TOPIC : GERIATRIC COUNSELLING
PRESENTED BY : JASPREET KAUR (17)
ARUSHI SHARMA (20)
HARPREET SINGH (16)
SUBMITTED TO : DR NALINI MALHOTRA
GERIATRIC COUNSELLING
• In the healthcare field, the term “geriatric” refers to the care of the elderly. Usually they are
defined as individuals being 65 years of age or older, although sometimes that age range
may be expanded as young as 55. As people age, the may begin to face unique issues and
diagnoses not commonly seen in other age groups.
• Geriatric counselling is a process that offers assistance for older adults to cope with the
difficulties that they may experience in their transition period from middle to older years.
• Old age is a period when deteriorating physical health gives rise to a lot of mental issues as
well.
• Geriatric counseling is a specialized form of counseling focused on addressing
the emotional, psychological, and social needs of older adults.
• It aims to support elderly individuals in coping with aging, managing chronic
illnesses, navigating life transitions, addressing family dynamics, and
enhancing overall well-being in later stages of life.
Old People Ratio in india
• India has 104 million senior adults (60 years and above), or 8.6% of the total
population, according to the Census of 2011.
• There are more women than men among seniors (60+).
•According to the Quality of Life for Elderly Index from the Economic
Advisory Council to the Prime Minister (EAC-PM), the percentage of
seniors in the population is expected to increase from 7.5% in 2001 to
over 12.5% by 2026 and reach 19.5% by 2050.
•A man’s life is normally divided into five stages namely: infancy,
childhood, adolescence, adulthood and old age.
• Old age is viewed as an unavoidable, undesirable and problem ridden
phase of life. Problems of aging usually appear after the age of 65 years.
• These problems may be divided under 5 heads:
1. Physiological, 2.psychological , 3 social, 4 emotional ,5 financial
PHYSIOLOGICAL PROBLEMS
• Old age is a period of physical decline.
• Even if one does not become sans eyes, sans teeth, sans everything, right away, one does
begin to slow down physically.
• faulty diet, malnutrition, infectious, intoxications, gluttony, inadequate rest, emotional
stress, overwork ,endocrine disorders and environmental conditions like heat and cold .
• skin becomes rough and looses its elasticity. Wrinkles are formed and the veins show out
prominently on the skin.
• The hair becomes thin and grey, nails become thick and tough.
• Women go through menopause generally at the age of 45 – 50 years accompanied by
nervousness,
• headaches, giddiness, emotional instability, irritability and insomnia.
PSYCHOLOGICAL& EMOTIONAL
PROBLEMS
• Mental disorders are very much associated with old age. Older people are susceptible to
psychotic depressions. The two major psychotic disorders of older people are senile dementia
(associated with cerebral atrophy and degeneration) and psychosis with cerebral
arteriosclerosis (associated with either blocking or ruptures in the cerebral arteries)
• Other psychological problems like :
• Slow down memory process
• Stress
• Depression
• Isolation
• Loneliness
• Forgetting problems
SOCIAL PROBLEMS
• Older people suffer social losses greatly with age.
• Their social life is narrowed down by loss of work associated, death of relatives, friends and
spouse and weak health which restricts their participation in social activities.
• Due to loss of most of the social roles they once performed, they are likely to be lonely and
isolated severe chromic health problem enable them to become socially isolated which results
in loneliness.
• Negligence by kids towards their old parents.
• Disillusionment due to retirement.
• Feeling of powerlessness, loneliness, uselessness and isolation in elderly.
• Generational gap.
•
FINANCIAL PROBLEMS
• Retirement and dependence of elderly on their child for basic necessity.
• Sudden increase in out of pocket expenses on treatment.
• Migration of young working-age persons from rural areas has negative impacts on the elderly, living
alone or with only the spouse, usually poverty and distress.
• Insufficient housing facility.
• National survey carried out by the NGO Help Age India has shown that as many as 47% of elderly
people are economically dependent on their families for income and 34% are relied on pensions and
cash transfers, while 40% of the surveyed people have expressed the desire to work “as long as possible”.
COMMON DISORDERS IN OLDER
POPULATION AND THEIR ASSESSMENT
• Geriatric people go through many changes as a part of ageing, but sometimes these changes
may lead to the development of geriatric syndromes. These syndromes can be further
subdivided into two broad areas:
• Physical diseases: Vision and hearing problems, body aches, osteoarthritis, chronic
obstructive pulmonary disease (COPD), diabetes etc.
• Psychological disorders: Depression, anxiety issues, paranoia, loneliness (may contribute to
the empty-nest syndrome), dementia or alzheimer’s disease (the most common reason for a
decline of the cognitive functioning) etc.
ASSESSMENT
• The diagnosis of psychological issues in geriatric population requires expertise in
the respective area. Sometimes it is a challenging task to differentiate between
normal changes due to ageing and the presence of an actual disorder. Various tools
are used by the counsellors in clinical settings for making their assessment more
sensitive and efficient like
• in-depth clinical interviews (structured, semi-structured or unstructured),
• validated psychometric tests like questionnaires, and neuropsychological evaluation
ASSESSMENT
• Psychometric tests: Psychometric tests are structured, reliable and valid tests used
for assessment of cognitive decline (memory loss etc.) and psychopathology
(depression etc.) in geriatric population. Various types of psychometric tests are
available which can be used on geriatric population
• MMSE (Mini mental state examination for cognitive functions
• Dementia Rating scale
• DASS (depression, anxiety and stress scale)
• Geriatric Depression Scale
• Neuropsychological evaluation assessment of the functioning of the brain in relation to
human behaviour. It aims at studying cognitive functions of individuals and their relationships with
resulting behaviours. injuries or organic damage of the brain, but also assesses healthy brain functioning
of individuals with psychotics or other disorders.
