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Depression and Suicide in Older Adults Resource Guide
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Journal Articles
Books
Book Chapters
Reports
Information for Older Adults & Their Families
Introduction
Depression and suicide are significant public health issues for older adults. Depression is one of the most common mental disorders experienced by elders, but fortunately is treatable by a variety of means. Current cohorts of older adults in the United States evidence lower rates of major depression than younger cohorts, but experience minor depression or significant subsnydromal depressive symptoms at rates equal to or greater than younger groups. Adults soon to enter later adulthood, most notably the so-called Baby Boom cohort, seem to be evidencing depressive disorders at significantly higher rates than previous groups; this trend towards greater incidence of depression in subsequent cohorts seems steady. The reasons for these changes are the subject of much debate and not clearly understood. Because depression tends to be a recurrent disorder, this means that many older adults will have experienced previous bouts of depression and will be at increased risk.
Depression is not only a prevalent disorder but is also a pervasive problem. Depressed older adults, like younger persons, tend to use health services at high rates, engage in poorer health behaviors, and evidence what is known as "excess disability." Depression is also associated with suicide. Older adults have the highest rates of suicide of any age group, and this is particularly pronounced among men.
Several efficacious treatments are available for geriatric depression but seem to be underused. Pharmacotherapy and several versions of psychotherapy, including interpersonal, brief psychodynamic, problem-solving, and cognitive-behavioral, significantly reduce depressive symptoms. Interestingly, when given thorough descriptions of these treatments, older adults state a preference for receiving psychologically based treatments.
Geriatric depression will continue to be a topic worthy of much scientific and applied interest in the years to come. This resource guide provides some current information we hope will be useful as you learn more about this important health issue.
Forrest Scogin, PhD
Department of Psychology
University of Alabama at Tuscaloosa
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Journal Articles
Clinical determinants of suicidal ideation and behavior in geriatric depression
Alexopoulos, G., Bruce, M. L., Hull, J., Sirey, J., & Kakuma, T. (1999). Archives of General Psychiatry, 56(11), 1048-1053.
Most older adults who commit suicide see their physicians within a few months of their death and more than a third within the week of their suicide. Therefore, reliable assessment of suicide risk is critical; protective measures may avert suicide. The principal aim of this study was to determine which clinical characteristics could be used to assess suicidality in 354 61-93 yr old patients with depression who were studied for a mean of 1.8 yrs. Results demonstrate that elderly patients with severe depression, poor social support, and history of serious suicide attempts have high suicide potential.
The "vascular depression" hypothesis
Alexopoulos, G.S., Meyers, Barnett S., Young, R.C., Campbell, S., Silbersweig, D., & Charlson, M. (1997). Archives of General Psychiatry, 54(10), 915-922.
Proposes the "vascular depression hypothesis" which suggests that cerebrovascular disease can predispose, precipitate, or perpetuate a depressive syndrome in many elderly patients with underlying neurologic brain disorders. This article reviews findings relevant to the vascular depression hypothesis and discusses their clinical and heuristic implications. The vascular depression hypothesis is supported by the high frequency of depression in patients with hypertension, diabetes, coronary artery disease, and stroke; the frequency occurrence of silent stroke and white matter hyperintensities in geriatric depression; and the association of depression with lesions impairing the integrity or regulation of the circuits linking basal ganglia and prefrontal cortex.
Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults
Arean, P. A., Perri, M. G., Nezu, A. M., Schein, R. L., Joseph, T. X., & Christopher, F. (1993). Journal of Consulting & Clinical Psychology, 61(6), 1003-1010.
Compared the effects of 2 psychotherapies based on divergent conceptualizations of depression in later life. 75 older adults diagnosed with major depressive disorder were assigned randomly to problem-solving therapy (PST), reminiscence therapy (RT), or a waiting-list control (WLC) condition. Participants in PST and RT were provided with 12 weekly sessions of group treatment. Dependent measures, taken at baseline, post-treatment, and 3-mo follow-up, included self-report and observer-based assessments of depressive symptomatology. At post-treatment, both the PST and the RT conditions produced significant reductions in depressive symptoms, compared with the WLC group, and PST Ss experienced significantly less depression than RT Ss. Moreover, a significantly greater proportion of Ss in PST vs. RT demonstrated sufficient positive change to warrant classification of their depression as improved or in remission at the post-treatment and follow-up evaluations.
