Are you interested in specializing in behavioral gerontology?

Consider the following before you get started:

1) Consider the population of individuals aged 60 and older with whom you would like to work. More specifically, what are you imagining when you think of “older patients?” In general, older adults are a heterogenous and diverse population; most live independently at home. What are you assumptions or biases? 

For example, are you interested in working in psychiatric facilities or institutional settings such as skilled nursing facilities? Both serve individuals across the lifespan. Are you interested in specific conditions and their effects on behavior? Conditions to consider are visual impairment, hearing loss, or orthopedic problems (the top three difficulties), cancer, neurological diseases, or psychiatric disorders. You might also think of assessments and interventions related to general behavioral health (e.g., health promotion and disease prevention).

2) If you are thinking about providing services to individuals with late-life cognitive impairment in facilities, are you familiar with facilities and regulations in your state? Each state regulates its own service delivery. One of your first steps should be to look at current policies and procedures. See also:

3) The first concern should be not to do any harm. In other words: Are you equipped to understand the contexts in which individuals age in the U.S., or in the country in which you are practicing? Particularly at a time when COVID-19 has revealed rampant ageism and inequities, work in facilities must take into account that we — as providers– should not participate in questionable or substandard practices. Here are some questions to ask yourself (and your staff, if you run a company):

  • What is a “behavior problem?” How do you know it’s a problem? For whom?
  • How would you assess?
  • If you plan to work with individuals with neurological diseases, how would you reconcile potential requests for behavioral reduction plans with a population that has very limited opportunities for activity engagement and whose repertoires are narrowing?
  • Do you anticipate ethical issues, for example, related to consent? Who would consent to assessment and intervention? Do you know your state laws related to surrogate consent?

4) The work with individuals who are vilified and often discriminated against by others (e.g., older adults with cognitive impairment and histories or behavioral health problems, such as substance abuse, living in institutional care, etc.) is difficult. Supervision teams are needed to prevent provider burnout, effort discounting, and drift toward non-behavior analytic conceptualizations — including blaming the patient, failing to advocate for the patient, or as mentioned above, participating in questionable practices. Therefore, further education is necessary before embarking on more training.

5) Most states are interested in keeping people in their homes (aging in place), and only a very small percentage of old-old adults (over 85) are living in facilities. You should check your state plan on aging to get acquainted with the services that are available and the needs in your particular area. For example: