Old age brings with it unique challenges in diagnosis, treatment, and care; dementia complicates these issues even more. Improving the management and care of persons with dementia has positive implications for patients, caregivers, and physicians alike. Two types of secondary complications can be analyzed in relation to dementia: conditions that arise outside of the dementia and then conditions that appear to develop due to the neurological degeneration inherent in dementia. Examples of psychiatric complications include depression, anxiety, and psychosis. Medical problems consist of issues such as stroke, cardiovascular problems, cancer, infections, orthopedic issues, diabetes, nutritional disorders, vision and hearing problems, as well as general pain. The high comorbidity of dementias with other psychiatric and medical issues can complicate the diagnosis and treatment of patients with dementia. Issues in the central nervous system (CNS) have long been looked at as possible predictors of dementia.

Alzheimer’s disease (AD) and related cortical dementias are a major health problem. Patients with AD and related dementia have more hospital stays, have more skilled nursing home stays, and utilize more home health care visits compared to older adults without dementia. This chapter discusses the role of family caregivers and how they interact with in-home assistance, day care, assisted living, and nursing homes in the care of an individual with dementia. It also discuss important transitions in the trajectory of dementia care, including diagnosis, treatment decision making, home and day care issues, long-term care placement, and death. It highlights the importance of caregiver assessment, education, and intervention as part of the care process. Dementia caregivers are at risk of a variety of negative mental health consequences. Another important moderating variable for dementia caregiver distress is self-efficacy.

Online dating is becoming more and more common among younger people as well as older adults. There are many different websites that people interested in online dating can use or subscribe to nowadays. There are also many dating services that aim at a large part of the population and try to distinguish themselves by means of the particular matching services they offer or by the number of potential partners people have access to through their site. Throughout most of human history, until very recently, one's choice of dates was restrained by geography. In addition, there are biological approaches that can be used as a complement to dating websites and are often integrated into these sites. Often people move their conversations off the dating website relatively quickly and converse by e-mail or phone to get to know each other better.

To truly understand how important and central memory is to us, it is important to understand what life is like for people who experience memory loss, or amnesia. This chapter examines the amnestic syndrome, which has been widely studied and the knowledge of which has significantly influenced theories of memory. The abilities and nonabilities of those with amnestic syndrome demonstrate that there are multiple independent systems of memory. The chapter also examines two controversial diagnoses, the main feature of which is memory loss dissociative identity disorder (DID) and psychogenic or dissociative amnesia. It discusses a form of memory loss that does not fit the technical definition of amnesia because it eventually affects not just memory but all cognition: Alzheimer’s disease (AD). AD is common among older adults and demonstrates how a worsening loss of memory and cognition can lead to a complete disruption of everyday life.

Improved nutritional status is an important component of efforts to improve the health of older adults, whose ability to consume a healthy diet is affected by comorbidities and behavioral, cognitive, and psychological factors. In addition to genetics and nutrition intake, nutritional status of the elderly could be affected by socioeconomic factors, such as education and income levels, and environmental factors, such as proximity to stores and transportation, that can affect food variety and availability. Nutrition and aging are connected inseparably because eating patterns affect progress of many chronic and degenerative diseases associated with aging. Anthropometric measurements are often used for nutritional assessment of older adults and are reliable across ethnicities. The Mini-Nutritional Assessment (MNA) tool was developed to evaluate the risk of malnutrition among frail older adults. Dietary patterns may better capture the multifaceted effects of diet on body composition than individual nutrients or foods.

This chapter focuses on informal caregiving among minority groups. It also focuses on context of caregiving and discuss the various specific challenges caregivers of minority older adults face. The chapter examines some of the specific caregiving interventions tailored for families of color and discuss the implications for practice, policy, and research. Medical advances and greater longevity point to healthier and longer lives for many, but both formal and informal caregiving remain a concern as individuals age and develop conditions that require care. Caregivers are often able to realize the positive aspects of caregiving when they are not struggling with financial or social support challenges. Despite the vast literature on caregiving in general, research pertaining to the needs and experiences of racial/ethnic minority older adults and their caregivers is limited, particularly for American Indians, Pacific Islanders, specific Asian American and Latino subgroups, and religious minorities groups such as Muslim Americans.

This chapter provides definitions and theoretical perspectives regarding the productive engagement of older adults. It explores the productive engagement of four ethnic minority groups African Americans, Hispanic Americans, Asian Americans, and Native Americans. The chapter discusses programs and policies that will help increase the productive engagement of older adults. It is possible that older adults will be judged by their ability to be productive and expected to be productive. Those older adults who have been disadvantaged across the life course will continue to be disadvantaged in later life when they still face discrimination in access to or support for productive engagement. Both definitions and theoretical perspectives are important to understanding the productive engagement of older racial/ethnic minorities. At the societal level, increasing the productive engagement of older adults, in general, may increase the supply of experienced employees, volunteers, and caregivers.

This chapter provides a selective review of research on social support among older African American, Hispanic, Asian American, and Native American adults. It focuses on social support as a dependent variable in relation to different sources and types of aid provided to older African American, Hispanic, Asian American, and Native American adults. The chapter highlights the findings in three specific areas: marriage and romantic relationships, extended family and non-kin as sources of informal social support, and black-white differences in informal social support. Informal social support networks are critical for individuals of all ages but especially for older adults who are dealing with difficult life circumstances. Older African Americans depend on informal social support networks of family and friends for assistance in emergency situations, as well as for help with various tasks of daily life. Elderly Asians often utilize kin and social support networks for a variety of reasons.

This chapter discusses current thinking in the field of social support and social relationships, and physical and mental health among older racial and ethnic minorities. Social relationships are an important predictor of health and psychological well-being across the life course. Many minority older adults will face the continued challenges of declining functional status due to physical and mental health conditions over the course of their lives. Most empirical studies on social support among older racial and ethnic minority adults explore the association between social support and both physical and mental health. The wealth of studies on social support among minority older adults has much to offer with respect to understanding the correlates of emotional support and patterns of assistance. The biological mechanisms explaining the link between social support and physical health outcomes have been largely unexplored among older racial and ethnic minority groups.

This chapter summarizes and discusses the findings of the predictors of nursing home admissions and the issues regarding access among four groups of racial/ethnic minority older adults: blacks/African Americans; Hispanics/Latinos; Asians/Pacific Islanders; and American Indians/Native Americans. It provides a summary of the need for providing culturally competent nursing home care and future directions for alleviating racial/ethnic disparities and segregation in nursing home care. Minority older adults were once disproportionately underrepresented among nursing home residents. With the demographic revolution among racial/ethnic minorities and older adults, the number of racial/ethnic minority nursing home residents will continue to increase. Improvement in the quality of nursing home care for racial/ethnic minorities also requires culturally competent care. In providing culturally competent nursing home care, nursing home administrators and staff should involve community representatives from faith/spiritual communities and from civic and cultural organizations in the facility’s planning, monitoring, and quality-improvement meetings.

Social work is an applied discipline with a long tradition of using the theories and methods of social sciences to enhance practice, policy, and research. In their professional roles, social workers practice work with minority older adults and their families in diverse community-based and institutional settings that encompass social and health services. The conduct of social work practitioners and researchers in working with human populations is guided by the Code of Ethics of the National Association of Social Workers. A more sustained and concerted effort is required to ensure that there is a sufficient supply of gerontologically trained social workers to meet the growing demands of a more aged and diverse society. Social work researchers and practitioners will need to be responsive to the impact of government social spending cuts on the availability and delivery of services to their elderly clients who are most in need.

This chapter enhances the understanding of the multifaceted challenges that individuals, especially older adults, seeking housing with a criminal background face. It reviews the ways in which individuals, especially older adults, can be vulnerable in terms of safety and security in their housing settings. Older adults may be particularly concerned about security and safety at home because their homes have been shown to be places where they can be victimized, either by telephone scams, door-to-door solicitation, bullying in age-congregate settings, and witnessing other crimes occurring in their residences. The chapter discusses ways in which forensic practitioners can support vulnerable populations, including older adults. It also discusses the complexities of affordable and safe housing using case examples and descriptions focusing on the older adult population. The chapter provides further recommendations on other areas of assessment and intervention that forensic social workers can conduct.

