Module 5
Aging and Mental Health Issues
a. Psychological Disorders in Adulthood
The criteria used to judge behavior as ‘‘abnormal’’ include feeling personal or
subjective distress, being impaired in everyday life, causing a risk to the self or other
people, and engaging in behavior that is socially or culturally unacceptable (Halgin &
Whitbourne, 2008). The category of psychological disorders includes the range of
behaviors and experiences that fall outside of social norms, create adaptational
difficulty for the individual on a daily basis, and put the individual or others at risk of
harm. People who have a hobby of collecting coins would not be considered
abnormal, for example, because they are engaging in a behavior that does not hurt
them or others and is culturally acceptable. By contrast, consider people known as
‘‘hoarders’’ who collect old newspapers, magazines, and cereal boxes until their
homes are virtually unlivable because they are so squalid and overcrowded. These
individuals might very well be considered to have a psychological disorder because
they are not only engaging in behavior that is outside the norm but also may be
putting themselves at risk for fire and other harm due to the dirt and debris that have
accumulated in their home.
Specific sets of behaviors that meet the conditions of abnormality are given a
diagnosis according to the criteria set forth in the psychiatric manual known as the
Diagnostic and Statistical Manual, the most recent version of which is the Fourth
EditionText Revision known as the DSM-IV-TR (American Psychiatric Association,
2000). Unfortunately, for our purposes, the DSM-IV-TR was not developed with
consideration of how the diagnostic categories for psychological disorders might
change over the adult years. Given some of the distinctive characteristics of these
disorders in later life, this creates problems in applying diagnoses to older adults.
However, there is no alternative to this system, and therefore we must use it here to
provide the framework. The fifth edition is expected for publication in May 2013, and
gerontologists hope that it will better address issues of diagnosis for use with older
adults.
The DSM-IV-TR is organized into five axes or dimensions that are intended to
characterize completely an individual seeking psychological help. Axis I includes all
the major clinical syndromes: collections of symptoms that together form a
recognizable pattern of disturbance comparable to an illness in medical terms. The
major syndrome categories include mood disorders, dementia, anxiety disorders,
substancerelated disorders, schizophrenia, sexual disorders, eating disorders, sleep
disorders, and disorders of childhood and adolescence. Axis II includes disturbances
that are of a more chronic or long-standing nature, what are known as personality
disorders. One way to think of personality disorders is that they are exaggerations of
personality traits found in everyone that, for some people, create significant problems
in daily life. Mental retardation and disorders in the individual’s ability to carry out
the tasks of daily living are also included on Axis II.
The ratings on Axis III are used to characterize medical conditions that,
although not a primary focus of treatment, have a bearing on the client’s
psychological condition. These are particularly important in diagnosing psychological
disorders in older adults, for whom medical conditions may present a particular
challenge. You have already learned in previous that certain medical diagnoses are
associated with anxiety or depressive symptoms. For older adults in particular, ratings
on Axis III provide valuable diagnostic information. Axis IV is used to rate
psychosocial stressors and environmental problems. Again, these can be important
influences on a middle-aged or older adult’s psychiatric diagnosis, particularly for
people with low incomes, those who live alone, or and bereaved individuals suffering
from recent losses. Axis V is used to characterize the individual’s overall level of
functioning, ranging from suicidal (ratings of 1–20) to superior (91–100). By rating a
person on Axis V, it is possible for the mental health worker to get a sense of how well
the individual is coping, and gain information that can be useful in planning
interventions.
As stated in the previous section, Axis I is used to provide a diagnosis of
which major disorder or disorders whose symptoms are shown by the individual
seeking treatment. These conditions may persist for many years, and even if the
symptoms dissipate over time, the individual may be on more or less constant alert for
a renewed outbreak. Fortunately, a minority of adults experience these disorders, but
those who do face struggles in their family relationships, work lives, and ability to
live independently in the community. Each Axis I diagnosis includes a set of specific
criteria that must be met in order for the diagnosis to be correctly applied. Here we list
their major features in abbreviated fashion, but in a real-world setting, whoever is
providing the diagnosis must go carefully through each of the criteria to ensure that
the individual actually should receive the diagnosis. In general, these criteria involve a
fairly high degree of severity and persistence of symptoms over a period of time
usually no less than two weeks. In other words, just because a person may seem to be
depressed or anxious does not mean that the person should be diagnosed with the
disorder on the spot.
Abnormalities in the individual’s experience of emotion are known as mood
disorders. There are essentially two categories of mood disorders. The first includes
depressive disorders, characterized by periods of dysphoria (sad mood) lasting
varying amounts of time and involving varying degrees of severity. In major
depressive disorder, the major symptom is an extremely sad mood (lasting at least 2
weeks). Other symptoms include appetite and sleep disturbances, feelings of guilt, and
a low sense of self-worth. The second category of mood disorders includes bipolar
disorder(formerly known as manic depression). People with bipolar disorder
experience what is known as a manic episode, a period typically lasting at least 1
week, in which they feel unusually ‘‘high,’’ meaning that they are elated, grandiose,
expansive, and highly energetic.
Over the course of adulthood, about 18% of adults are estimated to meet the
diagnostic criteria for major depressive disorder. This represents the ifetime
prevalence, meaning that it includes anyone who has ever received this diagnosis. At
any given time, however, about 1 to 5% of adults in the United States have major
depression or its milder and more chronic form, known as dysthymia. The rates of
major depressive disorder and dysthymia in women are about double the rates for men
(Kessler et al., 2005). Contrary to what you might think about older people and
depression, people over 65 are actually less likely to experience a depressive disorder
than are people under the age of 65.
Though the prevalence of a diagnosable mood disorder is lower in older than
in younger adults, many older adults report symptoms of depressive disorders. As
many as 15 to 30% of older adults living in the community experience depressive
symptoms with higher rates among those seen in medical settings such as inpatient
hospitals or clinics (Whitbourne & Meeks, 2010). Moreover, although women are
more likely to experience the diagnosable condition of major depressive disorder,
depressive symptoms are higher in men between the ages of 60 and 80. By that point,
the rates of depressive symptoms in men and women are roughly equal.
However, there are age differences in the symptoms of depression, and what
appears as a depressive symptom for a younger adult may not appear as one in an
older adult. The traditionally recognized ‘‘psychological’’ symptoms of depression
such as dysphoria, guilt, low self-esteem, and suicidal thoughts are less likely to be
acknowledged by older adults. Rather than seeking treatment for these psychological
symptoms, older people are more likely to seek treatment for physical symptoms such
as pain and abdominal disturbances.
Health care professionals are not well trained in recognizing the signs of
depression in their older clients (Charney et al., 2003). In part this is because older
adults do not necessarily report their symptoms in a manner that allows for accurate
diagnosis. In addition, health care providers are not attuned to diagnosing
psychological disorders in their older clients. Complicating the situation further,
physicians spend less time per visit with an older patient than they do a younger
patient.
