Guidelines for Psychological Practice with Older Adults

Introduction

Adopted as APA Policy by the APA Council of Representatives in August, 2013

The “Guidelines for Psychological Practice with Older Adults” are intended to assist psychologists in evaluating their own readiness for working with older adults, and in seeking and using appropriate education and training to increase their knowledge, skills and experience relevant to this area of practice. “Older adults” typically refers to persons 65 years of age and older and is widely used by gerontological researchers and policy makers. We use “older adults” in this document since it is commonly used by geropsychologists and is the recommended term in APA publications (APA, 2010). The specific goals of these professional practice guidelines are to provide practitioners with (a) a frame of reference for engaging in clinical work with older adults, and (b) basic information and further references in the areas of attitudes, general aspects of aging, clinical issues, assessment, intervention, consultation, professional issues, and continuing education and training relative to work with this group. The guidelines recognize and appreciate that there are numerous methods and pathways whereby psychologists may gain expertise and/or seek training in working with older adults. This document is designed to offer recommendations on those areas of awareness, knowledge and clinical skills considered as applicable to this work, rather than prescribing specific training methods to be followed. The guidelines also recognize that some psychologists will specialize in the provision of services to older adults, and may therefore seek more extensive training consistent with practicing within the formally recognized specialty of Professional Geropsychology (APA, 2010b). 

These professional practice guidelines are an update of “Guidelines for Psychological Practice with Older Adults” originally developed by the Division 12/Section II (Society for Clinical Geropsychology) and Division 20 (Adult Development and Aging) Interdivisional Task Force on Practice in Clinical Geropsychology and approved as policy of APA by the Council of Representatives in August, 2003. The term “guidelines” refers to pronouncements, statements, or declarations that suggest or recommend specific professional behavior, endeavors, or conduct for psychologists. Guidelines differ from standards in that standards are mandatory and may be accompanied by an enforcement mechanism. Thus, guidelines are aspirational in intent. They are intended to facilitate the continued systematic development of the profession and to help ensure a high level of professional practice by psychologists. These professional practice guidelines are not intended to be mandatory or exhaustive and may not be applicable to every clinical situation.

They should not be construed as definitive and are not intended to take precedence over the judgment of psychologists. Professional practice guidelines essentially involve recommendations to professionals regarding their conduct and the issues to be considered in particular areas of psychological practice. Professional practice guidelines are consistent with current APA policy. It is also important to note that professional practice guidelines are superseded by federal and state law and must be consistent with the current APA Ethical Principles of Psychologists and Code of Conduct (APA, 2002a; 2010a). These guidelines were developed for use in the United States, but may be appropriate for adaptation in other countries.

Need

A revision of the guidelines is warranted at this time as psychological science and practice in the area of psychology and aging have evolved rapidly. Clinicians and researchers have made impressive strides toward identifying the unique aspects of knowledge that facilitate the accurate psychological assessment and effective treatment of older adults as the psychological literature in this area has burgeoned.

As noted in the Guidelines for Psychological Practice with Older Adults (APA, 2004), professional psychology practice with older adults has been increasing, due both to the changing demography of the population and changes in service settings and market forces. The inclusion of psychologists in Medicare in 1989 markedly expanded reimbursement options for psychological services to older adults. Today, psychologists provide care to older adults in a wide range settings from home and community-based to long-term care settings. Nonetheless older adults with mental disorders are less likely than younger and middle aged adults to receive mental health services and, when they do, are less likely to receive care from a mental health specialist than younger persons (Institute of Medicine, 2012; Bogner, de Vries, Maulik, & Unützer, 2009; Karlin, Duffy, & Gleavs, 2008; Klap, Unroe, & Unützer, 2003; Wang, et al., 2005).