This chapter sheds light on how the managed care system works as well as the counselor's role in managed care and the importance of advocacy and issues related to payment and reimbursement. It offers a starting point to understand the system, and counselors must continue to seek more resources, join organizations and build networks with other counselors and change makers to become active members of the professional community. Managed care is an integral part of the healthcare system, and it is imperative for counselors to be able to understand the system in order to navigate it better. Counselors can anticipate the issues that are related to cost and payments and can provide more efficient service to the clients, if they understand how managed care system operates. The chapter demystifies the issues of payment for counseling services, specifically third-party billing, managed care, medical assistance programs, and other issues therein.

Housing communities for older adults are not a contemporary concept. The guiding concept of creating older communities is the desire to give older adults an alternative concept of housing that will allow them to sustain themselves economically, while giving choice and an element of control over their health care, social networks, and physical environment. Many older adults choose retirement communities for an added sense of personal security and continued independent living as a beginning preparation for their ultimate mortality. Aging in place encompasses an older adult staying in his or her home throughout the aging cycle or moving to housing that provides limited services such as an option for communal dining, cleaning services, and transportation. Like aging-in-place strategies, continuing care and assisted living facilities provide medical and nonmedical living services to older adults who are unable to live independently because of medical illness, cognitive decline, or disability.

Angela was extremely excited to begin school as a kindergarten student and was matched with a supportive teacher for her first year in the rural community in which her family lived. She was lively and talkative around adults, and her parents worked hard to find opportunities for Angela to connect with kids her own age. However, in their small community there were limited possibilities for connection, and Angela often retreated physically behind her parents in public.

During the first parent–teacher conference for Angela, her parents were surprised at the teacher’s observations that Angela was reading well beyond the level of her peers. Not knowing many other children with whom to compare Angela’s abilities, they had assumed she was on par with most other kids her age. While there were no services available in their school system until the third grade, the kindergarten teacher remarked that the Lees might want to look into additional enrichment opportunities for Angela elsewhere. However, the teacher was eager to provide additional reading opportunities. Because reading was one of Angela’s favorite activities, this arrangement seemed to be a good fit.

It was during Angela’s third-grade year that challenges began for her at school. She often came home upset that she was reprimanded at school, and she rarely talked about positive interactions with her peers. She shared with her parents that she did not have much in common with many of the girls in her class, and that they often teased her about her friendship with a boy in the class they all thought was “weird.” This social tension was exacerbated when she was reprimanded for not showing her work in math class. She expressed her frustration with “Why do I need to write out all the steps for something when I just know the answer!” A friend of Angela’s parents worked in the school Angela attended and shared with them that contacting the school counselor might be the best next step.

The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.

This chapter provides a brief overview of models of clinical supervision. It also offers a brief discussion of best practices, common struggles, and a salutogenic- or wellness-based approach to supervision, emphasizing how the latter complements parallel treatment interventions with consumers. Self-care is an important part of a counselor's efforts to maintain general and mental health. The chapter urges counselor trainees to develop continuing education and continued professional development as a part of their career-pathway planning. The discussion emphasizes the importance of remaining current, concerning clinical counseling issues as an ethical issue that is inherent in being a professional. The chapter focuses on the practice and importance of clinical supervision and continuing education for professional counselors. It reviews some of the most common theoretical approaches to supervision and how they may be used. The chapter concludes with a discussion of the ethical mandate and benefits of continuing education for counselors.

This chapter presents a broad and general overview of the structural and physiological changes that occur with aging as well as the underlying pathophysiology of age-related diseases. The body comprises eleven organ systems that include the integumentary, muscular, skeletal, nervous, circulatory, lymphatic, respiratory, endocrine, urinary/excretory, reproductive, and digestive systems. As such, the ensuing sections are arranged by organ system and structured to cover age-related physiological changes and common disorders. Older adults experience a myriad of physiological changes as they age. While some of these physiological changes are benign, other changes increase the risk of age-associated pathophysiological changes, which can result in significant functional impairment or morbidity. These pathophysiological changes are not to be considered part of the normative aging process. Thus, it is essential that providers distinguish between the two states.

School Counselors are uniquely positioned to work as individuals in educational settings to support children and their families, teachers, administrators, and other invested educators. This chapter reviews the school setting which presents distinctive legal and ethical challenges related to counseling minors. It discussed the various roles of school counselors’ within the school setting, as well as ethical challenges and considerations for practice. The chapter compares the ethical codes applicable to the practice of school counseling. It identifies strategies to maintain ethical school counseling practice. School counselors make significant contributions to the educational and personal development of students. When the law and ethics conflict or they cannot be clearly applied in the specific circumstances, school counselors seek consultation, consider ethical implications, apply an ethical decision-making model, and stay apprised of societal changes to make decisions ethically.

The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.

Counseling adults in transition is an exciting and challenging job that gives us an opportunity to function at many different levels. Advocacy, consulting, and program development are three ways that one can assist the clients with their transitions–through changing the situation, enhancing their sense of self, developing more supports, and increasing the strategies available to them. Some counselors now work in the corporate world, and others are community organizers; some counselors design programs in colleges and universities, whereas others develop workshops for senior centers; some walk the halls of legislatures as lobbyists, whereas still others talk about mental health on talk shows, on their own or others’ blogs, on twitter, or other internet sites and social media. This chapter talks about a variety of ways counselors can do these things, including consulting, developing programs, and advocacy.

Clinical gerontological social work practice with older adults is a rapidly growing field encompassing many practice venues. The social work mission with older adults encompasses micro practice, mezzo practice, and overriding macro policies affecting an older adult. Because of the increasing population of older adults, gerontological social work education must be expanded to meet the needs of this population. Collingwood, Emond, and Woodward (2008) propose a theoretical orientation that is adaptable to a social worker assisting older adults. The case of Georgina is an example of how a social worker must understand and implement knowledge of developmental stage theory, environmental influences, and resilience theory when working with an older adult in crisis. A social worker working with older adults must employ advocacy skills and provide concrete services, as well as psychotherapeutic interventions.

The use of counseling technology and electronic communication between clients and counselors has received increasing attention. While there is great potential in using the internet to deliver counseling services, it is critical that counselors are aware of the ethical implications whenever they use technology to interact with clients. The chapter focuses on the ethical use of counseling technology and provision of distance counseling services. It identifies common ethical tensions underlying the decision to use technology when providing counseling services. The chapter promotes the critical-evaluative thinking underlying e-professionalism and technology ethics as necessary habits in the digital age. A focus on accessibility is critical because we are all dependent on digital technology as a necessary form of assistive technology to function in a digital society. Social media has become the way people communicate, and thus counselors need to inform clients about the inherent threats to privacy and confidentiality.

Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.

This chapter provided an overview of the possible effects that the work of counseling may have upon counselors themselves. It has long been recognized that exposure to the distressing experiences and feelings of others can cause similar distress in those who listen and provide intervention. We also recognize that counselors can derive benefit and grow from the work that they do with their clients. Finding approaches to the work of counseling that enhance the potential for growth while minimizing distress is significant part of maintaining successful counseling practice. The chapter addresses issues related to counselor self-care and maintaining a healthy ability to continue with the work of counseling. The issues that are addressed include vicarious responses to trauma (both positive and negative), a biopsychosocial systemic approach to counselor wellness, strategies for engaging in wellness-focused self-evaluation, techniques and tools for stress management, and approaches for maintaining a healthy work/life balance.

This chapter focuses on the prominent psychosocial theories and models used to predict service utilization. It begins with a discussion of Andersen’s Behavioral Model of Health Services, the most commonly used framework for predicting formal service use among older adults. The need-use gap has been documented in use of mental health services, home and community-based services (HCBS) among non-Whites, among caregivers of older adults, and in the use of adult day care, respite care, personal care, meals, and transportation services. The chapter focuses on help-seeking behavior models that were not necessarily developed for or frequently used with older populations, but have the potential for enhancing the study of service use in late life. Developing new theories and further elaborating and testing existing models are essential for unraveling the use-need paradox and helping reduce the barriers to programs and services that, when accessed, can contribute to increased well-being of older adults.