Many insurance companies reimburse for mental health diagnosis and
intervention at a lower rate than for physical disorders, adding to the likelihood that
an older adult will not seek treatment for psychologically-based symptoms. The
situation has improved for Medicare recipients with recent changes in Medicare
reimbursement. In 2008, the U.S. Congress approved a revision to Medicare
providing parity for mental health treatment meaning that the insured pay the same
out-of-pocket expense that they would for medical care (Medicare Improvement for
Patients and Providers Act, H.R. 6331). Other deterrents to appropriate diagnosis of
depressive disorders in older adults relate to attitudes toward depression among
mental health professionals. Some may assume that depression is a natural
consequence of aging and therefore pay less attention to its symptoms. Alternatively, a
psychologist or physician may wish to avoid stigmatizing older clients by diagnosing
them with a psychological disorder (Duberstein & Conwell, 2000). Misdiagnosis may
also occur because the symptoms of mood disorders occur in conjunction with a
medical condition, leading to the physician’s failure to detect the mood disorder or to
misattribute the symptoms to a physical cause (Delano-Wood & Abeles, 2005).
Careful diagnosis with attention to possible underlying medical conditions or
dementia is therefore vital.
When trying to determine the cause of an older adult’s depression, it is
important for health care workers to look for possible psychosocial factors other than
those that are more affective in nature. These additional factor include functional
limitations (Okura et al., 2010), sensory impairments, the inability to provide basic
self-care tasks (Yong, 2006), and pain. Institutionalization presents another risk factor,
as do changes in cognition and personality, particularly among the oldest-old
(Margrett et al., 2010). Psychosocial issues such as bereavement, loneliness, and
stressful life events can also serve as risk factors for depressive disorders in both
middle.
Not only do physical conditions increase the risk of major depressive disorder,
but older adults become more likely to suffer further impairments in physical and
cognitive functioning when their psychological symptoms are untreated. Depressive
symptoms predict mortality in older adults (St John & Montgomery, 2009), perhaps
through the immune system. Depression may activate cytokines that eventually
increase the risk of cardiovascular disease, osteoporosis, arthritis, Type 2 diabetes,
cancers, periodontal disease, frailty, and functional decline (Kiecolt-Glaser & Glaser,
2002). Researchers know considerably less about bipolar disorder in later adulthood
than they do about major depressive disorder. Rates of bipolar disorder are lower in
older adults (0.1%) than in the younger population (1.4%) (Depp & Jeste, 2004).
There may be neurological contributions as suggested by the fact that bipolar disorder
in older adults is related to a higher risk for cerebrovascular disease (Subramaniam,
Dennis, & Byrne, 2007) and white matter hyperintensities. Bipolar disorder exacts a
high psychosocial cost on those who have experienced its symptoms throughout their
lives. For example, older adults with a lifetime history of ‘‘rapid cycling,’’ in which
their symptoms alternate frequently between depression and mania, feel that their life
goals were significantly interfered with if not entirely derailed.
Excessive anxiety is the major symptom of anxiety disorders; anxiety in
relation to these disorders is defined as a state in which an individual is more tense,
apprehensive, and uneasy about the future than would be warranted by the person’s
objective circumstances. As an example, if you lived in a neighborhood with a high
rate of crime, worrying about someone breaking into your house would not be
atypical. However, if you were living in a neighborhood with a low crime rate, an
excessive preoccupation with being victimized might signify that your anxiety is
symptomatic of a disorder. Approximately 12% of adults are diagnosed with an
anxiety disorder per year (Kessler et al., 2005). As is true with depressive disorders,
older adults are less likely (7%) than young adults (21%) and middleaged adults
(19%) to be diagnosed with an anxiety disorder. Older women are nearly 5 times more
likely than men to be diagnosed with an anxiety disorder.
It is possible that the lower diagnosis of anxiety disorders in general among
older adults reflects their greater resilience. It is also possible that, as with major
depressive disorder, health care professionals are not well-trained in recognizing and
diagnosing anxiety disorder symptoms in their older clients. Similar to mood
disorders, the symptoms of an anxiety disorder may present or coexist with medical
symptoms (Mehta et al., 2007), particularly for some forms of anxiety disorders
including post-traumatic stress disorder, panic attacks, and agoraphobia (which we
discuss below). As we also have seen, health practitioners may not be attuned to
diagnosing psychological symptoms in an older individual with physical health
problems. As a result, the practitioners may miss the diagnosis of an anxiety disorder
along with an opportunity for intervention. The implications of failing to diagnose
anxiety disorders can be serious, as the presence of anxiety symptoms has been linked
to mortality risk, particularly in African American older adults.
Anxiety disorders fall into six general categories. Generalized anxiety disorder
is associated with an overall sense of uneasiness and concern without specific focus.
People who experience this disorder are very prone to worrying, especially over
minor problems. They may also have additional symptoms such as feeling restless and
tense, having trouble concentrating, being irritable, and having difficulty sleeping.
About 2 to 5% of adults are reported to have symptoms of generalized anxiety
disorder over a 1-year period; medical patients have higher rates (8%) (Wittchen,
2002). Among older adults, the 6-month prevalence (those who reported symptoms in
the past 6 months) is 2%, and the lifetime prevalence is estimated to be 3.6%, with a
median age of onset of 31 (Kessler et al., 2005). However the prevalence rates are
higher among certain minority groups; older Latina/o immigrants to the United States
seem to be particularly at risk.
The form of anxiety disorder known as panic disorder involves the experience
of panic attacks in which people have the physical sensation that they are about to die
(e.g., shortness of breath, pounding heart, sweating palms, and so on). People who
suffer from panic disorder may have these episodes at unpredictable times. Eventually
they may also develop agoraphobia, the fear of being trapped or stranded during a
panic attack. Their fear of having a panic attack leads them to avoid places such as
elevators, shopping malls, or public transportation, where escape during an attack
would be difficult.
People with a specific phobia have an irrational fear of a particular object or
situation. This disorder is the most commonly observed form of anxiety disorder in
older adults. Among all adults, the lifetime prevalence rate is estimated at 12.5% and
among adults 60 and older the prevalence is also fairly high with estimates at 7.5%
(Kessler et al., 2005). People can fear almost any specific object or situation, but the
most common are fear of snakes, enclosed places, and seeing blood. Social phobia
involves anxiety in situations in which a person must perform some action in front of
others. The term is somewhat misleading in that it is not literally a fear of other
people but a fear of being publicly embarrassed or made to look foolish. In some
cases, the individual becomes anxious at the thought of eating in the presence of other
people. Severe symptoms of social phobia are present in about 12% of adults, with a
peak in prevalence rate among adults in their 30s. Women are more likely to suffer
from this disorder than are men (Kessler et al., 2005). Obsessive-compulsive disorder
is a form of anxiety disorder in which people suffer from obsessions, or repetitive
thoughts (such as the belief that one’s child will be harmed) and compulsions, which
are repetitive behaviors (such as handwashing). The obsessions and compulsions are
unrelenting, irrational, and distracting. There is also a condition on Axis II known as
obsessive-compulsive personality disorder, in which an individual has the personality
traits of being excessively rigid and perfectionistic. People with obsessive-compulsive
anxiety disorder have persistent feelings of anxiety that are partially relieved only by
performing compulsive rituals or thinking certain thoughts.
