When I was interviewing for graduate school, I was asked if I thought my dual major as an undergraduate in sociology and psychology would be "detrimental” to my career as a geropsychologist. Evidently, it was the interviewer’s belief that systems had little to do with the individual adult. I have often reflected on that moment and recognized the critical role it played in my professional development. It is difficult for me to imagine working with an older adult and not knowing his or her background, not exploring the interplay between one’s social structure and sense of self, and not integrating families and other professionals into a patient’s care. However, there are many that do not know the benefits of this work or how it can be done, particularly as it pertains to older adults.
As I participated in this year’s CFHA conference, I was surprised by how few people I met expressed interest in geriatrics. In fact, I was alarmed. It was disheartening to hear Doctors Blazer and Martinez report on the "silver tsunami” and the Institute of Medicine’s report on the limited number of workforce prepared to care for this rapidly growing population.
I wondered: how could this be? Is it a lack of funding? A lack of educators? A lack of awareness? And the answer seems to be: All of the above. So how do those of us who are passionate about our work with this population demonstrate that it is a worthwhile endeavor desperately needed in our current culture?
The numbers alone should demand our attention:
- 72.1 million: the number of older adults projected by 2030 in the US alone (Administration on Aging, 2011).
- 7 - 8%: the number with severe cognitive impairment (Freedman, Aykan, & Martin, 2001).
- 5 - 10%: the number of older adults seen in primary care suffering from major depression and dysthymia (Lyness et al., 1999).
- 20%: the number of older adults with chronic disabilities in the US (Manton & Gu, 2001).
- 29%: the number of the US population providing care for a chronically ill or older adult family member (National Alliance for Caregiving, 2009).
Though these numbers are powerful, they do not capture the full story of our aging population. There are many families who invite us into their lives to share their experiences of successful and sometimes less than successful aging. Recently, I was meeting with an aging patient and her friend. They both expressed gratitude to me for not shouting and talking down to them as if they were children, noting that this was so often their experience with others. I was reminded during this encounter of the stigma attached to aging. Why is it that we assume we must shout or that an aging individual must be suffering from cognitive impairment? These assumptions are unhelpful.
I am fortunate enough to have learned many lessons on aging from all four of my beloved grandparents and my parents who provided them with much of their care. I was taught to live and breathe the idea of respect for my elders, but it was more than that: it was a message of providing the aging people around me with dignity and a listening ear. It was from them that I learned how to grieve and on some days, how not to. I learned how to be flexible, as they gracefully made transitions and altered their expectations when necessitated by medical and physical need. I learned perseverance as my grandmother insisted she was not old, not ready to die, and kept taking the stairs rather than using an elevator at the age of 90. When I wasn’t learning from them, 30 older adults and their professional caregivers at adult daycare facility were teaching me every summer during my adolescence about the power of gentle touch and laughter as sources of healing.
I recognize that others are not as fortunate as I, who had the wonderful opportunity to know all four of these people until my early adulthood. But I challenge all providers who have not had such opportunity to listen to your older patients, to hear their stories, and to learn from them. Geriatric educational programs might not be accessible to all of us, but these patients are abounding, and ready and willing to teach us. Let us take a moment to be educated through their experiences, their voices, their families, and their lived-wisdom.
Lauren DeCaporale, PhD is a second-year postdoctoral fellow in Primary Care Family Psychology with a specialization in geriatrics/internal medicine at the University of Rochester Medical Center, Institute for the Family, Rochester, NY.
Administration on Aging (2011). Profile of older Americans. Aging statistics. Retrieved from http://www.aoa.gov/aoaroot/aging_statistics/index.aspx
FreedmanVA, AykanH, MartinLG.Aggregate changes in severe cognitive impairment among older Americans: 1993 and 1998.J Gerontol B Psychol Sci Soc Sci.2001;56:S100-S111.
Lyness JM, Caine ED, King DA, Cox C, Yoediono Z. Psychiatric disorders in older primary care patients. J Gen Intern Med. 1999;14:249–254.
MantonKG, GuX.Changes in the prevalence of chronic disability in the United States black and nonblack population above age 65 from 1982 to 1999.Proc Natl Acad Sci U S A.2001;98:6354-6359.
National Alliance for Caregiving (2009). Caregiving statistics. Who are Family Caregivers?. Retrieved from http://www.thefamilycaregiver.org/who_are_family_caregivers/care_giving_statstics.cfm