Counselors and clients are immersed in a social and cultural context and embedded in multiple systems and subsystems, such as family, workplace, community, and society. This chapter addresses system views, integrated care, barriers to treatment, multicultural issues, and the use of multicultural and social justice skills in the provision of clinical mental health counseling. Specific topics include a discussion of systems, holistic care, barriers to healthcare, and culturally competent counselors. The chapter further explores the connections between culturally competent care and the potential role for clinical mental health counselors in ascertaining the systemic need for new agency- and integrated healthcare-based programs. The student is introduced to basic tenets of system worldviews, developing integrated new programs aimed at meeting the clinical mental health needs of diverse and varied clients, and the application of multicultural and social justice skills in clinical mental health counseling.

The concept of being an old gay male adult, old lesbian adult, old bisexual adult, or old transgender adult is remote and insignificant to most people. There is an abundance of literature about the younger lesbian, gay, bisexual, and transgender (LGBT) community and a dearth of literature about the older LGBT community. Coming out is a difficult process for anyone, at any developmental stage. It is most difficult when old gay men or old lesbians do not initiate a decision to disclose their sexual identity until late life. Older adults with HIV disease are a significant subpopulation of the current older adult cohort. Transgender older adults are more likely to have a history, as compared with nontransgender people, of sex work, substance and alcohol abuse, and depression. Advocacy model can be adapted to meet the social and clinical needs of the LGBT community.

Our professional roles have evolved over time, and there is a great variety among the roles and functions of clinical mental health counseling (CMHCs) in each and every different system of work. However, there are also great commonalities that continue to define our identity as professionals. This chapter takes an in-depth look at the variety of functions, counseling and administrative roles, and tasks that may be required of counselors in clinical mental health settings. Pertinent issues include balancing consumer care with administrative duties, balancing employee well-being with productivity standards/financial concerns, ethical marketing and recruitment, and remaining current in the field while in nonclinical roles. The chapter helps the reader to discuss the clinical tensions experienced among CMHCs in relation to their job roles and synthesize an understanding of the complex role a CMHC serves in relation to best practices, professional ethics, and legislative regulations.

A psychologist must confront many prejudices against older adults that are manifested in most people in non-older adult cohorts. Clinical psychologists specializing in geropsychology work with individual older adults; family members of older adults, including spouses/partners, siblings, and adult children; and caregivers when treating the psychological problems experienced by older adults and dealing with issues of caregiving to older adults experiencing mental illness, dementia, and/or psychological reactions to co-occurring medical illnesses. Unfortunately, despite the fact that older adults are affected by the forces of ageism and stigma, and the fact that community psychologists strive to understand and improve social inequalities and to enable empowerment of marginalized people, there is a significant dearth of research in the field of community psychology. There are four types of ageism: personal, institutional, intentional, and unintentional. The majority of older adults have experienced age discrimination and stigmatization at some time after the age of 65.

Aside from the study of theories of counseling and psychotherapy, there is probably no other area of study that is more related to the everyday practice of counseling that than the area of professional ethics. This chapter defines terms related to the ethical practice of counseling and psychotherapy such as an “ethics”, “morality”, and an “ethical dilemma”. It differentiates professional versus philosophical ethics. The chapter outlines mandatory versus inspirational standards of practice. It also addresses professional credentialing issues, along with the need for ethical sensitivity in decision making. The chapter explains the system of ethics governance in counseling and defines skills necessary to become a professional decision maker. Decision making is a cornerstone of professionalism. Counselors must be viewed, and must view themselves, as intellectuals. They must also invest in their profession and be actively engaged in professional activities that better the profession and those served by the profession.

Documentation and record keeping are not only legal and ethical mandates, they are also instrumental in providing competent, quality care to clients. This chapter discusses the importance of the record keeping and documentation processes for clinical mental health counselors. Specifically, it reviews record keeping practices and policies. Also included are legal and ethical issues related to appropriate documentation and record keeping, including the Health Insurance Portability and Accountability Act, subpoenas, and court orders. The chapter helps the reader to distinguish the content of clinical records and identify what is included in a client's clinical file. It helps to recognize the ethical obligation of professional counselors related to record keeping; and appreciate the legal elements of record keeping and how professional counselors can adhere to the laws regarding clinical documentation. The goal of counseling is to facilitate change for the client; quality record keeping is an instrumental element of that process.

Counselors hear stories about what might have been, about what should have been, and about what did not happen. Yet much research and counseling advice has been focused only on marker events such as marriage, childbirth, changing jobs, divorce, or being fired. Most of these events are observable; many have rituals and celebrations attached to them. Counselors have enormous power to help clients exchange heartbreaks for heartmends. Counselors need to help clients deal with nonevents. Thus, this chapter focuses on specific suggestions and strategies for counselors to use with their clients. It suggests a three-step program for counselors to use as they help clients work through their nonevents. The three steps are counselors need to use are: understand the concept of nonevents as a way to listen with a third ear; develop specific strategies for clients to use as they cope with nonevents; and teach lessons for life literacy.

This chapter begins with analysis of life-span development and life-course perspectives as applied to research on older adults and their families. It examines theories that are useful for guiding such research, thus yielding broader and deeper understanding of the ways older adults and their relatives negotiate family roles, responsibilities, and interactions in the context of both traditional and pluralistic family configurations. The chapter also examines the promise and problems associated with two key theoretical approaches that have been particularly effective in guiding family gerontology research in recent years, intergenerational solidarity and conflict, and intergenerational ambivalence. These approaches are strong in their own right and have the further advantage of linking well with life-span development and life-course perspectives. The chapter focuses on their theoretical tenets and principles, empirical applications, and strengths and limitations, with a critical assessment throughout. It considers theoretical and empirical directions for future research in family gerontology.

Many older adults are diagnosed with mild cognitive impairment (MCI), a condition that does not meet the criteria for dementia. MCI is considered a risk factor for Alzheimer’s disease-related disorders (ADRD). Although Alzheimer’s disease is a serious problem, this chapter focuses on the five types of dementia commonly seen in practice. These include vascular dementia, dementia with Lewy bodies, Korsakoff syndrome, frontal lobe dementia (including Pick’s disease), and Alzheimer’s disease. Psychoeducational support groups allow the merging of learning about dementia with concomitant psychological support. The breaking of denial enables older adults in these support groups to make better sense of their disease, increasing their abilities to comply with treatments and caretakers. Leisure activities, whether community based or solitary, are shown to be protective against dementia or, at the least, stall the onset of dementia.

This chapter reviews age-related changes in personality and emotional functioning. There are several theoretical approaches to studying personality, and most of them have examined the extent to which the theory applies to older adults. For example, Joan Erikson's proposal of a ninth stage of psychosocial development, as well as ways in which attachment processes may be important in late life, and ways in which coping strategies change with age, all represent the application of existing theories to later life. The chapter focuses on emotional functioning in late life. Overall happiness and life satisfaction tends to increase with age. Older adults also show more effective strategies for regulating emotions, including situation selection and attentional deployment toward more positive features of the situation. Some of these changes can be accounted for through two theoretical models: socioemotional selectivity theory and the strength and vulnerability integration (SAVI) model.

It is important for beginning Clinical Mental Health Counseling (CMHC) students to understand that their engagement in the CMHC specialty is one part of the larger professional counseling framework. This chapter provides a historical overview of the counseling profession and its developmental trajectory, emphasizing the origins of mental health treatment and the reemergence of counseling as a wellness-based approach. It offers discussion concerning the push toward a pathogenic model of conceptualizing mental illness and the subsequent, current resurgence of a strength-based notion of care. The chapter provides an overview of the major theories of counseling as a means for understanding the development of counseling as a unique and separate field from psychology, psychiatry, and social work. It identifies the specializations within the counseling field, the range of employment opportunities and the current labor market, and how counseling is integrated within a system-of-care approach.