Life-sustaining treatment and assisted death choices in depressed older patients
Blank, K., Robison, J., Doherty, E., Prigerson, H., Duffy, J., & Schwartz, H.L. (2001). Journal of the American Geriatrics Society, 49(2), 153-161.
Examined the effect of depressed mood in older, medically ill, hospitalized patients on their preferences regarding life sustaining treatments, physician-assisted suicide (PAS), and euthanasia and to determine the degree to which financial constraints affected their choices. 158 hospitalized, nondemented patient's aged 60-94 yrs participated. The sample was divided, into a depressed group and a nondepressed control group. Ss underwent a structured interview evaluating their life-sustaining treatment choices and whether they would accept or refuse PAS or euthanasia under a variety of hypothetical conditions. These choices were reevaluated with the introduction of financial impact. Assessment included measures of depression, suicide, cognition, social support, functioning, and religiosity. Depression was found to be highly associated with acceptance of PAS and euthanasia in most hypothetically clinical scenarios in addition to patients' current condition. The authors found that depressed Ss and even Ss with subtle, passive suicidal ideation were markedly more interested in PAS and euthanasia than nondepressed Ss in hypothetical situations.
Suicide in the elderly
Caine, E.D. & Conwell, Y. (2001). International Clinical Psychopharmacology, 16(Suppl2), S25-S30.
Suicide is a major public health problem, with rates rising to their highest levels in many countries and cultures during the second half of life. The risk factors that contribute to later-life suicide are distinctive from those in younger populations. This paper reviews a variety of potential approaches for effective suicide prevention among elders, and considers as well both age-specific and general barriers that impede such efforts. It proposes that future effective measures will need to integrate public health and individual-oriented therapeutic approaches to intervention, and that specific efforts will need to be developed to address the natural history of suicidal processes.
Suicidal Behaviors in Older Adults, Theme Issue
Conwell, Y. & Pearson, J.L. (2002). American Journal of Geriatric Psychiatry, 10 (4).
This issue of the American Journal of Geriatric Psychiatry contains five articles related to suicide in older adults: Risk Factors for Late-Life Suicide: A Prospective, Community-Based Study; Access to Firearms and Risk for Suicide in Middle-Aged and Older Adults; Suicidal and Death Ideation in Older Primary Care Patients With Depression, Anxiety, and At-Risk Alcohol Use; Cognitive Functioning and Geriatric Suicide Ideation: Testing a Mediational Model; and, Suicidality in Older African Americans: Findings From the EPOCH Study.
The epidemiology of common late-life mental disorders in the community: Themes for the new century
Gallo, J.J., & Lebowitz, B.D. (1999). Psychiatric Services, 50(9), 1158-1166.
The prevalence and incidence of the major mental disorders of late life that are common in the community and in primary health care are reviewed. As the population ages, dementia, depression, and other mental conditions of the aged will demand more attention from clinicians and investigators to minimize their effects on disability, the use of health care services, and the quality of life for older adults and caregivers. Up to 15 to 20 percent of older adults have significant depressive symptoms, and it is estimated that as many as 45 percent of persons age 85 years and older have significant cognitive impairment and dementia. Other mental-health-related conditions, such as anxiety disorders, alcohol abuse, and prescription medicine misuse, are also important considerations but have not been as well studied as depression and dementia. Because an increasing proportion of older adults are members of minority groups, clinicians need to increase their awareness of how cultural factors relate to risk for mental disorders in late life.