The psychological disorder known as schizophrenia is perhaps the one that
most mystifies students of psychopathology because its symptoms seem so puzzling
and extreme. A person with schizophrenia has a wide range of unusual symptoms,
including hallucinations (false perceptions) and delusions (false beliefs), both of
which are known as positive symptoms. However, many people with schizophrenia
also experience the so-called negative symptoms of apathy, withdrawal, and lack of
emotional expression. In addition to these symptoms, people with schizophrenia may
suffer from disturbances in speech and motor behavior. There are several types of
schizophrenia, but all share the common feature of involving a severe disturbance in
the person’s ability to remain in touch with reality.
Epidemiologists estimate that 1% of the population has schizophrenia at some
point in their lives, with higher rates for adults 30 to 44 (1.5%) than people older than
65 (0.2%) (Keith, Regier, & Rae, 1991). The 1-year prevalence is estimated at .5% in
the United States (Wu, Shi, Birnbaum, Hudson, & Kessler, 2006). In part the apparent
decrease in older age groups reflects the fact that people with this disorder do not
survive until old age. The nature of this disturbance and its association with other
illnesses and substance abuse mean that a person with schizophrenia experiences
feelings of isolation and an identity as being ‘‘different’’ (Quin, Clare, Ryan, &
Jackson, 2009). Perhaps as a consequence, older adults with schizophrenia have
higher suicide rates than older adults in the community without this diagnosis (Cohen,
Abdallah, & Diwan, 2010). On the positive side, older adults who have suffered from
schizophrenia for many years develop a wide range of coping skills (Solano &
Whitbourne, 2001). Those naturally developing mechanisms can be augmented with
clinical interventions that focus on methods to cope with everyday life problems.
The first systematic definition of schizophrenia as ‘‘premature dementia’’
(dementia praecox) was developed by the German psychiatrist Emil Kraepelin, and
for many years it was thought of as a permanently disabling condition. However, it is
now known that the long-term outcome of the disorder is highly variable.
Approximately 20 to 25% of people who develop the disorder improve to the point of
complete remission, and at the other end of the spectrum, 10% remain chronically
impaired. Among the remaining 50 to 70%, the disorder shows a varying course with
gradual improvements in social functioning and a reduction of psychotic symptoms
(Meeks, 2000). Some individuals can achieve very significant recovery after many
years of being chronically impaired, including being able to work, drive a car, and live
independently in their own homes.
For years, clinicians referred to a condition known as late-onset schizophrenia,
a form of the disorder that was thought to originate in adults over the age of 45 years
(Jeste et al., 1997). However, this condition is now thought not to be schizophrenia
but rather some other phenotype of psychotic disorder, the risk factors for which may
include sensory deficits, comorbid dementia and delirium, social isolation, and
substance abuse.
Disorders involving significant loss of cognitive functioning as the result of
neurological dysfunction or medical illness form the category in DSM-IV-TR known
as delirium, dementia, and amnestic disorders. In previous versions of the DSM these
disorders were referred to as ‘‘organic’’ or ‘‘cognitive’’, indicating that they have
different causes and characteristics than the other psychological disorders included in
the diagnostic system. Although you might hear these terms used, they were
considered too imprecise to be useful and were dropped from official parlance.
The term dementia is used to apply to a change in cognitive functioning that
occurs progressively over time. Its symptoms include loss of memory and of the
ability to use language (aphasia), to carry out coordinated bodily movements
(apraxia), to recognize familiar objects, and to make rational judgments. In contrast to
the long-term changes that occur in dementia, the condition known as delirium, is an
acute state in which the individual experiences a disturbance in consciousness and
attention, as well as memory loss, disorientation, and an inability to use language.
Delirium has many causes including substance use, intake of medications, head injury,
high fever, and vitamin deficiency. Most cases of delirium subside within days, but
the condition may persist as long as a month. Although relatively frequent in acute
care medical settings, occurring in up to nearly 40% of hospitalized older adults
(Boustani et al., 2010), the condition is uncommon within community-residing
populations. Therefore, when an older person shows signs of delirium, treatment
should be given right away (Andrew, Freter, & Rockwood, 2006). Unfortunately, the
individual with delirium may be misdiagnosed with dementia, and an opportunity for
intervention will have been lost or at least made more complicated.
In 2008, illicit drugs were used by an estimated 20.1 million persons 12 years
and older in the United States, representing 8% of the population (Substance Abuse
and Mental Health Services Administration, 2009b). The majority of adults who abuse
or are dependent on alcohol or illicit drugs are in their late teens and early 20s, but the
overall numbers and percents of older adults are on the rise with the aging of the Baby
Boom generation. As of 2008, an estimated 4.3 million adults aged 50 and older
(4.7%) had used an illicit drug within the past year. Older adults are particularly at
risk for abuse of prescription drugs, as 36% of the medications used in the United
States are taken by adults over the age of 65 years. Nonmedical use of prescription
drugs is the most common form of illicit drug abuse among people 65 and older with
an estimated prevalence of .8%.
Attention has only recently been drawn to the problems of older drinkers. In
part, this is because people who use alcohol to excess tend not to live past their 60s
and 70s. By the time they reach the age of 70, they have either become abstinent or
died from excessive alcohol use or from related high-risk behaviors such as smoking
(Vaillant, 2003). Nevertheless, a sizable number of older adults abuse substances with
estimates ranging from 2 to 5% of men and 1% of women (Abeles et al., 1997) and
another 1 to 2% of men and 0.3% of women over 65 who abuse alcohol (Grant et al.,
1995). In contrast to the under-65 population, prevalence rates of alcohol abuse are
higher for African Americans in the over-65 age group. Hispanic females over 65
have the lowest rates of alcohol abuse. Estimates are that, as is true for drug abuse, the
problem of older drinkers and substance abusers is likely to grow with the aging of
the current cohort of Baby Boomers.