Stigma is the foundation that distorts the many social constructs affecting how social workers view older adults. Many socially constructed optics produced by stigma can bias social workers’ views of older people. It is important for a social worker to understand that race, ethnicity, and sexual orientation are social constructs that bias clinical care. Additionally, stigma associated with race, ethnicity, and sexual orientation produce psychosocial stressors that converge on older clients, which exacerbate their physical and psychological health statuses. The stigma of mental illness serves to increase the suffering of older people struggling with psychological problems while increasing the suffering of family members, loved ones, and caregivers who experience courtesy stigma. The stigma of suffering from mental illness may also prevent an older person from seeking treatment for his or her psychological problems. Older adults suffering from dementia also suffer from the negative reactions to them because of their diagnosis.

This chapter discusses the history of the Medicare in the United States; specific components of Medicare Parts A, B, C, and D; and how Medicare provides healthcare resources to older adults and people with disabilities. Medicare, a healthcare program perceived to be a universal program rather than one based upon a needs test, currently provides healthcare to people who reach the age of 64. Comprised of four parts, it can provide hospital care, general healthcare, hospice care, home healthcare, and prescription drug coverage. The chapter provides an overview of the Medicare program, its various components, and aspects of healthcare that are covered through its component parts. Although there are currently no needs tests or limitations as to who qualifies for services, the chapter concludes with some dilemmas for the future of healthcare coverage, including “an empty pot at the end of the rainbow” and rationing of healthcare services and procedures.

This chapter talks about psychoactive substances that are commonly misused or abused by older adults. It is important for a psychologist to understand the psychopharmacological dynamics of each substance, how they are administered by an older adult, the symptoms of intoxication and withdrawal, and the psychosocial consequences experienced by the older adult misusing or abusing psychoactive substances. Unlike younger adults, older adults are more likely to avoid illicit substances such as cocaine, heroin, methamphetamine, psychedelics such as lysergic acid diethylamide (LSD) or mescaline, and designer drugs. Historically, the psychoactive substance of choice was alcohol. There are two general types of opioid psychoactive substances: naturally occurring opioids and synthetic opioids. Naturally occurring opioids include opium and its derivatives morphine and codeine, and heroin, which is a chemical manipulation of morphine. Unfortunately, many older adults suffer with chronic pain from cancer, arthritis, or injuries, causing a need for opioid medications.

This chapter discusses clinical work with the geriatric/older adult partial hospitalization program (PHP)/intensive outpatient program (IOP) cohort, aged 65 and older and reviews the cohort’s age-related issues, which include an interplay of medical problems and dementia. It presents the younger clinician’s challenges in assuming the role of helper with this population and also reviews applications of the games of treatment planning and group therapy. Older adults decline in function and physical health and develop more and more medical conditions that are both stressors and causes of mental health symptoms. Many older adults have more and more sources of chronic pain, which diminish their quality of life throughout the day. Dementia is another medical condition connected with depression, anxiety, and psychosis that will be encountered in the older adult cohort. The clinician should respect boundaries in general by treating older adult patients as adults with self-determination.

This chapter provides an overview of how clinical mental health counselors work with crisis, disaster, and trauma issues. A focus is placed on the pragmatic, neurobiological, and existential natures of crisis, disaster, and trauma along with the ways that these dynamics are implicated in numerous counseling scenarios. The chapter presents the basic crisis intervention skills, discusses disaster response, and emphasizes the importance of understanding trauma. It anticipates that students will have an advanced course that covers these important topics more fully. The chapter provides an adaptation-resilience building framework for conceptualizing disaster response. It then discusses the issue of psychosocial trauma from a multidimensional perspective, and elaborates some of the key aspects of trauma. The chapter explores the most salient issues involving crisis, disaster, and trauma, with a focus on their implications for the clinical mental health counseling (CMHC) profession.

The heightened awareness of coming of death, and the anticipation of dying, results in many older adults experiencing an existential crisis. For some older adults approaching or in the age bracket of 75 to 84 years of age, the expectation of death becomes acute and triggers a need for end-of-life planning, also referred to as advance care planning. Palliative care is considered a good death because it keeps an older adult comfortable, provides counseling, and is a means to control pain that a dying older adult would otherwise experience. There is a significant need for psychologists to provide counseling to older adults experiencing disenfranchised grief because adults experiencing this type of grief suffer from difficulty experiencing their loss when it is not validated by others. Euthanasia is accomplished by an older adult’s request to his or her physician based on the intention of ending pain and suffering when terminally ill.

This chapter focuses on the unique characteristics presented by three special populations that frequently receive psychotropic medications–children and adolescents, older adults, and women who are pregnant or plan to become pregnant. It is intended to sensitize social work practitioners to the unique considerations frequently encountered with these populations and to highlight the importance of combining medication therapy with counseling when addressing the mental health needs of these special populations. The chapter also provides a sampling of some Diagnostic and Statistical Manual for Mental Disorders (5th ed.; DSM-5) diagnoses frequently identified in children and highlights the medications commonly used to treat the mental disorders. Assessing and determining the medications to use to assist children and adolescents suffering from a mental disorder is never easy. Two conditions that present a particular challenge for prescribers and other members of the collaborative team are attention deficit hyperactivity disorder (ADHD) and conduct-related disorders.

The practice of professional counseling is governed at the national and state levels by a variety of governing boards and regulatory agencies. This chapter focuses on the legal and ethical issues that are salient to clinical mental health counselors. Specifically, it discusses the American Counseling Association (ACA) Code of Ethics, the American Mental Health Counselors Association (AMHCA) Code of Ethics, state licensure and national certification, confidentiality, mandated reporting, duty to warn, and scope of practice. The chapter also focuses on the responsibility of counselors to engage in ethically based practice. In addition, the chapter connects the ACA and AMCHA ethical codes and the Council for Accreditation of Counseling and Related Educational Programs standards to several topics in ethical practice, including values clarification, bias assessment, boundary awareness and maintenance, and self-reflection. The chapter concludes with a case scenario to illustrate chapter concepts and a section on resources to provide further information.

Groups have been around since the beginning of humankind and across all cultures. People have historically gathered into groups to create, achieve, and resolve matters that would be otherwise impossible. Besides the potential to accomplish tasks, groups are sources of meaning and belonging, meeting needs for personal contact and interaction. This chapter focuses on group counseling as a useful modality for facilitating transition work with clients. Groups are complex, requiring counselors to combine individual counseling and group-leadership skills. It begins with some general information about the unique value of groups and discusses factors that are relevant to group work, including therapeutic factors, cultural diversity, and multicultural competencies. It also illustrates the different types of groups designed for adults who are experiencing various types of transitions. The chapter turns to an examination of the value of groups in helping people assess their assets and liabilities in each of 4 S areas.

This chapter discusses the historical overview of older adults, challenges faced by older workers and the future trends. It opens with a case study of a 65 years old man who is a former high school coach and history teacher. People are delaying retirement and working longer for a number of reasons including such factors as significant changes in Social Security. An employer’s perception of older adults as lacking flexibility in adapting to changes or learning new job tasks and skills can contribute to older adults being overlooked for promotions and advancement. Ageism is still a significant negative force in the work world and is visible in hiring practices, promotion decisions, and terminations. Discrimination in the workplace can impact an individual’s physical and emotional health. The perception that other employees have regarding older adults can create issues that contribute to discrimination in a workplace setting.

This chapter briefly discusses the history of the Caregiver Support Act and its specific components and explains how the Caregiver Support Act provides resources to older adults and people with disabilities. It provides an overview of the current status of family members serving as caregivers, with special attention to grandparents raising grandchildren. It then discusses a current profile of relative caregivers raising children in the United States; reasons for the increase in relative caregiving; and issues facing grandparents raising grandchildren. It also provides some background into the literature and promotes an awareness of issues that grandparents face as primary caregivers. A literature review examines some of the current issues and services needed. The chapter discusses resources and services designed to meet the needs of grandparents raising grandchildren, and reviews programmatic responses through the national resources. Finally, the chapter outlines some best practice interventions for review in the text.

