Clinical psychologists in aged care in Australia: A questionof attitude or training?

Current state of research on psychotherapy for home-living vulnerable older adults with depression

Older home-living vulnerable adults often suffer from chronic conditions accompanied by restrictions in mobility, social participation and reduced independence. Among this rapidly growing population depression is a common and serious health problem; however, there are shortcomings in the diagnosis of depression and provision of psychotherapy. Despite growing evidence in treating depression among the group of nursing home residents or the "young-old", there is a research gap regarding needs-oriented healthcare strategies for very old, frail or care-dependent older adults living at home. The present article provides an overview of different outpatient psychotherapeutic treatment approaches for vulnerable older adults with depression, in particular adaptations tailored to those who are homebound or in need of care. Based on the current state of research, this article derives recommendations for psychotherapy in this special setting to consider the physical and psychosocial resources of this patient group. Furthermore, healthcare strategies for embedding psychotherapy in collaborative, telehealth or home-delivered healthcare services are described and their applicability as psychosocial support for older adults during the coronavirus disease 2019 (COVID-19) pandemic is discussed. Psychotherapy is an efficacious treatment for depression in home-living vulnerable older adults. Further implementing telehealth or home delivered settings, individually tailored psychotherapeutic approaches as well as collaborative and stepped care approaches can increase utilization and medical supply of this patient group. More research and innovative programs are needed to improve access to and provision of psychotherapeutic care as well as their social inclusion.

Do Treatment Attitudes and Decisions of Psychotherapists-in-Training Depend on a Patient's Age?

OBJECTIVE

The objective of this study was to analyze how psychotherapists' treatment attitudes and decisions depend on a patient's age.

METHODS

A sample of psychotherapists-in-training (N = 97) responded to questions concerning a naturalistic case vignette of a female patient with symptoms of depression and anxiety. The patient was described as being either 79 or 47 years old.

RESULTS

Results revealed no evidence that psychotherapists-in-training had more negative treatment attitudes towards an older relative to a younger patient. However, the patient's age had an influence on participants' therapeutic approach. Specifically, psychotherapists-in-training recommended short- as opposed to long-term therapy, considered motivational clarification less important, and viewed clarifying techniques as less appropriate for an older patient.

CONCLUSIONS

The stereotype of the rigid and resigned old person appears to be an important and potentially problematic factor in psychotherapy. Interventions to help therapists to reflect on their individual representations of aging may increase the likelihood of successful psychotherapy.

Age cues in patients' descriptions influence treatment attitudes

Objectives: Ageism on the part of service providers has been widely cited as an important factor limiting access to and adequate quality of mental health services for old, especially very old adults. The objective of this study was to analyze how treatment attitudes depend on age cues in patients' descriptions.Method: A sample of psychotherapists-in-training (N = 114) responded to questions concerning a naturalistic case vignette of a male patient with symptoms of depression. Based on random assignment, participants either read the original (real-life) case description including very-old age cues ('very-old patient condition') or the manipulated case description ('middle-aged patient condition') which was identical with the exception that the most salient age cues were replaced by a younger chronological age of the patient (52 years) and age-neutral cues (e.g., "black hair" instead of "light grey hair"). All other aspects of the vignette including the patient's psychological symptoms and medical conditions were kept constant.Results: Participants showed less favorable attitudes towards the patient in the 'very-old patient condition' relative to the patient in the 'middle-aged patient condition', as indicated by more negative affect, less conviction in the treatability of the patient, a poorer prognosis, less interest in treatment provision as well as less subjective treatment competence.Conclusion: Mental health care providers' 'age bias' continues to be a problematic factor in psychotherapy with older adults. An "age-aware education" for psychotherapists is needed for better realizing the potentials of psychotherapy with older adults.

Cultural Adaptations to the Measurement of Attitudes to Ageing: Psychometric Assessment of the Malay Reactions to Ageing Questionnaire

The aims of this study were to culturally adapt the Reactions to Ageing Questionnaire (RAQ) for a non-Western (Malay) population, and explore attitudes to ageing in relation to age, gender, and education. Eight new culturally relevant items were generated by asking Malay-speaking participants about their reactions to ageing. A Malay version of the extended 35-item RAQ was then administered to 911 Malaysian participants aged 18 to 60 years. Exploratory factor analysis revealed four factors. Three of the factors were similar to those identified in the original RAQ, while "Family and Religion" emerged as a new factor. More negative attitudes to ageing were observed in younger and female respondents. There were no effects of education. This culturally adapted RAQ exhibits robust psychometric properties, and could be used to assess attitudes to ageing in Malaysia and other Southeast Asian countries. Moreover, we have identified a "core set" of RAQ items that could be applicable worldwide.

Images of Aging in the Psychotherapeutic Context

Both psychotherapists and their clients have mental representations of old age and the aging process. In this conceptual review, we draw on available research from gerontology, social and developmental psychology, and communication science to consider how these “images of aging” may affect the psychotherapeutic process with older clients. On the basis of selected empirical findings we hypothesize that such images may affect the pathways to psychotherapy in later life, therapist-client communication, client performance on diagnostic tests as well as how therapists select and apply a therapeutic method. We posit that interventions to help both older clients and therapists to reflect on their own images of aging may increase the likelihood of successful treatment. We conclude by making suggestions for future research.