Comparative Effects of Cognitive-Behavioral and Brief Psychodynamic Psychotherapies for Depressed Family Caregivers
Gallagher-Thompson, D., & Steffen, A.M. (1994). Journal of Consulting and Clinical Psychology, 62(3), 543-549.
Clinically depressed family caregivers of frail, elderly relatives were randomly assigned to 20 sessions of either cognitive-behavioral or brief psychodynamic individual psychotherapy. At post treatment, 71% of the caregivers were no longer clinically depressed according to research diagnostic criteria, with no differences found between the two outpatient's treatments. The results suggested therapy specificity; there was an interaction between treatment modality and length of caregiving on symptom-oriented measures. Clients who had been caregivers for at least 44 months improved with CB therapy. These findings suggest that patient-specific variables should be considered when choosing treatment for clinically depressed family caregivers.
Suicide in later life
Gallagher-Thompson, D., & Osgood, N.J. (1997). Behavior Therapy, 28(1), 23-41.
This paper addresses a number of issues related to suicide among older persons in the United States. A presentation of the epidemiology of late life suicide is followed by a discussion of known risk factors for both suicide attempts and completed suicides. Other issues discussed include the assessment of suicidality among older men and women, and the highly controversial topic of "rational" suicide. The article concludes with suggestions for intervention in order to reduce suicide ideation and improve the individual's quality of life.
Empirically Validated Psychological Treatments for Older Adults
Gatz, M., Fiske, A., Fox, L., Kaskie, B., Kasl-Godley, J., & McCallum, T. (1999). Journal of Mental Health and Aging, 4(1), 9-46.
Psychological treatments with older adults were evaluated against criteria developed by the Division of Clinical Psychology of the American Psychological Association for documenting effective psychosocial interventions. To be included as evidence, the studies must exclude dual or ambiguous diagnoses and must adhere to standardized treatment manuals. Demonstrated efficacy compared to waiting list control groups qualifies an intervention as "probably efficacious", whereas being categorized as "well established" requires superiority to a psychological placebo group or control treatment (or equivalence to another well-established treatment). Major findings included: use of behavioral and environmental treatments for behavior problems in dementia patients met criteria for "well established"; cognitive, behavioral, and brief psychodynamic therapy for the treatment of depression in older adults met criteria for "probably efficacious"; life review and reminiscence met the criteria for "probably efficacious" for both cognitively intact and demented individuals with symptoms of depression and those living in settings that restrict independence; cognitive behavioral treatment of sleep disorders, support groups for caregivers based on a psychoeducational model, and memory and cognitive retraining with dementia patients all met the criteria for "probably efficacious."
Removing the barriers to effective depression treatment in old age
Harman, J.S., & Reynolds, C.F., Journal of the American Geriatrics Society, (2000) Vol 48(8) 1012-1013.
Notes that although antidepressants and psychotherapy have been shown to be effective in treating older patients with depression, non-treatment or under-treatment for depression is common in this population. The authors argue that there must be further efforts to improve access to and quality of care for depression among older adults. Reasons why diagnosis and treatment of depression among older adults are inadequate are discussed and barriers to effective treatment are explored. Specifically, inability to pay for services and mixed results of previous efforts to improve rates of diagnosis and treatment are cited.
Hopelessness as a measure of suicidal intent in the depressed elderly
Hill R.D. Gallagher D., Thompson H.W., & Ishida T. (1998). Psychology and Aging, 3(3), 230-232.
Suicidal ideation in the elderly has been related to depression, changes in health and anticipation of a limited future. The present study examined the Hopelessness Scale (HS) and its relation to these factors in a depressed geriatric population. A total of 120 elderly outpatients, who had applied to receive psychotherapy for depression, completed the HS, Beck Depression Inventory (BDI), health ratings, and the Schedule for Affective Disorder and Schizophrenia (SADS) at intake. The HS was found to be internally consistent, and a principal component analysis revealed three distinct factors that were related to hope, feelings of giving up, and future planning. The HS, BDI, and health ratings were predictive of suicidal ideation as measured by specific items in the SADS. The relationship between suicidal ideation hopelessness, depression, and health perceptions for the depressed aged are discussed.
Incidence of depression in long-term care settings
Parmelee, P.A., Katz, I.R., & Lawton, M. P. (1992). Journals of Gerontology, 47(6), M189-M196.
Conducted a 1-yr longitudinal study to examine incidence and persistence of depression among nursing home and congregate apartment residents. Of 868 persons (mean age 83.9 yrs) interviewed at Time 1, 15.7% displayed possible major depression (MD), and 16.5% displayed minor depressive symptoms. A follow-up interview a year later with 448 Ss yielded an incidence rate for possible MD of 6.6% among persons with only minor or no depression in the previous year. For Time 1 nondepressives, the incidence of possible MD was 5.6%, and of minor depression, 6.3%. More than 40% of Time 1 possible major depressives showed no remission of symptoms a year later. In contrast, more than half of Time 1 minor depressives showed no depression at follow-up; however, another 16.2% appeared at follow-up to suffer possible MD. Change in depression was associated with cognitive status, functional disability, and physical health. In general, persistence of depression was associated with greater decline.
How effective are psychotherapeutic and other psychosocial interventions with older adults? A meta analysis
Pinquart, M. & Soerensen, S. (2001). Journal of Mental Health and Aging, 7(2), 207-243.
Meta-analysis was used to synthesize the effects of 122 psychosocial and psychotherapeutic intervention studies with older adults. Three research questions were explored: (1) what is the effectiveness of psychotherapeutic and psychosocial treatments (cognitive-behavioral therapy, reminiscence, psychodynamic approaches, relaxation, supportive interventions, control enhancement, psychoeducational treatments, activity treatments and training of cognitive abilities) on self-ratings of depression, clinician-rated depression, and other measures of subjective well-being in older adults; (2) the influences of moderator variables, and (3) whether the effects of psychosocial and psychotherapeutic interventions vary by age. Psychotherapeutic interventions changed self-rated depression and other measures of psychological well-being by about one half standard deviation and clinician-rated depression by more than one standard deviation.
Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: A randomized controlled trial in patients older than 59 years
Reynolds, C.F., Frank, E., Perel, J.M., Imber, S.D., Cornes, C., Miller, M.D., Mazumdar, S., Houck, P.R., Dew, M.A., Stack, J.A., Pollock, B.G., & Kupfer, D.J. (1999). Journal of the American Medical Association, 281(1), 39-45.
This 7-yr study examined the efficacy of nortriptyline and interpersonal therapy (IPT), either alone or in combination, in the treatment and recurrence prevention of major depression of adults aged older than 59 yrs. 180 elderly patients (mean age 67.6 yrs) with recurrent, nonpsychotic unipolar major depression were treated acutely with nortriptyline and IPT. 107 Ss whose remissions were stable for 16 wks were randomly assigned to 1 of 4 maintenance therapy conditions (1) medication clinic with nortriptyline, (2) medication clinic with placebo, (3) monthly maintenance IPT and nortriptyline, or (4) monthly maintenance IPT with placebo. Survival analysis showed a highly significant effect for active treatment over placebo in preventing recurrence of major depressive episodes. The best outcome was observed in Ss assigned to the combined treatment condition, with 80% remaining depression-free. On pairwise analysis, each of the active treatment conditions was significantly better than placebo in preventing recurrence. Older age was associated with a higher and more rapid rate of recurrence during the 1st year of maintenance with all treatments except combined nortriptyline and IPT.
Efficacy of psychosocial treatments for geriatric depression: A quantitative review
Scogin, F. & McElreath, L. (1994). Journal of Consulting and Clinical Psychology, 62(1) 69-74.
