Behavioral treatments and pharmacotherapy: acceptability ratings for elderly individuals

Two studies compared acceptability ratings of a positive behavioral treatment (differential reinforcement of incompatible behavior), a mildly aversive behavioral procedure (time-out), and pharmacotherapy used for older adults. In Study 1, college students were presented with descriptions and asked to rate the treatments of case clients who were depicted as either young or elderly, cognitively intact or impaired, and engaging in physical aggression, verbal abuse, or noncompliance. The respondents in Study 2 were adults aged 30-49, and senior center participants aged greater than or equal to 60 who were asked to evaluate only the scenarios involving elderly case clients. The Treatment Evaluation Inventory and a Semantic Differential Scale were used to assess acceptability. Results showed that: (a) college students rated medication higher for elderly case clients, and the behavioral treatments higher when applied with children; (b) adult and elderly respondents assigned the highest acceptability ratings to the differential reinforcement of incompatible behavior procedure, followed by medication and time-out; (c) all respondents assigned differential acceptability ratings depending on the behavior problem described, with more severe problems generally warranting more invasive treatments; (d) acceptability ratings of treatments did not differ as a function of cognitive capacity of case clients. Implications of these results for clinicians employing behavioral interventions with elderly clients are discussed, and suggestions are made for additional research.