Elderly man drinking coffeeAging is a natural process that may present challenges for some individuals and their families. Although many older adults look forward to moving from middle age into their later years, it may be difficult for others to adjust.

All adults may experience health issues and stress as they approach and pass middle age, and the support of a therapist or other mental health professional may help ease the transition.

Understanding Aging and Geriatric Issues

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While some adults may approach their "Golden Years" eagerly, anticipating retirement, grandchildren, or simply a new phase of life, others may dread the physical and mental effects of aging. It may be difficult for some adults to face the transition to retirement, deal with new frailty or medical conditions, or find enjoyable, meaningful activities if they do experience physical challenges that limit their mobility. It may also be difficult for some older adults to face mortality, especially when friends, peers, or spouses and partners pass on, and they may come to experience isolation in the wake of many such deaths. Older adults may also find it challenging to attend to basic needs in the presence of Alzheimer’s disease or other forms of dementia, which affect approximately one in ten Americans of retirement age.

Ageism, or discrimination based on a person's age, may also affect some older adults, and this practice may lead to forced retirement or cause well-intentioned loved ones to ignore an older adult's desires or opinions. According to a United Nations Population Survey, 37% of adults over the age of 60 reported experiencing age discrimination in the last year, and 43% were afraid of personal violence. Only 49% of these adults reported being treated with respect, which indicates that just over half of the adults surveyed had experienced instances of disrespect. Further, more than half of adults over the age of 60 found it difficult to pay for basic services, 66% wished they had an opportunity to work, and 47% worried "always" or "very often" about money. 

Medical Issues of Aging

One of the challenges older adults may experience is distinguishing the normal effects of advancing age from signs of actual physical or mental illness. Many people over the age of 65 continue to live happy and healthy independent lives. Most older adults will experience some changes in cognition, but this is a normal part of the aging process. Researchers have found that healthy older adults often experience mild decline in the areas of:

  • visual and verbal memory
  • visuospatial abilities
  • immediate memory, or the ability to name objects
  • hearing and vision
  • bodily strength
  • appetite and energy level

A health care professional can help older adults become accustomed to these kinds of changes and distinguish them from a serious health condition such as Alzheimer’s disease or Parkinson’s disease (a referral to a psychiatrist or internist may be necessary).

Those who spend time with or care for older adults can help reduce the impact of these issues by using certain strategies to allow for varying degrees of impairment. Caregivers and family members might, for example, use plain language and focus on important details rather than unnecessary information, clearly communicate directions and use written reminders as memory aids, provide written information in an easy-to-read format and consider providing an audio format when necessary, and speak clearly and face to face.

Older adults who experience some limitations on their activity and abilities due to aging are often able to adapt to these changes and continue their lives in the manner they wish, occasionally with some type of assistance or accommodations. 

Cognitive and Mental Health Concerns

Older adults often experience mild mental decline as they grow older, but some adults may be affected by dementia, which can lead to significant impairment in function and may influence the development of conditions such as depression, paranoia, and anxiety. Alzheimer's, a progressive condition that also impacts memory and mental function, is the most common form of dementia and is the cause of 50 to 80% of all cases of dementia in the United States. 

Statistics show that about 15% of adults over the age of 60 have a mental health condition. Mental health concerns often experienced by older adults include:

  • Anxiety, which affects 6% of older adults
  • Sexual dysfunction and sleep problems. The likelihood of either of these conditions increases with age. 
  • Depression, which occurs in approximately 7% of the older adult population and is often undiagnosed and untreated. Older adults who live in a community have been shown to experience depression at lower rates than younger adults, however. 
  • Behavioral concerns, such as aggression, motor overactivity or wandering, and verbal outbursts. These are often caused by delirium, depression, or dementia. 
  • High suicide rates. Older adults experience the highest suicide rate of any age group. 
  • Alcohol and substance dependency. 2-5% of men and 1% of women over the age of 65 are dependent on drugs or alcohol, but the Substance Abuse and Mental Health Services Administration reports that by 2020, half of all Americans between the ages of 50 and 70 will be at high risk of alcohol and marijuana dependency, compared to fewer than 9% of all Americans in 1999. 

Therapy for Geriatric Issues

Therapy can help older adults who may have difficulty with the transitions of aging to manage their emotions, find new sources of enjoyment and meaning, and find new support systems. It can help people face their fears of death, if they have such fears, and deal with grief as friends and family members pass on. Family or individual therapy can also assist family members who may be caretakers of their elder relatives, as it can assist them in dealing with their emotions, communication issues—which may be especially helpful if an elder has some form of dementia—and community resources. Possible diagnoses associated with aging might be include depression or anxiety. Dementia is technically a medical diagnosis rather than a mental one, but therapeutic treatment may be able to help treat some of the symptoms associated with dementia.

