Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review

Background: The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings. Objective: The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings. Methods: This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies. Results: Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018. Conclusions: In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed

CBT for Older Adults - 2023 (Seminar Series on Ageing)

This seminar will focus on the use of cognitive behavioural therapy (CBT) for older adults, including those living with dementia. The research outcome data supporting CBT in late-life mental health conditions and dementia is slowly increasing, however contextual understanding of working with staff and families is essential. This presentation addresses the opportunities, barriers and modifications required to provide this model of care to older adults with and without dementia. Research and case studies are discussed, with a particular focus on the practical applications of CBT

Cognitive behavioural therapy in dementia care (Seminar Series on Ageing)

This talk will focus on the use of cognitive behavioural therapy (CBT) for older adults living with dementia. Research, case studies and practical suggestions will be used to highlight the opportunities, barriers and changes required to provide individuals with this model of care

A survey of Australian psychologists in aged care: the relationship between training, attitudes and professional practice with older clients\ud

The proportion of Australian adults aged over 65 years is due to increase over the next\ud 20 years with corresponding increases in mental illness. A growing demand for clinical\ud psychology services to older adults is expected yet overseas surveys indicate a low rate\ud of specializing in working with the over-65 age group. The status of geropsychology in\ud Australia is examined through exploratory analysis of survey data from a practising\ud psychologist sample and from a post-graduate psychology trainee sample. Six published\ud studies are reported that examine the relationship among training, personal contact and\ud attitudes, and the relative contributions of these three factors to decisions on working\ud with older adults among Australian psychologists. Pilot research highlights the\ud importance of interest in working with older clients and additional training external to\ud formal degree courses in discriminating between those psychologists who specialised in\ud aged care compared to generalist practitioners. A national survey of psychologists\ud identifies clinical exposure to older adults while training and negative expectations of\ud subjective ageing as additional factors predicting specialist category membership. Low\ud rates of professional involvement with older clients in general highlight the\ud corresponding dearth of psychologists specialising in aged care service provision, a\ud finding congruent with overseas research. The positive influence of clinical contact, as\ud opposed to the absence of predictive ability for personal contact, is also emphasized in a\ud survey of post-graduate psychology students. Professional attitudes, such as confidence\ud and interest in working with older adults, are other predictors of interest in working\ud with older clients among students. The use of the Reactions to Ageing Questionnaire in several analyses also highlights the importance of affect in influencing behaviour, with\ud professional attitudes predicting personal attitudes towards ageing, as opposed to\ud personal contact or formal training. The final study underscores the role of contextual\ud relevance, with training contributing to more variance in interest in working with older\ud adults among trainees, as compared to practitioners whose professional interest was\ud influenced more by attitudes. The contact hypothesis is not confirmed in this research in\ud either the student or the practitioner samples. Strategies to promote the field of clinical\ud geropsychology across a variety of settings, ranging from training to clinical service\ud delivery are discussed

Predictors of working with older adults in an Australian psychologist sample: revisiting the influence of contact

Despite increasing numbers of older people in most global populations and increasing evidence of the efficacy of psychological therapy in older clinical populations, few psychologists work with older clients as compared with other clinical groups. In the present research, the authors examine potential influences on psychologists choosing to specialize in working in the field of aging. The authors surveyed 1,498 psychologists Australia-wide to examine which factors exerted the most influence on choosing to specialize in clinical work with older clients. Clinical exposure to older clients and age-related course content within training programs, together with further education external to formal training, were significantly correlated with specializing in aged care. Holding a more negative attitude toward one's own aging was another predictor of specialist category membership, with interest in working with older clients also being a significant factor based on direct logistic regression analysis. In contrast to previous work, amount or quality of contact with older persons did not appear to relate to working with older adults. These findings highlight the importance of quality training experiences in influencing attitudes toward working with older adults

Student placements in residential care: how do we provide a positive experience?

Very few Australian residential care facilities have access to psychological services. Clearly, very few Australian psychologists provide services to residential care facilities. Various factors underlie this situation. The tensions in the dual funding of health care between Commonwealth and the States and chronic under funding of aged care services are major issues, but factors within the profession are also relevant. The limited exposure to older adults and issues that are common in clinical training programs is one factor. The limited number of placements available for students to gain practical experience with older adults is also something of concern if more psychologists are to have positive experiences in working with older adults. This forum will explore strategies for increasing placement opportunities for students to work in residential care facilities and increasing incentives for psychological services in residential care. Another issue for discussion will be methods for increasing the number of supervisors for such work and for ensuring positive outcomes

The current status of clinical geropsychology in Australia: a survey of practising psychologists

Little recent objective evidence exists to qualify past concerns regarding the low numbers of psychologists working with older adults in Australia. The present study reports on figures from two surveys of Australian psychologists, finding that of the 1,699 psychologists surveyed, only 6% specialise in treating older adults. This figure is comparable to those from studies conducted overseas, where more training and employment opportunities are available. Reasons for such low figures are explored together with recommendations to meet the future demand for psychological services as the proportion of elderly adults within the Australian population increases

Clinical psychologists in aged care in Australia: a question of attitude or training?

Despite increasing numbers of older people in the Australian population, few psychologists work with this segment of the population. The prevalence of psychological disorders in this age group is substantial and there is increasing evidence for the effectiveness of psychological treatments for these conditions in older adults. This study explored the reasons for the limited number of psychologists who work with this growing population. A survey of more than 500 Australian psychologists based in Sydney, Australia, used the Reactions to Ageing Questionnaire to assess attitudes, and other questions enquired about training, current practice, and interest in work with older adults. The response rate was 39%, with 17% of the respondents being specialists in work with older adults. Stereotyped attitudes did not differentiate specialists from generalists, but interest in therapy with older adults did, along with age, years of practice and working in an aged care setting. While the limited survey restricts the generalisability of the results, they do suggest that training in itself is not sufficient to overcome a reluctance to work with older adults. Supervised practice settings appear to be effective, but greater efforts are needed to increase both academic training and work settings for work with older adults in Australia

Predictors of interest in working with older adults: a survey of postgraduate trainee psychologists

Despite the growing number of older adults that implies an increasing need for psychological services, few psychologists choose to specialize in working with older clients. The present cross-sectional research examined predictors of student interest in working with older clients in an effort to understand factors that may influence future psychologists to work in this area. The targeted sample consisted of Australian postgraduate psychology students whose course coordinators responded to a request to participate in this national survey. Four hundred and thirty-one postgraduate trainee psychology students completed the survey that examined training, contact, and attitudinal variables. This represents a 45.3% response rate from surveys being distributed by course coordinators. Having undergone or intending to do a placement within an aged care setting was the most powerful predictor of interest, with confidence in working with the elderly, and positively anticipating old age being attitudinal factors related to increased interest. Amount or quality of contact with older adults and formal education through aging-related coursework failed to predict interest, based on hierarchical regression analysis. Implications for future training of psychologists highlight the importance of quality clinical experiences with older clients during training as opposed to pure coursework