Anxiety and Depression: Implications for Older Adults

By the year 2030, it is projected that one in every three Americans will be 55-years-old or older. This age group is by far thefastest growing segment of the population. With the growing number of older adults, the importance of understanding aging and common disorders of laterlife is essential. In particular, anxiety anddepression are among the most common problems in older adults. However, differentiating anxiety and depression at the mood, symptom, and syndromal levels has been a long-standing problem in psychopathology research. In addition to a growing need for research, clinicians will also need to take an active role in the development and implementation of treatment as the population of older adults increases. In particular, mental health service providers must become informed about the economic implications for older adults as the structure of health insurance continues to change.     

Sexuality in Older Adults (65+)—An Overview of the Literature,Part 1: Sexual Function and its Difficulties

Objectives: The aim of the current article was to provide an overview of literature on sexual function and sexual difficulties in older adults. Method: The authors conducted a narrative review of papers published in English between January 2005 and July 2015 based on an extensive search in PsycINFO. Results: The review showed that although common biological changes may adversely affect sexual function in old age, sexual experience seems to also be affected by psychological and interpersonal factors. Conclusions: Greater life expectancy and better medical care will result in older individuals with chronic diseases living longer. The need for help to cope with changes in sexual health is likely to increase in older adults, as sexuality may be negatively affected through several pathways.     

The Healing Power of Laughter: The Applicability of Humor as a Psychotherapy Technique With Depressed and Anxious Older Adults

The nation’s older adult population is steadily increasing in numbers as the Baby Boomer generation ages over time. Mental health providers are encountering older adults who are presenting to therapy with problems related to depression and anxiety. The authors demonstrate how empirically-supported treatments such as Cognitive-Behavioral Therapy, Problem Solving Therapy, and Interpersonal Therapy are effective in treating older adults within the individual and group counseling setting. Humor as a therapeutic tool is introduced as an easily integrated instrument of positive change through several case studies as depicted by the authors.     

Most Successful Intervention Strategies for Abused Older Adults

ABSTRACT

In this Project CARE study, intervention plans for 83 cases, with a total of 473 strategies, are analyzed in a qualitative content analysis method. The 473 strategies are designed and implemented by an abuse-trained, multidisciplinary, health and social service agency, home care team. Each strategy is rated by the team for its acceptance/refusal by clients and levels of success. The most accepted and successful strategies for abused older adults are concrete: nursing and other medical care and homemaking assistance, followed by empowerment strategies, such as support groups for abused older adults, information about rights and resources and volunteer buddy/advocates. Less successful strategies for abused persons are referrals to general community activities and programs. For caregiver abusers, the most successful and accepted interventions involve individual supportive counselling to reduce anxiety, stress and depression and education and training. Abuser-oriented strategies are most accepted and successful in the study. Thus, it would seem pertinent for intervenors to focus services and strategies on abusers and not only on abused older adults, in particular offering them supportive individual counselling to reduce anxiety, stress, and depression. For abused care receivers, home-based services can offer the necessary support to move out of their abuse situation with the help of volunteers and support group activities.     

From Despair to Integrity: Using Narrative Therapy for Older Individuals in Erikson’s Last Stage of Identity Development

Adults aged 65 and over are a growing population in the United States today. This population is underrepresented in the mental health literature despite the high rates of depression and suicide. Additionally, the newest generation of older individuals is more likely to seek therapy than past generations, furthering the need for mental health professionals to be prepared for treating older individuals. Erikson in Childhood and society, Norton, New York, (1950) describes this time period as being critical in terms of the final identity crisis, integrity versus despair. Integrity is marked by a positive evaluation of the individual’s entire life, less anxiety about death, and a feeling of gaining wisdom. Individuals who do not resolve this crisis can manifest despair in a number of ways, including depression, anger, and regret. This model proposes utilizing Narrative therapy (White in Maps of narrative practice, Norton, New York, 2007) to understand how elderly individuals evaluate their lives in reference to their environment. The model utilizes externalization, unique outcomes, and re-membering conversations to unlock subjugated stories and promote integrity.     

Post-Stroke Depression Among African-American Elders

ABSTRACT

In the United States, the expanding 65 and older population comprises 13% of the total population (U.S. Census, 2000, population estimates; projections). African-Americans will be the largest segment of Non-Caucasians 65 and older (Administration on Aging, [AoA], statistics, 2005). Post-stroke depression (PSD), is a common post-stroke consequence (May et al., 2002; American Stroke Association [ASA], 2005, behavior changes). Existent research on PSD focuses predominantly on Caucasian Americans. To my knowledge, no singular study examines the effects of PSD among African-American older persons. This article provides information that reveals the need to examine African-American elders in relation to PSD.     

