Guide to Counseling on Aging Careers

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“When older adults have the resources to receive accessible, culturally responsive mental health care, they are better equipped to navigate life transitions, maintain meaningful relationships, and stay engaged in their communities.”

Nicole Kratimenos, EdD, President-Elect of the American Mental Health Counselors Association (AMHCA)

America is getting older. By 2030, one in five Americans is expected to be over the age of 65. And projections show that the number of older Americans will grow from roughly 58 million in 2022 to more than 82 million by 2050 (Population Reference Bureau 2024).

Part of the reason for these increases is demographic: the world’s largest generation, the Baby Boomers, is aging. But the shift is also characteristic of wider societal trends: modern advances in medicine and public health have extended longevity, while lower birth rates have shifted the age structure of the population.

Just as medicine and technology have evolved, so has our understanding of aging and the careers available to support it. Mental health counselors have always been available to help their older clients navigate the aging process, but they’re far from the only professionals counseling on age-related needs. Many professions are centered around the reality of population aging, and some include specialized training to address the unique psychosocial needs of older adults.

Counseling is critical for this demographic. Older adults may face significant mental health challenges, in part due to social isolation and its effects. Recent CDC data show that older adults, especially those aged 75 and older, experience some of the highest suicide rates of any age group (Harvard Gazette 2025). Research also consistently links social isolation and loneliness with increased suicide risk and poorer mental health outcomes in later life, underscoring the connection between emotional support and overall health.

Older adults have a broad range of mental health needs, and counseling professionals must be prepared to serve them. It’s increasingly important that the medical and mental health professionals an older person comes in contact with have at least some training relevant to counseling on age-related needs, whether that’s within general practice or as part of a specialization.

To learn more about careers specializing in counseling on age-related needs, read on.

Meet the Expert: Nicole Kratimenos, EdD, LMHC, NCC, CRC, QS, C-DBT, BC-TMH

Dr. Nicole Kratimenos is president-elect of the American Mental Health Counselors Association (AMHCA). She is also an assistant professor at Barry University and an adjunct professor at National Louis University and St. Petersburg College. She teaches advanced courses in clinical mental health counseling, with an emphasis on psychopathology, multicultural issues, substance abuse, and leadership.

Dr. Kratimenos is a qualified supervisor for the State of Florida and the owner of Sound Mind Counseling, a practice located in the Tampa Bay area. She has delivered numerous peer-reviewed presentations at national and regional conferences on topics such as trauma, dual disorders, and adapting multicultural experiences to virtual didactic formats. A

dditionally, she has authored articles on holistic counseling, dual disorders, and trauma. Her book, A Life Full of Sunshine and Puddles, assists readers in living more emotionally conscious and intellectually insightful lives. Dr. Kratimenos received the Florida Mental Health Counselors Association (FMHCA) Counselor of the Year Award in 2021.

CounselingSchools.com: How would you characterize the importance of mental health to an aging population?

Dr. Kratimenos: Mental health plays an essential part in the quality of our lives and especially as people age. Older adults often experience layered losses over time. For example, changes in health, shifts in identity and independence, retirement, grief, and, for many, a gradual increase in isolation. These types of changes can deeply impact emotional well-being.

As a counselor myself, I have observed that in this stage of life, mental health care is not only about diagnosing or treating disorders; it’s about supporting dignity, autonomy, and a continued sense of purpose in the individual.

When mental health needs are overlooked, we often see worsening physical health, increased cognitive concerns, and reduced overall functioning. When older adults have the resources to receive accessible, culturally responsive mental health care, they are better equipped to navigate life transitions, maintain meaningful relationships, and stay engaged in their communities. Supporting mental health in later life is both a public health necessity and an issue of equity.

CounselingSchools.com: In what ways does working with older clients (65+) affect one’s approach as a mental health counselor, if at all?

