APA guidelines for psychological practice with older adults

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These guidelines help psychologists in evaluating their readiness for working with older adults, as well as seeking and using appropriate education and training in this area of practice.

Read the complete guidelines (PDF, 682KB) for more details, including the rationale behind each guideline and notes on application.

Introduction

Although “older adults” typically refers to persons 60–65 years of age and older, gerontological researchers and policy makers increasingly recognize that this demarcation is socially constructed, and is linked to many sociocultural referents, including family status, lived experience, and health conditions that vary widely across generational cohorts and socioeconomic and cultural groups. These guidelines draw on research which flexibly employs various age cutoffs consistent with this nuanced approach. We use “older adults” in this document since it is commonly used by geropsychologists and is the recommended term in APA publications and inclusive language guide.

The specific goals of these professional practice guidelines are to provide practitioners with a frame of reference for engaging in professional work with older adults and basic information and further references in the areas of attitudes, general aspects of aging and broad impacts of intersectionality, clinical issues, assessment, intervention, consultation, professional issues, and continuing education and training relevant to practice.

The term “guidelines” refers to pronouncements, statements, or declarations that suggest or recommend specific professional competencies, behavior, endeavors, or conduct for psychologists. Guidelines differ from standards in that standards are mandatory and may be accompanied by an enforcement mechanism. Thus, guidelines are aspirational and are intended to facilitate the continued systematic development of the profession and to help ensure a high level of professional practice by psychologists.

The guidelines should not be construed as definitive and are not intended to take precedence over the professional judgment of psychologists. Guidelines essentially involve recommendations regarding professional conduct and issues to be considered in particular areas of psychological practice.

Need

Psychological science and practice in the area of geropsychology have evolved rapidly. Clinicians and researchers have made impressive strides toward identifying the unique aspects of knowledge that facilitate the accurate psychological assessment and effective treatment of older adults as the psychological literature in this area continues to burgeon.

Psychologists provide care to older adults in a wide range of settings from home and community-based clinics, to telehealth, integrated primary care, and long-term care settings. Nonetheless, older adults with mental disorders are less likely than younger and middle-aged adults to receive mental health services and, when they do, are less likely to receive care from a mental health specialist than younger persons.

The demand for psychologists with a substantial understanding of later life wellness, cultural, and clinical issues will expand as the older population grows and becomes more diverse, and as cohorts of younger individuals who are receptive to psychological services move into old age.

Compatibility

These guidelines build upon APA’s Ethics Code and are consistent with the Criteria for Practice Guideline Development and Evaluation and preexisting APA policy related to aging issues.

The guidelines are also consistent with the efforts that psychology has exerted over the past two decades to focus greater attention on the strengths and needs of older adults, and to develop workforce competency in working with older adults.

Development process

In 2021, the APA Policy and Planning Board, in accordance with Association Rule 30-8.4, provided notice that on December 31, 2023, the APA Guidelines for Psychological Practice with Older Adults would expire. The Board of Professional Affairs and the Committee on Professional Practice and Standards then conducted a review and recommended that the guidelines should not sunset, and that revision was appropriate.

Members of the Guidelines for Psychological Practice with Older Adults Revision Working Group considered the recent relevant background literature as well as the references contained in the initial guidelines for inclusion in the revision of the guidelines. They participated in formulating and/or reviewing all portions of the guidelines document and made suggestions about the inclusion of specific content and literature citations.

Reorganization of the guidelines was based upon consensus of workgroup members and informed by subject matter experts.

Attitudes

Guideline 1
Psychologists are encouraged to work with older adults within their scope of competence.

Guideline 2
Psychologists are encouraged to recognize ways in which their attitudes and beliefs about aging and about older adults may be relevant to their assessment and treatment of older adults, and to seek consultation or further education about these issues when indicated.

Guideline 3
Psychologists are encouraged to increase their knowledge, understanding, and skills with respect to working with older adults through training, supervision, consultation, and continuing education, and to apply their expertise in advocacy to support the psychological well-being of older adults.

General knowledge about adult development, aging, and the older adult population

Guideline 4
Psychologists strive to gain knowledge about theory and research in aging.

Guideline 5
Psychologists strive to be aware of the social and psychological dynamics of the aging process.

Guideline 6
Psychologists strive to understand diversity in the aging process, particularly how sociocultural factors such as sex, gender identity, race, ethnicity, socioeconomic status, immigration status, sexual orientation, disability status, religion, spirituality, employment status, and urban/rural residence may influence the experience and expression of health and of psychological problems in later life.

Guideline 7
Psychologists strive to be familiar with current information about biological and health-related aspects of aging.

Foundations of geropsychology practice

Guideline 8
Psychologists strive to be knowledgeable about psychopathology within the aging population and cognizant of the prevalence and nature of that psychopathology when providing services to older adults.

Guideline 9
Psychologists strive to be familiar with current knowledge about normal and disease-mediated cognitive changes in older adults.

Guideline 10
Psychologists strive to understand and address issues pertaining to the provision of services in the specific settings in which older adults are typically located or encountered.

Guideline 11
Psychologists strive to be familiar with the application of telehealth practices and policies in assessing and treating older adults across settings and living situations.

Guideline 12
In working with older adults, psychologists are encouraged to understand the importance of interfacing with other disciplines, and to make referrals to other disciplines and/or to work with them in collaborative teams and across a range of sites, as appropriate.

Guideline 13
Psychologists strive to understand the special ethical and/or legal issues entailed in providing services to older adults.

Guideline 14
Psychologists strive to be knowledgeable about public policy, state and federal laws, and regulations related to the provision of and reimbursement for psychological services to older adults and the business of practice.

Assessment

Guideline 15
Psychologists strive to understand the functional capacity of older adults in their own social and physical environment.

Guideline 16
Psychologists strive to be familiar with the theory, research, and practice of various methods of assessment with older adults, and knowledgeable of assessment instruments that are culturally and psychometrically suitable for use with them.

Guideline 17
Psychologists strive to develop skill at conducting and interpreting cognitive and functional ability evaluations with older adults.

Intervention

Guideline 18
Psychologists strive to be familiar with the theory, research, and practice of various methods of intervention with older adults, particularly with current research evidence about their efficacy with this age group.

Guideline 19
Psychologists strive to develop skills in adapting psychotherapeutic interventions, including environmental modification, in a manner sensitive to cultural and other individual differences among older adults.

Consultation

Guideline 20
Psychologists strive to recognize and address issues related to the provision of prevention and health promotion services for older adults.

Guideline 21
Psychologists strive to understand issues pertaining to the provision of consultation services in assisting older adults.