A meta-analysis of 17 studies examined the efficacy of psychosocial treatments for depression among older adults. Psychosocial treatment was defined as an intervention, the primary mode of action which was through psychological or social mechanisms such as psychotherapy, bibliotherapy, or behavior therapy. Studies were included only if a comparison was made to a control condition (no treatment, delayed treatment, or placebo treatment) or another psychosocial intervention. Results indicated that treatments were reliably more effective than no treatment on self-rated and clinician-rated measures of depression. Effect sizes for studies involving participants with major depression disorder were also reliably different from zero, as were effect sizes from studies involving participants with less severe levels of depression. These findings compare favorably with several other quantitative reviews of treatments for depression. Results suggest more balanced presentations of the potential benefits of psychosocial interventions are warranted.
Behavioral treatment of depression in dementia patients: A controlled clinical trial
Teri, L. (1997). Journals of Gerontology Series B-Psychological Sciences & Social Sciences, 52B(4), 159-166.
The current study is a controlled clinical investigation of 2 nonpharmacological treatments of depression in patients with Alzheimer's disease (AD). Two active behavioral treatments, one emphasizing patient pleasant events and one emphasizing caregiver problem solving, were compared to an equal-duration typical care condition and a wait list control. 72 patient-caregiver dyads were randomly assigned to 1 of 4 conditions and assessed pre- and post-treatment, and at 6-mo follow-up. Patients in both behavioral treatment conditions showed significant improvement in depression symptoms and diagnosis as compared with the 2 other conditions. These gains were maintained at follow-up. Caregivers in each behavioral condition also showed significant improvement in their own depressive symptoms, while caregivers in the 2 other conditions did not. Results indicate the importance and effectiveness of behavioral interventions for treatment of depression in AD patients and their caregivers.
Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression.
Thompson, L., Coon, D.W., Gallagher-Thompson, D., Sommer, B.R., & Koin, D. (2001). American Journal of Geriatric Psychiatry, 9(3) 225-240.
This study evaluated the efficacy of desipramine alone vs. cognitive/behavioral therapy alone (CBT) vs. a combination of the two, for the treatment of depression in older adult outpatients. 102 patients (mean age 66.8 yrs) meeting criteria for major depressive disorder were randomly assigned to one of the three treatments for 16-20 therapy sessions. All treatments resulted in substantial improvement. In general, the CBT only and combined groups had similar levels of improvement. In most analyses, the combined group showed greater improvement than the desipramine alone group, whereas the CBT alone group showed only marginally better improvement. The combined therapies were most effective in patients who were more severely depressed, particularly when desipramine was at or above recommended stable dosage levels.
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Books
Assessing and treating late-life depression: A casebook and resource guide
Karel, M.J., Ogland-Hand, S., Gatz, M., & Unuetzer, J. (2002). New York: Basic Books, Inc.
This practice-oriented, research-based casebook draws on extensive clinical and academic data on late-life depression and its treatment as a resource for practitioners and researchers. The authors--a practicing psychologist and two clinical geropsychologists among them--provide an interdisciplinary framework for understanding and treating late-life depressive symptoms. The authors elucidate the problems and principles of late-life depression with fourteen extended case studies. Explicating the range of syndromes and strategies for assessing and treating them, they conclude with a guide to medications, screening tools, innovative models, and supplementary resources.
Suicide and depression in late life: Critical issues in treatment, research, and public policy
Kennedy, Gary J. (Ed). (1996). New York: John Wiley & Sons.
The authors explore the biology, psychology, epidemiology, and sociology of depression and suicidal behavior in late life as well as ethical principles that underlie clinical research and therapeutic intervention. The range of treatment including environmental manipulations, psychotherapy, family counseling, medications, and ECT is reviewed, and guidelines for effective interventions are provided. The limits of existing scientific data and social policy are detailed. Readers will gain a better understanding of the dilemma presented by the older adult's thoughts of death in relation both to mental illness and rational expectations for the end of the life span.
Elder suicide: Research, theory and treatment
McIntosh, J.L., Santos, J.F., Hubbard, R.W., & Overholser, J.C. (1994). Washington, DC: American Psychological Association.
