Handbook of Clinical Behavior Therapy with the Elderly Client APPLIED CLINICAL PSYCHOLOGY Series Editors: Alan S. BeHack, Medical College of Pennsylvania al EPPI, Philadelphia, Pennsylvania, and Michel Hersen, Universily of Pilisburgh, Pillsburgh, Pennsylvania Current Volumes in this Series ACTIVITY MEASUREMENT IN PSYCHOLOGY AND MEDICINE Warren W. Tryon BEHAVIORAL CONSULTATION AND THERAPY John R. Bergan and Thomas R. Kratochwill BEHAVIORAL CONSULTATION IN APPLIED SETTINGS An Individual Guide Thomas R. Kratochwill and John R. Bergan THE CHALLENGE OF COGNITIVE THERAPY Applications to Nontraditional Populations Edited by T. Michael Vallis, Janice L. Howes, and Philip C. Miller CLINICAL PSYCHOLOGY Historical and Research Foundations Edited by C. Eugene Walker ETHNIC VALIDITY, ECOLOGY, AND PSYCHOTHERAPY A Psychosocial Competence Model Forrest B. Tyler, Deborah Ridley Brome, and Janice E. Williams HANDBOOK OF BEHAVIOR MODIFICATION WITH THE MENTALLY RETARDED Second Edition Edited by Johnny L. Matson HANDBOOK OF CLINICAL BEHAVIOR THERAPY WITH THE ELDERLY CLIENT Edited by Patricia A. Wisocki PSYCHOLOGY A Behavioral Overview Alan Poling, Henry Schlinger, Stephen Starin, and Elbert Blakely USING RATIONAL-EMOTIVE THERAPY EFFECTIVELY A Practitioner's Guide Michael E. Bernard A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon adual shipment. For further information please contad the publisher. Handbook of Clinical Behavior Therapy with the Elderly Client Edited by Patricia A. Wisocki University of Massachusetts Amherst, Massachusetts Springer Science+Business Media, LLC Llbrary of Congress Cataloglng-ln-Publlcation Data Handbook of elinieal behavior therapy with the elderly ellent I edlted by Patrieia A. Wisoeki. p. em. -- (Applied elinieal psyehology) Ineludes bibliographieal referenees and index. 1. Behavior therapy for the aged. I. Wlsoeki. Patrieia A. II. Series. [DNLM, 1. Behavior Therapy--in old age. WT 150 H2331 RC489.B4H376 1991 618.97'689' 142--de20 DNLM/DLC for Library of Congress 91-1962 CIP ISBN 978-1-4899-0640-3 ISBN 978-1-4899-0638-0 (eBook) DOI 10.1007/978-1-4899-0638-0 © Springer Science+Business Media New York 1991 Originally published by Plenum Press, New York in 1991. Softcover reprint ofthe hardcover 1st edition 1991 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher To my parents, Anne and Peter Wisocki, role models for graceful and successful aging, and to my husband, John L. Tierney Contributors THOMAS F. BERGQUIST, Department of Psychology, University of Alabama at Bir mingham, Birmingham, Alabama 35294 RICHARD R. BooTZIN, Department of Psychology, University of Arizona, Tueson, Arizona 85721 KATHRYN LARsEN BURGIO, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213 LoUIS D. BURGIO, University of Pittsburgh School of Medicine, Pittsburgh, Pennsyl vania 15213 LAURA 1. CARSTENSEN, Department of Psychology, Stanford University, Stanford, California 94131 BRAD CRENSHAW, Department of Psychology, University of Massachusetts, Am herst, Massachusetts 01003 PATRICIA C. DICKERSON, Behavioral Medicine Unit, Division of General and Preven tive Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294 JEFFREY J. DOLCE, Behavioral Medicine Unit, Division of General and Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294 LINDA WARREN DuKE, Department of Psychology, University of Alabama at Bir mingham, Birmingham, Alabama 35294 MARY-LoUISE ENGELS, Behavior Therapy Unit, Douglas Hospital Center, Verdun, Quebec, Canada H4H 1R3 MINDY ENGLE-FRIEDMAN, Baruch College, City University of New Ycirk, New York, New York 10010 JANE E. FISHER, Department of Psychology, Northern Illinois University, DeKalb, Illinois 60115 vii viii CONTRIBUTORS CHARLES J. FOGELMAN, The Baltimore Psychologists, Baltimore, Maryland 21420 WILLIAM E. HALEY, Department of Psychology, University of Alabama at Bir mingham, Birmingham, Alabama 35294 BENJAMIN 1. BANDEN, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213-3417 PATRICIA HANRAHAN, University of Chicago, Chicago, Illinois 60637 ARTHUR MACNEILL HORToN, JR., Department of