A contribution towards understanding ways of working with older adults

• Main Author: Greenwood, Diane E.
• Published: University of Warwick 2014
• Subjects: 150; RC Internal medicine
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.632882

This thesis comprises a literature review, an empirical paper and a reflective paper. The systematic literature review involved critical assessment of eleven randomised controlled trials in which cognitive-behavioural therapy (CBT) for anxiety or depression was modified for older adults. The aim was to identify older adult-specific modifications as well as effectiveness in symptom reduction. Most commonly, modifications aimed to support understanding and homework completion, but few were age-specific. Studies comparing modified and standard CBT are lacking. Modified CBT may be more effective than wait-list, usual treatment and minimal contact. Efficacy is less clear compared with medication or an active control, and unknown compared with an alternative therapy. Future research should consider qualitative and quantitative evaluations of treatment effectiveness, and directly compare standard and modified CBT alongside an alternative therapy. The empirical paper describes an exploration of the lived experiences of volunteer befrienders to people with dementia. Individual semi-structured interviews were conducted with nine befrienders aged between 25 and 66 years. Transcripts were analysed using Interpretative Phenomenological Analysis. The notion of the person underlies the three main themes: ‘The person as the centre’, ‘A paradoxical relationship’ and ‘Core existential experiences’. Befrienders valued their befriendees’ happiness and individuality, and experienced some emotional challenges. The befriending relationship was experienced as special, paradoxical and complex, and enabled befriendees to reconnect with their individuality, community and humanity. Future research should explore issues including effectiveness, attrition and support. The reflective account summarises the helpful and challenging boundaries I experienced in conducting my doctoral research. The challenge for me was in knowing when to adapt something that was already there and when to be adaptable myself. Clinical training has developed a wide range of skills and competencies, which will be valuable in making adaptations and being adaptable as a qualified Clinical Psychologist.