This volume synthesizes research findings, identifies gaps in our knowledge, and explores current controversies related to elder suicide. Thoughtful theoretical discussions examine sociological, psychological, biological, and other theories of suicide. While emphasizing the cognitive-behavioral orientation, the book provides an overview of clinical approaches to depressed and suicidal elders, identifying aspects unique to elder suicide, exploring assessment and intervention modalities, and specifying warning signs. Varied case histories illustrate the many complicated aspects of elder suicide. The book also explores sensitive ethical and philosophical issues raised by elder suicide, including the current debate over assisted suicide.
Suicide in later life: Recognizing the warning signs
Osgood, N. J. (1992). New York: Lexington Books/Macmillan, Inc.
This book portrays the problem of later-life suicide. Suicide statistics are provided to outline the dimensions of the problem and highlight past and future trends. Case studies are provided to dramatize the plight of the vulnerable elderly and to show how suicidal elders feel. The primary intention of this book is to provoke thought about attitudes and beliefs about aging and old people and to examine societal attitudes and public policy toward the elderly.
Physical illness and depression in older adults: A handbook of theory, research, and practice.
Williamson, G.M., Shaffer, D.R., & Parmelee, P.A. (2002). New York: Kluwer Academic/ Plenum Publishers.
This handbook consists of 3 major sections. The first considers risk factors for the development of depression in older adults. The second section graphically illustrates the need for complex models when studying associations between physical illness and depression. The third section considers critical diagnostic and treatment issues.
Openness to experience and completed suicide across the second half of life
Duberstein, P. R. (1996). In J.L. Pearson, & Y. Conwell, (Eds.), Suicide and aging: International perspectives (pp. 49-64). New York: Springer Publishing Co.
This chapter offers the testable hypotheses that persons low in OTE [openness to experience] are at risk for taking their own lives because their affective dampening, cognitive certainty, diminished behavioral repertoire, and rigidly defined self-concept have decreased their capacity to adapt to the expectable age-associated changes in role, health, and function that accumulate over time. Concrete thinking and excessive focus on proximal, low-level goals place them at risk for descending into states of suicidal meaninglessness in times of stress or crisis. This state of awareness increases the desirability of suicide as an action-oriented solution to the stressors of aging. Other lines of investigation are suggested including research on OTE in attempted suicide, OTE and the neurobiology of suicidal behavior, OTE and gender differences in suicidal behavior; and clinical intervention designed to increase the degree to which one is open to experience.
Suicide among ethnic elders
Baker, F.M. (1996). In G.J. Kennedy (Ed.), Suicide and depression in late life: Critical issues in treatment, research, and public policy. Publication series of the Department of Psychiatry, Albert Einstein College of Medicine of Yeshiva University, No. 13. (pp. 51-79). New York: John Wiley & Sons.
Statistics on suicide are presented for each group of ethnic elders [African Americans, American Indians and Alaskan Natives, Asian Americans and Pacific Islanders, Hispanic Americans]. The chapter then discusses the attitude toward the completion of suicide by each group of ethnic elders and concludes with a summary of the known information and the areas where further investigation is indicated.
Mood disorders in older adults
King, D.A., & Markus, H.E., (2000). In S.K. Whitbourne (Ed.), Psychopathology in later adulthood. Wiley series on adulthood and aging (pp. 141-172). New York: John Wiley & Sons.
Discusses mood disorders in older adults, focusing on depressive disorders, as these are the most prevalent and concerning disorders found in older adults. Although other disorders are addressed, this chapter emphasizes the etiology, diagnosis, and treatment of unipolar major depression in older persons. A case study of a 76-yr-old woman with major depression is used throughout the chapter to highlight key factors and symptoms that facilitate a differential diagnosis of her mood disorder. Other topics discussed include epidemiology and theories of depression. The chapter also reviews various biological, psychological, and social systems approaches to treatment.
Suicide in old age: Causes, clues, and concerns.
Lesnoff-Caravaglia. (1987). Handbook of applied gerontology (pp. 259-296). New York: Human Sciences Press, Inc.