Dr. Kratimenos: Working with older adults naturally shifts how mental health counselors approach therapy. We tend to place greater emphasis on life review, meaning-making (through the use of existential therapy), and honoring the client’s lived experience and resilience. In my work with older adults, I have noticed that counseling sessions often move at a different pace and require attention to issues such as medical conditions, cognitive changes, family dynamics, and caregiving roles.

This mental health work is also strengthened by the collaboration with other providers and an awareness of systemic barriers such as ageism, access to care, and insurance limitations. When working with the older adult population, we as clinicians focus on coping strategies while gently challenging patterns that may no longer be serving the client. Above all, this population reinforces the importance of meeting clients where they are and recognizing aging as a normal developmental stage, rather than a problem to be fixed.

CounselingSchools.com: Is there any new research, data, or practice related to counseling on aging that you think is particularly interesting?

Dr. Kratimenos: One area I find especially meaningful is the growing research on the connection between trauma and aging. There is increased recognition in the mental health field that unresolved trauma from childhood, years of systemic oppression, or later-life medical struggles can cause a resurfacing or intensification of trauma effects in older adulthood.

New findings also support the significance of adapting evidence-based approaches, such as trauma-informed care and mindfulness-based interventions, to better fit the developmental and cognitive needs of older adults.

Additionally, research highlighting the role of social connection and sense of purpose in emotional and cognitive health aligns strongly with what many mental health counselors encounter in their work with this population. These findings reinforce that effective mental health care for older adults must move beyond simply helping reduce their symptoms, but rather address deeper concepts such as identity, meaning, and connection, underscoring the need for more specialized training in geriatric mental health. In my clinical work, I have seen how addressing unresolved trauma in later life can often dramatically improve engagement and, in many cases, overall quality of life.

Meet the Expert: Amanda Krisher, LCSW-C

Amanda Krisher is the associate director of behavioral health at the National Council on Aging (NCOA) Center for Healthy Aging. She received her master of social work (MSW) degree from the University of Maryland School of Social Work in Baltimore, and is a Licensed Certified Clinical Social Work (LCSW-C).

With over 15 years of direct practice and program management experience, Krisher is a seasoned professional in the older adult care industry. She previously served as the senior director of a live virtual training program for older adult care professionals and as a clinical social worker for community health programs and hospice organizations. As a leader in older adult care, she has presented at national conferences and statewide meetings.

CounselingSchools.com: How would you characterize the importance of mental health in relation to aging?

Krisher: Mental health is a crucial aspect of aging, and we are seeing an increased focus on supporting mental health and wellness as we age.

Mental health conditions are not inevitable as we age. A common myth is that all older adults will experience depression, when in reality, only about 4 percent of older adults are diagnosed with depression, according to the CDC. Untreated mental health conditions can decrease a person’s quality of life, which may result in slower recovery time from illness, decreased mobility, functioning and/or cognition, or increased symptoms of chronic health conditions.

For those who experience a mental health challenge, we know that treatments such as therapy and medication work and can reduce or even eliminate symptoms. We also know that physical activity, social connections, engaging in hobbies, and spiritual support can all improve mental health for older adults.

CounselingSchools.com: Is there any new research, data, or practice related to aging that you think is particularly interesting?

Krisher: Ageism has a significant impact on our health and well-being. Dr. Becca Levy recently researched how our beliefs about aging determine how well and long we live. She found that those who have a positive view of aging can extend their life by roughly 7.5 years.

The National Center to Reframe Aging, dedicated to ending ageism and advancing an equitable, complete story of aging, provides incredible tools and resources for everyone to use to combat ageism.

There is a significant body of research around the importance of social connection and the impact of loneliness and isolation. Isolation can increase a person’s risk of heart disease, stroke, type 2 diabetes, and early death. The risk of developing dementia is increased by 20 pervrny. Individuals experiencing isolation are also at an increased risk for depression, anxiety, suicidality and self-harm, and substance use disorders.