House Demolition and Mental Health: Victims and Witnesses

This research examines the immediate effects of losing one's home and witnessing the demolition of others' houses on the mental health of Palestinian adults and children. The loss group consisted of 47 adults whose homes were demolished, the witness group of 24 adults who witnessed the house demolition, and the control group of 33 adults. The groups were compared for their anxiety, depression, and paranoiac symptoms. In addition, 38 children in the loss group, 36 children in the witness group, and 50 children in the control group were compared for their psychological symptoms. The results showed that adults who were exposed to house demolition showed a higher level of anxiety, depression, and paranoiac symptoms than the witness and control groups. The children in the loss group showed a higher level of psychological symptoms than the children in the witness and control groups. The witness group differed from the control group in having more depression among women and more psychological symptoms among children. Women suffered more from anxiety, depression, and paranoiac symptoms than men in the loss and witness groups but not in the control group.     

Mistreatment and Self-Reported Emotional Symptoms: Results From the National Elder Mistreatment Study

Many community-residing older adults in the United States report past year mistreatment; however, little is known about mental health correlates of abuse. This study investigated whether a recent history of emotional, physical, or sexual abuse is associated with self-reported emotional symptoms (e.g., anxiety, depression) among a representative sample of older adults. Results demonstrated that each abuse type increased likelihood of reporting emotional symptoms; when other known correlates were controlled, only emotional abuse remained a significant predictor. Additional study of mistreatment-related correlates of depression and anxiety is needed, with a focus on the often overlooked category of emotional mistreatment.     

Mistreatment and self-reported emotional symptoms: results from the National Elder Mistreatment Study

Many community-residing older adults in the United States report past year mistreatment; however, little is known about mental health correlates of abuse. This study investigated whether a recent history of emotional, physical, or sexual abuse is associated with self-reported emotional symptoms (e.g., anxiety, depression) among a representative sample of older adults. Results demonstrated that each abuse type increased likelihood of reporting emotional symptoms; when other known correlates were controlled, only emotional abuse remained a significant predictor. Additional study of mistreatment-related correlates of depression and anxiety is needed, with a focus on the often overlooked category of emotional mistreatment.     

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

Abstract

Background: Malnutrition is common in subjects undergoing hemodialysis and is associated with increased morbidity and mortality. Studies investigating factors associated with malnutrition and effect of various interventions to treat these patients are needed. We aimed to screen older and young patients undergoing chronic hemodialysis, for malnutrition, and seek its association with clinical factors including anxiety and depression and laboratory variables including urea/creatinine ratio (UCR).

Methods: Duration of hemodialysis treatment, medications taken, anthropometric measurements and routine laboratory results were recorded. Mini nutritional assessment and Beck anxiety and Beck depression inventories were applied. Study variables between subjects with malnutrition, malnutrition risk and normal nutritional states were compared. Older and younger patients were also compared regarding malnutrition and laboratory results. Linear regression analysis was performed to seek independent factors associated with malnutrition score.

Results: Clinical and laboratory data except for UCR were found to be similar among young and older patients. UCR increased, while albumin, body mass index and weight circumference decreased along with worse nutritional state. Low albumin level, body mass index and UCR and higher hemoglobin level and depression score were independent factors associated with malnutrition.

Conclusion: In addition to routinely used markers of malnutrition UCR may provide additional information regarding malnutrition in this population.     

Dating Relationships in Older Adulthood: A National Portrait

Dating in later life is likely common, especially as the proportion of older adults who are single continues to rise. Yet there are no recent national estimates of either the prevalence or factors associated with dating during older adulthood. Using data from the 2005–2006 National Social Life, Health, and Aging Project, a nationally representative sample of 3,005 individuals ages 57–85, the authors constructed a national portrait of older adult daters. Roughly 14% of singles were in a dating relationship. Dating was more common among men than women and declined with age. Compared to non‐daters, daters were more socially advantaged. Daters were more likely to be college educated and had more assets, were in better health, and reported more social connectedness. This study underscores the importance of new research on partnering in later life, particularly with the aging of the U.S. population and the swelling ranks of older singles.     