Many older adults also enter therapy to seek treatment for mental health issues not related to aging, in higher numbers than they did in the past. This appears to be due to the fact that attitudes pertaining to mental health issues have begun to change as awareness increases. Many older adults grew up in a time when mental illness was stigmatized and when all mental issues faced by seniors were written off as aging or dementia. But now, therapy is considered by many older adults as a form of treatment, and research shows that seniors are often more serious about therapy, realizing that their time is limited, and that they tend to obtain results more quickly than younger people do. In therapy, seniors may address issues from childhood or early adulthood; current life adjustments; and issues such as stress, anxiety, depression, or family concerns, among others.  

Older adults may also be more likely to enter therapy late in life now than they were in the past simply because people live longer now than they did previously. A person who is 60 years of age is likely to have 15 or 20 years remaining in life, and the transitory period that occurs for many at this stage may begin a process of reflection that leads many older adults to seek therapy.

Promoting the Health of Older Adults

Encouraging active and healthy aging may improve the mental health of older adults. Security and social support, adequate training for geriatric care professionals, promotion of good mental and physical health, and community programs may all help meet the needs of the elder population. Family and caregiver support and informed and compassionate care, when offered rather than forced on an individual, can also help older adults maintain their independence with the knowledge that help is available if needed.

Myths about older adults that depict them as individuals who experience frailty, loneliness, cognitive impairment, and frequent irritability often contribute to the belief that older adults cannot make decisions for themselves and should not be allowed their freedom when they reach a particular age. Many older adults are able to live independently, experience only a slight decline in cognitive abilities, and do not experience personality changes as they grow older. 

Case Example

  • Stress experienced as a result of caring for aging mother: Rosa, 72, is brought to therapy by her daughter, Maria. Maria has been visiting her mother every day for five years, ever since Maria’s father (Rosa’s husband) died, leaving Rosa alone. Maria helps Rosa shop and cook and clean and keeps her company. But lately, Rosa needs more and more help, and Maria feels she cannot meet her mother’s needs anymore. Rosa is irritated by this and angrily tells her daughter, “You don’t even care about me.” The therapist takes a thorough personal history of the family and comes to suspect that Rosa is suffering from a form of dementia. The therapist refers Rosa to a physician, who confirms this. The therapist then works with Maria to find appropriate, affordable, professional services for Rosa, including an adult day center and an in-home nurse that Rosa’s insurance covers. The therapist also helps Maria and Rosa understand the symptoms of Rosa’s illness, helps Maria deal with feelings of guilt as well as communication difficulties, and facilitates joint sessions to help the two talk about what Rosa is going through.
  • Therapy to assert independence with well-meaning family: Tobias, 64, enters therapy, discouraged and distressed by his family. He tells his therapist that he lives alone in a small house, but his family has been encouraging him to sell his house and move into an apartment complex for senior citizens so he can be near "other people his age" and so he does not "get lonely." Tobias tells the therapist that he is happy on his own, that he has plenty of friends, and that he has no desire or reason to make any changes in his life. The therapist asks if his family has any reason to be concerned about him, and Tobias admits that he recently had a few accidents due to vision changes but that since he has begun wearing glasses, he has experienced no more difficulties. The therapist affirms Tobias' right to make decisions for himself, and together they explore ways that Tobias can assert himself with his family. Tobias continues in therapy for several sessions, and the therapist helps him work through his frustration with his declining vision and his fear of other changes related to aging.

References:

  1. Alzheimer's & Dementia - What We Know. (n.d.). Retrieved from http://www.alz.org/research/science/alzheimers_research.asp
  2. Atiq, R. (2006, June 1). Common Themes and Issues in Geriatric Psychotherapy. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990651
  3. Ellin, A. (2013, April 22). How Therapy Can Help in the Golden Years. Retrieved from http://well.blogs.nytimes.com/2013/04/22/how-therapy-can-help-in-the-golden-years/?_r=0
  4. Graham, J. (2013, January 2). Aging adults face universal issues of access to care, poverty, discrimination. Retrieved from http://healthjournalism.org/blog/2013/01/aging-adults-face-universal-issues-of-access-to-care-poverty-discrimination
  5. Mental health and older adults. (2013, September 1). Retrieved from http://www.who.int/mediacentre/factsheets/fs381/en
  6. Older Adults: What Challenges Might Older Adults Have? (2011, August 22). Retrieved from http://www.cdc.gov/healthliteracy/developmaterials/audiences/olderadults/understanding-challenges.html
  7. Older Adults' Health and Age-Related Changes. (1998, April 1). Retrieved from http://www.apa.org/pi/aging/resources/guides/older.aspx