The taking of one's own life is no longer an uncommon human phenomenon with approximately 10,000 persons over the age of sixty-five take their lives each year. Increased alcohol consumption causes, clues and concerns regarding this topic are described including differences between young and old suicides along with prevention.
Alcoholism, drug abuse, and suicide in the elderly
Murphy, G.E. (2002). Treating alcohol and drug abuse in the elderly (pp. 72-82). New York: Springer Publishing Co.
Discusses the contributions of alcoholism, drug abuse, and depression to suicide in the elderly. Case events are presented that help to understand the suicidal decision in aging substance abusers, but the importance of estimating suicide risk is highlighted. Seven attitudinal risk factors for suicide in substance abusers are presented, followed by discussion of preventing suicide. In addition, the importance of diagnosing and treating major depression in elderly alcoholics and substance abusers is noted.
Suicidal behavior in later life: Research update
Pearson, J.L., Maris, R.W., & Canetto, S.S., (2000). Review of suicidology (pp. 202-225). New York: The Guilford Press.
Reviews the available research evidence on risk factors and correlates in later-life suicidal behavior, and suggests opportunities for research. Information is presented from studies on completed suicide, attempted suicide, suicidal ideation, and indirect life-threatening behaviors. The identification and adequate treatment of depression is proposed as the most promising research avenue when preventive interventions in later-life suicide are considered.
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The Surgeon General's Report on Mental Health (1999)
Department of Health and Human Services. U.S. Public Health Service. Washington DC.
http://www.mentalhealth.org/features/surgeongeneralreport/chapter5/sec1.asp
Chapter 5, Older Adults and Mental Health, first reviews the normal developmental milestones of aging, highlighting the adaptive capacities that enable many older people to change, cope with loss, and pursue productive and fulfilling activities. The chapter then considers mental disorders in older people, including their diagnosis and treatment, and the various risk factors that may complicate the course or outcome of treatment. Gains that have been realized in making appropriate mental health services available to older people and the challenges associated with the delivery of services to this population are discussed. The chapter concludes with a review of the supports available for older persons that extent beyond traditional, formal treatment settings.
Older Adults and Mental Health: Issues and Opportunities (2001)
Department of Health and Human Services. Administration on Aging, Washington DC.
http://www.aoa.dhhs.gov/mh/report2001/default.htm
This report focuses on community-based services that can be utilized by a wide range of elders, including older persons in good mental health, for whom outreach and education might be helpful; older persons who are experiencing acute stress or crisis and those with severe mental disorders. While substance misuse and abuse are closely intertwined with mental health and merit full discussion, the primary focus of this report is on mental health and aging and the services and systems are designated to deal with these areas of concern.
The Surgeon General's Call To Action To Prevent Suicide (1999)
U.S. Public Health Service, Washington, DC.
http://www.surgeongeneral.gov/library/calltoaction/calltoaction.htm
This report outlines more than a dozen steps that can be taken by individuals, communities, organizations, and policymakers to prevent suicide.
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http://www.aoa.dhhs.gov/naic/Notes/mentalhealth.html
This Administration on Aging web page contains useful information and links to different sites on aging and mental health issues.
http://www.nia.nih.gov/health/agepages/depresti.htm
The National Institute on Aging website has Age Pages on various topics. "Depression: A Serious but Treatable Illness" discusses its causes, symptoms, treatment and helpful resources.
http://iml.umkc.edu/casww/depressn.htm
This website addresses important points on differentiating depression from the normal aging process and grief or dementia. It also describes illnesses that could be mistaken for depression.
http://www.mentalhealth.org/suicideprevention/elderly.asp
Links to the National Strategy for Suicide Prevention that contains helpful links and important statistics on the issues of suicide and aging.
www.suicidology.org/older_men_and_women.htm
This website has a fact sheet, "The Suicide of Older Men and Women" that describes what to look for if you suspect a loved one is contemplating suicide.
http://www.americangeriatrics.org/education/forum/depression.shtml
Contains a list of important Questions & Answers about the topic of depression and elders.
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