Never in the history of humanity have so many people grown so old at the same time. This unprecedented global "aging boom"--which will more than double the number of people older than 65 by 2050--is forcing society to rethink medical care and social services and even reassess legal issues related to aging. The key challenge is to "find ways of redefining and reshaping the aging experience," said Rosemary Blieszner, PhD, chair of a symposium that was part of APA President Alan E. Kazdin's programming on Psychological Science's Contributions to the Grand Challenges of Society at APA's 2008 Annual Convention.
Psychologists can play an important role in making this societal shift successful by helping people avoid disease by choosing healthy lifestyles, maintaining cognitive and physical function, and engaging with life by improving their social skills, problem-solving abilities and goal-setting behaviors, said Sara Honn Qualls, PhD, a gerontology expert at the University of Colorado at Colorado Springs.
"These are all areas where psychology has research to guide us," said Qualls. "As clinicians, we have many constructs we can use to work with clients to help them age successfully."
While we can all expect our health to decline as we age, some will fare far better than others. Medical technology--in particular, genetic testing--is now able to predict something about this process.
For eight years, symposium presenter Robert C. Green, MD, MPH, has studied the issues that crop up when people learn about their risk of developing perhaps the most feared age-related condition: Alzheimer's disease.
His research looks for the presence of a gene called APOE. Having one copy of the gene increases a person's risk of developing Alzheimer's disease by three times; having two copies increases their risk 15 times. Green has examined a variety of topics including how best to explain "genetic susceptibility," the motivations behind getting tested and the psychological risk involved.
Green found that although study participants didn't suffer psychologically from finding out they were at greater risk of developing Alzheimer's, they buy more health and long-term care insurance than those who did not have the gene.
When Green presented these findings to an audience of insurance experts, "they almost stormed the stage," he said. "They felt that if people can have the information, insurance companies should get it, too."
Rethinking the law
While legislators will soon grapple with issues around genetic testing and insurance, the law has long been used to decide when people can no longer make decisions or care for themselves. Those decisions will only become more common as society ages, said Charles Sabatino, JD, director of the American Bar Association's commission on law and aging.
But unfortunately, said Sabatino, "lawyers and judges don't understand clinical issues and clinicians don't understand the law."
Studies of legal judgments to determine whether an older adult should be assigned a guardian find that clinical assessments are often unreliable because they lack the depth and focus the legal community needs.
To bridge the legal-clinical chasm, the ABA and APA collaborated on a series of handbooks designed to educate various groups about the assessment of older adults with diminished capacity. They wrote the first for lawyers, the second for judges and the third, released at the symposium, for psychologists.
All three can be viewed on APA's Web site at www.apa.org/pi/aging.
As medical technology begins to predict how well we'll age, and lawyers and psychologists grapple with how to deal with the legal ramifications of aging, the health-care system is facing a dramatic shift in focus, said Qualls.
Traditionally, health care has focused on acute care in which a provider treats discrete illnesses from the confines of a clinic or hospital. With a growing majority of adults over age 65 dealing with at least one chronic health issue - from hearing or vision loss to diabetes to heart disease - the health system will need to focus more of its resources on chronic care, said Qualls.
In fact, there will be so many people with chronic mobility and sensory problems that instead of retrofitting homes and businesses to accommodate people with age-related disabilities, society will need to redesign public and private spaces on a much broader scale, said Qualls.
Psychology is contributing to these issues through basic and applied research by:
Deciphering the psychological processes at work during aging.
Discovering how people care for themselves and seek help.
Developing assessments of cognitive and emotional strengths and weaknesses.
Designing interventions to get patients to take charge of their health.
Creating housing that fosters well-being.
Developing technologies to promote independence and safety, including elder-friendly smart houses and computers.
This session was sponsored by APA's Board of Directors and the Committee on Aging.
Beth Azar is a writer in Portland, Ore.
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