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Ageism and the Counseling Profession: Causes, Consequences, and Methods for Counteraction – The Professional Counselor

Ageism and the Counseling Profession: Causes, Consequences, and Methods for Counteraction

Matthew C. Fullen

As the number of older adults increases, it is important to understand how attitudes toward aging influence society, the aging process, and the counseling profession. calculate my age
ism—defined as social stigma associated with old age or older people—has deleterious effects on older adults’ physical health, psychological well-being, and self-perception. In spite of research indicating that the pervasiveness of ageism is growing, there are few studies, whether conceptual or empirical, related to the impact of ageism within the practice of counseling. This article includes an overview of existing literature on the prevalence and impact of ageism, systemic and practitioner-level consequences of ageism, and specific implications for the counseling profession. Discussion of how members of the counseling profession can resist ageism within the contexts of counselor education, gerontological counseling, advocacy, and future research will be addressed.

Keywords: ageism, aging, older adults, gerontological counseling, advocacy

Currently, there are approximately 47.8 million adults age 65 & kết thúc living in the United States, & this number is expected phệ grow bự 98 million — or more than one in five Americans — by 2060 ( Administration on Aging, 2017 ). Much of this growth can be attributed lớn the aging of the boomer generation, the age cohort born between 1946 & 1964. Approximately 10,000 boomers turn 65 every day ( Short, năm nay ). Increases béo the average life span also have expanded the number of older Americans, with a person age 65 now living an average of 19.4 additional years, và many living well beyond that age ( Administration on Aging, 2017 ). Nonetheless, many misconceptions remain about the aging process, và recent research demonstrates that the prevalence of ageism is growing ( Ng, Allore, Trentalange, Monin, và Levy, năm ngoái ). Ageism — defined here as mạng xã hội stigma related lớn old age or older people ( Widrick và Raskin, 2010 ) — is associated with the lack of mental health services available mập older adults ( Bartels và Naslund, 2013 ), & when negative attitudes toward aging are internalized by older adults, significant consequences Khủng health & well-being may occur ( Levy, 2009 ) .
Within the counseling literature, there appears Khủng be a lack of research on ageism và its impact on older adulthood. A keyword tìm kiếm of leading counseling journals dating back mập 1992 results in a single publication on the topic of ageism within the American Counseling Association’s Journal of Counseling và Development ( Saucier, 2004 ), as well as a single empirical study in Adultspan Journal ( McBride và Hays, 2012 ). Therefore, phệ elucidate the effects of ageism, as well as its role within the field of professional counseling, this article will provide a Reviews of existing literature on the prevalence of ageism, its consequences among mental health professionals, và the impact of internalized ageism on older adults. The article concludes with recommendations for how counselors, counselor educators, & counseling students can mitigate the effects of ageism và promote positive perceptions of aging .