Health promotion efforts will play a powerful role as we work to enhance function and reduce morbidity by intervening on modifiable risk factors such as physical activity (PA), inactivity, social engagement, and nutrition. This chapter examines the state of the art of theoretical foundations for health behavior change that are used to design and implement health promotion programs for older adults. The principles of social cognitive theory (SCT) have been used frequently in health behavior interventions. The chapter uses the ecological model as a guide to describe the level(s) targeted by each theory. It presents the most prominent multilevel approach, the social-ecological model. Recently, there has been a push toward broader ways of thinking about behavior change using structural approaches that target all levels of the social-ecological model. The chapter presents theories targeted at each level and argues for the use of multilevel interventions whenever possible.

This chapter focuses on using humanistic sandtray as a structured play therapy intervention with clients aged 9 years and older. Humanistic sandtray therapy is a type of play therapy that can be used with clients of many ages, from preadolescents to older adults. This approach to sandtray emphasizes the primacy of the therapeutic relationship and views the relationship as the curative factor in therapy. In sandtray, therapists and clients benefit from the symbolic nature of the experience because it increases safety and provides clients with a metaphorical and indirect mode of expression. The chapter illustrates the case example to help clients go deeper into their inner experiencing and awareness so that they might move in the direction of becoming a more fully functioning person. Fully functioning people are moving in the direction of increasingly trusting their inner experiencing and becoming open to a wide range of emotions.

This chapter discusses prominent theoretical models that link age-related changes in emotional processes with changes in cognition. It also discusses the dynamic integration theory (DIT), which outline how older adults may optimize emotional experience to compensate for reduced affective complexity resulting from declines in fluid cognitive processing. The chapter evaluates the current evidence for and the potential contributions of these theories. It introduces neuroscientific perspectives and reviews how these perspectives interpret age-associated changes in the brain in terms of cognitive-emotional processing. Aging Brain model (ABM) and DIT, therefore, provide more neurologically based explanations for age-related changes in emotional processing, whereas socioemotional selectivity theory (SST) postulates motivation as the cause of such changes. Another theory that might be relevant to the aging literature is the arousal competition biased theory, which posits that the affective state of the perceiver may also play a role in the salience of information.

Medical problems challenge older adults’ abilities to cope with illness, and at times they experience co-occurring psychological disorders. Therefore, social workers must provide services to assist older adults who are experiencing acute or chronic medical conditions. Older adults experiencing arthritic pain often experience a co-occurring depression. The major cancers experienced by older adults are breast cancer; chronic lymphocytic leukemia; lymphocytic lymphoma; colorectal cancer; lung cancer; mouth, head, and neck cancers; multiple myeloma; prostate cancer; skin cancers; and vulvae cancer. Those older adults suffering from diabetes have a greater chance of co-occurring vascular and cardiovascular conditions and a greater rate of institutionalization and subsequent mortality. Coordination with family members and caregivers about self-care issues, medicine compliance, safety issues, health socialization, and exercise is important because social workers often overlook psychoeducation with medically ill clients.

This chapter includes a discussion of the practice-oriented framework for service use delineated by Yeatts, Crow, and Folts and the caregiver identity theory articulated by Montgomery and Kosloski. Throughout history, family members, most often women, have been the primary providers of care for individuals, young and old, who are in need of assistance. What has occurred in the past century is significant growth in the number of family members who are providing care and expansion of the responsibilities that these family caregivers now assume. The steady expansion of family caregiving has been mirrored by the steady expansion of research focused on caregivers and interventions to support them. The behavioral model of services utilization has been used to study the use of a wide range of health services by older adults and caregivers.

Primary care providers (PCPs) often assess for complex needs and refer to specialty geriatric clinics focused on the unique needs of older adults. Being familiar with the components of a geriatric assessment is important for providers working in primary care as is familiarity with available community resources. The presence of behavioral health providers in primary care settings often helps bridge this gap, raising the likelihood of patients receiving a thorough geriatric assessment, referral, and follow-up as part of an integrated care plan. Facilitating effective referrals and coordinating services for geriatric patients is one of the primary interventions available to behavioral health specialists (BHSs) in primary care settings. Geriatric assessments require that the BHS remember that patients have autonomy. Geriatric depression is frequently comorbid with anxiety and often complicated further by the presence of comorbid physical illness or cognitive impairment that may limit pharmacological treatments and interfere with recommended behavioral interventions.

Advocacy is key for the clinical mental health counseling profession. Clinical mental health counselor advocates (CMHCAs) rely on the advocacy competencies to guide their assistance to clients in removing barriers and to secure deserving resources, or to advocate on behalf of clients, groups, or communities. This chapter addresses the importance of advocacy and social justice advocacy, and the strategic positionality of the clinical mental health counselor as an advocate for addressing social and institutional barriers that reduce client access, equity, and success. It identifies the advocacy competencies and approaches to advocate for clients care, and emphasizes the ways that they foster resilience and growth. Specific cases illustrate clients' and professionals' understandings of and access to a variety of community-based resources. The chapter also addresses strategies to advocate for the profession and for clinical mental health counseling professionals.

In older adults, sexual activity declines as a result of multiple causes like medical illness, disability, psychological problems, and social constructs that exist in institutional settings. Another phenomenon of older adult sexuality is that many older adults are aging without major health problems that would limit their sexual functioning. Older men often reveal their problem with erectile dysfunction to a health care provider or social worker. There are multiple approaches to treating erectile dysfunction in older men. The first and primary intervention is referral to an urologist. Functional problems contributing to the decline in sexual activity of older women include co-occurring anxiety or depression, urinary incontinence, thyroid conditions. Many older adults suffering from various forms of dementia become sexually disinhibited and show increasing hypersexuality as their cognitive deficits increase. Social workers have an opportunity to provide psychoeducation to families and caregivers in managing hypersexuality exhibited by patients suffering from dementia.

This chapter explores a paradigm shift in policy and practice related to the delivery of services and supports to older adults or adults of any age with disabilities-the growth of person-centered (PC) and participant-directed (PD) practice initiatives. It discusses new theoretical approaches, particularly the Consumer-Directed Theory of Empowerment (CDTE), which are salient to explaining the growth and impact of PC and PD initiatives as an evolving practice model that represents a paradigm shift from past approaches to working with older adults and persons with disabilities. Research is needed on recent practice and policy changes that have implications for the continued development and examination of theories that support PC and PD care. With both the aging and the increasing diversity of the US population combined with federal policy initiatives related to LTSS, the demand for PC and PD initiatives will continue to grow.

Scholars studying social connectedness draw on the sociological theory of social capital. In recent years, social scientists have proposed theoretical and conceptual models to explore the role of social connectedness in the specific context of aging. Recent data on the social networks of older adults paint a rich picture of the individual, or egocentric, social networks of the elderly community-dwelling population. This chapter discusses the theory of social capital, and explores the main effects and stress-buffering models of social connectedness and health. Although social capital theory has effectively guided empirical research, new ideas and concepts in aging research are generating interest among scholars, and are taking the field in innovative directions. A series of studies based on the Veterans Affairs Normative Aging Study (NAS), an ongoing study of aging established in 1963, documents a relationship between air pollution and various health conditions such as increased blood pressure and inflammation.

The medical model of psychopathology currently guides psychiatrists and many psychologists who are treating older adults experiencing psychological problems. Use of this model causes contradictions and distortions for the treating clinician and limits the effectiveness of treatment for older adults experiencing psychological problems. There are three areas of concern that illustrate these contradictions and distortions. The first area of concern is the fact that only two classes of psychiatric diagnoses meet the characteristics of a disease. The second area of concern is how the current use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) continues a tradition among psychiatry, managed-care companies, and insurance companies that puts pressure on psychiatrists, psychologists, hospitals, and psychiatric rehabilitation facilities to treat in the most cost-effective and short-term manner. The third area of concern is the relationship that has occurred between psychiatry and pharmaceutical marketing forces.

