Psychologists are at the forefront of research on questions related to health and aging. Why are most older adults successful in adapting to the stressors of late life, while others become suicidal? Why do most older adults remain mentally sharp, while others have memory problems? Research on the aging brain provides clues to the risks and protective factors for mental disorders across the life span.
Given the often-complex mental and physical health problems of older adults, health care providers and families often turn to psychologists because of their skills in psychological and neuropsychological assessment. Psychologists are also the leading scientists responsible for the development of diagnostic tools. Psychologists have the necessary expertise to assess and differentiate between disorders such as dementia, depression, anxiety, delirium, adjustment reactions, side effects from medications, or combinations of these problems. The legal profession looks to psychologists to help determine whether older adults have the capacity to manage their own affairs.
As with younger adults, a variety of mental health disorders, such as anxiety and depression, affect older adults. Stressors common in late life significantly affect the health and independence of older adults. Life stressors include adapting to and coping with late-life transitions, grief, poverty, multiple medical conditions, functional limitations, cognitive changes, chronic pain, and care for an infirm family member.
Psychologists use psychological interventions, including various psychotherapies, to help older adults deal with mental health disorders and late-life stressors. The most common psychological interventions include cognitive–behavioral, interpersonal, and psychodynamic psychotherapy; behavior modification and disease management strategies; cognitive training techniques; and environmental modification. Alone or in combination with psychiatric medications, psychological interventions have been shown to be effective in the treatment of many mental health disorders. The availability of nonpharmacological treatments for mental health problems is especially important for older adults. This is because they are often on multiple medications for physical health problems, are more prone to certain adverse side effects of psychiatric medications than younger individuals, and, as noted, often prefer psychotherapy to psychiatric medications.
Psychologists conduct research on and provide treament for a wide range of mental health disorders and life problems that affect older adults including the following.
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Adjustment to the stressors of late life. Psychologists work with older patients to deal with the many life stressors that accompany aging, such as decline in health, loss of loved ones, and relocation to a new living situation.
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Anxiety disorders. Psychologists use psychotherapy and supportive counseling to treat anxiety disorders in older adults, the frequency of which is comparable to that of depression in older people. Anxiety-related disorders include generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and obsessive–compulsive disorder.
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Capacity assessment. Families, health care providers, attorneys, and judges concerned about an older person's capacity to make medical or legal decisions call upon psychologists. Psychologists have been leaders in the development of the instruments that assess specific capacities in older adults.
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Caregiving. Family caregivers provide care to most of the 10 million older adults in the United States who have a disabling condition. Although the role of caregiving can be rewarding, it can also be quite stressful and taxing. Caregivers may suffer from depression, anxiety, substance abuse, anger, and stress-related health problems, including cardiovascular disease. Psychologists help family members to better deal with the practical and emotional demands of caring for a physically or cognitively impaired older relative.
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Dementia. Psychologists help individuals who are in early stages of dementia build coping strategies and reduce distress through psychotherapy and psychoeducational support groups. Memory training strategies help to optimize remaining cognitive abilities. Psychologists also teach behavioral and environmental strategies to caregivers of those with dementia to deal with common behaviors such as aggression and wandering. Unlike sedating medications, these strategies do not lead to additional confusion or impairment of mental functioning. In addition, as individuals with dementia often also suffer from depression, paranoia, and anxiety, the psychologists' skills in differential diagnosis and treatment are helpful in these complex cases.
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Depression. Depression in older adults is a very treatable disorder. However, symptoms of depression in older adults are often overlooked because they are inaccurately assumed to be a normal part of aging or may coincide with medical illnesses or life events that commonly occur as people age. Psychologists successfully identify and treat both major depressive disorder and subclinical forms of depression with psychotherapy.
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End-of-life care. Psychologists assist older adults and their families with advanced care planning. They counsel terminally ill patients and their families on how to manage feelings, decrease distress, and manage pain, and after the death, grief. As depression and anxiety are often associated with a terminal diagnosis and the progression of a disease, psychologists assess and treat these mental health conditions to minimize suffering and distress. Psychologists also train physicians to recognize and ameliorate patient and caregiver psychological distress.
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Health promotion. As experts in human behavior, psychologists have been at the forefront in developing effective health promotion programs and strategies to enhance healthy behaviors. Two examples of health promotion efforts that have proven beneficial for older adults include memory-training programs that enhance memory performance and physical activity programs that elevate mood, relieve symptoms of depression, and contribute to the effective management of hypertension and diabetes.
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Incontinence. Psychologists use behavioral training methods, such as biofeedback, bladder training, goal setting, and self-monitoring, to reduce incontinence. These treatments have proven to be more effective than drug therapy. Incontinence has significant implications for the independence of older adults. It is the second most common reason why families admit an elder relative to a nursing home, which in itself is associated with depression in older adults.
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Insomnia. Insomnia is prevalent among older adults, especially medically ill elders. Older adults are especially vulnerable to the adverse effects of sleep medications, including memory impairment and impaired daytime performance. Psychologists have developed effective nonpharmacologic treatments for insomnia, including cognitive–behavioral techniques, sleep restriction and stimulus control, and sleep hygiene instruction.
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Long-term care. There is a very high prevalence of mental health disorders in long-term care institutions, such as nursing homes. Psychologists' presence in these settings has greatly increased in the past decade. Psychologists work with facility staff to more effectively manage resident behavioral problems, such as aggression and wandering, and to improve quality of life for both staff and residents. Psychologists work with individuals and with groups of residents to help them better adjust to life in long-term care, medical problems, depression, anxiety, and the loss of cognitive abilities.
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Management of chronic diseases. Psychologists help older adults manage multiple chronic medical conditions that often accompany aging, such as heart disease, stroke, and arthritis. A major goal of such management is to prevent excess disability and hospitalization through treatment adherence and behavioral interventions, including physical activity, biofeedback, nutrition, and stress reduction techniques.
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Substance abuse. Alcohol abuse is a significant problem for some older adults and is one the eight leading causes of death among older Americans. Psychologists can help older adults boost their motivation to stop drinking, identify circumstances that trigger drinking, and learn new methods to cope with high-risk drinking situations. Some older adults have problems with addiction to prescription medication for anxiety and need help in reducing or stopping medication. In addition, as the baby boomer cohort enters old age, the prevalence of both alcohol and illicit drug use will likely increase.
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Suicide. Older adults, particularly White men, have the highest rates of suicide in the United States. Depression is suicide's foremost risk factor. Psychologists are skilled at identifying depression and assessing for suicide risk. Those at risk for suicide are often not identified by primary health care providers. It has been reported that two-fifths of older adults who commit suicide visited a physician within the past week and three-quarters within the past month. Primary care providers often overlook the potential link between physical symptoms and mental health problems.