Prevalence and Impact of Ageism

Prevalence of Ageism

The term “ ageism ” was first used in the late 1960 s Khủng describe discriminatory beliefs or practices that are predicated on the age of a person or nhóm ( Butler, 1969 ). Like racism or sexism, prejudice associated with age is both pernicious & challenging béo quantify. Many myths about aging are assumed Khủng be true without additional consideration, leading bự a “ commonsense reality ” about old age or older people that is then perpetuated throughout a society ( Angus và Reeve, 2006, p. 141 ). Moreover, scholars argue that ageism is currently met with less disapproval than racism or sexism ( Cuddy và Fiske, 2002 ; Nelson, năm nay ; Palmore, 2005 ), although more recent empirical research is needed bự substantiate this hypothesis. Nevertheless, research indicates that views about aging are becoming more negative ( Ng et al., năm ngoái ). Dominant myths include the notion that older adults are : ( a ) lonely & depressed ; ( b ) increasingly similar as they grow old ; ( c ) sick, frail, và dependent ; ( d ) cognitively & psychologically impaired ; ( e ) sexless & boring ; và ( f ) unable mập learn or change ( Thornton, 2002 ; Whitbourne và Sneed, 2002 ). Thes e myths persist in spite of research that demonstrates that older adults are heterogeneous, possess many psychosocial resources, frequently have high levels of self-rated & objectively measured health, & mostly bởi not experience dementia or other forms of cognitive impairment ( Whitbourne và Sneed, 2002 ) .
Stereotypes about older adulthood are transmitted throughout society & may lead lớn detrimental consequences for the health và well-being of older people. For example, truyền thông representations of older adults are likely Khủng reinforce negative views about older adulthood. Television shows, movies, & advertising depict older people according béo stereotypes about aging — or omit them altogether ( North và Fiske, 2012 ) — & older people who watch more television kết thúc the course of their lives tend phệ view aging in a more negative light ( Donlon, Ashman, và Levy, 2005 ). Ageism is transmitted through mạng xã hội truyền thông as well. References Khủng older adults on Facebook are commonly comprised of references béo cognitive or physical debilitation, the infantilization of older people, or suggestions that older adults be banned from public activities lượt thích driving or mua sắm ( Levy, Chung, Bedford, và Navrazhina, năm trước ) .
Negative stereotypes may lead Khủng age-based discrimination, a phenomenon that experts describe as both “ understudied ” & “ surprisingly pervasive ” ( North và Fiske, 2012, p. 983 ). For example, Posthuma and Campion ( 2009 ) described several workplace-based stereotypes that exist, in spite of a lack of supporting evidence. Thes e include the notion that older workers have lower levels of ability và motivation, lower productivity, và greater resistance béo change. Within the realm of health care, physicians may be less likely béo offer particular medical treatments béo older patients because of a belief that certain ailments are the inevitable consequences of natural aging ( Bowling, 2007 ). Ageism may result in elder abuse, both within care facilities và among family members ; however, it is underreported because of a lack of awareness among health và mạng xã hội service providers ( Nelson, 2005 ) .
Negative stereotypes about aging develop in a manner that parallels stereotypes lượt thích racism or sexism. Levy’s ( 2009 ) stereotype embodiment theory suggests that ageist views may be transmitted culturally & internalized by older adults, leading phệ significant changes béo health và functioning. Older adults are first exposed béo negative stereotypes about aging when they are young. As individuals age into older adulthood, their negative beliefs about aging become increasingly salient & self-directed. On the other hand, if an individual is socialized lớn hold more positive views toward aging, these viewpoints may serve as a buffer against internalized ageism ( Levy, 2009 ) .
Furthermore, stereotype embodiment theory ( Levy, 2009 ) suggests that when stereotypes are assimilated from the surrounding culture, they eventually become self-definitions that influence a person’s functioning & health. Stereotype embodiment theory concludes that : ( a ) stereotypes are internalized throughout the life span ; ( b ) they are likely lớn operate unconsciously ; ( c ) as views of older age become increasingly relevant béo a person’s identity, the age stereotypes become more salient ; & ( d ) self-referential views on aging are developed via pathways that may be both top-down ( i. e., societal perspectives are passed on lớn the individual ) & longitudinal ( i. e., views on old age begin in childhood ) .
Cuddy, Norton, & Fiske ( 2005 ) argued that groups within a society are often categorized based on two traits — warmth & competence — và the authors found that most participants rated older adults as warm, but incompetent. Contrary mập the belief that ageism is only a concern in Western countries, Cuddy et al. reviewed a large-scale international study that included college students in Belgium, Costa Rica, Hong Kong, Nhật Bản, và South Korea. Across samples, participants viewed older adults as significantly more warm than competent, non-competitive, và having lower mạng xã hội status. Within their study, this trend persisted even when looking at cultures và countries that are typically described as more collectivist ( i. e., Hong Kong, Nhật Bản, & South Korea ) .
Research indicates that ageism is prevalent within environments where older adults receive housing & health care services. In an ethnographic study on the impact of age & illness within a residential care setting, Dobbs et al. ( 2008 ) found that some family members, staff, & residents held negative attitudes about aging that resulted in an environment affected by ageism. In their study, examples of negative age bias included neglecting lớn gather resident đầu vào prior béo making decisions, using infantilizing speech with older people, & stigmatizing residents because of dementia or physical disability. In a similar study completed within a multi-level care setting, Zimmerman et al. ( năm nay ) found that the use of multi-level, stepped care ( i. e., adults with differing independence levels residing within the same setting ) reinforced stigma related phệ age và health, with older adults differentiating among themselves based on which levels of care were required .

