Deborah A. DiGilio, MPH has been the Director of the American Psychological Association Office on Aging since 2001. She received a Masters of Public Health with a specialization in health behavior and education from the University of North Carolina at Chapel Hill in 1982. Since that time, DiGilio has “aged in the aging field” holding positions in aging and health in the DC area including at George Mason University, AARP, the American Public Health Association, and Kaiser Permanente of the Mid-Atlantic States.
How did you decide to work in the aging field?
After my graduate training, I had planned to work in a hospital setting in women’s health. However, when I arrived in DC, I was offered a job as a program coordinator of a health education and physical activity program for older adults. In the early 80s, health promotion and fitness for older adults was not something you heard a lot about. The program we designed had a peer training component and received the DHHS Secretary’s Award for Excellence. It was a formative experience for a twenty-something, as I witnessed the physical and psychological benefits of the program and the social engagement it encouraged. I was hooked. Over the years, in each of my subsequent positions, and particularly at Kaiser, I was struck again and again by how older adults with very similar health profiles functioned so differently. In many cases, it was due to their mental health status. I decided I wanted to focus specifically on the mental and behavioral health needs of older adults and found a home at APA.
Why is the training of the health care workforce to care for older adults so important?
Across professions, the healthcare workforce is too small and not adequately trained to meet the challenge of the growing aging population. The urgency of the situation is only increasing due to the growing number of Americans living to old age and the aging of the health workforce itself. A 2012 Institute of Medicine report estimated that each year 5.6 to 8.0 million older adults in the United States experience one or more mental and behavioral health conditions. They experience a wide range of mental health and substance use problems, including those developed earlier in life that persist into or recur in old age, as well as late onset disorders. In addition, the “baby boomer” generation will bring with them a history of mental disorder and substance abuse distinct from earlier cohorts. We need to increase the number of specialists and also enhance the basic competence of all health and direct care workers and trainees to work with older adults and be aware of their biopsychosocial needs.
What is the American Psychological Association’s mission?
The mission of APA is to advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives. The Office on Aging was established in 1998 to extend APA’s efforts to improve the health and well-being of older adults. The office provides consultation and information to APA entities, psychologists, other professionals, policymakers and the public. It establishes linkages with health and aging organizations to work cooperatively to address the needs and support the strengths of older adults, their families and caregivers.
How does the APA work to support the eldercare workforce and older adults?
APA seeks to increase exposure to information about adult development and aging at all levels of psychology education. Beginning with high school, efforts focus on early exposure so that students can better understand normal aging, as well as health-related behaviors, mental and behavioral health disorders, and addictions. Later in the career trajectory, efforts are focused on expanding education and training opportunities for psychology students, interns and postdocs for specialized training in geropsychology, and for continuing professional development and faculty development in geropsychology. Given our Nation’s aging population, APA seeks to increase the competencies of all psychologists to work with older adults. Our efforts have resulted in Guidelines for Psychological Practice with Older Adults, geropsychology competencies, and guidance for work in integrated care settings, with family caregivers, and as Medicare providers. In addition, a wide array of additional education and training materialshave been developed and disseminated.
APA’s broad advocacy agenda focuses on a range of workforce, research, justice, health and economic issues that impact older adults, their families and caregivers. APA works to increase federal support for psychology education and training necessary to address the mental and behavioral health needs of older adults and other underserved populations. APA supports economic policies and increased funding for family caregiver programs that provide the safety net for family caregivers across the lifespan. APA also supports expanded psychological research to increase the prevention, diagnosis and treatment that impact older adults with comorbid chronic conditions and to investigate social determinants of health, including cultural factors contributing to the health disparities in older adult minority populations.
What do you see as the future of the elder care workforce?
Everyone is all in! Given the demographic shift in our population, even if one does not plan to work with older adults, they will most likely have professional (and personal) interactions with them. Older adults are a majority of primary and specialty care patients. Older adults are caregivers of their grandchildren and of their own children who are aging with disabilities or combat induced traumas. Young and middle aged adults are caregivers of older parents. There are more multi-generational families living together. It is my hope that more interaction with older adults will lead more individuals of all ages to see that working with older adults can be engaging, enjoyable and fulfilling.