The DSM-IV-TR diagnosis of antisocial personality disorder is characterized
by psychopathy, a set of traits that are thought to lie at the disorder’s very core. The
traits associated with psychopathy fall into two dimensions. Factor 1 is a cluster of
traits that represent disturbances in the capacity to experience emotions such as
empathy, guilt, and remorse. This cluster also includes manipulativeness,
egocentricity, and callousness. Factor 2 incorporates the unstable and impulsive
behaviors that contribute to the socially deviant lifestyle of the individual with this
disorder. Studies of the relationship between age and antisocial personality disorder
provide support for the notion that the maladaptive personality traits that constitute
the essence of this personality disorder are extremely stable over time (Harpur, Hart,
& Hare, 2002). One large-scale study of psychopathy, conducted on nearly 900 male
prisoners between the ages of 18 and 89, showed that there were no age differences on
Factor 1, which represents the ‘‘personality’’ contribution to the disorder. By contrast,
scores on the items that reflect socially deviant and impulsive behaviors decrease
dramatically across age groups. This characterization corresponds closely to data on
the numbers of prisoners by age reported by the U.S. Department of Justice. The rate
of imprisonment drastically decreases after the age of 45.
Changes over adulthood in the impulsive and antisocial element of
psychopathy may reflect a number of factors other than changes in the personality
disorder itself, however. Once again we return to an explanation involving survivor or
attrition effects. The apparent decrease in antisocial behavior may reflect the fact that
people who were high on Factor 2 (impulsivity) of psychopathy are no longer alive. In
addition to having been killed in violent crime or as the result of drug or alcohol
abuse, such individuals also have a higher than expected mortality rate due to poor
health habits (Laub & Vaillant, 2000). Other personality disorders also change in
prevalence over adulthood (Segal, Coolidge, & Rosowsky, 2000). Histrionic and
borderline personality disorders are less likely to be observed in older adults. By
contrast, the prevalence is higher for obsessivecompulsive and schizoid personality
disorders as well as dependent personality disorder. These rates fit the pattern
suggested by the maturation hypothesis, which proposes that the ‘‘immature’’
personality types (borderline, histrionic, narcissistic, and antisocial) improve or at
least become more treatable in older adults. By contrast, the ‘‘mature’’ types
(obsessive-compulsive, schizoid, and paranoid) become more symptomatic over time
(Engels, Duijsens, Haringsma, & van Putten, 2003). There are many possible
explanations for the maturation hypothesis, including brain injury, disease, and life
stresses. It is also possible that older adults with longstanding personality disorders
become better at coping with their symptoms.
b. Elder Abuse
A condition that may become one of serious clinical concern is the abuse of an
older adult through the actions taken by another person, or through selfneglect that
leads to significant loss of functioning. The term elder abuse is used to refer to a large
category of actions taken directly against older adults that inflict physical or
psychological harm. To protect vulnerable adults, Adult Protective Services (APS)
were mandated by Title XX of the Social Security Act in 1975. Although a federal
program, there is little or no funding attached to it. This means that the states are
responsible for enforcing the regulations and as a result, there is considerable
variation in the definitions and reporting mechanisms for abuse. Elder abuse is a
notoriously difficult behavior to document because it is one surrounded by guilt,
shame, fear, and the risk of criminal prosecution.
Victims of abuse often find themselves trapped in a cycle of fear and silence,
afraid to report the abuse due to the very real threat of punishment or retaliation by
their abusers. This fear is deeply ingrained and multifaceted, stemming from the
abuser's manipulative tactics, threats, and acts of violence that create a pervasive
sense of helplessness and dread. The psychological grip exerted by the abuser can be
so strong that victims may feel as though there is no safe way to escape or seek help,
fearing that any attempt to do so will result in further harm, not only to themselves but
potentially to their loved ones as well.
Abusers typically employ a variety of coercive methods to maintain control
over their victims. These can include physical violence, verbal threats, emotional
manipulation, financial control, and social isolation. By isolating their victims from
friends, family, and support networks, abusers make it even more difficult for victims
to reach out for help or to believe that they have any viable options for escape. The
constant threat of punishment, whether through physical harm or other forms of
retribution, keeps victims in a state of constant fear and anxiety, reinforcing their
reluctance to report the abuse.
Furthermore, victims may also be concerned about not being believed or
facing skepticism from authorities and others if they do come forward. This fear is not
unfounded, as societal attitudes towards abuse can sometimes be dismissive or blame-
shifting, leaving victims feeling invalidated and unsupported. The stigma associated
with being a victim of abuse can also play a significant role, as individuals may fear
being judged, shamed, or ostracized if their situation becomes known.
On the other hand, perpetrators of abuse have a vested interest in keeping their
actions hidden, as revealing their abusive behavior would expose them to social
condemnation, legal repercussions, and potential criminal charges. Abusers are
acutely aware that their actions are socially unacceptable, if not outright criminal, and
they go to great lengths to ensure that their behavior remains concealed. This secrecy
is crucial to their ability to continue exerting control over their victims and to avoid
accountability for their actions.
Perpetrators often manipulate and intimidate their victims into silence, using
threats of violence, further abuse, or harm to loved ones to dissuade them from
speaking out. They may also employ tactics such as gaslighting, where they
manipulate the victim into doubting their own perception of reality, making it even
harder for the victim to feel confident about reporting the abuse. The abuser's goal is
to maintain a facade of normalcy and respectability, often presenting themselves as
upstanding members of the community while privately engaging in abusive behaviors.
The combination of victims' fear of retaliation and perpetrators' desire to
conceal their actions creates a powerful barrier to reporting abuse. This dynamic
makes it incredibly challenging for victims to break free from the cycle of abuse and
seek the help they need. It underscores the importance of creating supportive
environments where victims feel safe and empowered to report abuse without fear of
retribution.
Efforts to address this issue must focus on increasing awareness, providing
accessible resources and support for victims, and ensuring that authorities and support
services are trained to respond effectively and sensitively to reports of abuse. Legal
protections and enforcement must be strengthened to hold abusers accountable and to
offer victims the security they need to come forward.
In summary, victims of abuse often do not report their situations due to the
pervasive fear of punishment by their abusers, who use a range of coercive tactics to
maintain control. Perpetrators, on the other hand, seek to keep their abusive actions
hidden to avoid social and legal consequences. This interplay of fear and secrecy
creates significant obstacles to addressing and preventing abuse, highlighting the need
for comprehensive measures to support victims and hold abusers accountable.
Estimates of the prevalence of elder abuse first became available in the 1980s
when the issue received national attention after it was brought before the U.S. Select
Committee on Aging in 1981. At that time, it was suggested that 4% of the 65 and
older population are victims of moderate to severe abuse. The most recently
conducted comprehensive survey, based on data from nearly 5,800 respondents across
the United States, yielded estimates of prevalence within the last year for people 60
and older of 4.6% for emotional abuse, 1.6% for physical abuse, and 5.2% for
financial abuse.
In a comprehensive survey conducted among a diverse group of respondents,
it was found that up to 10% of all individuals surveyed indicated that they had
experienced some form of abuse or neglect within the past year. This alarming
statistic underscores the pervasive nature of abuse and neglect in our society,
highlighting the urgent need for increased awareness, prevention, and intervention
efforts.