The good news is that creating and increasing social connections can lead to lower blood pressure, BMI, A1C, and smoking rates. It can also reduce the risk of coronary artery disease, including stroke. From a mental health prospective we see a reduced risk for depression, anxiety, cognitive decline, stress, and PTSD. Additionally, we see an increase in happiness and resilience.

CounselingSchools.com: What does the future of aging look like in America?

Krisher: Every day, roughly 10,000 people turn 65. These numbers will continue until 2030, when everyone from the Baby Boomer generation has turned 65. Currently, in 11 states, older adults outnumber youth, and this trend will continue as the Baby Boomers age and birth rates decline. We are living longer thanks to medical and technological advances, and we have the unique opportunity and privilege to learn from older adults about how to age well.

We are on the precipice of creating conditions for every person to age well with the tools and resources they need to have the best quality of life and celebrate aging. Building a strong workforce that is committed to aging services, utilizing technology, and reducing ageism are some ways we can ensure that every person can age well!

Careers in Counseling on Aging

Licensed professional counselors (LPCs), licensed clinical mental health counselors (LMHCs/CMHCs), licensed clinical social workers (LCSWs), and related counseling professionals are trained to treat clients across the lifespan.

However, some roles and specializations are available for those who wish to focus specifically on counseling on age-related needs—eight of those career options are detailed below.

Become an End-of-Life Counselor

End-of-life counselors are trained in working with emotions related to death, dying, grief, and bereavement. They may work with a patient who has received a terminal diagnosis, or their family. They may also counsel patients who are struggling with a chronic condition.

End-of-life counseling is a category that also includes palliative counseling, which seeks to treat the effects of a particular condition, rather than the cause; it also includes hospice counseling, which involves counseling patients who are terminally ill.

End-of-life counselors may work in a hospice setting, a palliative care center, a hospital, private practice, or in a consultative capacity.

Often, end-of-life counselors are either licensed social workers (LSWs/LCSWs) or licensed clinical mental health counselors (LMHCs/CMHCs) by training, but multiple career pathways exist. Professional organizations for end-of-life counselors include the Social Work Hospice & Palliative Care Network (SWHPN) and the Association for Death Education and Counseling (ADEC).

Become a Geriatric Counselor

Geriatric counselors work directly with older adults and those aging. While they generally work with clients aged 65 and up, they can work with clients as young as 50, providing both physical and psychological assessments and focusing their sessions on a client’s continued interaction with the aging process.

They may work either in private practice, in an assisted living facility, in a long-term care facility, in a senior services agency, or in a consultative capacity.

Geriatric counselors are often clinical mental health counselors (CMHCs) by training; the American Mental Health Counselors Association (AMHCA) offers an official credential for CMHCs specializing in geriatric counseling. Associated organizations for geriatric counselors include the American Mental Health Counselors Association (AMHCA) and the National Coalition on Mental Health and Aging (NCMHA).

Become a Gerontological Social Worker

Gerontological social workers, also known as geriatric social workers, help coordinate social, psychological, and medical care for older adults, typically aged 65 and older. They will perform psychosocial assessments and may provide direct forms of counseling to clients who struggle with issues like depression or to the family of aging clients with conditions like dementia.

Gerontological social workers can work in community health centers, assisted living facilities, long-term care facilities, hospice facilities, and senior centers.

Gerontological social workers will almost always have an advanced degree in social work and earn the official title of Licensed Clinical Social Worker (LCSWs). Professional associations of interest to gerontological social workers include the Association for Gerontology Education in Social Work (AGESW) and the National Association of Social Workers (NASW).

Become a Gerontologist

Distinct from geriatricians (who are physicians who specialize in older patients’ health), gerontologists are experts in the study of aging. Gerontologists educate others about the effects of aging; they also help design and implement policies and services that help meet the needs of the elderly. Taking a multidisciplinary approach, they will incorporate counseling, education, advocacy, and research into their practice.

Gerontologists can work in assisted living facilities, long-term care facilities, community health centers, senior centers, or universities.