Unquestionably, the demand for psychologists with a substantial understanding of later life wellness, cultural, and clinical issues will expand in future years as the older population grows and becomes more diverse, and as cohorts of middle-aged and younger individuals who are receptive to psychological services move into old age (Karel, Gatz & Smyer, 2012). However, psychologist time devoted to care of older adults does not and likely will not meet the anticipated need (Karel, et al., 2012; Qualls, Segal, Norman, Niederehe, & Gallagher-Thompson, 2002). Indeed, across professions, the geriatric mental health care workforce is not adequately trained to meet the health and mental health needs of the aging population (Institute of Medicine, 2012).

Older adults are served by psychologists across subfields including clinical, counseling, family, geropsychology, health, industrial/organizational, neuropsychology, rehabilitation, and others. The 2008 APA Survey of Psychology Health Service Providers, found that 4.2% of respondents viewed older adults as their primary focus and 39% reported that they provide some type of psychological services to older adults (APA Center for Workforce Studies, 2008). Relatively few psychologists, however, have received formal training in the psychology of aging. Fewer than one third of APA member practicing psychologists who conducted some clinical work with older adults reported having had any graduate coursework in geropsychology, and fewer than one in four received any supervised practicum or internship experience with older adults (Qualls, et.al, 2002). Many psychologists may be reluctant to work with older adults because they feel they do not possess the requisite knowledge and skills. In the practitioner survey conducted by Qualls et al., a high proportion of the respondents (58%) reported that they needed further training in professional work with older adults, and 70% said that they were interested in attending specialized education programs in clinical geropsychology. In two small surveys of psychology students, over half of those surveyed desired further education and training in this area, and 90% expressed interest in providing clinical services to older adults (Hinrichsen, 2000; Zweig, Siegal, & Snyder, 2006).

Compatibility

These guidelines build upon APA’s Ethics Code (APA, 2002a, 2010a) and are consistent with the “Criteria for Practice Guideline Development and Evaluation” (APA, 2002b) and preexisting APA policy related to aging issues. These policies include but are not limited to the “Resolution on Ageism” (APA, 2002d), “Integrated Health Care for An Aging Population” (APA Presidential Task Force on Integrated Health Care for An Aging Population, 2008), “Resolution on Family Caregivers” (APA, 2011), and the “Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change” (APA, 2012b).

The guidelines are also consistent with the efforts that psychology has exerted over the past decade to focus greater attention on the strengths and needs of older adults, and to develop a workforce competent in working with older adults. Building on the adoption of the Guidelines for Psychological Practice with Older Adults (APA, 2004), The National Conference on Training in Professional Geropsychology was held in 2006 (funded in part by APA) and resulted in the development of the Pikes Peak Model for Training in Professional Geropsychology at the doctoral, internship, postdoctoral, and post-licensure levels (Knight, Karel, Hinrichsen, Qualls, & Duffy, 2009). That same year, the Council of Professional Geropsychology Training Programs (CoPGTP) was established “to promote state-of-the-art education and training in geropsychology among its members, to provide a forum for sharing resources and advancements in and among training programs, and to support activities that prepare psychologists for competent and ethical geropsychology practice” (http://www.copgtp.org). In 2010, the APA Commission on the Recognition of Specialties and Proficiencies in Professional Psychology recognized Professional Geropsychology as a specialty in professional psychology. Currently an initiative is underway to develop a geropsychology specialty through the American Board of Professional Psychology (ABPP). This will be one means to identify competent professional geropsychologists by a well-recognized credentialing body.

Within APA, the Office on Aging and the Committee on Aging have ongoing initiatives to actively advocate for the application of psychological knowledge to issues affecting the health and well-being of older adults and to promote education and training in aging for all psychologists at all levels of training and at post licensure. In the past decade, aging has been a major focus of three APA Presidential Initiatives – Dr. Sharon Brehm’s Integrated Health Care for an Aging Population initiative, Dr. Alan Kazdin’s Psychology’s Grand Challenges: Prolonging Vitality initiative (PDF,1MB) and Dr. Carol Goodheart’s Family Caregivers initiative.Further, many divisions within APA in addition to Division 20 (Adult Development and Aging) and Division 12-Section II (Society for Clinical Geropsychology), and some state, provincial and territorial psychological associations have initiated aging interest groups and other efforts directed toward practice with older adults.