The survey, which encompassed a wide range of demographic groups,
including various ages, genders, socio-economic statuses, and geographic locations,
revealed that abuse and neglect are not confined to any single segment of the
population. Instead, these harmful experiences can affect anyone, regardless of their
background or circumstances. The forms of abuse reported included physical abuse,
emotional or psychological abuse, sexual abuse, and neglect, each carrying its own set
of devastating consequences for the victims.
Physical abuse, which involves the infliction of bodily harm or injury, was a
significant concern among the respondents. Victims reported experiences ranging
from minor injuries to severe physical assaults, emphasizing the immediate and long-
term physical and psychological impacts of such violence. Emotional or
psychological abuse, which includes behaviors that harm an individual’s self-worth or
emotional well-being, such as verbal abuse, manipulation, and coercion, was also
widely reported. This type of abuse can be particularly insidious, as it often leaves no
visible scars but can deeply affect a person’s mental health and quality of life.
Sexual abuse, encompassing any non-consensual sexual activity, was another
critical issue highlighted by the survey. Respondents disclosed experiences of sexual
harassment, assault, and exploitation, which not only violate personal boundaries and
dignity but also have profound psychological and emotional repercussions. Neglect,
which involves the failure to provide necessary care and support, was reported by
individuals who felt that their basic needs for food, shelter, medical care, and
emotional support were not being met. This form of abuse is particularly detrimental
as it can lead to serious health complications and developmental issues, especially
among vulnerable populations such as children and the elderly.
The survey’s findings bring to light the widespread nature of abuse and neglect
and the profound impact these experiences have on individuals’ lives. The fact that up
to 10% of respondents reported experiencing such harm within the past year suggests
that these issues are far more common than many might assume. It highlights the
importance of creating supportive environments where individuals feel safe to
disclose their experiences and seek help.
Addressing the issue of abuse and neglect requires a multi-faceted approach.
Prevention efforts must include education and awareness campaigns to inform the
public about the signs of abuse and the resources available for victims. Schools,
workplaces, and community organizations play a crucial role in these efforts by
fostering environments that promote respect, empathy, and support. Additionally,
intervention strategies must be strengthened to ensure that victims receive timely and
effective assistance. This includes providing access to mental health services, legal
support, and safe housing options for those escaping abusive situations.
Moreover, policymakers and healthcare providers must collaborate to
implement policies and practices that protect individuals from abuse and neglect. This
involves establishing and enforcing laws that hold perpetrators accountable, as well as
developing comprehensive support systems for victims. Healthcare providers, in
particular, can play a pivotal role by being vigilant in recognizing the signs of abuse
and providing appropriate referrals and interventions.
In conclusion, the survey’s finding that up to 10% of respondents have
experienced abuse or neglect within the past year is a stark reminder of the prevalence
and severity of these issues. It calls for concerted efforts from all sectors of society to
address and prevent abuse and neglect, ensuring that victims receive the support and
protection they need. By working together to raise awareness, strengthen prevention
and intervention strategies, and promote a culture of respect and safety, we can make
significant strides in reducing the incidence of abuse and neglect and improving the
lives of those affected.
The problem of elder abuse is a serious social and mental health issue. The
victims are vulnerable to psychological distress (Yan & So-kum, 2001) and have
higher mortality rates (Dong et al., 2009). Although many individuals throughout life
are potentially victims of abuse or neglect, it is the older adults in poor health who are
at particularly high risk. Targeting their caregivers, and providing them with better
coping skills as well as adequate reimbursement and social support, are important
preventative strategies to reduce the incidence of this very tragic situation.
c. Suicide
Although suicide is not a diagnosis in the DSM-IVTR, suicide is a condition
that is closely related to the issue of psychological disorders in later adulthood.
Approximately 90% of adults who complete suicide have a diagnosable psychiatric
disorder. The most frequent diagnoses of suicidal individuals are major depressive
disorder, alcohol abuse or dependence, and schizophrenia. Among suicidal adults of
all ages, the rates of psychiatric disorders are very high, ranging from 71% to over
90%.
Each year, approximately 33,000 people in the U.S. population as a whole die
of suicide. The majority are ages 25 to 54 (Xu et al., 2010). The age-adjusted suicide
rate in the United States of all age, race, and sex groups is highest for all demographic
categories among White males aged 85 and older at about 48 suicide deaths per
100,000 in the population (Centers for Disease Control and Prevention, 2010f). The
actual number is approximately 800, but the rate is high because this is a small
segment of the population as a whole. Nevertheless, the issue of suicide in older
adults is one of concern for older adult White male widowers, particularly those who
suffer from cancer and cardiovascular disease.
Depressive symptoms and major depressive disorder are strongly related to
suicidal feelings in older adults. However, the older adult contemplating suicide may
not appear even to a trained clinician to be severely depressed but instead may seem
to show only mild to moderate symptoms of depression. As a result, suicides are much
more difficult for health care workers to detect (Duberstein & Conwell, 2000). Other
subclinical symptoms that older adults may have include hostility, sleep difficulties,
anxiety, and depression (Liu & Chiu, 2009). Given the difficulty of diagnosing
depression among older adults, it would seem particularly important for health care
providers to be aware of suicide risk factors when working with older adults. Sadly, it
is estimated that from 43 to 76% of all suicide victims had seen a health care provider
within a month of their death (Duberstein & Conwell, 2000).
Greater sensitivity to the symptoms of mood disorders, when combined with a
more thorough evaluation of additional psychological and medical risk factors, could
potentially increase the likelihood that healthcare providers would be able to intervene
effectively and in a timely manner. This approach necessitates a holistic
understanding of the patient's overall health and well-being, recognizing that mood
disorders often do not exist in isolation but are intertwined with a host of other factors
that can influence their severity and manifestation.
Mood disorders, such as depression and anxiety, can present with a wide range
of symptoms that may not always be immediately apparent or easily distinguishable
from other medical conditions. For instance, symptoms like fatigue, changes in
appetite, sleep disturbances, and difficulty concentrating can be attributed to various
physical health issues, making it challenging to identify their true origin without a
nuanced and sensitive approach. By training healthcare providers to be more attuned
to these subtle signs and to consider the broader context of the patient's life, it
becomes more feasible to identify mood disorders at an earlier stage.
Additionally, a thorough evaluation of psychological risk factors is crucial.
This involves looking into the patient's history of mental health, family background,
past traumas, and current life stressors. Understanding the psychological landscape of
the patient provides valuable insights into potential triggers and exacerbators of mood
disorders. For example, a patient experiencing high levels of stress at work, dealing
with a recent loss, or having a family history of mental illness might be more
susceptible to developing mood disorders. By incorporating these considerations into
their assessment, healthcare providers can gain a more comprehensive understanding
of the patient's mental health status.