Impact of Social Forces

Scholars posit a wide range of hypotheses bự explain the prevalence of ageism, but two systemic processes — modernization và medicalization — are identified in the literature as the most likely catalysts of negative attitudes toward aging ( Cuddy và Fiske, 2002 ; Ng et al., năm ngoái ). In regard lớn modernization theory, Cuddy and Fiske ( 2002 ) explained that views of older adulthood have changed as a result of the shift from an agrarian society bự an industrial society. Technological advances, increased literacy rates among young people, & a trend toward urbanization resulted in greater competition between young và old generations, as well as weakened intergenerational mạng xã hội ties between young people và their families of origin. The sum of these mạng xã hội changes led bự decreased status for older people, resulting in the “ warm, but incompetent ” stereotype that is now associated with them ( Cuddy et al., 2005 ) .
Relatedly, improvements in health care have extended the life span & increased the ratio of older bự younger people. Previous research shows that as the ratio of older adults bự younger adults increases, views about older adulthood become increasingly negative ( Ng et al., năm ngoái ). Given that the number of older people will increase markedly in coming years, it is possible that negative attitudes toward older people will continue bự grow unless intervention occurs .
The second major mạng xã hội force described in the literature is the medicalization of aging, which refers béo associating old age with a person’s physical health or illness, béo the detriment of other aspects of well-being ( Ng et al., năm ngoái ). The dominance of medical conceptualizations of old age is described as one of the “ master narratives ” associated with the modern study of aging ( Biggs và Powell, 2001, p. 97 ). Although the causes of medicalization are many & complex, they can be summarized by the shift from viewing old age as a natural part of the life span mập the viewpoint that old age, và even death itself, are problems that modern medicine may be able bự solve ( Ng et al., năm ngoái ). Past research indicates that the medicalization of aging predicts negative attitudes toward aging & consequentially leads bự “ the objectification of older adults as patients rather than as individuals with interesting life experiences ” ( Ng et al., năm ngoái, p. 2 ) .

Consequences of Ageism

Impact on Older Adults’ Health and Well-Being

There is a substantial body toàn thân of research indicating that age stereotypes influence older adults ’ health & well-being. For instance, older adults ’ perceptions of aging are associated with memory performance ( Levy, Zonderman, Slade, và Ferrucci, 2011 ), hearing decline ( Levy, Slade, và Gill, 2006 ), developing Alzheimer’s symptoms ( Levy et al., năm nay ), & dying from respiratory or cardiovascular illnesses ( Levy và Myers, 2005 ). In fact, Levy, Slade, Kunkel, & Kasl ( 2002 ) found that even after controlling for age, gender, socioeconomic status, loneliness, và functional health, older adults with more positive self-perceptions of aging lived 7.5 years longer than those with less positive self-perceptions of aging .
Conversely, research indicates that positive perceptions of aging may provide a salutatory effect on health & well-being. Older adults with positive age stereotypes are 44 % more likely phệ fully recover from severe disability compared phệ those with negative age stereotypes ( Levy, Slade, Murphy, và Gill, 2012 ), và older military veterans who resisted negative age stereotypes had significantly lower rates of mental illness compared béo those who fully accepted them ( Levy, Pilver, và Pietrzak, năm trước ). Thes e positive differences were found for suicidal ideation ( 5.0 % vs. 30.1 % ), anxiety ( 3.6 % vs. 34.9 % ), và PTSD ( 2.0 % vs. 18.5 % ), even after controlling for age, combat experience, personality, và physical health. In regard bự variables that may influence older adults ’ self-perceptions of aging, Fullen, Granello, Richardson, and Granello ( in press ) found that resilience — the ability lớn bounce back from adversity — và multidimensional wellness were significant predictors of positive age perception, whereas increased age và decreased physical wellness predicted internalized ageism. Furthermore, resilience appeared Khủng buffer older adults from experiencing internalized ageism as they grew older. However, older adults may not be exposed phệ interventions béo promote resilience và well-being because of ageism’s impact on the availability of mental health services among older adults .

