On the 30th anniversary of its inception, the United Nations International Day of Older Persons turns its focus, inevitably, to the global pandemic and the hard lessons being learnt across the globe.
In this blog, members of our Older People Expert Reference Group, therapists working across the UK in a range of settings including third sector and private practice, share insights and learning from their work with older clients.
Amid the negative impact felt by many older people, there are also some positives in better understanding the wide diversity of later life, and the enduring importance of client autonomy and choice, in making sure therapy meets the needs of older people during the pandemic and beyond.
Alongside the risk to physical health, the impact of the pandemic on our mental health is becoming increasingly evident, with greater numbers of people reporting they have experienced depressive symptoms as the usual patterns of social contact, work routines, family life and all facets of the life we know have been interrupted.
“There’s been a very mixed experience for older people during the pandemic, with significant setbacks and gains”, says Sian Wareing-Jones, who has older clients in private practice and in her role at Jersey Alzheimer’s Association.
“With age being identified as a risk factor, there’s been a great deal of fear and anxiety among older people and this has been reinforced by the language used in directives from government, the restrictions of ‘shielding’ and messages to all of us about protecting ‘the vulnerable’.
“On top of the very real risk to physical health, the pandemic has reinforced the myth of ‘older people’ as a homogenous group, when in reality, we know that every older person has experienced the past months in very different and unique ways – we must be careful not to fall into a trap of making assumptions about people based on their age.
“On the other side, we’ve also seen a lot of older people empowered to draw on community networks, learn new skills with technology and find novel ways of seeking their own support.
“This has included people with dementia, and informal family carers attending our two separate Zoom support groups, and clients accessing one-to-one and family group counselling via Zoom and by phone, none of which we offered prior to the restrictions of Covid-19.”
Importance of choice
Avoiding assumptions based on age and recognising the importance of choice has also been evident in the move from face-to-face sessions to telephone or video counselling.
While some clients chose to suspend therapy until their face-to-face sessions could resume, others made the switch well to phone or online sessions. Having grown up when telephones were used only for talking, the switch to remote therapy by phone was embraced by many older clients.
“For some, the telephone offers convenience and security that overcomes barriers to accessing therapy in more traditional ways” says Cathy Green, whose telephone counselling service in Belfast received funding at the outset of the pandemic.
Cathy believes that the offer of telephone counselling resulted in her reaching clients who wouldn’t otherwise have overcome reticence or anxiety about meeting in person.
But Cathy also found that the high volume and wide range of general telephone support that became available in the early days of the lockdown created a challenge in differentiating the counselling offer from more general telephone support.
“Our service struggled to clearly articulate the difference between counselling and the check-in and chat telephone support that was essential for many, but that weren’t able to respond to more complex problems.
“The move out of lockdown has seen clients actively seeking face-to-face counselling again either privately or through their GP as months without human contact has taken its toll and resulted in a sharp rise in people presenting with depression.
“The fear from older people that they will never go back to the way they were, the lost time that they can't afford to lose, decline in mental and physical health and even more time to reflect on family or lack off family connections was brought sharply into focus.
“Within my own older client groups, the decline of their physical health happened first and the impact then on their mental health was very visible. The original fear of not going back to the way they once were has sadly come true for some.”
For Sian Wareing-Jones a big lesson from the switch from face-to-face work with clients is the importance of flexibility and offering as much choice as possible to clients.
“For me, there is nothing that will replace meeting somebody else, listening to them and no amount of telephone or Zoom meetings will ever adequately replace that – but if we cannot do that then the next best thing must be made available and accessible.”
The results of a study from Australia in May1 challenges widely held assumptions that older people are unable or unwilling to use technology to communicate with others and has indicated that counselling using telehealth can be valuable to care home residents.
Our own care homes research project is soon to resume with the use of video in place of face-to-face counselling, with the support of residential care teams who have increasingly been using tablets and smartphones to connect residents to family and friends.
From personal experience, Expert Reference Group member Sarah Baker believes that it isn’t using the technology itself, but rather its set-up, that presents a problem (not just for older people, but for people of all ages) and that once a tablet or phone is connected, the experience of holding a conversation is one that can be very rich and meaningful.
“My 95-year-old mother, a self-confessed technophobe, has always been unwilling to learn how to use a computer or mobile phone, so we were only able to make contact with her on her landline during the Covid 19 Lockdown.
“Following admission to hospital with a fractured hip after a fall, I was only allowed to see her for half-an-hour, once a day on the recovery ward. Trying to communicate from behind a mask and from two metres away in a busy, noisy environment was no easy task, as mum is partially-sighted and hard of hearing.
“On the rehabilitation unit she was introduced to Skype calls. A member of staff set it all up for her and then left us to talk for as long as we liked. She was able to see my husband for the first time in months and even say hello to our dog, and she could show me her room and introduce me to members of staff involved in her care.
“She described it as ‘miraculous’, and much better than my visits in hospital. She is now a convert, and I’m certain that the support and help from the staff was the critical factor in her taking to what she calls ‘new-fangled technology’.”
Covid-19 and the demands made to contain it, look set to be with us for a long time. As older people remain at greatest risk of the virus, the lessons so far demonstrate the importance of avoiding easy stereotypes and assumptions about how living with the pandemic affects older people.
We know older people and people from BAME communities are at particular risk from dying from the virus and that this will continue to impact upon the mental health of those often least likely to seek or have access to therapy.
Role of counselling
Through our Older People Expert Reference Group, BACP will continue to explore the role of counselling in contributing to the United Nation’s ambition to develop and maintain new ways of increasing well-being for all of us in later life.
Cathy Green reflects: “This is not the time for any of us to become complacent. It is time to reflect on what we have learned so far, focus on individual need and listen to the lived experiences of our older people during this pandemic, so as we can continue to offer choice and give the best support that we can in the days ahead.”
Join members of BACP’s Older People Expert Reference Group who will share insights and knowledge from their work at our forthcoming CPD webinar.
And please add your voice to BACP’s Covid-19 campaign calling on all UK government to recognise the psychological impact of the pandemic.
1. Bhar S, Solver M, Collins R et al (2020) Establishing Telehealth Counseling for the Aged Care Community in Australia. The Beck Institute
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Views expressed in this article are the views of the writer and not necessarily the views of BACP. Publication does not imply endorsement of the writer’s views. Reasonable care has been taken to avoid errors but no liability will be accepted for any errors that may occur.