Assessment of the Older Client: General Guidelines for Assessment

With the graying of America, Americans 55 and older are becoming one of the nations largest and fastest growing groups. Their economic, political, and social impact is formidable and far reaching. Thanks to the marvels of modern medical technology, many older Americans can expect to live well into their 80s, 90s, and beyond. This age group poses special challenges and opportunities for the mental health professional. The purpose of this article is to make some practical suggestions and propose some evaluative tools that work well with older people. Older adults often present with multiple problems; these may include emotional distress, cognitive impairment, chronic physical conditions, and changes in social network or environmental context.

*General Guidelines*

In graduate school, we learned that one of the most important ingredients for change in the counseling process, regardless of what theoretical orientation one holds, is the client/ counselor relationship. One key factor is the counselors self-awareness. This is especially important in assessing the older client. We need to be aware of our own myths, false beliefs, and stereotypes about ageism. Dupress and Patterson argue that the views associated with professional ageism (particularly those noting that mental illness in old age is inevitable, untreatable , disabling, and irreversible) become self-fulfilling prophecies, leading to a lack of prevention and treatment, which in turn tends to confirm the original belief.1 To prevent the negative effect of ageism on the interview and assessment process, we need to learn about the aging process, have greater exposure to older adults, and examine our own personal feelings about aging and how they affect our professional performance. To begin with, it is helpful to remember the fifth commandment, Honor your father and your mother(Ex. 20:12).

Some scholars have interpreted this commandment not only to include respecting and honoring ones own parents but other older people in ones midst. As counselors , we need to reduce the stress of the interview and assessment.  More than any other age group, we will probably get resistance to testing from older clients. I would not

recommend the use of computer self-scoring tests as the older client generally is not as comfortable with the use of computers as the young client. Some ways the counselor can reduce the stress for the older client include:

* addressing the person by title and last name;

* sitting near the person so that he or she can see your face and hear what you say;

 

* being respectful, honest, and hopeful;

* pacing the assessment and giving the client enough time to respond to questions (a slow and relaxed pace also reduces anxiety);

 

* sharing something of oneself. When one is assessing the older client, one often has to deal with problems of hearing loss and/or vision impairment. More than 50% of Americans over 65 are affected by some hearing impairment. What are some helpful things a counselor can do? Try doing the interview in a quiet setting and minimize distractions. Sit in good light and make certain the client can take advantage of facial expression. Also, speak slowly and distinctly. Many older clients also have vision impairments, including decreases in visual acuity, depth perceptions, peripheral vision, adaptation to light change, and tolerance for glare. Some practical suggestions for working with the visually impaired are to ask the client about his or her preferred means of communication. Ask the client to describe any problems with lighting in the consulting room such as glare or insufficient lighting. Limit nonverbal directions and rely more heavily on verbal or kinesthetic cueing.

]]>

 

Assessment Tools for the Older Client The Dupress and Patterson

Inventory1 offers the counselor a structured interview model to determine the assets and needs of the older client. Some of the areas assessed include meal and food preparation, economic old resources, social relationships, health care, and leisure activities. This is a very nonthreatening tool that works well with the elderly. The Mini-Mental State Examination2 is a very simple tool that assesses orientation, attention, calculation, immediate and short-term recall, language, and ability to follow simple commands. Although it is not used to make a formal diagnosis, it is used to detect impairments, follow the course of an illness, and monitor the clients treatment responses. It is easy to administer and score.

 

The Short Care Inventory3 is a briefer version of the CARE (Comprehensive Assessment and Referral Evaluation). It measures three content are expression, dementia, and disability with good inter rater reliability and internal consistency. Whatever data the counselor gets from the assessment should be contrasted with the older adults perception of his Anxiety Inventories Anxiety disorders are common among the older client. Phobias and pervasive anxiety (generalized anxiety disorder) are frequently found. Many self-report measures of anxiety don’t have norms for the elderly. The few tests that do are the

 

State-Trait Anxiety Inventory4, and Zungs Self-Rating Anxiety Scale.5

The counselor needs to remember that anxiety in older adults may be an appropriate situation. For example, helplessness anxiety is generated by a potential or actual loss of control or mastery. Also, a series of negative life experiences may result in a persons reaching the breaking point and appearing highly anxious. Many older adults who show symptoms of anxiety disorder have underlying health problems that may be responsible for the symptoms. It is important to evaluate the older adults behavior in context.

*Depression Inventories*

Most older Americans lead healthy, fulfilling lives. However, according

to the National Institute of Health, approximately 15% of community residents over 65 years of age (about 5 million persons) experience serious and persistent depressive symptoms. With the symptoms of depression, the counselor has to assess suicide risk. Older adults, especially white males, are the group at highest risk for suicide. Those older adults with substance abuse problems and those with dement illnesses who are aware of their cognitive impairment and depressed about it should be assessed for suicidal risk. The Geriatric Depression Scale6 consists of 30 yes or no questions regarding symptoms of depression that are more relevant to the elderly.

A somewhat less frequently used instrument, although still appropriate for the older patient, is the Zung Self-Report Depression Scale.7 The Beck Depression Inventory8 is also a valuable assessment tool. Whatever data the counselor gets from the assessment should be contrasted with the older adults  perception of his or her level of functioning. Schaie and Schaie recommend that the counselor compare the data with the clients assumed level of functioning.9 With permission of the client, the counselor should solicit feedback from the clients family to get a sense of the older adult in context. It is also important to determine the clients capabilities and adaptive response to role requirements.

The assessment information and specific recommendations should be presented to the client in terms that the client can understand and relate to. In other words, the presentation should be free from psychological jargon. Its also important for the report to balance both the older adults strengths and weaknesses. I often preface my remarks in giving an assessment report by saying that the assessment is like a single snapshot, a picture in time, that is related to other important snapshots in the family album: family members input, the clients own self-appraisal, and reports from the clients family physician. Find a therapist for immediate help.

The purpose of the assessment is to show as clear a picture of the person in his or her environment as possible. When in doubt about the use of a particular test, I recommend two important reference books. The Mental Measurements Yearbook, sometimes refer  to as MMY or Buros, after Oscar K. Buros, who compiled and published the first volume in 1938. It provides reviews of new or revised tests and is updated every four years. The other reference book is Test Critiques. Both can be found at any major university library. Take help from telephone psychologist.