Medical risk factors also play a significant role in the development and
progression of mood disorders. Chronic illnesses, such as diabetes, heart disease, and
thyroid disorders, can contribute to or exacerbate symptoms of depression and
anxiety. Medications for these conditions can also have side effects that impact mood.
Thus, a thorough medical evaluation that includes a review of the patient's current and
past health conditions, medications, and overall physical health is essential. By
integrating this information with psychological assessments, healthcare providers can
better differentiate between mood disorders and other medical conditions, leading to
more accurate diagnoses and appropriate treatments.
Moreover, enhancing sensitivity to mood disorder symptoms and conducting
thorough evaluations can lead to more personalized and effective interventions. Early
detection allows for timely and tailored treatment plans that address the specific needs
of the patient. This might include a combination of pharmacological treatments, such
as antidepressants or anxiolytics, and psychotherapeutic approaches, such as
cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), or other evidence-
based modalities. In some cases, lifestyle modifications, such as improved diet,
regular exercise, and stress management techniques, can also play a significant role in
alleviating symptoms.
Healthcare providers who are well-versed in the complexities of mood
disorders and who approach patient care with a high degree of sensitivity and
thoroughness are better equipped to offer holistic and compassionate care. This not
only improves patient outcomes but also helps to reduce the stigma often associated
with mental health issues. Patients are more likely to feel understood and supported,
which can enhance their engagement in treatment and adherence to prescribed
interventions.
Furthermore, increasing the sensitivity and thoroughness of evaluations can
have broader implications for public health. By improving the early detection and
treatment of mood disorders, healthcare systems can potentially reduce the overall
burden of mental illness on individuals, families, and communities. This can lead to
decreased rates of disability, improved quality of life, and reduced healthcare costs
associated with untreated or poorly managed mood disorders.
In conclusion, fostering greater sensitivity to the symptoms of mood disorders
and conducting more thorough evaluations of psychological and medical risk factors
can significantly enhance the ability of healthcare providers to intervene effectively.
This comprehensive approach enables earlier detection, more accurate diagnoses, and
personalized treatment plans, ultimately improving patient outcomes and contributing
to the overall well-being of society.
d. Treatment Issues in Mental Health Care
With the aging of the Baby Boom generation, mental health researchers are
turning their attention with great concern toward the need for more research and
training in providing services to older adults. Clearly, more training will be needed
both for practitioners currently in the field and those who will be entering the ranks of
therapists and other mental health care workers (Qualls, Segal, Norman, Niederehe, &
Gallagher-Thompson, 2002). Publication of the APA Guidelines for Psychological
Practice with Older Adults (American Psychological Association, 2004) led to the
development of training models in the emerging field of professional geropsychology.
The psychological disorders variety of potential causes and, therefore, may be
treatable by a variety of approaches. Clinicians who work with adult populations
recognize the need to differentiate the approaches they take to young and middle-aged
adults from the approaches they take to older adults (Zarit & Zarit, 1998). In addition
to potentially different etiologies for disorders at different points in adulthood,
clinicians must take into account the potential effects of chronic medical conditions as
well as normal age-related changes in physical, cognitive, and social functioning
(Hinrichsen & Dick-Siskin, 2000). Variations by ethnic and minority status must also
be recognized by clinicians. It is essential that clinicians become competent in
assessing and treating individuals from a range of backgrounds.
Clinicians begin their treatment of a client’s psychological disorder by
conducting a multi-faceted clinical assessment. The assessment procedure involves
social factors that potentially affect the individual’s current state of functioning.
Psychological assessments provide a diagnosis (according to the DSMIV-TR) and lay
the groundwork for a treatment plan. In some cases, assessments may be used for
special purposes, such as when the clinician is making legal determinations of mental
competence or evaluating an individual’s appropriateness for a particular occupation.
When used in the context of treatment, psychological assessments focus on providing
the most accurate reading possible of a client’s specific disorder to provide the basis
for treatment.
A key area of differential diagnosis is distinguishing between dementia and
other psychological disorders, particularly depression. As we have seen, depression
can cause pseudodementia, which is memory loss and difficulties in concentration
leading to symptoms that closely resemble dementia. However, there are important
differences in the symptom pattern of individuals with these disorders (Small, 2009).
In depression, the symptoms of dysphoria are more severe, and the individual is likely
to exaggerate the extent to which he or she is experiencing memory loss. People who
have dementia tend, in contrast, to be overconfident about their cognitive abilities.
They may show very wide variations in performance from one test to another, but
older adults with dementia show a progressive loss of cognitive abilities that tends to
affect them across the board. The timing of symptoms is another diagnostic key,
because older adults with depression experience cognitive symptoms prior to
depressive symptoms. If the cognitive symptoms persist after the depression has been
treated, then the dementia is more likely the cause.
Assessment should also be tailored to the physical and cognitive needs of
older individuals. First, they should be made to feel comfortable and relaxed, and
should be given sufficient time to ask questions about the procedure, which may be
unfamiliar and hence stressful. There are also practical concerns that psychologists
should address such as making sure that the people they are testing have the correct
eyeglasses and hearing aids if necessary. An older adult who has difficulty writing due
to arthritis, for instance, will be unable to complete paper-and-pencil measures. Rest
periods may be necessary during a lengthy testing session, or the session may have to
be divided into shorter segments. The clinician should also be aware of the changes in
sensory abilities, motor functions, and cognitive processes that may hamper the older
client’s understanding of problems or questions given during the assessment process.
For example, materials should be presented in large print to clients who are visually
impaired. Even seemingly insignificant distractions, such as the hum of a computer,
may compromise an older adult’s performance (Edelstein, Martin, & McKee, 2000). It
is also important to be sensitive to cultural or language differences between clinician
and client, regardless of the age of the client.
In a clinical interview, the clinician asks questions of the client to establish
insight into the client’s psychological processes. The clinician can also use the
opportunity to interact face-to-face with the client to observe the client’s behavior.
There are several standardized instruments used to provide DSM-IV-TR diagnoses in
as objective a fashion as possible. However, these are not typically adapted for use
with older adults. An unstructured interview can also be beneficial in assessing older
adults with cognitive difficulties who find it difficult to concentrate or need help in
maintaining their focus (Edelstein, Martin, & McKee, 2000). However, to be most
useful, the clinical interview should also be combined with more structured
instruments (Blazer, 2004) such as those we describe below.
An assessment instrument used extensively in the diagnostic process for older
adults is the mental status examination. The most well known is the Mini-Mental
State Exam (MMSE). Although the MMSE is quick, relatively easy to administer and
is useful for charting changes in dementing symptoms over time, it is not particularly
specific to dementia and does not allow for precise measurement of cognitive
functioning. Newer methods using computerized testing are more sensitive
particularly to early signs of cognitive deficits (Saxton et al., 2009). Another problem
with the MMSE is that it is a less effective tool for African Americans and Mexican
Americans. Given these and other limitations of the MMSE, geropsychologists are
increasingly turning to more sophisticated cognitive and neuropsychological testing
methods that examine a broader range of abilities.
