By 2050, nearly 84 million Americans will be age 65 or older, according to estimates by the U.S. Census Bureau. Most of these adults will continue to enjoy stable mental health—in fact, historically, the rates of mental health disorders for this group are lower than those of younger adults.

However, one in four older adults will experience a mental health problem such as depression or anxiety, and the physical and cognitive changes some people experience as they age can make these issues even more challenging. In addition, as some people age, their risk of suicide increases: The suicide rate for men age 85 years and older is nearly 39 percent higher than that of any other age group, according to 2016 data from the Centers for Disease Control and Prevention. Another cause for concern is substance use problems among older adults. By 2020, the number of older adults with substance use issues is expected to double to 5 million, likely attributable to the higher drug use rates among the baby boomer generation compared with previous generations.

Pair these needs with the meager number of psychologists who specialize in geropsychology—only 1.2 percent of psychologists, according to 2018 data from APA's Center for Workforce Studies—and it's clear there is a crisis brewing when it comes to serving older adults (Training and Education in Professional Psychology, in press). In fact, in 2012, the Institute of Medicine reported that health providers from all disciplines were woefully underprepared to meet the mental and behavioral health needs of the nation's older adult population.

In response, psychology is boosting its efforts to prepare more psychologists to treat older adults, focusing not only on creating specialists but also on training all psychologists on the special needs of this population. This training is particularly essential as the country continues to move toward "age-friendly health systems," an approach that focuses on the four Ms: mobility, medications, mentation/mental activity, and what matters. Led by the American Hospital Association's Health Research & Educational Trust, the Institute for Healthcare Improvement and the Catholic Health Association of the United States, the method is designed to ensure that older adults get the best care possible. That means that all health-care teams are working to make sure older people have mobility plans when receiving medical care or while in long-term care; reviewing medications regularly to minimize harm; addressing conditions that affect thinking and are common in older people, such as dementia, depression and delirium; and incorporating what matters to the person, such as his or her values, goals and preferences, into all care plans.

"This initiative has a goal of having 20 percent of all health systems in the United States age-friendly by 2020," says Erin Emery-Tiburcio, PhD, co-director of the Center for Excellence in Aging at Rush University Medical Center in Chicago and chair of APA's Committee on Aging (CONA). "That's an aggressive rollout, and we need to make sure psychologists—including generalists and those in subfields that regularly work with older adults such as rehabilitation psychology, clinical neuropsychology and clinical health psychology—are involved with this and informing the whole health-care team about how to meet the mental health needs of older adults."

Of course, practitioners are not the only psychologists needed to support this population. There are also growing roles for psychologists in research on aging as well as in academia to train the next generation of geropsychologists. The field has also put an increased focus on attracting and supporting professionals throughout their careers working to improve the lives of older adults.

2018-12-geropsych-sa-2 Helping to overcome stigma

While opportunities abound for psychologists who want to work directly with older adults, they are particularly needed on integrated-care teams, says geropsychologist Maggie Syme, PhD, an assistant professor in the Center on Aging at Kansas State University. Given the complex medical and mental health care needs of this population, educating physician, pharmacy, and occupational and physical therapy colleagues and working with them and other providers to develop appropriate treatments are key to improving older adults' overall well-being.

Psychologists with expertise in aging help health-care teams better understand the unique needs of older adults, says neuropsychologist Vonetta Dotson, PhD, an associate professor of psychology at Georgia State University.

"A lot of psychologists see older adults as just adults who have gotten older, and they don't necessarily appreciate all the biological, cognitive, social and psychological complexities of older individuals," says Dotson, a member of CONA.

In fact, a critical part of psychologists' work on geriatric care teams is helping other health providers overcome any stereotypical ideas they have about older people, says Syme, who notes that such misconceptions are among the reasons too few students pursue careers working with older adults.

"The lack of awareness [about the benefits of working with older adults] and negative attitudes trickle all the way down to undergraduates and high school students," she says. "It's just not a sexy choice to be in aging."

Much of this stigma stems from societywide negative attitudes about aging—and may obscure the rewards of working with older adults, says Emery-Tiburcio. "Older adults just bring such a richness of experience and so much complexity into our jobs as psychologists. I often find myself learning way more from them than they are getting from me."

Geropsychologists play another important role: providing support to the country's nearly 35 million caregivers, says developmental psychologist Joseph Gaugler, PhD, a professor in the School of Public Health at the University of Minnesota. "There's a large body of evidence pointing to the range of caregiving outcomes that affect the well-being of the care recipient as well," says Gaugler, past president of APA Div. 20 (Adult Development and Aging).

Geriatrician Ellen Binder, MD, a primary-care provider at an assisted-living and skilled-nursing facility just outside of St. Louis, agrees. She says that the need for psychologists who can work with both older adults who might be experiencing cognitive issues as well as their caregivers continues to grow exponentially.

