Matthew J. Edlund M.D.

The Power of Rest

Therapy

Does Psychotherapy Aid the Elderly?

Sometimes Older You Get, the Better It Gets

Posted May 02, 2013

Is Psychotherapy Useful to the Elderly?

Yes. Of course.

Recently the issue has gained some prominence. Abby Ellin wrote an article in the New York Times “A Load Off Their Minds”, that attracted considerable attention. Yet that title sums the dismal state of public awareness of what is a major problem. Psychotherapy does a helluva lot more than take “a load off minds,” particularly of the elderly.

What Is the Problem?

Mental health in the population, and especially older people. About 30% of American adults get clinically depressed; many argue the rate in the elderly is higher. Alcoholism and drug dependence are also common – and uncommonly treated. Chronic diseases, from pain and arthritis to sleep disorders and coronary disease, have major, mutually reinforcing effects on physical and mental health. Add on the side effects of standard medical treatments and medications - and the encroaching public health disaster of Alzheimer’s – and the mental health problem in older folks is simply huge.

Why Is Coming to the Fore Now?

Demographics and money. People are living longer. Their physical, mental and social problems increase as they age. Plus there are more older people – a result of the post WWII baby boom.

And as always, there is the issue of money. Mental health parity – equal coverage for mental and physical illness - was supposedly “signed into law” over a decade ago. Thanks to the inventive actions of insurance companies, much of the implementation is only now affecting older people. Things start to happen when somebody actually pays for a service.

What About the Family?

Families have changed – often dramatically. The extended family of grandparents, parents and children now looks a historical remnant throughout much of America. Despite the economic ravages of the Great Recession, our generations generally live apart.

Yet many of today’s elderly remember the family structures of earlier times. They are often hurt and angry that they live alone, that their children are not around to help them throughout the day.

Formerly much of elder-care was performed by the female members of the following generation. Women who in previous decades worked at child rearing and elderly support while at home now labor for pay packets outside. They recognize that they should be treated equally with men in business and work. Many households would not survive without their income. Meanwhile, many working men are unwilling – or cannot conceive - of leaving the workforce to take care of parents. That leaves fewer family members able to take care of older parents – though many working women, especially, still feel the responsibility keenly.

The result – great intergenerational stress and much loneliness. And loneliness is not merely painful – it is often a killer.

Now add on the sad truth that half of people 85 and over will suffer from Alzheimer’s. Family problems – social, economic, psychological – simply mount.

And psychotherapy is an obvious place for family intervention.

Why Is Mental Health in the Elderly So Poorly Addressed?

Because we continually go back and reinvent the wheel.

Psychotherapy research on older folks goes back decades. I remember work by Emily Mumford in the 1980’s showing that psychotherapy not only worked well in the elderly, but was more effective in that group than in younger patients. Perhaps most telling, her data showed marked decreases in medical costs for those getting psychotherapy.

In an age where every headache deserves an MRI scan, we’re talking big bucks.

How Could Psychotherapy Save Us Health Care Money?

The ways are relatively limitless. Let’s just take a look at depression – the second highest economic cost to global economies of any diagnosis, eclipsed for now only by heart disease. Depression has multiple, manifold physical manifestations. Norman Geschwind, when chief of neurology at Harvard, often lectured on how depression could mimic almost any neurological disease – down to “pathognomonic” physical stigmata of stroke. And depressed people get lots of symptoms. They also get more medically ill (one reason the insurance companies love to cherry pick people with mood disorders off their lists). They even get more Alzheimer’s disease.

Treating depression effectively – through cognitive-behavioral psychotherapy, family psychotherapy, and non-pharmacologic techniques like light, physical, and social activity, can save a lot of lives and money.

Why Is Psychotherapy Particularly Powerful in the Elderly?

One big reason is drugs. Old folks take a lot of drugs. And effects and side effects of drugs are multiplied by age.

Aided by Big Pharma, many physicians routinely give older people antidepressants, anti-anxiety agents, even potent anti-psychotics as the “main” treatment for a host of mental problems – even symptoms as common as insomnia. It’s usually faster to prescribe pills than taking “all that time” to take about their overall problems, family issues, and behavioral means that could make people better.

Meanwhile, more hospital admissions arise from drug “side” effects. 

Psychotherapy has many effects, but it does not create drug side effects. It can be used readily, for example, to get people off sedative-hypnotics and other addictive drugs. And people also greatly benefit from talking with somone, social support, intelligent advice and sympathetic understanding.

Bottom Line

Psychotherapy for the elderly can and does do a lot more than take “a load off the mind.” It can treat common problems like insomnia and depression, knit families together, mitigate the effects of polypharmacy, alleviate loneliness and isolation, and at the same time provide major physical health benefits.  Elderly folks need to regenerate their bodies just as much as young folks. Humans bodies and brains rebuild - or die.

And psychotherapy can also save money. These days, that looks like a deal we shouldn’t pass up.