Several interview-based measures exist for the assessment of specific
symptoms in older adults. The Geriatric Depression Scale (GDS) includes a true–false
set of questions about depressive symptoms that excludes somatic disturbances likely
to be endorsed by older adults regardless of their level of depression (such as changes
in energy level or sleep). Its validity is well established with older adult populations
(Nyunt, Fones, Niti, & Ng, 2009). The Anxiety Disorders Interview Schedule
(ADISR) (DiNardo & Barlow, 1988) is useful in assessing older adults, as it has been
found to provide ratings in agreement with clinical diagnoses of social phobia, general
anxiety disorder, simple phobia, and panic disorder (Scogin, Floyd, & Forde, 2000).
The Hamilton Rating Scale of Depression (Hamilton, 1967) and the Hamilton Anxiety
Rating Scale (Hamilton, 1959) have also been tested with older adults and are useful
in evaluating both the severity and number of the individual’s symptoms. These
instruments remain the most widely adopted by clinicians, although newer and more
sensitive methods are being developed.
Easier to administer, but with a higher cost of placing greater burden on the
test-taker, are self-report clinical inventories in which the client answers a set of
questions concerning the experience of particular symptoms related to a diagnostic
category. Many of these tests were developed for young or middle-aged adults, and
therefore their applicability to older adults is either unknown or low. Unlike
interviews, these measures cannot be adapted to the needs or background of the client.
Older adults and people from diverse cultural backgrounds may not interpret the
questions as the authors of the test had intended, leading to results that do not provide
a valid indication of the client’s psychological status.
The strategies available to clinicians for treating psychological disorders in
older adults fall into two categories: medically based treatments involving
pharmacological or other bodily treatments and psychologically based treatments
involving, primarily, psychotherapy.
y far, the most common method of medically based treatments for
psychological disorders involves psychotherapeutic medications, substances that by
their chemical nature target the central nervous system. In prescribing these
medications to older adults, clinicians must take precautions to avoid adverse drug
reactions. As we have previously mentioned, medications take longer to clear the
excretory system of the kidneys, so unless prescribed in lower doses, older adults are
at risk of accumulating toxic levels in the blood. Another risk in prescribing
psychotherapeutic medications to older adults is that of polypharmacy people receive
multiple prescription medications. In addition to having potent effects of their own,
psychotherapeutic medications can also interact in harmful ways with other
prescription medications. Because older adults typically see multiple health
professionals, they are great risk for these unintended consequences. A physician
might prescribe a sleep medication to an older adult patient who is already taking an
antianxiety or cardiac medication. The sleep medication can have the undesirable
outcome of causing the older person to become suicidal.
In the case of major depressive disorder, despite their potential drawbacks and
side effects, psychotherapeutic medications are highly effective (50 to 70%) for older
adults. The most commonly prescribed antidepressants include selective serotonin
reuptake inhibitors (SSRIs), which are particularly useful for older adults (Klysner et
al., 2002; Mottram, Wilson, Ashworth, & Abou-Saleh, 2002). Unfortunately,
clinicians often fail to diagnose depression correctly in older adults, which may lead
to either undertreatment of depressive symptoms or treatment with the wrong
medication, such as antianxiety medications rather than antidepressants.
Lithium carbonate is an effective medication for the treatment of bipolar
disorder. To prevent recurrence of manic episodes, the individual must take lithium on
a continuous basis. For older adults, it is particularly important to monitor lithium
levels because, perhaps more so than other psychotherapeutic medications, it is not
cleared through the kidneys as quickly as it is by the kidneys of younger adults.
In cases of severe depression in which medications do not produce results,
individuals may undergo electroconvulsive therapy (ECT). In this treatment, an
electric current is applied through electrodes attached across the head. The individual
suffers seizure-like symptoms (which can be controlled through muscle relaxants), but
the main effect of the treatment is thought to result from the passage of electrical
current through the brain. Despite the risks associated with this procedure, ECT is
considered a method of last resort. It is an effective alternative for individuals over the
age of 60 who have not responded to other forms of treatment.
A number of psychotherapeutic medications are used to treat anxiety
disorders. Benzodiazepines are the most frequently prescribed antianxiety
medications, and although effective, are highly addictive. They require higher and
higher doses to obtain their intended outcome, and when discontinued, they are likely
to lead to significant withdrawal symptoms. Older adults are particularly vulnerable to
these effects and, furthermore, may experience a number of additional potentially
dangerous side effects such as unsteadiness, daytime sleepiness, impaired cognitive
functioning, and slowed reaction time resulting in increased risk of falling (Woolcott
et al., 2009). The medication buspirone has fewer of these side effects, but it is not
necessarily as effective in treating generalized anxiety disorder (Flint, 2005). There
are also circumstances in which it is not appropriate to prescribe buspirone, such as
when the individual also suffers from symptoms of depression (Flint, 2005). Other
medications useful in treating anxiety in older adults are beta-blockers, which reduce
anxiety by lowering sympathetic nervous system activity. Older adults with certain
chronic diseases such as cardiovascular disease cannot use this medication, however.
SSRIs are another category of medications used in treating older adults with anxiety
disorders although their effectiveness versus placebo in people with anxiety disorders
is not well established.
A wide range of treatment models have been shown to be effective for
reducing symptoms of the major disorders experienced by older adults (Fiske,
Wetherell, & Gatz, 2009). Research on the outcome of these treatments shows that
psychotherapy in addition to, or instead of, pharmacological interventions can be
highly efficacious (Schulberg et al., 2007). Behavioral treatment focusing on
increasing the number of positive reinforcements in the individual’s life was shown a
number of years ago to have beneficial effects in reducing depressive symptoms in
older adults (Teri, 1994). Such an approach is based on the notion that older adults
may be experiencing depressive symptoms owing to decreases in pleasant events in
their lives associated with physical changes, loss of friends, and loss of rewarding
social roles.
In cognitive-behavioral treatment, the clinician encourages the client to
develop new behaviors and constructive ways of thinking about the self. This
approach appears to have considerable relevance to work with older depressed clients,
particularly for those who have a tendency to focus excessively on age-related
changes in physical functioning, memory, and health. The elements of cognitive-
behavioral treatment for older adults with depression include instructing clients to
keep track of their pleasant and unpleasant events, helping them understand the
relationship between their mood and these behaviors, looking for changes that can be
made in daily life, increasing their social skills, and teaching them to be alert to and
try to change their negative thoughts about the self. Even as few as seven sessions can
produce positive results.
Interpersonal therapy (IPT) integrates cognitive methods with a focus on
social factors that contribute to psychological disturbance. Interpersonal therapy
involves a combination of methods, but its main focus is on training in social skills,
interpersonal relationships, and methods of conflict resolution. IPT is an effective
treatment method either as an adjunct to or replacement of pharmacological
interventions. There are, then, encouraging results from studies investigating
psychotherapy effectiveness in later life. However, psychotherapy with older
individuals presents a number of challenges. These involve factors that alter both the
nature of psychological difficulties experienced by older adults and the nature of the
therapeutic process.
