Opportunities and challenges in establishing an age-friendly practice

With the growing number of older adults within the Australian population, there is a vital need for practising psychologists to consider broadening their scope of practice to include older adults, and indeed to establish age-friendly practices. In this way, older adults who would benefit from psychological services will be more likely to be able to access competent evidence-based treatment. However, while this presents opportunities for the practising psychologist, there are a number of challenges associated with establishing an age-friendly practice. To learn more about the opportunities and challenges of an age-friendly practice, this article shares the insights of three psychologists in practice who are committed to working with olderadults.

What are some of the key considerations in establishing an age-friendly practice?

In addition to a psychologist being competent to practise with older adults, key features of an age-friendly practice include:

Practitioner considerations:

• Developing a sound knowledge base
• As a psychologist working in an age-friendly practice, it is critical to have a sound knowledge of the ageing process. Psychologists working with older adults not only need to understand the normal ageing processes but be familiar with prevalence rates and various presentations of different mental health problems in older adults. For example, anxiety and depression are less common in older adults compared with younger populations (Australian Bureau of Statistics, 2007). Such knowledge and familiarity will assist psychologists to more competently recognise abnormal symptoms in an olderclient.
• Awareness of life’s context
  An age-friendly practice practitioner needs to assess the older person’s life context, as well as cohort, generational, and familial effects. These factors need to be taken into consideration as part of any formulation, as these factors tend to shape the older adult’s values and beliefs. Further, the practitioner needs to be mindful that as people age, there is a greater degree of variation in their life experience. In later life people have generally made a greater range of choices and have led very different lifestyles. Assuch, the older population is the most heterogeneous.
• Challenging myths or biases
  Personal biases can be a barrier to treating an older adult, and can also influence the older adults’ views about their own ability to access treatment and achieve change. Forexample, the widely held myth that there is ‘no point’ in treating people at the end of their lives, or that ‘you can’t teach an old dog new tricks’ is not only corrosive, butincorrect.
  
  In contrast, age can lead to greater cognitive flexibility. For example, in some cases, older people’s vast experience helps them to experientially know that there are different ways of looking at problems in life, and can therefore be more open to looking at problems or issues in new ways (Knight, 2006, InLaidlaw, Kishita, &Chellingsworth,2016).
  
  Another potential bias is the notion that depression is a natural consequence of the losses, physical health problems and role changes that occur with age. However, this is also incorrect and can lead the practitioner to miss opportunities to treat an older person’s mental health concerns (Laidlaw, Thompson, Dick-Siskin, & Gallagher-Thompson, 2009).

• Practical considerations
  There are practical aspects to consider in an age-friendly practice including having wheelchair-accessibility, proximity to car parks, and being flexible about where patients are seen. For example, the rates of mental health issues like anxiety are more prevalent in older adults living in residential aged-care facilities (RACFs) (Bryant, Jackson, & Ames, 2008) and will sometimes require seeing the client at the RACF. In another example, where dementia is part of the presentation, meeting the person in the RACF allows for a more comprehensive and helpful assessment that encompasses interactions with staff, residents and living conditions.
• Working as part of a multidisciplinary team
  An age-friendly practice often requires practitioners to be activemembers of a multidisciplinary team due to the potential complex health needs and service requirements ofthe olderperson.

What are some of the barriers and complexities to developing an age-friendly practice?

• General lack of awareness of the role of psychology
  A significant barrier to successfully establishing an age-friendly practice is the general lack of awareness of the role that psychologists can play in caring for older adults’ wellbeing. Potential referrers such as GPs and geriatricians can neglect to identify mental health issues in older patients, or fail to be aware of the evidence-based interventions for older adults experiencing anxiety or depression.

• Help-seeking attitudes
  Another barrier is related to the help-seeking attitudes of some older adults. For some older adults, their attitudes towards mental health issues can influence their willingness to seek treatment. There can also be a cohort effect as older adults are less au fait with seeking psychological treatment than youngerAustralians.

• Funding
  It can be difficult for an older adult living in a RACF to access funding for their treatment because residents receiving government funding for their care under the Aged Care Act are not eligible for funding under the Better Access initiative. Further, for older adults seeking treatment for behavioural andpsychological symptoms of dementia, would not be covered under the Better Access initiative (Department ofHealth, 2012).

What are some useful strategies to overcome thesebarriers?

• Raising awareness of psychology’s role
  It is first necessary to raise awareness about the typical presenting problems for older adults and the benefits of therapy for them. Second, a dialogue that changes the narrative about therapy for older adults is needed so that referrers are more mindful that all age groups are entitled tothe same quality of life.
  
  It is important to have regular contact with referrers via a range of methods including letters, newsletters and information sheets that specifically highlight the issue. Another useful strategy is to include a range of information about treatments for older adults on the practice’swebsite.
• Exploring alternative funding opportunities
  For older adults requiring treatment in a RACF, an age-friendly practice needs to be flexible and explore the range of funding opportunities available. In some cases, an older adult living in a RACF may be eligible to access funding for psychological services as part of their older adult’s care package, perhaps under allied health services or via a particular referral pathway. My Aged Care is a good first point of call when finding alternative or additional support services. For further information, visit www.myagedcare.gov.au
  
  Many older adults are also able to claim mental health treatment via the Department of Veterans’ Affairs. This requires the psychologist to be registered as an approved provider with that Department.
• Considering flexible fee structures
  Flexible fee structures can also be an effective way to improve access to psychological services, particularly for older adults living in RACFs. It is often necessary to be willing to forego gap payments to ensure older adults are able to claim for their treatment (for example, with the Department of Veterans’ Affairs).

How does one maintain the knowledge and skills required to work with older adults when there aren’t that many psychologists with expertise in this area?

• Psychologists who take on older adults as clients must ensure they have the appropriate knowledge, skills and, (where necessary), supervision, to ensure the best treatment outcome. One strategy to support this is to work in a practice where there are a number of psychologists (or other staff) who demonstrate an interest in and are well versed in the treatment of older adults. As with all areas of practice, psychologists’ interest in and positive regard for this demographic should be genuine, as the commitment necessary to having a satisfactory level of knowledge and skills, (given the breadth of the area) and the patience required in titrating treatment, may create frustration if this area of a psychologist’s work is not considered fulfilling.
  
  Furthermore, positive responses will be enhanced not only by arewarding experience with treating psychologists but also by the clients’ experience of the practice overall. That is, feeling validated, safe, respected, and accepted. All staff, including administrative staff can contribute here, with appropriate education and training.
• Being part of groups such as the APS Psychology and Ageing Interest Group is a good way to keep track of opportunities to extend your knowledge, be notified of potential CPD opportunities, and be part of a network of psychologists interested in ageing and older adults.
• Keeping up-to-date with the APS Ethical guidelines for the provision of psychological services for, and the conduct of research with, older adults is recommended.

The authors can be contacted c/o [email protected]