Counseling of older adults has become an important concern for mental health professionals in the past few decades. Indeed, because of the increased life expectancy, the share of elderly people in the community has grown substantially and will continue to grow in the future. However, despite the advancement of healthcare that allowed for improving life expectancy, older adults still experience a range of health problems that can affect their quality of life. Chronic illness is particularly prevalent in this age group and often causes disability. Still, living an independent and fulfilling life is one of the key goals for the elderly. Rehabilitation counseling can help older adults with a disability to enjoy life and live more independently, thus facilitating enhanced well-being and quality of life. The present paper will focus on rehabilitation counseling of older adults with disabilities, discussing their developmental issues, needs, and the role of appropriate interventions in enhancing their lives.
Development of Older Adults
Aging is an essential developmental task that presents multiple challenges to individuals and their families. According to Erikson’s theory of personality development, the central developmental crisis experienced by older adults is integrity versus despair; by resolving this crisis successfully, older adults obtain wisdom that is critical to healthy aging (Perry, Hassevoort, Ruggiano, & Shtompel, 2015). As older adults experience individual challenges related to physical and emotional well-being, their families also have to adjust to the changes. Duvall’s family development theory is composed of eight developmental stages (Martin, 2018).
Older adults usually present an example of aging families. This stage of family development lasts from retirement to the death of both partners. During older adulthood, there is a significant shift in family roles as children face the need to care for their aging parents. This creates a challenge for the entire family since older adults often develop chronic physical and mental health conditions that affect their daily life and social functioning. Children and other young family members become informal care providers to the elderly, assuming control over some tasks, such as financial management, household duties, and medical assistance (Morgan & Brazda, 2013). The need for family support increases with a disability, and it is necessary for counselors to provide guidance to family members taking care of disabled older adults.
Older age is also characterized by cognitive challenges, which cause changes in learning and personality. According to Love, Ruff, and Geldmacher (2015), aging is associated with neurobiological changes, including cortical and white matter volume loss and impaired cerebral functional connectivity. These changes affect cognitive abilities, causing difficulties in learning new information and personality changes. Some neurodegenerative disorders, including Alzheimer’s disease, cause dramatic shifts in behavior and self-efficacy, thus putting more pressure on older adults and their families.
Counseling Intervention
Rehabilitation counseling can offer help to older adults with a disability, as it provides essential tools and support for developing coping mechanisms and improving the quality of life. Thus, individual rehabilitation counseling can help older adults and their families to progress through the last developmental stage seamlessly. The proposed intervention for the population of interest (older adults with disabilities) is tele-counseling.
Tele-counseling is a relatively new concept in healthcare technology, which includes providing counseling services at a distance. Sessions are carried out using a phone, a tablet, or a computer, and can include either a voice-only conversation or a video chat, which makes it ideal for patients who find it difficult to attend face-to-face sessions due to their chronic illness or disability (Ali, Gillespie, & Laney, 2017). Tele-counseling can also be a useful alternative for people living in rural areas, as stated by Bryant, Garnham, Tedmanson, and Diamandi (2018). The focus of the intervention should be on individual counseling, although it would be useful to add close family members to the sessions from time to time. Tele-counseling can provide numerous benefits for disabled older adults. Most importantly, it can help older adults to adjust to their new status and cope with their disability. As noted by Fortmann et al. (2013), “telephone-administered psychological interventions improved QOL, coping skills, community integration and depression in individuals with SCI and other acquired (permanent) physical disabilities” (p. 485). Besides, tele-counseling is an important opportunity for disabled older adults, as sessions can be carried out in the comfort of their home. The tele-counseling intervention for the population of interest would include weekly 60 to 90-minute sessions focusing on developing coping mechanisms, reintegrating into the community, and communicating with younger family members.
Crisis or Trauma Intervention
At times of crisis, older adults with disability face serious challenges that impact their physical and psychological recovery. They might experience physical injuries, loss of family members or loved ones, or develop increased stress or anxiety due to the impact of the crisis on their community. To promote recovery following a disaster or a major crisis, it is equally important to focus on the physical and mental well-being of older adults. Developing adequate coping mechanisms and building resilience should be the focus of rehabilitation counseling following disasters.
In later life, resilience is a vital quality that can help older adults to recover from traumatic events. There are three primary models of individual, family, and couple resilience that are relevant to older adults. First of all, the compensatory model presents a resilience factor, which counteracts the risk factor, thus creating resilience (Zimmerman, 2013). In older adults experiencing trauma or a disaster, family and social support can become a substantial resilience factor. Secondly, the protective model of resilience states that there are specific protective factors mediating the effect of risk exposure (Zimmerman, 2013). Similarly, social support can act as a strong protective factor; however, other factors protecting older adults from risk exposure include their health condition, socioeconomic status, and community resources available. In the context of trauma, family resilience reflects individual resilience that is strengthened by the network of relationships evident in the family (Walsh, 2016). Thus, in order to ensure successful disaster or trauma recovery for older adults, it is crucial to focus on building individual resilience as well as strengthening family relationships.
A necessary counseling intervention following a traumatic event should include both individual and family therapy. Group counseling is a useful opportunity to bring the family together in a joined recovery effort. It would be helpful to start the intervention as soon as the first response to the traumatic event is finished and actions have been taken to attend to the direct victims of the event. Ideally, the group counseling intervention should include weekly meetings with the counselor. For older adults with a disability, additional individual meetings should be carried out, as they might not be affected by the event in the same way as their family members. The counselor should also include cultural considerations in planning the intervention. For instance, people from certain cultures might have specific customs or traditions that would help them in obtaining community support. People from other cultures, on the contrary, would be more prone to internalizing trauma instead of attempting to overcome it in a healthy manner.
Other Recommendations
In order to develop interventions for older adults with a disability, it is essential to have a framework for understanding their specific personality traits, competencies, and other factors affecting counseling. Such framework should address the individual’s developmental stage, history of family relationships, medical information, and causes of the disability. Any alternative interventions should take into account this information and build upon it to assess the patient’s needs, goals, and existent psychological patterns, such as resilience or coping mechanisms. Depending on this information, the counselor can choose between different intervention types and counseling methods, applying strategies that can assist the patient in achieving his or her developmental goals, cope with trauma, and adjust to life changes. A successful intervention should seek to improve the individual’s quality of life and help him or her to reintegrate into society at an appropriate pace.
Conclusion
The present paper focused on older adults with a disability and their options for rehabilitation counseling. As shown above, older adulthood is a critical stage of individual and family development that presents some challenges. Older adults with physical or mental disabilities may find some of these challenges overwhelming, and thus need additional support from their family and community. Tele-counseling can provide numerous benefits to older adults with disabilities by improving their coping mechanisms, preventing depression, and assisting them in gaining social support. During the times of crisis, many older adults with disabilities experience significant trauma, which requires individual and family resilience. Therefore, it is vital for counselors to use different strategies depending on the individual’s needs, goals, and current situations. Successful rehabilitation counseling can help older adults to become more independent and improve their quality of life, all the while preventing adverse psychological outcomes.
References
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