This chapter summarizes pertinent issues discussed throughout the text, especially reinforcing the multiple emphases on systems-of-care, ecological, salutogenic, social justice, and diversity approaches. In addition, the chapter identifies new frontiers for counseling practice, such as new opportunities for counselors within the Veterans Administration and TRICARE system, in hospital settings, in hospice programs and assisted living environments, in other community settings, in school-based programs, in college counseling centers, and in sports counseling. The chapter also addresses the influence of technology upon the counseling profession, discussing the Internet-based services, such as virtual counseling, and telecounseling. It provides a discussion of the ethical, legal, and practice concerns related to this developing branch of counseling. With our professional organizations and the advocacy efforts of our practitioners and educators, the future holds great promise for the further development of professional counseling as an important part of the field of mental health and wellness.

For older adults, the phenomenon of death is accepted and does not induce the fear experienced by younger adults. Older adults who do not engage in end-of-life planning may receive unwanted, unnecessary, costly, and painful medical interventions or withdrawal of desired treatment. Many older people feel that the goal of palliative care is to make the best possible dying experience for the older adult and his/her family. In addition to palliative care, an older adult will most likely find himself or herself in an intensive care unit as part of his or her terminal care. Euthanasia, or hastened death, is seen by some as an alternative to palliative care. A psychological aspect of death that an older adult is concerned with, in addition to place of death, is whether he or she will die in his or her sleep or die suddenly, making the death experience an individual phenomenon.

Psychologists work with micro-level and macro-level orientations. Clinical psychologists with a micro-level orientation focus on individuals, families, and small groups when performing psychotherapy. Community psychologists have a macro-level orientation. The aging population presents many opportunities for psychologists, both those engaged in scholarship and those working clinically with older adults, and for community psychologists addressing issues relating to social structures and organized communities of older adults, economic issues such as poverty and access to medical services, and issues relating to senior housing. Contemporary theory indicates that it is equally important for psychologists working with older adults to focus on the positive aspects of aging when addressing the psychopathological problems older adults are experiencing. Erikson’s stage theory originally had seven stages: basic trust versus basic mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; identity versus role confusion; intimacy versus isolation; and generativity versus stagnation.

Work environments are cultures that create particular ethical climates that influence the quality of service provided to clients. This chapter addresses how organizations influence ethical practice. It defines “Organizational culture”, “organizational climate”, and “ethical climate”; each term represents factors unique to the work environment that affect ethical behavior. The chapter also addresses several work-place issues, such as dealing with impaired colleagues, mobbing, “burn-out”, whistle blowing, boundary issues at the work-place (e.g., sexual harassment) and substance abuse affecting worker performance. It defines “impaired professional” and describes the effects of impairment on professional practice. Counselors are profoundly influenced by the environments and work cultures in which they practice. Work environments are cultures that create a particular ethical climate that influences the quality of services provided to clients. Ethical and unethical colleagues influence their coworkers to behave ethically and unethically.

Counselors must exercise their ethical and professional judgment responsibly. This chapter reviews decision making models applied in mental health contexts. It classifies past models based on theory and/or practice. The chapter describes in detail the Tarvydas Integrative Decision Making Model of Ethical Behavior and how it is applied to mental health practice. It is a model that brings together the best of ethical theory to date in one comprehensive model. The chapter presents the Cottone Social Constructivism Model of Ethical Decision Making as a theory driven approach. The model is built on radical social constructivism, a unique philosophy that purports that decisions are not made psychologically by a person; rather decisions are an outcome of the relational matrix within which a decision maker finds him or herself. Three intellectual movements are defined: principle ethics, virtue ethics, and relational ethics.

This chapter combines the increasing number of studies that pertain to the stereotype embodiment theory (SET) and reflects upon to represent the current state of this theoretical perspective and how it can help explain age stereotypes’ contributions to health and aging. It describes the history, cultural context, and nature of age stereotypes and age self-stereotypes in a largely ageist society. The chapter presents SET, which provides a framework for explaining how age stereotypes are acquired to subsequently influence health outcomes. It discusses replication studies conducted in different countries, as well as meta-analyses, to demonstrate the validity of this theory as well as to illustrate the meaning and impact of its components. The chapter illustrates how SET may be applied to shape future healthy aging research, policy, and practice. Empirical evidence supports the importance of age stereotype self-relevance among older adults.

This chapter makes a distinction between grief counseling and grief therapy. Counseling involves helping people facilitate uncomplicated, or normal, grief toward a healthy adaptation to the tasks of mourning within a reasonable time frame. The chapter reserves the term grief therapy for those specialized techniques that are used to help people with abnormal or complicated grief reactions. The overall goal of grief counseling is to help the survivor adapt to the loss of a loved one and be able to adjust to a new reality without him or her. Whatever one’s philosophy of grief counseling and whatever the setting, there are certain principles and procedures that help make grief counseling effective. The chapter provides guidelines for the counselor so that he or she can help the client work through an acute grief situation and come to a good adaptation.

The focus of career counseling has been on helping individuals successfully enter the world of work. This chapter provides a description of the career counseling specialty, defining the roles and functions, employment settings, and clients of career counselors. It provides a brief history of the professional specialty, with information on historic and current credentialing. The chapter outlines professional credentialing and licensure matters for career counselors. It describes ethical and legal issues specific to the practice of career counseling and explains diversity issues and ethical decision making. It differentiates the roles and functions of practitioners of career counseling from those of practitioners of other counseling specialties. The chapter reviews the assessment issues of career counseling. Career counselors practice in a variety of settings and render services to diverse individuals, corporations, and organizations. They must have sufficient knowledge and training to assess clients and administer tests.

Children and adolescents depend on many systems to foster their social, emotional, personal, and developmental needs. School leaders, school counselors, communities, families, mental health counselors, and representatives from all systems in a child’s life need to collaborate and integrate care to produce the best outcomes for every child. This chapter identifies the many systems that impact child and adolescent development. It describes ecological systems theory and recognizes the many different types of families. The chapter explains how counselors in schools and mental health settings can adopt a systemic view of child and adolescents. It illustrates the impact of culture in the systems in which children and adolescents are embedded. The chapter explains how counselors can assist in collaborating with and connecting systems for best treatment outcomes. It outlines best practices for counselors working with children and adolescents.

While high-income nations have experienced increasing life expectancy as a consequence of better healthcare and healthier lifestyles, this does not mean that the size of the aging population will be the highest globally. The issue of HIV and older adults will continue to be a public health issue across the globe and will require the attention of factors related to socioeconomic context as well as sexual health and education. Regardless of the income of specific nations, families provide essential and important support for elders. The support of the oldest-old and those who require long-term supports and services earlier in life will be the most pressing issue for all nations going forward—rich and poor alike. These issues, in and of itself, is a great reason to participate and learn about international issues and global aging so that we can in fact face the challenge of change in our aging world.

The interpersonal environment in which older adults are embedded strongly influences their health and well-being. A state of social isolation can be defined as the absence of a meaningful interpersonal environment. This chapter presents some important theoretical and methodological distinctions. It looks at the association between several key aspects of the interpersonal realm, on the one hand, and selected positive and negative well-being outcomes, on the other. It examines the contribution of the construct of network type, a composite measure of social relations, to the study and the understanding of the interpersonal domain of older people, and its role in well-being. Following this, it considers another indicator of social relations—this time, a scale of social connectedness—and how this measure disentangles the effects of social relations and social activity on well-being. Finally, the chapter presents findings on the implications of changes that occur in the interpersonal environment on the mental health.

This chapter briefly discusses housing and housing education activities that offer several unique perspectives on understanding issues of housing for older adults. The housing education activities are as follows: (1) Find a Nursing Home, (2) Field Trips to Senior Facilities, (3) Household Disaster Planning Kits, (4) Long-Term Care Residence Disaster Planning and (5) Applying Anti-Racist Pedagogy to the Exploration of Senior Housing. Activity 1, simulates some of the challenges older adults and their families face by actively engaging participants in the process of evaluating nursing home quality. Activity 2, provides hands on context to understanding the diverse housing options in the senior housing continuum. Activity 3, addresses an often overlooked concern for persons aging in place. Activity 4, similarly addresses the issue of emergency preparedness, this time in the context of conducting research and a focus on institutional rather than individual planning.