Community need for university-based mental health services: identifying the top 5

The purpose of this study was to determine the community need for mental health and health promotion services provided by advanced practice nursing faculty at a small university in the midwestern United States. Fifty participants from a three-county service area were selected to complete a needs assessment survey. Survey results indicated strong community need for primary mental health services for low-income residents, older adults, pregnant women, and families with children. Mental health services (particularly for depression), health promotion, wellness information, and primary mental health care were among the leading areas of need. In addition, low-cost mental health services were identified as the most significant need, which was magnified in the underserved, Hispanic population.     

Effects of Testosterone Treatment and Chest Reconstruction Surgery on Mental Health and Sexuality in Female-To-Male Transgender People

ABSTRACT. Objectives: This study examined the effects of testosterone treatment with or without chest reconstruction surgery (CRS) on mental health in female-to-male transgender people (FTMs). Methods: More than 200 FTMs completed a written survey including quantitative scales to measure symptoms of anxiety and depression, feelings of anger, and body dissatisfaction, as well as qualitative questions assessing shifts in sexuality after the initiation of testosterone. Fifty-seven percent of participants were taking testosterone and 40% had undergone CRS. Results: Cross-sectional analysis using a between-subjects multivariate analysis of variance showed that participants who were receiving testosterone endorsed fewer symptoms of anxiety and depression as well as less anger than the untreated group. Participants who had CRS in addition to testosterone reported less body dissatisfaction than both the testosterone-only or the untreated groups. Furthermore, participants who were injecting testosterone on a weekly basis showed significantly less anger compared with those injecting every other week. In qualitative reports, more than 50% of participants described increased sexual attraction to nontransgender men after taking testosterone. Conclusions: Results indicate that testosterone treatment in FTMs is associated with a positive effect on mental health on measures of depression, anxiety, and anger, while CRS appears to be more important for the alleviation of body dissatisfaction. The findings have particular relevance for counselors and health care providers serving FTM and gender-variant people considering medical gender transition.     

The gatekeeper model: implications for social policy

One of the most important needs of an aging population is to insure that older adults are able to live as independently and safely as possible. The question for social policymakers is how to meet this goal in an era of shrinking resources and growing numbers of older adults. The Gatekeeper Model is highlighted as a method to insure that older adults at risk of problems that impact their ability to live independently can be helped by existing systems of care. The model trains employees of community businesses and corporations who work with the public to serve as community gatekeepers by identifying and referring community-dwelling older adults who may be in need of help. A research project was conducted at Spokane Mental Health, Elder Services Division, where the model was developed. The results indicate that community-based gatekeepers found 40% of clients. Gatekeepers find a distinct population of community-dwelling older adults who are not found by more traditional referral sources. The social policy implications of the Gatekeeper Model are discussed.     

Panel discussions

Objective.?To determine (a) the relationship between life satisfaction, anxiety, depression and ageing in the male community and (b) to identify the impact of vulnerability factors, personal and social resources on life satisfaction and distress.

Design.?A stratified random sample of the German male population (N?=?2144) was investigated by standardized questionnaires of life satisfaction (FLZ^M), depression, anxiety (PHQ), resilience (RS-11) and self-esteem (RSS).

Results.?No age-related change was found regarding overall life satisfaction. Satisfaction with health decreased in midlife (51–60 years), while the importance of health increased. Importance of and satisfaction with partnership and sexuality were only reduced in the oldest group (70+). Anxiety was highest around midlife (51–60 years), accompanied by reduced resilience and self-esteem. No clear age-related change was found regarding depression. Life satisfaction was strongly associated with resilience, lack of unemployment, the presence of a partnership, positive self-esteem, a good household income, the absence of anxiety and depression and living in the Eastern states.

Conclusions.?Personal and social resources and the absence of anxiety and depression are of crucial importance for the maintenance of life satisfaction in ageing men. There is also evidence for a crisis around midlife manifested by health concerns, anxiety and reduced resilience.     

A Review of Lesbian Depression and Anxiety

SUMMARY

The Surgeon General's first report on mental health identified depression and anxiety as significant mental health issues that disproportionately affect women. Research indicates that lesbians experience depression at rates that parallel those of the general female population, suggesting that depression is an important mental health issue for lesbians. Given the high rate of comorbidity between depression and anxiety disorders, it is likely that many depressed lesbians have struggled with problems related to anxiety as well. This paper reviews literature pertaining to lesbians and depression including incidence rates, risk factors, suicidality and treatment approaches, and stress and anxiety that may also contribute to the experience of depression among lesbians.     

