Policy paper

Older adults are faced with a unique transition in their later years of life. Many are at a higher risk of depression, isolation and worsening physical conditions from lack of self-care. Such risks can cause this population to be withdrawn from their society and isolate in their own homes. Isolation and lack of mental wellness can help increase the aging process by which older adults can deteriorate more rapidly. This, in turn, can place a burden on the health care systems as well as communities and the individuals themselves.

The use of therapeutic interventions can stretch beyond the scope of traditional psychotherapy. What we can see from previous research is that recreation and art yield positive outcomes for community dwelling older adults. Recreation can be used to help bolster creativity, socialization and sense of purpose for older adults. By doing so, the senior population can thrive within their communities, increase their physical health and avoid concurrent hospitalizations.

Given the data available, I propose that policy and lawmakers take into consideration the benefits of psycho-social day groups for older adults. By enacting such programming into communities, we can help decrease the financial and societal cost of care for the homebound and disabled senior population. Such programs will employ professional social workers and craft specialists alike to facilitate programs for older adults. Additionally, program members may volunteer to run their own programs in their areas of expertise. Facilities such as senior centers or community centers may host such programs, at no additional cost to the funding agencies that may provide such service.

I hope to see that further research is also funded to understand the efficacy and outcomes of the programs developed. Additionally, future research may help to identify areas for improvement and expansion. Ultimately the goal is to break isolation and re-acclimate seniors back into their communities in a positive and dignified way. Many efforts to reduce “the senior burden” have been founded on good intentions but not followed through to the end. Policy should stand to defend seniors’ rights and ensure their wellness is made a priority.

The transition of aging is unlike that of any other stage of human development. In many cases people retire, their children leave home, family and peers pass away and physical ailments become abundant. In America alone, out of 35 million people aged 65 and up, 6.5 million suffer from depression or other mental health ailments (NAMI, 2019). It is important to note that depression in older adults tends to surround specific circumstantial triggers as named above (NAMI, 2019). Social workers play a large role in helping older adults to go through this transition of aging with ease. Part of our work is to understand what their needs are and develop a plan for wellness so that they may live out their later stages in life in harmony. Surrounding such a transition, older adults are at a higher risk of depression, isolation and worsening physical conditions from lack of self-care (Chin-Teng et al., 2019). In turn, the instances of hospitalization, institutionalized care and morbidity have increased with the growing elderly population. The burden placed on society to nurture this population of mentally ill older adults comes at a high price (Phinney et al., 2014). Our ultimate goal is to help reduce the occurrence of such outcomes and enable the overall wellness of older adults.

Many interventions to increase the physical, mental and social lives of older adults have been measured. The desire to feel purpose and being a part of something bigger than themselves is the driving factor that can affect overall wellness if left unfulfilled. When therapies and interventions address this need, better outcomes can be yielded for this population (Faber, 2003). The use of traditional psychotherapy models such as Psychoanalysis, Cognitive Behavioral Therapy and Motivational Interviewing have undisputed benefits in helping patients of all ages to overcome mental illness. However, these interventions do not capture the need for social involvement and fulfillment of purpose. More recent research indicates that older adults also benefit from “purpose-driven” interventions surrounding arts and creativity (Hackney et al., 2015). By this, they can exercise other muscles in their brain and body that may reduce their risk for illness.

What we do not know, however, is how such therapies compare to one another. Research shows that recreational art therapies (such as visual art, performance art, etc.) have beneficial characteristics in improving the lives of mentally ill older adults. Moreover, how are the functions of these therapies being carried out and to what level of efficacy? Further research is needed to understand the effectiveness of such interventions in conjunction with the more traditional therapies. While recreational therapies alone may help improve the wellness of community dwelling and institutionalized older adults alike, it is uncertain to what extent this effectiveness has been measured. Very few – if any at all – studies have researched these interventions over time. To add, even less research has been conducted to compare both recreational and traditional therapies. If both therapies, utilized in conjunction with one another can help to decrease hospitalization and institutionalized care for mentally ill older adults, then we can support the need for implantation of such interventions in our agencies that serve this population.

While working with older adults, there are different variables that must be considered when examining treatment to sustain mental wellness. Such variables that are unique to the elderly population include the phenomena of isolation, physical disabilities and loss of purpose. As a result of these factors, the efficacy of different therapeutic interventions has been the focal point of research for the aging community. Previous studies have concluded that due to the nature of elderly-specific phenomena, short-term therapies such as Cognitive Behavioral (CBT) and Reminiscence are more effective at improving mental wellness (Duberstein, Lyness & Pinquart, 2007). Such interventions help address the common short-term problems that the older population is faced with – as opposed to therapies used for persons with ongoing mental illnesses (Duberstein et al., 2007). However, what our current research is lacking is the exploration of alternative therapies, those which may not involve a clinical outlook.

