Caring for older adults in one’s family is often a stressful experience, even under the best of circumstances. When older adults appear to be suffering from depression, anxiety, or symptoms related to grief, it can be hard for their children and other concerned family members to know what to say and do to help.
The purpose of this blog post is to encourage you! There are mental health and wellness strategies that can help your loved one deal with distress. I will tell you about a few of them, and point you in the direction of some free resources to learn more.
Mental Health Symptoms are Not a Natural Part of the Aging Process
One reason family members or medical professionals don’t always think to recommend mental health care for older adults is because of assumptions they carry. One assumption is that depression, anxiety, and extreme responses to grief are a natural part of aging. This is not true (Sadavoy, 2009)! According to Sadavoy,
“Old age is inevitably associated with various stressful life events and it is well recognized that many elders become depressed under their impact. Despite the fact that depression is arguably the most common psychiatric disturbance of old age I suggest that it is surprisingly uncommon, when one considers the array of challenges posed by old age. Because the majority of elders do not become depressed, it stands to reason that the stressors associated with aging only induce depression if mediated by other vulnerability factors in a given individual.”Sadavoy, J. (2009). An integrated model for defining the scope of psychogeriatrics: the five Cs. International Psychogeriatrics, 21(05), 805
When older people experience mental health challenges, it is for the same reasons as younger people. Here is an example. Let’s say an 82-year-old widower has to sell his house. His wife recently died, and he is ill and has financial problems. He may not like his options; he may not see a positive future ahead for himself. He does not want to downsize his possessions, especially because they remind him of beloved family members who have died. This man starts to show symptoms of depression, like sleeplessness, hopeless thinking, and irritability with the people around him.
Now, let’s take the example of the same situation with another person. What if the same situation were to occur for a 33-year-old widower? He also has to sell his house because he is ill and because of financial problems. He doesn’t like his options, he doesn’t see a positive future ahead, and he doesn’t want to get rid of items that remind him of his beloved wife. He might also have the same symptoms of depression as the 82-year-old. The difference is, people around both men might have different theories about his experience. It is more likely they will consider what the 33-year-old is experiencing as an understandable response to a bad situation, and that what the 82-year-old is experiencing is just part of the aging process.
Both men need help and counsel. Will they both get it? Or will the pain of one be disregarded more than the other? Like younger adults, many older adults respond to difficult life experiences with experiences of depression and anxiety. It is not aging that causes these symptoms, it is adversity (Bhar, et.al, 2022)
What are Anxiety and Depression?
I want to start with some definitions of anxiety and depression, and how they are different from just feeling sad or worried. First of all, they are distressing, internal experiences that happen most of the time instead of some of the time. They also affect the whole body and lead to challenges with sleeping, eating, and daily activities. Anxiety and depression can also contribute to physical problems, like stomach aches and headaches. These states actually make people physically ill, and they can put a strain on meaningful relationships.
Depression is a sense of feeling low all the time that doesn’t go away. When a person is depressed, they may not be able to have happy feelings, even when a happy thing is happening. They may find themselves pulling away from other people more than they used to, and they stop doing activities that used to bring them joy. Depressed people might start sleeping all the time, or be unable to sleep. They think thoughts of low self-worth and hopelessness, like “I’m worthless,” or “It’ll never get better, or “Everyone is better off without me”.
Anxious people, on the other hand, can’t turn off the worrying part of their brain. They are constantly wondering, “What if?” And the what ifs are often fears of personal failures, like “What if I mess up?” Anxious people make predictions that bad things will happen if they take any action at all, or if they don’t take action at all. When things go wrong, anxious people think it’s because they made mistakes and worry even more. To make matters worse, worried people can be so distracted by their worries they make more mistakes or miss more information, which just increases their worries about more bad things happening. And even if things go right, they might think, “just wait- things are going to fall apart any minute.”
To learn more about anxiety and depression, check out the downloadable pamphlets from Beck Institute.