Older adults, particularly those over the age of 75, have a greater probability
of physical health impairments that can compromise the effectiveness of therapy
because these conditions represent a significant threat to quality of life (Licht-Strunk,
van der Windt, van Marwijk, de Haan, & Beekman, 2007). Changes in identity
associated with these impairments can themselves stimulate the need for
psychotherapy. However, by boosting the older adult’s sense of mastery, even physical
limitations can be overcome, and the older person’s depressive symptoms can be
alleviated (Steunenberg, Beekman, Deeg, Bremmer, & Kerkhof, 2007). Reducing
symptoms of depression through psychotherapy can in turn lead to improvements in
perceptions of disability (Karp et al., 2009) and health-related perceived quality of
life.
Psychosocial issues involving relationships with family may also confront an
older adult and should be taken into account by clinicians providing psychotherapy.
These issues include death of family and friends, changes in relationships with
children and spouses, and the need to provide care to a spouse or parent. Finally, the
social context can play an important role in influencing the outcome of treatment. Just
as there are relationships between mental health and SES, there is a link between the
effectiveness of antidepressant treatment and social class. In one study older adults
from lower social classes were found to be less likely to respond over the course of a
20-week period to a combination of psychotherapy and medication than individuals in
middle and high income brackets.
Family issues may, however, be alleviated through the provision of therapy for
older adults experiencing symptoms of depression. Researchers investigating the
impact of interventions including both medication and interpersonal therapy observed
favorable effects on perceived burden among caregivers of the patients whose
symptoms responded to treatment (Martire et al., 2010). Generational differences
between current cohorts of older adults and the middle-aged individuals more
commonly seen in psychotherapy must be taken into account by clinicians as well.
Older adults may be skeptical about the therapy process, having been less socialized
than younger cohorts to accept the need for psychological interventions. Part of
therapy may involve educating older adult clients to feel less embarrassed or
stigmatized by the process. This seems particularly important in the case of older
Black adults, who are less likely than older adult Whites to use psychotherapy when it
is offered. Both older and younger men attribute a greater stigma to psychotherapy
than do women. Conversely, the therapist may bring to the situation negative attitudes
and stereotypes about aging that complicate the therapeutic relationship with the older
adult client.
e. Serious Psychological Distress
Though we psychological disorders in older adults, it is important to
remember that despite the presence of chronic physical health conditions, the majority
of older adults do not experience significant distress. This fact is borne out by the
National Health Interview Survey, which tracks the incidence of serious psychological
distress. Survey after survey in this series consistently reports lower rates of serious
distress within the past year for adults 65 and older (2.3 in 65 and older versus 2.8 in
those 18 to 24). These results are not limited to the United States.
A large-scale investigation conducted among nearly 7,500 adults in Australia,
ranging in age from 20 to 64, revealed intriguing patterns regarding mental health
across different age groups. The comprehensive study aimed to assess the prevalence
of anxiety and psychological distress within this diverse population, shedding light on
how these mental health issues vary across different stages of adulthood.
The findings of the study indicated that lower rates of anxiety and
psychological distress were observed among the older age groups compared to their
younger counterparts. This trend suggests that as individuals age, they might
experience a reduction in the intensity or frequency of anxiety and related
psychological distress. The research involved meticulous data collection and analysis,
considering various factors that could influence mental health, such as socioeconomic
status, employment, physical health, and social support systems.
The study's participants were drawn from a broad cross-section of the
Australian population, ensuring a diverse representation of different backgrounds and
life circumstances. Younger adults, those in their 20s and 30s, reported higher levels
of anxiety and psychological distress. This demographic often faces significant life
transitions and pressures, such as establishing careers, forming relationships, and
achieving financial stability. These stressors can contribute to heightened anxiety
levels and greater psychological strain.
Conversely, individuals in the older age brackets, particularly those in their
late 50s and early 60s, reported comparatively lower levels of anxiety and
psychological distress. Several factors might contribute to this trend. As people age,
they often develop better coping mechanisms and resilience, having navigated
numerous life challenges and gained valuable experience in managing stress.
Additionally, older adults might have more stable social networks and support
systems, including long-term relationships with family and friends, which can provide
a buffer against anxiety and distress.
The study also considered the role of employment and retirement. Many older
adults in the study were approaching or had reached retirement age, potentially
alleviating the stress associated with career demands and job insecurity. Retirement
can offer more time for leisure activities, hobbies, and social engagement,
contributing to improved mental well-being. However, it's important to note that
retirement can also pose challenges for some individuals, such as adjusting to a new
routine and potential financial concerns, which were taken into account in the
analysis.
Physical health, another crucial factor, was also examined in the context of the
study. While older adults might face more chronic health conditions, their mental
health appeared to benefit from better management of these conditions and a greater
acceptance of health-related changes. The study highlighted the importance of
maintaining physical health as a component of overall mental well-being,
emphasizing that good health practices can positively impact mental health outcomes
across all age groups.
Furthermore, the study explored the impact of social support and community
engagement on mental health. Older adults often have well-established social
networks, including long-standing friendships, community involvement, and family
ties, which can provide significant emotional support. These connections can play a
crucial role in mitigating feelings of anxiety and psychological distress, offering a
sense of belonging and stability.
In summary, the large-scale investigation involving nearly 7,500 adults in
Australia aged 20 to 64 found that older age groups exhibited lower rates of anxiety
and psychological distress compared to younger adults. The study's comprehensive
approach, considering various influencing factors, underscores the complexity of
mental health across different life stages. These findings highlight the potential
benefits of age-related factors such as improved coping mechanisms, stable social
networks, and life experience in reducing anxiety and psychological distress. The
research offers valuable insights for developing targeted mental health interventions
and support systems tailored to the needs of different age groups, ultimately
contributing to improved mental health outcomes for the broader population.
Clearly, although older adults are at higher risk in an objective sense for
experiencing psychological disorders, a combination of selective survival, enhanced
use of coping mechanisms, and an ability to maintain an optimistic attitude toward
adversity seem to offer significant protective factors against psychological problems
in later adulthood. Increasingly, new methods of treatment are becoming available to
provide services to those older adults who need assistance in these adaptive processes.
In summary, when we think of the aging process, we are likely to anticipate a number
of negative changes that would have adverse mental health effects. By contrast, the
facts reveal that older adults are highly resilient to the physical, psychological, and
social changes involved in the aging process. It is nevertheless true that there will be
an increasing need for mental health workers in the coming decades trained in
diagnosis, assessment and treatment, and there will also be an increased need for
research on effective treatment methods for aging individuals in need of intervention.