In a study conducted in 2002, researchers attempted to look at the benefits of physical activity on the reduction of depressive symptoms in older adults (Deleger, Kaplan, Roberts & Strawbridge, 2002). The authors found that while remaining physically active is a protective factor against depression, further studies might include disabled subjects as well (Deleger et al., 2002). When studying the elderly population, it is important to be inclusive of those suffering from physical disabilities as they make up a larger percentage than any other age group. Other interventions such as visual or musical art therapy may help to include those with such physical limitations. A later study conducted in 2019, observed the efficacy of art therapies on nursing home patients (Ching-Teng, Ya-Ping & Yu-Chia, 2019). The authors concluded that such therapies proved beneficial for this population in sustaining positive mental hygiene (Ching-Teng et al., 2019). This research yielded positive results for use of art therapy in institutionalized settings. However, further policies surrounding allocations of funds often stifle a programs potential for implementing evidence-based practices.

Having such recreational programs available in the community may help to reduce stress for not only the senior population, but the community as a whole. Art programs do not come at as much of a cost as medical programs and can be conducted by volunteers, peers and students alike. Moreover, art recreation may help reduce the occurrence of visits to the doctor or hospital, by simply reducing stress in the older adult’s life. It would also be of interest to study the rate of which such programs would be utilized over other mental health models.

Conclusions and Recommendations

There are a few recommendations to consider while enacting such a policy change to help bolster the mental wellness of the senior community dwellers. Changes in policy surrounding community narratives will begin to mold the shape for better social programming for this population. Much of this change relies on the advocacy of professional social workers to be placed in such programs. By doing so, the needs of such a community can be better understood and targeted for change and development.

To start, we can take a look into the functions of already existing recreational programs servicing the senior populations. Many common programs offer activities such as art, exercise and congregate meals. To make such programming more fruitful to the well-being of older adults’ mental wellness, we propose a more “clubhouse” approach to center gatherings. Workshops and support groups may be provided in addition to recreational activities. When providing funding for such programs, it may be beneficial to consider volunteer peers from within to help run programming. This sort of creative planning would help to make any development in programming more affordable to the center of operations. Agency and community budgeting might take these factors into consideration as a necessity for the betterment of older adults in the community.

In addition, the narrative of other community dwellers and stakeholders alike must evolve to consider the importance of mental wealth in older adults. Senior centers should not merely act as a lunchroom, not the local loitering hot spot. Staffing of skilled and trained social workers may help to better identify the needs of the community and develop programming around those needs. Having such staff on hand will give the program better momentum and professionalism while addressing the needs of the mentally ill. Moreover, trained professionals can better help to advocate for the needs of older adults and the community programs in which they attend.

The development of a psycho-social day program creates accessibility for seniors in their local area without placing stigma on those who may suffer from mental illness. While such programs as case management tend to function well in senior communities,

Additional research is also needed to expand knowledge of the outcomes and efficacy. Such research can be used to understand if seniors are taking advantage of programming in their communities. Ultimately the goal is to break isolation and re-acclimate seniors back into their communities in a positive and dignified way. Many efforts to reduce “the senior burden” have been founded on good intentions but not followed through to the end. Policy should stand to defend seniors’ rights and ensure their wellness is made a priority.

References

Ching-Teng, Y., Ya-Ping, Y., & Yu-Chia, C. (2019). Positive effects of art therapy on depression and self-esteem of older adults in nursing homes. Social Work in Health Care, 58(3), 324–338.

Deleger, S., Kaplan, G., Roberts, R., & Strawbridge, W. (2002). Physical Activity Reduces the Risk of Subsequent Depression for Older Adults. American Journal of Epidemiology, 156(4), 328-334.

Duberstein, P. R., Lyness, J., & Pinquart, M. (2007). Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: A meta-analysis. Aging & Mental Health, 11(6), 645–657.

Faber, A. J. (2003). Therapy with the Elderly: A Collaborative Approach. Journal of Family Psychotherapy, 14(4), 1–14.

Hackney, M. E., Byers, C., Butler, G., Sweeney, M., Rossbach, L., & Bozzorg, A. (2015). Adapted Tango Improves Mobility, Motor-Cognitive Function, and Gait but Not Cognition in Older Adults in Independent Living. Journal of the American Geriatrics Society, 63(10), 2105–2113.

National Alliance on Mental Illness (2019). Depression in Older Persons. Retrieved from https://www.ncoa.org

Phinney, A., Moody, E. M., & Small, J. A. (2014). The Effect of a Community-Engaged Arts Program on Older Adults’ Well-being. Canadian Journal on Aging, 33(3), 336–345.