If Aging Doesn’t Cause Depression and Anxiety in Older Adults, Then What Does?
As I mentioned above, older people respond to challenges in much the same way as younger people, and sometimes that means symptoms of anxiety, depression. However, older people specifically experience these things sometimes because they are grieving the loss of significant relationships, and having to say “goodbye” more often than other age groups. They attend more funerals, and see more death than many younger people. Older people are also likely to be making stressful decisions, like moving, downsizing their possessions, retiring from jobs or volunteer opportunities, or being away from family (Sadavoy, 2009).
Another reason older adults may experience anxiety or depression is because of identity transitions (Sadavoy, 2009). A lot of people find meaning in their careers and in their families. Older adults are retiring, and their relationships with their children change. Suddenly, the job or the family role can’t define who you are anymore. That can make some people feel lost for a while. This is a normal stress that comes with any major transition, and most people work through it well. But for some, especially if they have a history of trauma or previous mental illness, they are grappling with chronic physical illness, or they are in a really tough situation, they may not find new roles or a new sense of identity easily. Sometimes, when people struggle through identity transitions, they experience depression or anxiety, even for people who may never have had significant struggles with them in the past.
Older Adults Are Open to, and Benefit From, Mental Health Help
Another common myth is that older people will refuse counseling. The research shows this is not true (Bhar, et. al, 2022)! One challenge that they do face is not that they won’t accept help, but that the way that help is offered needs to be considered carefully. By asking older adults if they want to “gain health and wellness”, for example, rather than telling them they are “mentally ill” and need help, they are often very willing to accept mental health help.
Additionally, since older adults in mental health services attend consistently, they are likely to have positive outcomes. This is because consistent attendance is an important factor in whether or not therapy can help a person. Additionally, social connections are often highly valued by older people, and they can gain immediate improvements by feeling less isolated and noticed.
Why Pursue Mental Wellness?
Let’s talk about the goals of mental wellness for older adults. The goals of mental wellness are not to just be less depressed or anxious. Instead, the goals are to help people continue to grow, to find opportunities to serve in their communities, and live full and vibrant lives, their whole lives. Mentally well people live longer, and they live healthier and happier lives. On average, mentally well people also recover from illness more quickly, and experience less physical pain. They are also more helpful to their families and friends, and neighbors.
What Kind of Mental Health Care Can Help Older Adults?
Reading this blog is a great starting point in considering how you can support your older loved ones. However, I strongly encourage you to talk with them and their doctors about whether a mental health counseling referral could help. Counseling is cheaper and has fewer side effects and risks than medications, so it could be a great place to start if an older adult is showing signs of depression or anxiety. Naming the symptoms your loved one is experiencing as possible depression or anxiety can help medical professionals make appropriate recommendations. Additionally, simply learning about anxiety and depression, and learning to understand your own challenges, or the challenges of your family and friends, helps people to feel less alone. It can also help a person decide what actions they want to take to feel better. Just discussing with someone you trust about whether they are experiencing anxiety or depression, and what to do about it, can help them take next steps. They might choose to ask their doctor about talking to a counselor, or to reach out to a trusted friend or pastor.
Cognitive Behavioral Therapy for Older Adults
There are certain therapies that can help older adults regain a sense of purpose and identity when they reach times of change, and that can help them reduce anxiety and depression and become more connected to others. Cognitive Behavioral Therapy (CBT) interventions, for example, have been demonstrated to be beneficial for older people (Bhar, et. al, 2022).
Planning and Engaging in Enjoyable, Realistic Activities
One CBT intervention that helps older people is planning and engaging in enjoyable and realistic activities (Bhar, et. al, 2022). This is called behavioral activation, or activity scheduling. This might take a bit of thought and creativity, especially if the things they used to like to do are things that are harder to do now. However, the research indicates older people also will benefit from trying new activities, and going back to old activities that they enjoyed in the past if they can.