Cognitive decline that is significant enough to interfere with independent living is known as dementia, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) introduced the term major neurocognitive disorder to refer to this condition. This chapter reviews the most common causes of neurocognitive disorders in older adults. It begins with a discussion of delirium, which should be ruled out whenever an older adult is showing signs of cognitive decline. Next, it presents an overview of the current diagnostic terminology, including mild cognitive impairment (MCI), dementia, and the DSM-5 diagnoses of mild neurocognitive disorder and major neurocognitive disorder. The chapter next reviews traumatic brain injuries (TBIs), Alzheimer's disease, Lewy body disease, Parkinson's disease, vascular disease, frontotemporal degeneration, which includes a behavioral variant and a language variant, and alcohol-related dementia.

Michael is a 12-year-old Black male in the seventh grade in a remote rural farm community. He recently relocated to this community from a large metropolitan area, where he was a sixth-grader in a culturally diverse elementary school. He is the oldest of three children with parents who have become pillars in the community despite being new there. Identified as gifted in his previous elementary school, Michael took science and math classes in higher grade levels by single-subject acceleration. He had to work much harder in his language arts classes, but he loved his school and was liked by his peers and teachers.

While Michael’s new school is culturally diverse, the school and community norms for students are different. The emphasis is on community fellowship, service, and helping one’s family. Little is said about college; instead, jobs in agriculture and manufacturing are emphasized. Michael has been invited several times to participate in the 4H club. Upon arriving at his new school, despite providing his previous years’ school records, he is placed in the traditional seventh-grade classes. He complains to his parents that his math and sciences courses are a repeat of information from his previous school. Michael is also encountering difficulties in his language arts classes, which require more traditional essay-writing than his last school did.

In a six-week progress report, Michael’s teachers noted that he seems unengaged and withdrawn in class. His parents believe he has become apathetic about school, and they are worried he might lose his love of math and science. In addition, Michael’s language arts homework frequently leads to anger and frustration at home.

Michael’s parents have requested meetings with his teachers, with the school counselor, Brenda, also attending. Prior to the meeting, she evaluates Michael’s cumulative file. Based on his grades, standardized test scores, and teacher comments, she determines that he is extremely bright and very talented in math and science, but has challenges in language arts and social sciences. His teachers’ comments include “Handwriting continues to be a challenge, but he is working very hard,” “Michael is a very hard worker, but writing paragraphs or persuasive essays requires much more effort,” “He is quick at multiple-choice questions and short-answer questions are okay,” “His reading comprehension is fantastic, but writing brings out frustrations,” and “I realized Michael was much more at ease with oral book reports than written. His love of learning really shines through when he gets to talk about what he knows, in all subjects. He even manages to get his peers interested.”

Brenda makes a phone call to the school counselor at Michael’s former middle school and the elementary school he attended. She hears wonderful things about Michael, as well as about his challenges with written work. Many of his former language-arts teachers allowed Michael to demonstrate his mastery of content and skills orally or via multiple choice or computerized testing. The middle school counselor reported that he and Michael’s parents had discussed talking to their school psychologist about more testing for Michael because they were concerned about the increased requirements for writing in middle school. But that conversation did not lead to changes before the end of the school year, when Michael’s family moved.

Counselors must consider how to approach the struggles, fears, and vulnerabilities young clients face in schools and communities, and how to help them make sense of their world. Counselors must understand their own level of self-awareness, cultural knowledge, theory of orientation, and commitment to counseling this population. Children and adolescents must gain a sense of control through counseling and feel respected and valued. Counselors identify the use of counseling theories listed in this chapter along with creative strategies and expressive approaches (e.g., drawings, music, toys, and books) as best practices for working with young clients. This chapter describes the different theoretical frameworks commonly used in child and adolescent counseling. It helps the reader to identify specific reasons why these theories effectively work with children and adolescents. The chapter applies interventions appropriate to the guiding theoretical framework.

Stewart and Tray are the seventh- and eighth-grade school counselors in a new middle school in a large urban district with a diverse student population. Wintercrest Middle School has been a magnet school for science, technology, engineering, and mathematics (STEM) for only 3 years. Currently students can take Algebra I, Geometry, Honors Biology, and semester classes in Advanced Computing, Introduction to Physics, Robotics, and Trigonometry. Logistically, the magnet school functions as a school within a school, with students attending classes in one wing of the school building. Teachers and students who are not involved in the magnet school are located in two other wings on the opposite side of the school. During the past school year, Tray and Stewart have sensed tensions in the school in various relationships, including within, between, and among teams of teachers, between parents and teachers, among students, and between administrators and teachers. Mr. Wallace, their building principal, has seen the explosive outcomes of some of these tensions and has encouraged the counselors to investigate the current school climate.

Mental health professionals who work with students must be well-versed in the protective factors that maximize youth academic, social and personal success. One can and must cultivate healthy communities and teach youngsters to advocate for themselves as one advocate for them. Significant research points to strategic ways one can strengthen schools, families and communities. All too often, violence, substance abuse, bullying, sexual assault, suicidal ideation and more threaten student well-being. The profession calls upon professional school and mental health counselors to be ethical, skilled, culturally attuned and ready to engage in prevention and intervention as they work with students and families. This chapter expresses familiarity with social challenges to healthy child development. It helps to recognize the crucial role of professional school and clinical mental health counselors in the cultivation of positive school and community contexts. The chapter hypothesizes counseling from a strengths-based, curious, and creative stance.

This chapter addresses emerging and persistent issues that need attention for the benefit of today's elders and the elders of tomorrow. It discusses several persistent and emerging issues that need to be addressed by the aging networks and by the field in general. The persistent issues include: ageism; professional competencies; the aging workforce on all levels; and LTSS in the community. The emerging issues include: goodness of fit and changing cohorts; diversity; and innovation and the aging networks. Services and programs of the aging network are components of the home- and community-based care system that, by definition, is a long-term care system. As the field of gerontology grows and the population of older adults continues to increase, the need for a gerontologically educated workforce becomes a critical factor in our ability to provide a good old age for everyone in our society.

The broad array of community-based services for older adults has developed over time as a result of the Older Americans Act (OAA) and the Administration on Aging (AoA) and the funding allocated to this act by Congress. With an expanding consumer base, the result of population aging, the aging networks have had to evolve over time, and while there have been and will continue to be some growing pains, there continues to be concerted efforts on many fronts to be support for providing services and programs that increase the quality of life for older adults. This chapter explores the expanding consumer base of the aging. It describes how long-term services and supports (LTSS) can be better managed and paid for to support those who need long-term support and services. Finally the chapter discusses how aging networks can and will evolve over time to serve the changing cohorts of older adults.

This chapter aims to discuss the cohort effects, health disparities and cultural stressors, and factors contributing to the resiliency and growth of ethnic, sexual, and gender minority older adults. Being part historian, student, and investigator can help clarify how these multifaceted aspects of identity affect the experiences of older adults in your personal and professional lives. The intersectionality of these factors makes for complex, inspiring, and sometimes distressing stories about overcoming adversity, achieving new heights, and at times sitting with the pain and frustration of discrimination and prejudice. The diversity within older adult populations also affords invaluable research opportunities to improve our knowledge of aging and enhance our provision of care. Moreover, developing a greater appreciation for older adults, including their strengths and hard-fought battles, can help us appreciate the privileges and civil rights we often take for granted.

This chapter uses the case study and relevant literature to understand using the transition model with work transitions. In looking at issues relating to self, one sees that it is important to consider salience, balance, resilience, self-efficacy, and meaning making. The dimensions of salience, balance, resilience, self-efficacy, meaning making, and sense of purpose are all critical aspects of a client’s work transitions. Listening for and asking about these dimensions will help counselors gain a more complete picture of a particular client’s experience and aspirations. The chapter looks at characteristics of the situation, support and strategies. It presents a multiplicity of issues related to the kinds of experiences, thoughts, and feelings that have an impact on adults engaged in work transitions. The chapter discusses what counselors might hear from the perspective of the 4 S transition model and proposition that all transitions involve moving in, through, out, and back in again.

