adults and addressing the differences in working with an older adult population. Psychological Assessment and Treatment of Older Adults, edited by Nancy A. Pachana, Victor Molinari, Larry W. Thompson, and Dolores Gallagher-Thompson, provides readers with a comprehensive text that addresses the complexity of working with older adults (Chapter 1) and the importance of a holistic clinical assessment for older adults (Chapter 2). Overviews for four diagnoses are presented (depression, anxiety, posttraumatic stress disorder, and dementia), along with how to assess each diagnosis and effective interventions that can be used with older adults depending on their diagnosis (Chapters 3–6). Topics relevant to older adults such as long-term care, decisional capacity, and elder abuse are discussed (Chapters 7–9) and finally, the text closes with end-of-life issues (Chapters 10–11). Interwoven throughout each chapter and specific to the topic(s) discussed are case examples that present practical applications, cultural implications, and the relevance of the Pikes Peak competencies.
Chapter 1 shares a brief overview of the heterogeneity among older adults. Pachana and Thompson emphasize the need for geropsychologists to provide person-centered care when working with older adults and note the competencies required for working with this specific population. Chapter 2 describes the components needed prior to and during a clinical assessment of an older adult in order to appropriately determine a psychiatric diagnosis and/or cognitive disorder. Samarina and colleagues highlight the importance of practicing culturally competent assessments of older adults that take into consideration ethnicity, cultural background, primary language, and gender identity, to name a few. Cultural implications are incorporated among the discussion for each of the validated assessment tools in the chapter and are further addressed in each of the remaining chapters in relation to the topics presented.
For older adults who have depression, cognitive behavioral therapy (CBT) is presented as an effective intervention in Chapter 3. Steffen, Gallagher-Thompson, and Thompson set the foundation in the beginning of the chapter by discussing the behavioral model of depression in late life and sharing an overview of CBT principles distinctly related to working with older adults. The authors concentrate the rest of the chapter on explaining how to use a strength-based therapeutic approach along with CBT strategies such as bringing out emotional experiences, behavioral activation, and cognitive restructuring. In Chapter 4, additional interventions for depression are discussed—acceptance and commitment therapy (ACT), interpersonal psychotherapy (IPT), and dialectical behavior therapy (DBT). Gallego-Alberto and colleagues provide an overview of each approach along with what to take into consideration when trreating older adults.
Older adults who have an anxiety disorder or posttraumatic stress disorder (PTSD) are the focus of Chapter 5. O’Riley and co-authors present each disorder with an overview of the prevalence among older adults, ways to assess for the disorder, and their occurrence with comorbidities. Interventions discussed in this chapter for anxiety include CBT, ACT, IPT, and different relaxation techniques. For older adults with PTSD, interventions noted in this chapter are cognitive processing therapy, eye-movement desensitization and reprocessing therapy, and prolonged exposure therapy. Chapter 6 discusses practice with persons with dementia and their caretaker. Gallagher-Thompson and Thompson begin the chapter with a comprehensive definition of “dementia” and then share recommendations of nonpharmacological interventions that may be used when helping persons with dementia and, depending on their stage, this may also include their caregiver. The nonpharmacological interventions discussed include CBT, reminiscence therapy, music therapy, and problem-solving therapy. Lifestyle interventions (i.e., exercise, brain games, diet, and social activity) are also presented as preventative measures that may reduce the likelihood of dementia.
Working with older adults residing in long-term care (LTC) is presented in Chapter 7. Rouse and Molinari note that while there are similarities between the mental health needs of older adults residing in the community and older adults residing in LTC, there are also differences between the settings that need to be taken into consideration by a practitioner working with a LTC resident. To guide geropsychologists working with older adults in LTC, the authors describe conceptual models (i.e., person-environment model, antecedent-behavioral consequence model, and behaviors models specific to older adults with dementia) that can be used to understand symptoms of mental health issues or problematic behaviors. Additionally, three evidence-based interventions [reminiscence therapy, CBT, and Staff Training in Assisted living Residences- Veterans Affairs (STAR-VA)] are discussed in relation to their application in LTC settings. Chapter 8 covers determining decisional capacity. Bush and Wood cover the main issues in determining capacity including differences in state statutes, influences of culture and family, and ethical and legal challenges. Finally, the authors describe the steps in a systematic capacity assessment process. Chapter 9 focuses on elder abuse. Page and Yehyawi note the challenges in defining elder abuse and the prevalence of elder abuse. The authors present and describe screening tools that geropsychologists may use to determine elder abuse. An emphasis is placed on the importance of taking into account capacity, undue influence, and the role as a mandated reporter.
Interventions used in palliative care contexts are shared in Chapter 10. Allen, Kasl-Godley, and Reel address the competencies needed when working with older adults in palliative care. The authors note the value in using developmental theory to guide which interventions are used with this population. Chapter 11 builds upon the previous chapter by presenting interventions for mental disorders (i.e., major depressive disorder, anxiety disorder, PTSD, and substance use) specific to older adults receiving palliative care. Kasl-Godley and Allen end the chapter focusing on those caring for someone receiving palliative care along with useful bereavement interventions for them.
This book is a valuable resource for clinical geropsychologists, social workers, or those working in a clinical capacity with older adults. It is also a useful guide for those in school to become clinicians working with older adults. One could envision this being used as a primary text in a graduate course on mental health and later life or specific chapters being used as supplemental readings for other gerontology-related courses. The book provides clinicians with a holistic view in order understand the complexities of working with an older adult population and describes evidence-based interventions to use when working with older adults. In addition, this book has several significant strengths including the expert knowledge provided by those in the field of clinical geropsychology, the extensive use of case examples, and the emphasis on cultural competence throughout the text.