Impact on Mental Health Professionals

The gap between the mental health needs of older adults và the number of mental health professionals with specific training in working with older adults is on the verge of a “ crisis ” ( Institute of Medicine, 2012, p. ix ). Scholars provide a variety of explanations mập tài khoản for this, including systemic factors — such as inadequate funding & a lack of training opportunities within academic programs ( Bartels và Naslund, 2013 ; Gross và Eshbaugh, 2011 ; Robb, Chen, và Haley, 2002 ) — và personal factors, including low interest in working with older adults ( Tomko, 2008 ) & therapeutic pessimism ( Danzinger và Welfel, 2 nghìn ; Helmes và Gee, 2003 ) .

Systemic ageism. Although older adults consistently report higher life satisfaction than younger or middle-aged adults (George, 2010), approximately 26% of all Medicare beneficiaries, or more than 13 million Americans, meet the criteria for a mental disorder (Center for Medicare Advocacy, 2013). Yet, mental health services currently account for only 1% of Medicare expenditures (Bartels & Naslund, 2013). Systemic barriers may be partially responsible for the lack of access to mental health services among older adults. For example, inadequate reimbursement rates is cited as one reason for the 19.5% decline in psychiatrists accepting Medicare between 2005–2006 and 2009–2010 (Bishop, Press, Keyhani, & Pincus, 2014). Similarly, Medicare payments to psychologists for psychotherapy decreased by 35% since 2001, after adjusting for inflation (American Psychological Association, 2014). Older adults are currently unable to use Medicare to access services provided by licensed professional counselors (LPCs) or marriage and family therapists (MFTs; Fullen, 2016b). This translates to an estimate of 175,000 mental health professionals who are unavailable to serve as Medicare-eligible providers (American Counseling Association, n.d.). Clients who age into Medicare coverage after working with these professionals face discontinuity of care caused by having to change providers.

Professional training barriers among the helping và health professions also may reflect systemic ageism. Half of the fellowship positions in geriatric medicine và geriatric psychiatry are unfilled each year, & only 4.2 % of psychologists focus on geriatric care in clinical practice ( Bartels và Naslund, 2013 ). Institutional barriers that inhibit student interest in careers related béo work with older adults include a lack of visibility for multidisciplinary gerontology programs, the absence of gerontological nội dung within textbooks, few faculty who are trained in gerontology, misconceptions about employment opportunities ( i. e., the assumption that the only aging sector jobs available are in nursing homes ), & a primary focus on the problems associated with old age when later life is discussed within the classroom ( Gross và Eshbaugh, 2011 ) .
Within the counseling profession, scholars describe a mixed commitment phệ gerontological counseling. Going back bự 1975, Salisbury ( 1975 ) và Blake và Kaplan ( 1975 ) described counseling with older adults as an overlooked tên miền within professional counseling. Twenty years later, Myers ( 1995 ) argued that gerontological counseling had evolved from “ forgotten và ignored ” ( p. 143 ) lớn a sub-discipline within the profession complete with standards và certification. However, the gerontological counseling specialization that existed between 1992 & 2008 was discontinued in 2009 when only two institutions had applied for accreditation ( Bobby, 2013 ). Perhaps more telling, the năm nay Standards of the Council for Accreditation of Counseling và Related Educational Programs ( CACREP ) include zero references Khủng the words old, older, older adults, or ageism ; only one reference each béo the words age và aging ; và four references bự the phrase life span ( CACREP, năm ngoái ). Nonetheless, Foster, Kreider, và Waugh ( 2009 ) found that many counseling students have interest in topics related Khủng gerontological counseling, including grief counseling ( 70 % ), retirement counseling ( 43 % ), family counseling with aging parents ( 64 % ), và counseling caregivers ( 55 % ). The same study found that many respondents were interested in working in a hospice setting ( 39 % ), a hospital geriatric unit ( 29 % ), a nursing home page ( 25 % ), private practice with older adults ( 43 % ), và a community setting with older adults ( 45 % ). However, it is unclear whether students who are interested in working with older adults receive training và employment opportunities within these contexts .