Psychiatry, University of Maryland Medical School, Baltimore, Maryland 21218 ROBERT C. INTRIERI, Pennsylvania State University, State College, Pennsylvania 16802 JEFFREY A. KELLY, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi 39216 KIM E. KENDALL, 416 17th Avenue East, Seattle, Washington 98102 NANCY KEUTHEN, Psychosomatic Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114 NATHAN 1. LINSK, Department of Medical Sodal Work, College of Associated Health Professions, University of Illinois at Chicago, Chicago, Illinois 60680 CLAIRE MORSE, Department of Psychology, Guilford College, Greenboro, North Carolina 27410 WILLIAM O'DONOHUE, Department of Psychology, Northern Illinois University, DeKalb, Illinois 60115 DANI B. PERS, Amherst Medical Assodates, Amherst, Massachusetts 01002 ELSIE M. PINKSTON, School of Sodal Service Administration, University of Chicago, Chicago, Illinois 60637 JOSEPH E. STRUCKUS, Department of Psychology, Gaylord Hospital, Wallingford, Connecticut 06492 LINDA TERI, Department of Psychiatry and Behavioral Sdences, University of Washington Medical School, Seattle, Washington 98195 CONTRIBUTORS ix PATRICIA A. WISOCKI, Department of Psychology, University of Massachusetts, Amherst, Massachusetts 01003 ]UDY M. ZARIT, Child, Adult, and Family Psychological Center, State College, Pennsylvania 16801 STEVEN H. ZARIT, Department of Individual and Family Studies, Pennsylvania State University, University Park, Pennsylvania 16803 Preface Although we speak of "the elderly" as if there were one body of people with common characteristics, older adults are more heterogeneous than any other popu lation. People over the age of 65 are also the fastest-growing segment of the population in the United States, currently numbering 25 million. The majority of older adults reside in their communities; a small fraction of them are cared for in institutions. Most may expect to experience some kind of physical impairment. Approximately a quarter of the population may expect to suffer amental health impairment. While traditional therapies have not been especially effective for older adults, behavior therapy has shown exceptional promise as a treatment modality. This book presents a comprehensive explication of the relatively new field of behavioral gerontology. It was written for the clinician interested in the interaction of medical, environmental, and psychological variables and their effects on treatment of elderly clients and for the researcher who will be looking to extend knowledge about interventions with this population. It will be useful for the graduate student in clinical psychology, as weIl as the experienced clinician, who will want to include the elderly in his or her therapeutic population. This book was designed in four parts. The first part contains an overview of the field of behavioral gerontology, including its distinguishing characteristics and a review of the behavioral intervention research, categorized by problem area. In the second part authors discuss the influence of medication, nutrition, residential placement, social support, and cognitive impairment on treatment, all factors essential to the design of an intervention program. In the third part chapters are presented about treatment applications for individuals presenting with a variety of problems, including anxiety, social skills deficits, dating-marital-sexual di lemmas, depression, memory impairment, insomnia, institutionalization, health, and pain problems. In the fourth part authors address ways of intervening in the health care system: staff training, family care, health service providers, and com munity services. The authors of these chapters are experts in their fields. Most are clinicians who have had direct experience with aging clients. Most are researchers who have carved out the areas of study they have written about. They have brought together a compendium of work valuable for practitioner and researcher alike. I am grateful for their efforts and acknowledge their significant contributions to the field of behavior gerontology. xi