Geriatric Psychology

In the early twenty-first century, seniors were the fastest growing population in the United States and many other countries. There will be an estimated 72 million Americans over age 65 by 2030, up from 40 million in 2010. Other than cognitive impairment, aging is generally associated with improved mental health. Nevertheless, with growing senior populations, geriatric psychology becomes increasingly important.

Psychological development continues throughout life. Although short-term memory and performance of certain specific mental tasks may deteriorate with age, other areas, such as wisdom and judgment, become sharper. Furthermore, in their early fifties, adults begin to undergo profound emotional changes— often referred to as attaining maturity—that may contribute to improved mental health. Thus, aging is typically accompanied by increased emotional equanimity. Numerous studies have found that older people moderate their emotional responses more effectively than younger people, approach problems with a more balanced attitude, and behave more appropriately. Older adults are more attentive to positive emotional stimuli and are more likely to remember positive emotions than negative emotions. Although learning and experience play an important role in the development of emotional control, there are also age-related decreases in the activity of amygdalae—structures in the brain that are responsible for intense emotions, particularly negative emotions. Thus, older adults are less prone to the following:

Other psychological changes accompany aging. Some studies have found that the ability to solve everyday problems improves significantly in later life. This ability, which has been called pragmatic creativity or crystallized intelligence, may reflect a lifelong accumulation of problem-solving strategies. The human brain also has an amazing ability to influence its own aging. From middle age on, the drive to achieve usually diminishes, and the need for community and belonging increases. Studies have repeatedly shown that strong social and community connections and physical activity are among the most important factors for successful aging. Seniors who play musical instruments have been found to be physically and psychologically healthier than their nonmusical peers. Furthermore, geriatric psychologists believe that the process of reviewing one's life is a part of normal aging that can lead to greater self-awareness and self-acceptance. These and other psychological factors can have a profound influence on the immune system and overall health.

An estimated 20% of Americans aged 65 and older have a diagnosable psychiatric disorder, including dementia. While anxiety and depression are the most frequent mental-health disorders affecting the elderly, more than 50% of nursing-home residents have some type of cognitive impairment, and many more have personality disorders exacerbated by chronic health problems. Elderly people with serious mental disorders are at high risk for obesity, high blood pressure, diabetes, heart conditions, respiratory illnesses, and infectious diseases, and they have a significantly shorter life expectancy than their mentally healthy peers. Furthermore, many older adults have sub-clinical mental health and substance-use problems associated with the loss of functional abilities. Almost 7% of Americans aged 65–74 report experiencing frequent mental distress. In addition to serious or disabling long-term mental disorders, older adults frequently experience stress and emotional turmoil surrounding circumstances such as retirement, moving from the family home, lowered social status, reduced physical and mental capabilities, loss of family and friends, disabling illness, and the prospect of death. Substance abuse, especially alcohol and pain medications, is a growing problem among the elderly. Dementia (which often coexists with anxiety and depression) and pain from chronic diseases are also major psychological issues.

An estimated 11% of older Americans suffer from anxiety disorders, which often go unrecognized both by the elderly themselves and their doctors. Like other mental disorders, anxiety is treatable with therapy and medications. Untreated, it can lead to cognitive impairment, poor physical health and disability, and a deteriorating quality of life. Common anxieties in the elderly are:

Although depression is not a normal part of ageing, estimates of depression among older Americans range up to 20% or higher. Many older adults with depression suffered depressive episodes earlier in life. A first episode of depression late in life is usually brought on by another medical condition, disability, or dependence on others. Seniors with depression and coexisting chronic health problems, such as diabetes or heart disease, are at higher risk for heart attacks, cancer, disability, and premature death. Hip fractures are slower to heal. Even mild depression can lower immunity and increase susceptibility to infections and cancer. Dysthymia, a mood disorder characterized by mild depression and irritability, is also common in the elderly and is sometimes mistaken for depression, anxiety, or even dementia. Up to 80% of older adults recover from depression with appropriate treatment; however, lack of treatment, misdiagnosis, or inappropriate treatment can have serious physical consequences.

Depression is a major risk factor for suicide. Adults 65 and older have a 50% higher suicide rate than the general population and account for 20% of all suicides. Non-Hispanic white males aged 85 and older have six times the suicide rate of the general population. Although 20% of older suicide victims saw a doctor on the day they died—and 40% in the previous week, and 70% in the last month—physicians often miss signs of suicidal depression.

Dementia is not a normal part of aging, and some forms of dementia are treatable and reversible. Alzheimer disease (AD), the most common type of dementia, affects one in eight Americans over 65— about 5.4 million people. New diagnostic tools and interventions have enabled earlier diagnosis of AD and treatments for problematic behaviors. Psychological intervention may also help prevent AD, since it is estimated that up to half of AD cases worldwide may be attributable to modifiable risk factors, including diabetes, midlife hypertension or obesity, smoking, depression, and cognitive and physical inactivity. Psychotherapy and support groups can help people with early-stage AD develop coping strategies and reduce stress. Memory-training strategies can optimize cognitive abilities. Geriatric psychologists can assess patient capacity for making healthcare and legal decisions and teach behavioral and environmental strategies for helping caregivers. AD and other forms of dementia are often accompanied by depression, anxiety, and paranoia, which can benefit from diagnosis and treatment by geriatric psychologists.

About 80% of older adults have at least one chronic health condition, and up to 65% have two or more. Geriatric psychology can help patients manage these conditions through behavioral interventions, including treatment adherence, physical activity, nutrition, biofeedback, stress reduction, and eliminating smoking and alcohol abuse that contribute to or exacerbate chronic conditions. Other roles for geriatric psychology include:

Older Americans with mental disorders are less likely than younger people to receive mental-health services and, when they do receive services, are less likely to receive them from a specialist. It is estimated that up to 60% of people over 65 with diagnosed mental or substance-use disorders do not receive services or treatment. Because their mental and physical health problems, substance use, and requirements for aging services often overlap, older people can fall through service gaps. The services that are available are not usually focused specifically on geriatric psychology. Physical health and mental health in older adults are interrelated in complex ways, and older people are more likely to complain to their primary-care provider about a physical problem than to seek mental-health care. Furthermore, their mental-health problems are often misdiagnosed, overtreated, or undertreated. Although many older adults would prefer psychotherapy to psychoactive medications, they often are not given this alternative. Other factors affecting mental healthcare access among the elderly are:

See also Anxiety disorders; Dementia ; Depression .