Therapy and Integrative Care Contributes to Reducing Depression in Older People

I recently blogged about the potential benefits of geriatric counseling for older individuals and their families.

Then my husband sent me a link to this July 25 article from the wonderful New York Times blog“The New Old Age” called “More Older People Treated for Depression.” Click on the link to read the entire piece. Some relevant quotes are listed below.

• “For years, mental health specialists lamented that depression was seriously under-diagnosed and under-treated in the elderly. Laypeople saw it not as a disease but as an inevitable part of aging. Doctors missed it because depression didn’t always look the way it did in younger patients– less sadness and weepiness, more physical symptoms and disengagement. Older people themselves often rejected help because mental illness carried a stigma.”

• “Not anymore. Over the past decade, ‘we’ve seen a really big increase in the recognition of depression and the initiation of treatment,’ said Dr. Unützer, a geriatric psychiatrist now at the University of Washington. ‘The bad news is that a lot of these folks aren’t a lot better.'”

• “One apparent explanation: the setting. A great majority of older people seek treatment through their primary care doctors, few of whom are able to offer much more than a prescription. One approach that has proved successful is to move more comprehensive care for late-life depression into existing offices and clinics.

• “Among 1,800 depressed people over age 60, a group randomly assigned to collaborative care showed far greater improvement. After a year, 45 percent had at least a 50 percent reduction in depressive symptoms, compared with that dismal 19 percent in usual care. They reported less functional impairment, greater quality of life.”

• “There’s an advocacy role for family members to play. Talking to a primary care doctor may be a good way to start treating depression, but in many cases that’s not where to stop.”

• In one personal story cited in the blog article, a depressed elderly woman who has not found effective help begins to receive treatment in a comprehensive care center and from atherapist who visits her twice weekly in her assisted living apartment. “It has turned back the clock 10 years,” states her adult daughter.

Why Is Counseling An Important Health Tool For Older Adults?

As we gather more years in our lives, we naturally encounter more and more experiences. Many of them are lovely, joyful and profound. Many of them also inevitably involve loss. Loss can refer to deaths in our families, amongst our loved ones, our pets and extended community. Loss can also be experienced in relationship to job changes, retirement, living situations, finances, physical capabilities, independence, hopes and dreams.

Learning how to deal with cumulative loss is paramount to good mental health and one’s sense of wellbeing. Coping skills commonly used by people to manage grief and loss include cognitive/behavioral techniques, mindfulness meditation, prayer, support groups, self-help literature, workshops, exercise, music, poetry, writing and individual, marital, and/or family counseling.

Older generation adults may or may not have experience with, or a belief in the valuable benefits of, counseling. Many are strong survivors who believe in the value of discipline, determination and will power to surmount challenges.

Counseling may have never been part of their family culture. There can come a time, however, when “white knuckling it” alone through emotional pain may not be the most effective strategy for health. Oftentimes, older people don’t want to burden their adult children with their worries and concerns. Where can they turn?

Traditionally, older people have sought comfort from their family doctors or spiritual leaders. Doctors nowadays do not have the time they used to have to spend counseling patients. Spiritual leaders’ time is usually limited as they often have large congregations to care for. A wise and experienced geriatric counselor who is genuinely caring, nonjudgmental and a good listener can be a powerful support team member for older people.

Why Is It Important for Older Clients to see a Geriatric Counselor?

All Licensed Marriage & Family Therapists receive a deep training in counseling-psychology, a variety of evidence-based treatment models and solid intervention techniques. Similar to geriatric MD’s, however, geriatric counselors also have extensive additional training and experience in addressing specific issues encountered in aging. With older people, many more pieces of the health “puzzle” come into play.

For instance, physical health status, medications, living conditions, safety, socialization vs. isolation, independence vs. dependence, spirituality, lifelong learned personality patterns, nutrition, shifting roles in families, impacts of ageism in society, a continuing sense of purpose and value, an ability to contribute to their communities – all of these and more contribute to the older individual’s sense of wellbeing.

A close attention to working collaboratively as part of a compassionate and competent support team is also often called for in serving older clients. With each client’s express written permission and where beneficial to each client, geriatric counselors can contribute greatly to the client’s wellbeing through effective communication and teambuilding with physicians, caregivers, facility social workers, nurses, psychiatrists, care managers, spiritual leaders and family members. “It takes a village” is often true in serving the wellbeing of older clients.

Thus, it is important that geriatric counselors are well-versed and up-to-date with the common physical challenges, safety issues, emotional challenges, relationship/role changes, societal influences, support teams and environmental concerns encountered by aging clients. In order to effectively advocate for, educate on behalf of and serve this population as a therapist, simply knowing the basics of counseling psychology is not enough.

In Marin County, geriatric counselors can be found through a local google search, through a search on Marin County’s online site for the Division of Aging and Adult Services, through the Find A Therapist tool on the Marin California Marriage & Family Therapists website, or through a referral from your spiritual advisor or physician.