by Cori McLaughlin, MSW, LSW,
Director, American Day Treatment Centers

Among many myths about aging is that American families do not care for their older members.  Such myths are based on isolated anecdotes as opposed to aggregate data.  Families are committed to their older members and provide a spectrum of assistance.  The majority of problems occur with older individuals who have no children or spouse, thereby reducing the opportunity to receive family aid, and with those over 85 years of age whose children are also older.

Families, and the older adult themselves, fall prey to negative stereotypes that little can be done for late-life mental health problems.  Mental health problems in later life, like physical health problems can be treated.  Normal aging is not characterized by mental or cognitive disorders.  Nor is persistent bereavement "normal".  Of those 55 years of age and older, 5% meet criteria for major depression, and up to 30% suffer from "depressive symptoms".   Risk factors include: being widowed, persistent insomnia, physical illness, educational attainment less than high school, impaired functional status, and heavy alcohol consumption.

There are many reasons that diagnosis is difficult in older adults.  Depression and anxiety co-occur with medical disorders and are more likely to be overshadowed by physical conditions.   Older adults are more likely to report physical symptoms than psychological ones.  Combine this with the fact that 55% of internists, or primary care physicians who are preferred by older adults, felt confident in diagnosing depression, and even fewer, 35% felt confident prescribing antidepressants to older adults.

Another reason for under diagnosis is the stereotype of depression and hopelessness being natural conditions of older age, especially with prolonged bereavement.  Again, this stereotype leads to the older adult under reporting symptoms of depression; therefore obtaining an accurate history is vital for diagnosis.

Diagnosing and treating depression in the older adult is important for improving their quality of life.  Depression is the foremost risk factor for suicide in older adults.  Older adults have the highest rates of suicide in the United States, and those 65 years and older account for 25% of the nations suicides.  White men over 65 have a rate of suicide up to 6 times that of the general population. While thoughts of death may be developmentally expected in the older adult, suicidal thoughts are not. 

Family members should ask questions, stay as involved as possible, monitor and help to build support systems and a variety of activities for the older adult.  Medications are a consideration, as is psychotherapy.  Psychotherapy may be preferred for those who are unable to tolerate or do not wish to take medication.  Psychotherapy is increasingly being offered within health care centers, and even some primary care physician offices, therefore, decreasing stigma.  Psychotherapy helps strengthen coping mechanisms, and promotes healthy behavior.

Three types of psychotherapy are especially helpful to the older adult.  Reminiscence therapy is a reflection upon the positive and negative life experiences and enables the individual to overcome feelings of despair.  Cognitive behavioral therapy is designed to modify thought patterns, improve skills and alter the emotional states that contribute to onset or perpetuate the mental disorder.  Interpersonal therapy focuses on grief, role disputes, role transitions, and interpersonal deficits.

All older adults and their families should look for and encourage strategies to maintain mental health, avoid disease and disability, sustain high cognitive function and engage with life.  Wellness programs are important ways to promote mental and physical health.  Building a "social portfolio" of positive activities and interpersonal relationships will assist with transition into older age.

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