Ben, the middle school counselor from Chapter 5, continues to work with the district’s task force. There, he also meets Julie the district’s coordinator of gifted and talented services. Based on the superintendent’s concerns, Julie wants to re-imagine the district’s identification and programming for gifted youth. Ben’s experiences have given Julie new insights into potential roles of school counselors when working with high-ability learners and their parents. Julie was particularly drawn to Ben’s discussions of talking with parents about why their students were not identified. Ben’s frustrations with the gifted services have also included the pervasive mythology that the program is a “cookie” program used as a reward for “good” students with “good” behavior and even better grades—a myth that disenfranchises diverse populations in the school district, including underachieving students, and doesn’t accurately identity those students who may need services. Historically, because the district has implemented identification procedures in third grade, Julie has contacted several of the elementary school counselors in her district to get their perspectives. She is surprised by the range of their knowledge about identification and the degree of the school counselors’ involvement in this process. While Ben has informed her that all practicing school counselors have training in testing and assessment, not all have connected this with identification practices for gifted learners—until they meet with their first parent.

Public policy is an essential component to quality of life for older adults and provides funding and guidelines for the agencies and staff that provide services. This chapter provides activities that help students to develop a better understanding of public policy and aging. Activity 1, Examining Organizations that Benefit Older Adults in the Local Community (Rodriguez), provides a venue for students, community, and educators to "explore the local network of organizations that exist for older adults". In Activity 2, Letter to A Legislator: Civic Engagement for Gerontology Students (Temple), students have the opportunity to "write a persuasive letter to a legislator to support or oppose a proposed aging related social policy". Activity 3, What Will Your Future Look Like? Financing Retirement Exercise (Baker & Brown) provides a means for students to understand how "events in the economy, political spheres, and personal health status can influence their retirement income".

Health professionals are often called upon to intervene in complex ethical dilemmas that involve respecting an older adult's autonomy while also considering protective interventions to ensure safety. This chapter addresses the foundational ethical competencies for psychologists and geropsychologists including the unique challenges associated with surrogate decision making, legal, clinical, and psychosocial interventions specific to working with vulnerable older adults, ethical dilemmas that can emerge within various situations including assessment and integrated care settings, detection and intervention strategies in cases of elder abuse, neglect, and exploitation, and ethical approaches to research with older adults. Finally, the authors discuss the multicultural dimensions that influence how ethical and legal issues are conceptualized and addressed. The micro-and macrosystems in which older adults live and thrive require a level of cultural sensitivity, an understanding of aging processes, and knowledge about professional ethics and legal standards involved in decision making.

A speech/theater teacher at a large urban high school refers Andrew (pseudonym for a composite profile), 16, to the school counselor because “he’s out of control and living dangerously.” The counselor, who routinely examines the student’s school file before such a meeting, finds standardized test percentiles in the high 90s, a good attendance record, and regular participation in the arts, but also a high incidence of lateness to class and an academic record that has deteriorated in high school. Family information shows an older brother attending a distant university, parental divorce when Andrew was 5, and, at age 12, Andrew relocating with his brother and mother when she remarried.

Andrew presents as personable, verbal, socially smooth—and somewhat arrogant. He claims he can raise his current low grades before the semester ends. Missed assignments are the key. He says he adds provocative comments to class discussion, and teachers like him.

His best friend lives 2000 miles away, where Andrew lived prior to his move at age 12. Andrew has gravitated toward dramatic females locally, and his current girlfriend is in high conflict at home. His grades deteriorated after becoming involved with her. He has run away several times and now has thoughts of running away with her. He mentions a special relationship with a male friend. When he drinks, he drinks too much, and his friends worry about him.

Andrew believes the psychologists he saw in the past did not understand him. He was diagnosed with attention deficit hyperactivity disorder (ADHD) and depression, but was noncompliant with medication. He recognizes that he makes poor choices. He claims not to be suicidal currently, but has been in the past. He has self-harmed. He says his father has almost no contact with him, but his father does have a close relationship with his brother. Andrew says his own problems resemble his highly intelligent father’s. Andrew has been exploring anarchic and white supremacist groups online.

The counselor plans to meet with him in a week, but will informally check on him daily and then meet with him and his mother together, a meeting Andrew quickly agrees to. Regardless of whether a referral will be made eventually, the counselor hopes to build a therapeutic relationship with Andrew to be able to provide ongoing support at school as needed.

A few days after the school counselor’s meeting with Andrew, his mother contacts the counselor because of the girlfriend. She says Andrew struggles with impulse control, is easily distracted and affected emotionally, has difficulty managing emotions, and escalates conflict quickly when sad or angry. He resists authority at home, and his arguments with her leave her worn out and sad. She says her husband, Andrew’s stepfather, ignores Andrew and does not understand giftedness.

This chapter briefly outlines the history and structure of the Older Americans Act (OAA). It reviews the aging network of services and the network's development. In addition, the chapter provides an overview of the first major change in the operation of the OAA since its inception in 1965. The objectives of the OAA in Title I set the stage for a service philosophy that continues today, nearly 50 years after its enactment. The other titles of the act address specific policy initiatives and programs that address the policy intent of the act. Since its inception, the OAA has been an entitlement program based upon age and, more recently, special status such as being a family caregiver. Funding levels of OAA continue to be limited and most aging network services and programs are required to use additional resources to support the programs of importance to older adults.

This chapter discusses several topics relevant to older adults' mental health including access and use of mental health services, prevalence of common mental health diagnoses, assessment of mental health symptoms, and empirically supported treatments for older adults. Although some topics presented in this chapter need additional research focused specifically on an older adult population, several conclusions can be drawn from the material. First, several studies have documented that older adults use mental health services less frequently than other age groups, although it is unclear why this is the case and likely involves a combination of barriers/access to treatment and stigma. Second, several of the mental health problems discussed may present differently among older adults, such as the specific symptoms of depression that older adults endorse. Third, assessment instruments for older adults need to be selected cautiously to ensure that adequate validity and reliability has been established for this population.

This chapter explores changes that occur to the brain, beginning with an overview of modern technologies that are used to answer questions about brain functioning in older adults. Next it summarizes the changes that occur to the brain with normal aging. Finally, the chapter presents an overview of neuroplasticity. Although the human brain clearly loses volume with age, the brain also shows plasticity that can be used to maintain functioning in old age. Research in the coming decades can use the principles of neuroplasticity described previously to enhance the functioning of older adults, whether they are experiencing normal age-related change or damage to the brain following strokes or other neurological events. Neuroimaging methods will continue to be developed that allow us to determine what happens to the brain with age, and in response to neurological events, and how neuroplasticity enables the brain to adjust to such changes.

Our ideas about spirituality and our connection to others, the universe, and the world around us vary over time, and, because spirituality is tied to the search for meaning, it becomes an interesting platform for gerontologists and their work with older adults. The two activities in this chapter bring both breadth and depth to the issue of spirituality in the context of end-of-life issues and, specifically, a direct assessment that connects students to their own selves and older adults. In Activity 1, Spiritual Assessment, Beran brings to the classroom a tool that allows students to reflect on their own spirituality and then compare that to an understanding of the broad concept of spirituality. In Activity 2, Exploring Cultural Death Practices Through Group Presentations, Claver and Goeller provide an opportunity for students to become more engaged in considering death and dying and later life in a cultural context.

This chapter introduces some of the concepts that are important in the psychology of aging. It starts by discussing definitions of older adulthood and some characteristics, as a whole, of older adults. It then reviews the data on the projected increase in older adults in the United States and internationally. The chapter discusses the importance of birth cohort and continues to be an important theme throughout this book. Specifically, it reviews characteristics of the Baby Boom generation since most of the current generation of older adults were born in that era. Erik Erikson and Paul Baltes are two researchers who have made substantial contributions to the development of aging studies. The chapter then reviews development of the professional field and training resources that are available to students and professionals, and ends with a discussion of research methods that attempt to untangle the effects of age, cohort, and time of measurement.