"My struggle is that I don't know of many providers who are appropriately trained in the care of older adults or who are particularly interested in working with them," says Binder, who is also a professor of medicine at Washington University in St. Louis. "The need for the services of psychologists is huge. And for every patient for whom there's a cognitive problem, there's a caregiver who may be elderly themselves and may need help coping with these changes."

Roles for researchers

Psychologists are also increasingly in demand to study the psychological, medical and spiritual issues people experience at the end of life, says Brian Carpenter, PhD, a professor of psychological and brain sciences at Washington University and a former member of CONA.

"The end of life is a culmination of a person's experiences, the apex of their story, but we know too little about how people approach that moment and how to make it better," he says. "Psychologists can help explore questions about what it means to have a good death, and how to help people accomplish that when circumstances might be very challenging from a medical, social or psychological point of view."

Researchers are also needed to explore such areas as cognitive changes; adjustment to and potentially poor treatment of multimorbidity; sexuality and sexual health; caregiver and family stress; and more. One of the most pressing needs for this population is help coping with loss, says geropsychologist Sara Honn Qualls, PhD, who directs the Gerontology Center at the University of Colorado, Colorado Springs.

"In the last quarter of their lives, people experience a higher frequency of loss compared to other life stages, whether it's people around them dying, a loss of their roles in society, or losses in terms of hearing, vision, mobility or function," she says. "Almost everyone is going to experience some degree of decline, and sorting out what is normal can be difficult. Psychologists are well-equipped to help with this."

In addition, the vast majority of research that's been done on older adults now needs to be redone with the baby boomers because their generation is quite different from those who came before them, particularly in the area of drug use, says Emery-Tiburcio.

Preparing for geropsychology

Getting the training needed to treat and conduct research with older adults has become more formalized in recent years, which has helped increase awareness of the need for this specialty. During the past decade, professional geropsychology has been recognized as a specialty by APA and the American Board of Professional Psychology, and specialists in the field have developed a specific training model (known as the Pikes Peak model) and formed the Council of Professional Geropsychology Training Programs, or CoPGTP, to expand predoctoral, internship and postdoctoral training opportunities available for budding geropsychologists.

In an effort to encourage undergraduate and graduate students to explore and consider research, practice and academic careers in aging, this year CONA developed the Exploring Careers in Aging Roadmap, an online resource that includes guides for both undergraduate and graduate students. The guide includes:

  • Specific questions to consider in selecting a career in geropsychology to match personal interests.
  • Actions to take to be prepared and position oneself to embark on a career in aging, such as attending conferences related to aging and job shadowing professionals who work in aging.
  • Sources , including directories of programs, academic resources, and networking and job search essentials.
  • Profiles and descriptions of a wide variety of careers in aging and interdisciplinary careers that intersect with aging, such as urban and regional planning.

CONA is also creating a companion lesson plan for high school and undergraduate instructors to use in their AP psychology and introduction to psychology classes—an effort that the committee hopes can boost interest in geropsychology careers.

"Career opportunities are increasing along with the growth and diversity of individuals 65 years and older," says Deborah DiGilio, director of APA's Office on Aging. "It's so important for APA and other organizations to continue to fight ageism and promote increased education on adult development and aging and interactions with older adults at all ages."

But while such efforts offer hope for the future, for now there continue to be too few psychologists who specialize in aging—particularly academic psychologists to train the next generation of geropsychologists, Carpenter says. Many current professors of aging are nearing retirement, and the pipeline to fill their spots hasn't been able to keep up.

With nearly two-thirds of psychology health service providers reporting that they occasionally, frequently or very frequently provide care to adults age 65 and older, according to a 2015 APA survey, it's also important that even those without specific geropsychology training understand older adults, says Emery-Tiburcio. To help meet this need, a CoPGTP workgroup surveyed 150 professional geropsychologists about the most critical competencies general psychologists must obtain to effectively assess and treat older adults ( Clinical Psychology: Science and Practice , Vol. 25, No. 2, 2018 ). Based on the survey results, the group recommended that psychologists looking to obtain "exposure" level training to work with older adults receive at least 15 hours of continuing education focused particularly on normal aging, including the biological and health-related aspects of aging and mind-body interactions; the psychology of aging, including changes in sensory processes, cognition, personality and emotions; and the social dynamics of the aging process, including work and retirement, friendships, roles and family relationships.

Leaders in the field are now developing a two-day continuing-education workshop based on these recommendations, which they hope to eventually make available online as well to supplement existing resources.

Qualls also points to the need to foster student engagement with older adults through coursework, service learning opportunities or other initiatives. One example is CONA's 2017 work with APA's Teachers of Psychology in Secondary Schools (TOPSS) to develop the theme for the TOPSS annual essay contest for high school psychology students. The contest asked students to describe an "Aging World," and provide information concerning physical, psychological and social factors that influence the aging process. Through the contest's research and writing process, students learned about how to age well. Many of the student essays included reflections on grandparents and other older figures in their lives who had illustrated the importance of healthy aging.

"In many people's lives, older adults are kind of invisible," Qualls says. "So, a powerful positive experience personally creates visibility."