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.

Neighbor is a Verb

My 91 year old mother uses the word “neighbor” as a verb. As in, “People don’t neighbor here anymore”. She grew up and has lived most of her life in an era when people didn’t lock their doors and neighbors came over unannounced for a friendly cup of coffee or to borrow the proverbial cup of sugar.

She bemoans the fact that in her later years in an upscale retirement neighborhood in Scottsdale and now even in a good-sized retirement home, people tend to keep to themselves, valuing (apparently) their privacy.

My husband and I live in a small apartment complex that we manage. We have screened our renters and have a wonderful, stable group of 8 families. We have patio garden and deck areas filled with growning fruit, flowers, veggies and.. children! It is alive, and there are multi-generations living and enjoying each other here.

I bring this up because last week a new UCSF research study came out that has spread like wild fire around the Net and print media. It was published in the Archives of Internal Medicine. UC Health describes the results in: Loneliness Linked to Serious Health Problems, Death Among Elderly.

NPR’s Michael Krasny interviewed one of the study’s authors, Carla Perissinotto, M.D., M.H.S., assistant professor in the UCSF Division of Geriatrics and Karyn Skultety, director of clinical and community services for the Institute on Aging in an excellent radio piece: Loneliness in Later Years.

UCSF researchers interviewed 1,600 participants and asked them basically three questions:

Do you feel left out?
Do you feel isolated?
Do you have companionship in your life?

These questions address issues of loneliness. Note that loneliness is not the same thing as depression which is more about a lack of enjoyment, energy and motivation.

It’s important to note, and something that surprised the researchers (but not those of us who work with older people), that people can be very lonely even though surrounded by people as in an assisted living facility. It’s about the *quality* of relationships, not the *quantity*.

Back to my mother’s use of the word “neighbor” as a verb. Recently, a print poster has been making the rounds in the media called “How to Build Community”. One of the to-do items listed that especially caught my eye was “Sit on your front stoop”.

How many of us do that in our neighborhoods anymore? Granted not all of us have front stoops! But, even metaphorically, have we gotten so insular and isolated and fearful of our privacy that we no longer know and look out for our neighbors?

“Aging in Place” or “Aging in Community” initiatives that I’ve been writing about are initiatives sweeping the country that are two answers to the isolation and loneliness people are experiencing, especially for those who are becoming predominantly homebound.

“Neighbor” is a verb. How can we begin to use it in our communities to help not only those of us who are growing older and becoming less mobile but also overwhelmed single parents, latch key children, kids with no grandparents nearby, widows, etc.

Perhaps, as the poster creator lists, we can “turn off our TV’s, sit on our front stoops, greet people, organize a block party, know our neighbors, hire young people for odd jobs, have a potluck, and dance in the streets”.