Multiple losses are common as people age, including deaths of spouse, family, and friends. A less obvious form of loss involves the change in relationship quality with a spouse or friend who may be experiencing physical or cognitive impairment. These losses, as well as the awareness of one’s own mortality, often trigger a review and evaluation of unrealized dreams, lost opportunities, and unresolved relationships. This review may activate negative thoughts and maladaptive schema that impede the recovery process. In addition, the loss of meaningful relationships may isolate the older adult and reduce the opportunities for support and social interactions with others.

Cognitive-behavioral therapy interventions that seek to address these concerns can be helpful in reversing the negative spiral and engaging the individual in a more positive and adaptive response. For example, cognitive interventions that identify negative thoughts and challenge their accuracy will facilitate a more positive grief reaction and process. If the person believes that ‘I can’t survive alone,’ ‘My life is a total failure,’ or ‘I’ll never be happy again,’ then the person will find it difficult to interpret experience accurately. Cognitive techniques, such as ‘examining the evidence’ and ‘generating alternative thoughts,’ will facilitate a more positive recovery from loss and bereavement. In combination with behavioral techniques, such as increasing pleasant events and interactions with others, Cognitive-behavioral therapy helps move the person into a more problem-solving and adaptive response.

Cognitive-behavioral therapy (CBT) is an approach to treatment of psychological problems that emphasizes the relationship among cognitive processes (thoughts or beliefs), emotions, and behavior. The assumption is that what one believes about an event or experience impacts how one feels and behaves in that situation. Similarly, the activities or behaviors that one engages in will affect mood and thoughts. Thus, a depressed person is often trapped in a downward spiral of negative thoughts that lead to depressed feelings and disengagement from meaningful and pleasant activities. The approach to treatment assumes that changes in thoughts and behaviors will result in changes in mood. The process of treatment is active and directive, with the therapist and patient working collaboratively to identify and change negative or dysfunctional thoughts and increase participation in meaningful activities. The goal of CBT is to teach the skills needed to change the dysfunctional thinking and behaviors that contribute to negative mood. Thus, Cognitive behavioral interventions therapy emphasizes the teaching of coping skills for dealing with problems rather than ‘curing’ the problem. The expected consequence of teaching these skills is an increase in patients’ sense of self efficacy, competency, and coping abilities. These skills equip them to deal not only with present problems, but also with future problems. The leading figures in the development of general cognitive therapy approaches to treatment of mood disorders are Albert Ellis, Donald Meichenbaum, and Aaron Beck.

Abuse of drugs and alcohol is not uncommon among the elderly. The high rate of prescribed medication use, increased physiological sensitivity to drug effects, and the danger of interaction effects of multiple medications and/or alcohol place older adults at high risk for deliberate or accidental misuse of drugs or alcohol. In addition, some older adults turn to alcohol to help cope with stressful life events, thus increasing the risk of addiction or toxic interactions. (more…)

Research indicates that anxiety symptoms are more prevalent in elderly people than in any other age group, occurring at about twice the rate of younger adults. The types of anxiety disorders most common among the older population include generalized anxiety, mixed anxious-depressive syndrome symptoms, and phobias (often characterized by exaggerations of rational concerns). More rare are late-life onset of obsessive compulsive disorders (OCD) and panic disorders. (more…)

Depression is the most common mental health problem in the elderly. While the incidence in community-dwelling older adults is no higher than in the general population, the risk increases significantly with medical illness or institutionalization. Depression is probably the best researched of the psychiatric disorders in the elderly, with epidemiological evidence indicating that older adults have the highest suicide rate of any age group (one-fourth of all suicides are carried out by persons age 60 or older by taking sleeping pills suicide). (more…)

Cognitive-Behavioral Interventions Research documenting the efficacy of Cognitive-Behavioral Interventions in treating the psychological problems of older adults is encouraging. Cognitive-Behavioral Interventions has been shown to reduce symptoms of depression, anxiety, and somatic complaints (e.g., chronic pain elderly, insomnia) in multiple controlled studies. However, research also has indicated that there may be multiple variables to consider in determining whether Cognitive-Behavioral Interventions is the best approach to use with a specific patient and a specific problem. For example, differential effectiveness of Cognitive-Behavioral Interventions compared to other forms of psychotherapy is less certain. (more…)

Given the widespread use of technology in most occupations, one important issue concerns how the influx of technology will affect jobs for older workers and employment opportunities and the productivity for them. This issue is particularly important for today’s cohort of older workers, as they have not had the same exposure to technology that younger people have had. However, despite cohort differences, technology will continue to be a pertinent issue for future generations of older adults, as technology is dynamic and continuing to develop at an unprecedented rate. (more…)

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Hutchinson-Gilford Progeria syndrome (HGPS) is also known as progeria or progeria of childhood. Unlike Werner Syndrome, which has an autosomal recessive mode of inheritance, it is caused by a dominant mutation of a type known as a gain of function or a dominant negative. The affected gene is known as Lamin A/C. It codes for a protein that coats the inner lining of the nuclei of cells. There is evidence that defective forms of the protein result in two broad classes of abnormalities – a mechanical weakness of nuclei, with herniations of nuclear material, and defects in the regulation of gene expression. There is also evidence of accelerated replicative senescence of cultured somatic cells, but this is not as striking as in Werner Syndrome. (more…)

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The proportion of elderly at any age without any chronic conditions is small, and disease can trigger a cascade of events resulting in functional deficits and disability. An increase in the number of activities with which an elder has difficulty increases linearly with comorbidity, that is, coexistent medical conditions that further complicate not only the genesis of a functional deficit but also its treatment. For example, rehabilitation for a stroke for an individual who also has painful, degenerative changes in the foot and a low tolerance for stressful activity secondary to angina with exertion would present a particular rehabilitation challenge. Yet, this example encapsulates geriatric rehabilitation specialist’s emphasis on care and function, not cure and disease. (more…)

Older Person Care

• Older persons should benefit from family and community based care and protection in accordance with each society’s system of cultural values.
• Older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental, and emotional well-being and to prevent or delay the onset of illness.
• Older persons should have access to social and legal services to enhance their autonomy, protection, and care.
• Older persons should be able to utilize appropriate levels of institutional care providing protection, rehabilitation, and social and mental stimulation in a humane and secure environment.
• Older persons should be able to enjoy human rights and fundamental freedoms when residing in any shelter, care, or treatment facility, including full respect for their dignity, beliefs, needs, and privacy, and for the right to make decisions about their care and the quality of their lives.

Older Person Independence

• Older persons should have access to adequate food, water, shelter, clothing, and health care through the provision of income, family and community support, and self-help.
• Older persons should have the opportunity to work or to have access to other income-generating opportunities.
• Older persons should be able to participate in determining when and at what pace aging work withdrawal from the labor force takes place. (more…)

Over the past 60 years, many documents, including the 1948 Universal Declaration of Human Rights, have addressed the rights of all persons. But it was not until the Declaration on Social Progress and Development in 1969 that the human rights of the elderly were specifically mentioned in an international rights document (Office of the United Nations High Commissioner for Human Rights). The United Nations adopted the first International Plan of Action on Ageing in 1987 and the General Assembly of the United Nations adopted the Principles for Older Persons in 1991. (more…)