Resource Accessibility and Walkability Among Older Adults in Extended-Stay Hotels

Older adults represent a large and growing population group in the United States. This population cohort is projected to grow to 72.1 million, or 19% of the total population, by 2030, up from 40 million in 2010 (Administration on Aging, 2011; Federal Interagency Forum on Aging-Related Statistics, 2012). Despite reported decreases in the proportion of older adults living in poverty in recent years, inequities prevail. Approximately 40% of older American households reported housing cost burdens¹Cost burdens are expenditures on housing and utilities that exceed 30% of household income. (Federal Interagency Forum on Aging-Related Statistics, 2012). Many of these low-income older adults live in socially and economically marginalized positions, and housing them remains a major challenge complicated by (a) limited affordable housing options and (b) chronic health conditions that seriously undermine long-term health and mobility. In a study on the impacts of public housing transformation in Atlanta, Oakley, Reid, & Ruel (2011) reported that 26% of seniors entered public housing because of a health condition or disability. According to Smith (2006), seniors in public housing are in worse health than other older Americans, even other poor older Americans suffering from such chronic health conditions as hypertension, diabetes, arthritis, and asthma. Despite these realities, Ball (2012) has noted that older adults receive little attention in comprehensive development planning beyond specialized age-segregated retirement and care communities. Salkin (2009) echoes similar concerns about the tendency toward housing initiatives and designs for more affluent older adults. She commented that most states have focused attention on programs that are best suited for seniors who do not have the same income limitations as those who are truly on fixed incomes and living close to the poverty level (Salkin, 2009). While public housing remains the predominant affordable housing option for low-income older adults, such housing is out of reach for many low-income older adults who find themselves displaced and homeless. As a result, some of these adults move into extended-stay hotels to remain sheltered.     

Coping strategies used by LGB older adults in facing and anticipating health challenges: A narrative analysis

ABSTRACT

Given that lesbian, gay, and bisexual (LGB) older adults face notable health disparities compared to their heterosexual counterparts, there is a need for understanding how LGB adults cope with health challenges in late life. The current study analyzes narratives from nine LGB adults age 65 and older living in an urban area in the Southeast United States. Participants spoke of coping strategies related to health promotion behaviors, shifting perspectives of health and body, trusting in spirituality for comfort, and accepting the end of life. We discuss implications for social services professionals who work with older LGB adults and for future research.     

How do health shocks influence retirement decisions?

The financial viability of the nation’s Medicare and Social Security programs has come into question as older adult workers, in particular members of the baby-boomer generation, begin to voluntarily retire. Obviously, any deterioration in the health of older adults will inevitably increase pressure on the Medicare system. However, if older adults respond to changes in their health by reducing their labor supply, than this will also increase demand for the Social Security system. Using data on married and employed couples from the Health and Retirement Study (HRS), this paper determines how the labor supply of each member of a married couple is influenced by changes in the health, assets and medical expenditures of the other member of the couple. Therefore, adding to the extant literature as we determine how the labor supply of an individual responds to health shocks visited on their spouse. We find that the labor supply of both males and females is influenced by their own health shocks and health shocks suffered by their spouses.

Synthesizing ENABLE-AGE Research Findings to Suggest Evidence-Based Home and Health Interventions

ABSTRACT

As the quest for knowledge translation from research to practice and policy contexts is growing stronger, researchers need to develop strategies for synthesizing research findings. Since home environments constitute an important context for the delivery of health care and social services to older adults and people aging with disabilities, research in this field can serve as an example for such endeavors. Using 35 original publications and one unpublished doctoral dissertation based on the European ENABLE-AGE Project, we aimed to demonstrate a systematic approach to synthesize research findings generated by large research projects as the basis for evidence-based interventions. The synthesized findings highlighted the complex interactions between objective and perceived aspects of housing and aspects of health in very old age, impacting on, for example, residential decision making. Independence in daily activity is influenced by the sociocultural care and service context. A familiar and safe neighborhood, a social network, and a good supply of services are important to perceptions of participation. Going further, we suggest housing-related interventions that address problems and challenges related to ongoing demographic changes. This article contributes to the development of strategies for knowledge translation, connecting research and practice and policy contexts struggling to meet the societal challenges that accompany population aging.