Individual ageism. Research regarding the prevalence of ageism among individual mental health professionals is equivocal. When mental health professionals’ perceptions of clients based on age, gender, and health variables were studied, some researchers found health bias, but not age bias (Robb et al., 2002). Others reported that participants rated older clients as having a greater number of diagnostic problems (Helmes & Gee, 2003) and a worse prognosis than younger clients, in spite of all relevant information being matched across age groups (Danzinger & Welfel, 2000). Helmes and Gee (2003) found large differences in how older people were rated on key therapeutic variables. Older clients were viewed as less able to develop an adequate therapeutic relationship, less appropriate for therapy, and less likely to recover. Respondents in their study also felt less competent in treating older people, and they were less willing to accept older people as clients.

To counteract the potential influence of negative age bias on counseling treatment, McBride and Hays ( 2012 ) described the importance of linking work with older adults Khủng multicultural competence. The authors surveyed 360 counselors & counselor trainees và found a significant, negative correlation ( r = -. 41 ) between multicultural competence và negative attitude toward aging. Tomko ( 2008 ) found that multicultural competence was associated with improved clinical judgment when working with older adults ; however, it did not predict global attitudes toward aging. In sum, considerations of both the systemic và individual aspects of ageism have important implications for the counseling profession .

Implications for the Counseling Profession

The rapid growth of the older adult population will impact members of the counseling profession in a variety of ways. Shifting age demographics make it imperative that counselors understand how the pervasiveness of ageism impacts key professional values lượt thích diversity, mạng xã hội justice, và client advocacy. Four domains are outlined in which counselors may dedicate their attention phệ generating positive views of aging. Thes e domains include counselor education, advocacy, research, và counseling practice .

Counteracting Ageism Within Counselor Education

Within counselor training programs, resistance phệ ageism begins with incorporating discussions about aging và older adulthood into the counselor education curriculum. Therefore, it is important that professional accreditation standards lượt thích CACREP adequately reflect the mental health needs of older adults và their families. In its current size, the omission of keyword lượt thích aging, older adulthood, và ageism from these standards may send a mixed signal béo counselor training programs & their students about mạng xã hội justice và multicultural competencies as they relate mập older adults .
Once ageism is identified by a counselor education program as a priority, counselor educators need lớn develop strategies for incorporating this focus in the existing curriculum. For instance, a life span development course provides ample opportunities phệ discuss issues such as shifting population demographics, multigenerational families, & how an aging population will impact the counseling profession. Assessing students ’ current thoughts about the aging process, including both their own aging và that of family members, may create greater empathy for the needs of older adults. Similarly, when instructing mạng xã hội và cultural diversity courses, counselor educators should consider introducing topics such as ageism và age privilege & juxtaposing these constructs alongside dialogue about diversity & intersectionality ( black và Stone, 2005 ). Furthermore, when developing practicum or internship sites, counselor educators could make a point of developing placements in which older clients will be served. Identifying potential site supervisors who have experience in working with older adults is an important step, as it ensures that trainees are given adequate opportunities béo reflect on their own perspectives on aging, disability, advocacy, và related issues .

Counteracting Ageism Through Advocacy

In regard Khủng advocacy, counselors should resist ageism at national, state, & local levels. At the national màn chơi, the omission of counselors as approved Medicare providers limits the availability of mental health services for older adults và reflects the assumption that older adults ’ needs are primarily physiological. This issue creates challenges for members of the counseling profession who are interested in providing services across the life span. Mental health advocacy on behalf of older adults includes educating lawmakers about the importance of Medicare reimbursement as a means of creating mental health service access ( Fullen, năm nay b ). Professional organizations continue béo tư vấn grassroots advocacy, as well as lobbying efforts, béo influence Medicare policy on behalf of counselors. In fact, as of this biên tập there are bills in each chamber of the United States Congress ( i. e., S. 1879 ; H.R. 3032 ), và a federal advisory nhóm ( i. e., the President’s Interdepartmental Serious Mental Illness Coordinating Committee ; ISMICC ) recently recommended inclusion of counselors within Medicare ( National Board for Certified Counselors, n. d. ) .
At the state và local màn chơi, members of the counseling profession should forge partnerships with gerontology professionals. For example, advocacy occurs when professional counselors và counselor educators make connections with members of the local area agency on aging, directors of local assisted living or skilled nursing facilities, or state policymakers who are responsible for budgetary và policy decisions related bự aging. Thes e partnerships are mutually beneficial ; they provide members of the counseling profession with increased exposure mập the diverse needs of older adults in their communities, và they educate local gerontology professionals about the range of mental health services that counselors provide. Additionally, building interprofessional connections may lead béo research opportunities that can improve the care received by older adults .