• Neuropsychological assessment usuallyincludes assessment of all the four lobes of the brain and several
areas like:
• o Attention
• o Executive functions
• o Memory & Learning o Information processing
• o Problem solving o Motor functions (Ataxia) etc.
• Diagnosis in neuropsychological assessment Neuropsychological assessment follows a hierarchical
protocol to get a complete picture about the problem. It includes the following steps:
• Taking Medical or psychiatric history Developmental milestones Psychosocial history, etc. Interviewing
MMSE (Mini-mental state examination) for the assessment of cognitive functions.
• Few commonly used standardized measures are:
• o NIMHANS Neuropsychological Battery
• o PGI Battery of Brain Dysfunction (PGIBBD)
• o Wechsler Adult Intelligence Scale (WAIS)
• Thus, neuropsychological evaluation is an effective way to
assess the brain functions on the given tasks, to quantify the
impairment and to formulate effective treatment plans (e.g.
cognitive retraining) to increase the rehabilitation potential
of the elderly.
GOALS OF COUNSELLING IN GERIATRIC
POPULATION
• Counselling in geriatric population is intended to address cognitive decline and/or
psychological problems like anxiety and depression, and adjusting with the
physical changes. Since it is a specific stage of development with unique issues
and concerns, most counsellors interested in working with the aged need additional
professional training in this specialty (Kampfe, 2015). They need to have awareness
about the general concerns of the older people.
• In India, decrease in joint family system, migration of the younger generation to
bigger cities and outside the country, economic constraints, ill-treatment of the
elderly, abuse etc. make the aged vulnerable to psychological problems.
SOME OF THE ANTICIPATED OUTCOMES OF COUNSELLING ARE
BEHAVIOUR CHANGE, COPING SKILLS, ABILITY TO MAKE
DECISIONS, IMPROVEMENT OF THE INTERPERSONAL
RELATIONSHIP, AND ENHANCING MOTIVATIONAL LEVELS
Behaviour modifications in geriatrics: With advancement in age, the ability to adapt with the
environmental changes reduces up to a certain extent which poses many problems. Sometimes, some peculiar
behaviours may become problematic in nature and they can disturb the client or their loved ones attached
with them. However, with the help of some behavioural modification techniques in geriatric counselling,
problematic behaviour(s) can be changed.
Enhancing coping skills: Dysfunctions due to old age cause problems in dealing with real-life problems. An
inability to cope with these dysfunctions further increases distress and anxiety levels. Their management is
essential to prevent any psychological damage to the client. Counselling helps in learning new adaptive
coping skills like being assertive in nature, selectively attentive to external cues, adopting effective
strategies.
Ability to make decisions: Sometimes, clients face difficulties in decision making due to their
cognitive decline, personality traits or codependency. Counsellors can help improve their
cognitive functions and rebuild their self-esteem for decision making.
Improvement of the interpersonal relationship: Interpersonal relationships give a sense of
worth and meaning to the life, and increase the level of happiness. Counselling aims towards
helping the elderly to form quality relationships with their family members or people
associated with them like friends.
Enhancing motivational levels: Reduced levels of motivation are responsible for consistent
failures and low self-esteem. Therefore, counsellor helps in improving levels of motivation so
that the road to recovery becomes smoother.
QUALITIES OF A COUNSELLOR
1. Active Listening And Empathy
Demonstrating active listening and empathy are critical skills for aged care mental health counsellors. These two skills
involve being present with the client, attending to their needs, and understanding their feelings.Active listening involves
verbal communication techniques, such as restating what was said or asking clarifying questions. It also requires non-
verbal communication techniques like eye contact and nodding in agreement.
2. Communication And Verbal Skills
counsellors need to be able to use appropriate language for the age group being counselled. This may mean speaking
slower or using simpler words so seniors can understand the message. To effectively communicate with clients of any age
group, counsellors must also have good active listening skills and always demonstrate respect.
3. Observation And Non-Verbal Communication
Observing non-verbal communication cues is crucial in aged care mental health counselling. A counsellor must be aware of
a patient's body language and facial expressions, as these can give insight into their feelings and state of mind. In addition,
a counsellor must pay attention to details such as changes in speech patterns or tone of voice which may indicate a change
in mood or attitude. By noting these subtle changes, counsellors can better tailor their approach to each client.
Patience And Compassion
• Exercising patience and compassion when interacting with aged care mental health patients is essential for achieving
positive outcomes. Counsellors must maintain a sense of composure in difficult situations while displaying empathy
towards their clients. They must provide a safe space for patients to communicate their feelings without judgment or
criticism.
Therapeutic Approaches For The Elderly
• Therapeutic approaches for older adults are essential to promoting optimal mental well-being in this population, given their
unique vulnerabilities and changing needs. Cognitive Behavioral Therapy (CBT) is an evidence-based approach that has
proven effective in helping older adults cope with a multitude of mental health disorders, such as anxiety and depression.
CBT focuses on identifying negative thoughts and patterns of behaviour that can contribute to distress, then restructuring them
into more positive attitudes and behaviours .
Trauma-Informed Care
• The shift from traditional therapeutic approaches used with older people to a trauma-informed care approach is essential for
aged care mental health counsellors. Trauma-informed care is based on understanding the lasting effects of trauma and how
this impacts those seeking help.
• It has been found that, due to life experiences, many older adults have experienced traumatic events in their lives, which can
be further exacerbated by living in residential care. Therefore, counsellors must understand the importance of providing
elderly clients with a safe and supportive environment to facilitate healing from past traumas.
