Behavioral gerontology is the application of the principles of Applied Behavior Analysis (ABA) to address problems of aging.

A Growing Aging Population

The need for Board Certified Behavior Analysts (BCBAs) in healthcare is attributed to the demands of the fastest growing population in America – older adults. According to the 2020 United States Census Bureau, 55.8 million people are over 65 years of age, and 25 percent of them had been diagnosed with dementia.

By 2030, America is expected to become a “Super-Aged” Country in which over 20 percent of the population will be over the age of 65. And while the average lifespan has been increasing for a century now, the physical and psychological issues associated with advanced age have not been as easily addressed.

Aging adults frequently experience problems such as dementia, Alzheimer’s Disease, depression, and anxiety. As a result of, or in combination with, other physical infirmities, these conditions lead to a variety of problematic behavioral issues including aggression, disinhibition, confusion, hoarding, self-care deficits, and more.

A Shifting Emphasis to Applied Behavior Analysis in Geriatric Medicine

Despite the primary reliance of pharmacological treatment for most issues suffered by geriatric patients, medical providers have begun to question the wisdom of utilizing drugs to treat behavioral problems that are not necessarily medical in nature and that can create such side effects in aging adults as movement disorders, sedation, stroke, and death. Research studies have found that behavioral issues in older populations stem not just from medical problems, but from environmental factors.

By the nature of their work, BCBAs possess expertise in working with challenging behaviors. BCBAs are uniquely suited to address these issues because they examine the context in which problematic behaviors occur. ABA is based upon principles of behavior known as the ABCs:

• Antecedent – The trigger or event leading to a behavior.
• Behavior – The action or behavior in response to the antecedent.
• Consequence – The reinforcement mechanism associated with the behavior.

Because of their functional approach and emphasis on environmental factors, BCBAs can address various age-related maladies and infirmities as another variable that can influence behaviors. For example, the biological changes leading to worsening balance and weaker muscles and bones present antecedents with dramatic consequences such as falls and broken bones that result in emotional distress and withdrawn behaviors.

Those behaviors, in turn, can lead to other worsening biological issues, creating the reinforcement cycles BCBAs possess expertise in altering. By adjusting either the antecedent or the consequence, a BCBA can dramatically improve the quality of life and prognosis for the aging adult.

To understand aging adults and their environments, BCBAs conduct a Functional Behavior Assessment (FBA). This involves interviewing the aging adult and caregivers, examining medical and other records, and carefully considering the patterns and circumstances of their daily routine. In addition, an FBA yields critical information regarding the aging adult’s motivation and the purpose that his/her behavior serves.

The interventions devised from the information an FBA provides are incorporated into a Behavioral Treatment Plan. Such intervention programs include 1:1 direct intervention, environmental changes, rewards implemented as consequences for positive behaviors, and alterations in routines implemented by caregivers.

The primary goal of Applied Behavior Analysis is to set the environment up in such a way that the client can be as functionally independent as possible. In the gerontology population, BCBAs recognize that the aging adult is likely to have caregivers for the breath of their life span. This means that a critical component of behavioral treatment is the education and training of the caregivers in the aging adult’s life. The BCBA is continually working to systematically fade behavioral services through the demonstrated competencies of the caregivers and the mastery of behavioral treatment goals.

BCBAs in behavioral gerontology are responsible for the provision of direct client services as well as the clinical oversight of staff, family members, and medical providers who share responsibility for treatment plan implementation. The Behavioral Treatment Plan is likely to be changed over time as certain treatment modalities prove more or less effective, or as behavior changes warrant different focuses of treatment.