Counteracting Ageism Through Research

In spite of the numerous studies indicating that ageism has detrimental effects on older adults, there are currently very few studies that demonstrate the prevalence và impact of ageism within the counseling profession. For instance, research on in-session dynamics between counselors & much older clients could shed light on the ways in which age is broached in a counseling session. Additionally, research could focus on the benefits of professional counseling for older adult clients, as well as the effectiveness of novel interventions that are grounded in counseling theories or wellness ( Fullen và Gorby, năm nay ; Fullen et al., in press ). For instance, the development và validation of a wellness-based approach phệ counseling older adults might mitigate mental health issues or internalized ageism among older clients ( Myers và Sweeney, 2005 ), và it would serve as additional evidence for the necessity of adding counselors as Medicare providers .
At the institutional màn chơi, more research is needed béo understand the extent phệ which counselor training programs address ageism, và in which curricular contexts. It is important Khủng understand which pedagogical strategies are most effective, whether these impacts persist end giây phút, & how well training programs make inroads with local agencies that work with older adults. Research into advocacy efforts related bự Medicare reimbursement may also advance the profession. Although Medicare reimbursement is described as a priority for the counseling profession, there is currently little research on counselors ’ knowledge about Medicare or participation in Medicare advocacy .

Counteracting Ageism Through Counseling Practice

Finally, it is important Khủng consider how counselors might resist ageism within their counseling practice. Because of the heterogeneity of older adults, counseling services should be tailored béo the chất lượng needs of each client. Given that ageism has the potential bự influence how older clients are conceptualized by counselors, it is important for counselors Khủng reflect on their own beliefs about aging as well as their assumptions about the ability of older clients mập grow và change. Many counselors are not familiar with the wide range of mental health interventions that have been empirically validated with older adults ( Myers và Harper, 2004 ). For example, the SAMHSA-HRSA Center for Integrated Health Solutions ( n. d. ) provides numerous resources related mập providing behavioral health services mập older adults. Thes e resources address issues such as evidence-based treatments for late life depression, preventing suicide in older adults, screening for substance misuse, & assessing cognitive functioning .
Given the growing interest in wellness-oriented services for older adults, SAMHSA also provides evidence-based resources related Khủng health promotion & integrated care. Programs that focus on cultivating holistic wellness or resilience are relatively mới nhất, but they also may be worth considering as a means of countering ageism within the practice of counseling. Because the wellness approach incorporates multiple dimensions of functioning, older clients who are experiencing deficits in a particular tên miền ( e. g., limited mobility influencing ability Khủng drive ) may find that they can use alternative domains as a means of compensating ( e. g., greater reliance on mạng xã hội network Khủng carpool bự events ; Fullen, năm nay a ). Similarly, discussion of how older clients have used strengths bự navigate loss, overcome adversity, & resist ageism in their own lives may prove béo be key ingredients in the therapeutic process. Furthermore, incorporating resilience into an older client’s treatment kế hoạch may create a buffer against internalized ageism ( Fullen et al., in press ), as well as an opportunity lớn highlight older adults ’ abilities Khủng adapt in the face of adversity ( Fullen và Gorby, năm nay ) .

Conclusion

As the number of older adults grows, members of the counseling profession are increasingly likely lớn encounter older people who seek phệ benefit from counseling services. A review of existing research demonstrates that there are numerous causes of ageism, detrimental consequences associated with internalizing negative age stereotypes, & gaps in research related Khủng how the counseling profession should respond. In light of the counseling profession’s commitment béo diversity, mạng xã hội justice, & advocacy, it is important lớn better understand the broad impact of ageism. By combating ageism in the domains of public policy, research, teaching, & direct service with clients, members of the counseling profession have the opportunity phệ counteract ageism’s deleterious effects và promote more positive perceptions of growing older .

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest or funding contributions for the development of this manuscript .

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