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The conceptual orientation of policymakers and practitioners toward older adults is to view them as a problem population who must be protected and cared for, but not as functioning members of society whose skills and expertise should be maximized. To be sure, declines in functional abilities continually occur with age. For example, research indicates that the practical problem-solving ability of adults peaks in middle age and then declines thereafter, even on problems that are frequently encountered by elderly persons (Denney & Pearce, 1989). In this study, however, the problem-solving ability of 60- and 70-year olds was almost identical to the performance of 20-year olds. Thus, decline does not always mean loss of function. Indeed, despite our youth oriented society, in some performance situations we will do as well, or better, with older rather than with younger participants. That is not how society views older adults, however, and ultimately, how a problem is viewed determines the solutions that are attempted (Cower, 1973; Heller et al., 1984).
By calling for a focus on prevention, rather than a continued emphasis on counseling and psychotherapy, we are not implying that older adults are poor candidates for psychotherapy, and we certainly do not want to reinforce the continued neglect of this population by mental health specialists. Indeed, innovative therapeutic work with older adults and their families is being done (Herr & Weakland, 1979; Knight, 1986; Santos, Hubbard, McIntosh, & Eisner, 1984; Smyer, 1984; Smyer et al., 1990; Thompson, Gallagher, & Breckenridge, 1987). A theme in much of the newer therapeutic work is to help older adults rediscover and expand on existing competencies and improve their sense of perceived efficacy rather than the more traditional stance of having clients review their feelings about past negative events and relationships (Lewinsohn, Antonuccio, Steinmetz, & Teri, 1984; Rodin, Cashman, & Desiderato, 1987; Shostak, 1988). Rodin et al. (1987) concluded their review of intervention programs for older adults by noting that regardless of focus, the most effective therapeutic approaches are those that successfully combat helplessness and demoralization.
The prevention orientation we advocate involves a double-pronged emphasis. The first focuses on attempts to allay hopelessness and improve motivation and problem solving as suggested earlier. The second involves an examination of the ecological niche within which older adults live. one cannot expect much enthusiasm for life among those who are lonely and isolated and who no longer have valued roles in society. We used the examples of housing and employment patterns to illustrate some of the environmental presses impinging on older adults and to suggest that current policies are not immutable. Promising alternatives include a return to multigenerational housing, but now for unrelated individuals who, along with sharing some common living space, also share household duties. The part-time employment of older adults also can be an attractive option in situations in which technical skill, precision, and experience are valued more than is speed of performance. older workers also are a benefit in transmitting stable work habits and positive employment values.
Mental health professionals may feel uneasy considering these suggestions because housing and labor policies are certainly not under their control. The typical mental health specialist is usually far removed from policymakers and so may feel impotent about influencing national or even local policies toward the elderly. Policies, however, reflect public attitudes and traditions, and although these change slowly, shifts in public beliefs do occur over time. Although there are many factors associated with changes in community beliefs and practices (Heller, 1992; Heller et al., 1984), a primary ingredient is education in problem awareness. one need only see the changes that have occurred in public attitudes toward AIDS, for example, to understand the power of public education and discussion.
Israel (1988) described a variety of community-based interventions that have received some empirical support. These include programs aimed at strengthening existing social ties by education and consultation to family members of the elderly; various kinds of support groups and support services for older adults that facilitate independent living; training older adults in the role of natural helpers (e.g., health aides and school tutors); and participation in self-help and advocacy organizations run by and for older adults (e.g., the Gray Panther organization). Participating in and consulting with members of any of these groups is a useful way for mental health specialists to engage in active prevention programming.
The overarching theme in these activities involves helping the public to understand the social dilemmas that older adults face and the value of their continued integration as useful citizens. Public education is the major first step for policy changes to occur. Furthermore, it is not a message that will be hard for people to understand. After all, we are talking about our own self-interest, because those of us who live that long will be the major beneficiaries of any policy changes that occur.
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