Amazingly, research that indicates physical activity increases lifespans and quality of life as well (Mora, et.al, 2018). The same activities that can help you feel mentally stronger can help you live longer. God designed both our minds and our bodies to move. The more older people are encouraged to continue to be active, the more they will benefit both mentally and physically.
Planning, and engaging in, pleasant activities also include intentional connecting with other people. Older people can schedule and engage in opportunities to make new connections and to invest in the lives of other people in unique ways.
Make sure to consider singing and music, laughter and humor, when scheduling enjoyable activities!
Another intervention that helps is problem-solving (Bhar, et.al, 2022). Encouraging older people to talk through their problems with you or another trusted person can significantly reduce experiences of anxiety and depression, because it increases a sense of hopefulness and reduces a sense of isolation.
Reminiscing can be incredibly powerful (Bhar, et. al, 2022). Talking about past experiences with other people, using items from the past, or reconnecting with the past through music, can be very powerful. Reminiscing may help reduce depression and apathy, help improve social interactions and quality of life, and increase interest in the present and future.
Some simple questions you can ask an older person to help them reminisce in a helpful way are:
- Who was your favorite athlete or actor?
- Tell me about your first pet.
- What was your favorite food as a child?
- What was your neighborhood like growing up?
- What is one of your happiest memories?
- What is the story of your name?
- How did you meet your best friend?
Remember to ask questions about the people in any photographs the person might have displayed, or about artwork they have in their home. Personal items usually carry important memories that can help people recall precious memories and their own strengths.
One helpful way to reminisce is to recall specific problem-solving successes. Try the following activity:
Think back over your life and try to remember times when you managed to solve a problem, which required some effort or creativity on your part. Can you describe the problem you faced? How did you solve the problem – What did you do? How did you think of the solution? What qualities did you show, which helped solve that problem?
Discussing past problem-solving successes with older people can help them remember the solutions they already know.
“My Dear Friend”
Another tool that can help is called “My Dear Friend.” This is a form of Socratic dialogue, another CBT intervention. When talking with an older person who is struggling with depressed or anxious thinking, ask him or her, “suppose you had a friend with the same problem- what might you say she/he should do?” Sometimes it is easier to come up with solutions for others than for ourselves. Encourage older people to do the same for themselves that they would recommend for others.
Beck Institute has many resources on mental health and wellbeing! One great benefit of Beck Institute is the international resources. You can find mental health information and support from all over the world in their International Resources page. If you have a loved one whose first language is not English, you might find a page with resources in their own language that help them feel more comfortable reading and learning about mental wellness.
Depression and anxiety are NOT outcomes of old age. There are many reasons older people struggle with depression and anxiety, and they are for the same reasons anyone of any age might struggle with them. Times of transitions and change, times of grief and uncertainty, and times of adversity and challenge have the potential to affect people of all ages. There are mental health treatments that can help older people to thrive that don’t involve side effects. Older people can benefit from exploring the causes of their depression and anxiety, from scheduling enjoyable activities that connect them to other people, and using their past experiences to inform their responses to current challenges. They can also benefit from problem-solving, reminiscing, and giving advice to themselves they might give to their friends.
Be Blessed, and Be Well!
Carolyn Cummings, LMFT
Bhar, S., Koder, D., Jayaram, H., Silver, M., Davison, T (2022). Addressing Mental Health in Aged Care Residents: A Review of Evidence-Based Psychological Interventions and Emerging Practices. Advances in Psychiatry and Behavioral Health, 2022, Volume 2, Issue 1, pgs. 183-191.
Mora, J. C., & Valencia, W. M. (2018). Exercise and Older Adults. Clinics in geriatric medicine, 34 (1), 145-162. https://doi.org/10.1016/j.cger.2017.08.007
Sadavoy, J. (2009). An integrated model for defining the scope of psychogeriatrics: the five Cs. International Psychogeriatrics, 21(05), 805-812