Gerontologists will typically have advanced degrees in an area such as psychology or neuroscience, with a particular specialization in gerontology. Associated professional organizations for gerontologists include the Gerontology Society of America (GSA) and the American Society on Aging (ASA).

Become an Occupational Therapist

Occupational therapists help people across the lifespan do what they want and need to do, treating injured, ill, or disabled patients through the therapeutic use of everyday activities. They are particularly valuable to the older adult community that may struggle with issues of mobility, deafness, and blindness; they can also help people recover from strokes or set up environments with fewer fall hazards.

Occupational therapists can work in hospitals, private clinics, assisted living facilities, long-term care facilities, community health centers, and senior centers.

Occupational therapists serving older adults will need to have advanced degrees in occupational therapy and be licensed by the state in which they practice. They will also need to pass a national exam administered by the National Board for Certification in Occupational Therapy (NBCOT). The American Occupational Therapy Association (AOTA) offers a board certification in gerontology.

Become a Psychiatric-Mental Health NP

Psychiatric-mental health nurse practitioners (PMHNPs) are highly trained medical professionals who specialize in psychiatric care and issues of mental health. PMHNPs are qualified to diagnose, treat, and manage mental health issues across the lifespan, but their holistic, patient-centered approach makes them well-suited to treating older adults and counseling them on aging-related issues.

PMHNPs can work in their own independent practices (depending on the state), as well as in hospitals, community health centers, assisted living facilities, and long-term care facilities.

PMHNPs need at least a master’s degree, though a doctor of nursing practice (DNP) degree has strong support to become the new industry standard. PMHNPs will also need to be certified and licensed to practice. Professional organizations of interest to PMHNPs include the American Association of Nurse Practitioners (AANP) and the American Psychiatric Nurses Association (APNA).

Become a Geriatric Psychologist

Geriatric psychologists are psychologists who specialize in the study of mental health issues in older adult patients, often those 65 and older. They can also counsel patients on the effects of aging. Geriatric psychologists are experts in issues such as dementia, Alzheimer’s disease, and Parkinson’s disease, and help patients with these conditions enact strategies to make life more livable.

Geriatric psychologists can work in assisted living facilities, long-term care facilities, hospitals, hospice facilities, or senior centers.

Geriatric psychologists will need an advanced degree, usually a PhD, in psychology (note that geriatric psychiatrists are a distinctly different category; as medical doctors, geriatric psychiatrists can prescribe medications). For geriatric psychologists, professional associations of note include the American Psychological Association (APA), the American Psychosocial Oncology Society (APOS), and Psychologists in Long Term Care (PLTC).

Become a Rehabilitation Counselor

Rehabilitation counselors work with clients who have developmental, mental, physical, or psychological disabilities, helping them to live as independently as possible. When working with older adults, they can coach patients through coping strategies and counsel them on community resources.

Rehabilitation counselors can work in assisted living facilities, long-term care facilities, community health centers, senior centers, hospitals, and private practices.

While certification isn’t required in most states, many rehabilitation counselors choose to earn the industry-standard Certified Rehabilitation Counselor (CRC) credential from the Commission on Rehabilitation Counselor Certification (CRCC) to distinguish themselves professionally and demonstrate their mastery of the subject. Professional organizations of note to rehabilitation counselors include the American Rehabilitation Counseling Association (ARCA) and the National Rehabilitation Association.

Matt Zbrog

Writer

Matt Zbrog is a writer and researcher from Southern California. Since 2020, he’s written extensively about how counselors and other behavioral health professionals are working to address the nation’s mental health and substance use crises, with a particular focus on community-driven and interdisciplinary approaches. His articles have included detailed interviews with leaders and subject matter experts from the American Counseling Association (ACA), the American Mental Health Counselor Association (AMHCA), the American School Counselor Association (ASCA), and the Substance Abuse and Mental Health Services Administration (SAMHSA).