Americans are living longer.

Today, more than half of all U.S. citizens live to celebrate their 78th anniversary, and many will survive into their 80s and 90s. For mental health counselors, an aging population means some big changes are in store for the profession, says Capella University counseling faculty member Crystal Neal, PhD.

For decades, older Americans were fairly stoic. They grew up in hard times (the Depression, World War II) and believed in keeping to themselves. Unfamiliar with counseling and unused to expressing feelings and emotions, many avoided talking about their feelings, frustrations, and emotions.

The Baby Boomers, however, are progressing in positive help-seeking behaviors, Neal says.  “They’re living longer, often with chronic health issues, including depression, anxiety, and psychosis—and they want help with those problems.” Neal cites “An ongoing challenge is Medicare parity. This remains at the forefront of advocacy work for older adults seeking mental health treatment from licensed professional counselors.”

Counseling older populations requires some specific knowledge and skillsets, Neal notes. Working with people in their Golden Years often involves taking a narrative approach, knitting together stories and lessons learned from decades of life experience.

“We don’t speak the same way with older adults,” Neal says. “We have to look at their perspective—how their view of themselves has changed or remained the same throughout their lives. They may see themselves differently than they did in their heyday.”

New Age Problems

The approach to counseling today’s seniors isn’t the only thing that has changed, Neal says. Many mental health issues have also arisen that are unique or new to older populations. Among them:

Risking opioid addiction

The opioid epidemic has hit every segment of American society. Older individuals are no exception: Many have developed addictions to pain killers and other opioids after getting medical treatments. The 2016 National Survey on Drug Use and Health found that a third of all Medicare recipients reported being prescribed at least one opioid. “Older adults are not immune from addiction issues,” Neal says.

Divorcing, dating, and remarrying

Counselors and others often refer to the “widowhood effect,” an increase in the probability of a person dying fairly soon after their longtime spouse passes. But Neal says she’s seen some significant changes in that trend in recent years—with the living partners going on to date or remarry. What’s more, the divorce rate among adults over age 50 has roughly doubled since the 1990s, according to a Pew Research Center report. “Older folks are experiencing things that we typically associate with younger cohorts,” Neal says. They’re navigating the world of dating and sex, and wrestling with related issues about self-image and self-worth.

Chronic conditions

As health care improves, more Americans are living longer—but with chronic health issues. According to the National Council on Aging, roughly 80% of older adults have at least one chronic disease, and 77% have at least two. “Living with a chronic condition can spur depression and other mental health issues,” Neil says. “When people cannot engage in some of the activities that bring them happiness, it affects their mental health. Often, there’s related depression or other issues that need treatment.”

The good news, Neal says, is that counselors are keeping up and learning how to interact with older adults. “Counseling for older people is getting better as we learn how to effectively engage with them,” Neal says. “Our understanding of how aging affects mental health is getting better and better.”

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