Psychotherapy
Barriers To Treatment
The present body of research in geropsychology supports psychotherapy as a treatment option for older persons with psychological disorders. However, several limitations curb its effectiveness. Older adults are less likely to report psychological problems and to seek help from mental health professionals or physicians than are younger adults. This may be due to social stigma associated with treatment for psychological problems. Psychological problems in elderly persons may also be underdiagnosed because they may pass off psychiatric symptoms as signs of physical illness. The responsibility for the diagnosis of psychiatric disorders in older adults is often left to primary care physicians, who have a limited amount of time with their patients. Also, mental health professionals with expertise in geriatric psychology are quite few, and therefore may not be available for referral.
Even when diagnosed, not all late-life psychological problems are treated adequately. Ageism still pervades American health policy and the minds of many health care providers. Research by Ford and Sbordone found that psychiatrists viewed elderly patients as less likely to respond to treatment than their younger counterparts. Only since 1989 has Medicare covered outpatient mental health care, and it still only covers 50 percent of the cost, compared with 80 percent coverage of physical health care costs.
Despite these barriers, there is convincing evidence that older adults respond as well to psychotherapy as do younger adults. It is important to begin to address the individual, physician, and policy barriers that prevent older adults with psychiatric disorders from receiving aggressive treatment.
CHRISTINE M. VITT AUTUMN EDENFIELD THOMAS R. LYNCH
See also ANXIETY; COGNITIVE-BEHAVIORAL THERAPY; DEMENTIA; DEPRESSION; GERIATRIC PSYCHIATRY; INTERPERSONAL THERAPY; LIFE REVIEW; PROBLEM SOLVING THERAPY; PSYCHOLOGICAL ASSESSMENT.
BIBLIOGRAPHY
ALLEN, R.; WALKER, Z.; SHERGILL, P.; DATH, P.; and KATONA C. "Attitudes to Depression in Hospital Inpatients: A Comparison Between Older and Younger Subjects." Aging and Mental Health 2 (1998): 36–39.
AREAN, P. A.; PERRI, M. G.; NEZU, A. M.; SCHEIN, R. L.; CHRISTOPHER, F., and JOSEPH, T. X. "Comparative Effectiveness of Social Problem-Solving Therapy and Reminiscence Therapy as Treatments for Depression in Older Adults." Journal of Consulting and Clinical Psychology 61 (1993): 1003–1010.
BECK, A. T. Depression: Clinical, Experimental and Theoretical Aspects. New York: Harper and Row, 1967.
BERNSTEIN, D. A., and BORKOVEC, T. D. Progressive Relaxation: A Manual for the Helping Professions. Champaign, Ill.: Research Press, 1973.
BEUTLER, L. E.; SCOGIN, F.; KIRKISH, P.; SCHRETLEN, D.; et al. "Group Cognitive Therapy and Alprazolam in the Treatment of Depression in Older Adults." Journal of Consulting and Clinical Psychology 55 (1987): 550–556.
BUTLER, R. N. "The Life Review: An Interpretation of Reminiscence in the Aged." Psychiatry 26 (1974): 65–76.
DUFFY, M., ed. Handbook of Counseling and Psychotherapy with Older Adults. New York: John Wiley & Sons, 1999.
FORD, C. V., and SBORDONE, R. J. "Attitudes of Psychiatrists toward Elderly Patients." American Journal of Psychiatry 137 (1980): 571–575.
FRANK, E.; FRANK, N.; CORNES, C.; IMBER, S. D.; MILLER, M. D.; MORRIS, S. M.; and REYNOLDS, C. F., III "Interpersonal Psychotherapy in the Treatment of Late-Life Depression." In New Applications of Interpersonal Psychotherapy. Edited by G. L. Klerman and M. M. Weissman. Washington D.C.: American Psychiatric Press, 1983. Pages 167–198.
HIRSCHFELD, R.; KELLER, M.; PANICO, S.; ARONS, B.; BARLOW, D.; DAVIDOFF, F.; et al. "The National Depressive and Manic Depressive Association Consensus Statement on the Undertreatment of Depression." Journal of the American Medical Association 277 (1997): 333–340.
REYNOLDS, C. F., III; FRANK, E.; PEREL, J. M.; IMBER, S. D.; CORNES C.; et al. "Nortriptyline and Interpersonal Therapy as Maintenance Therapies for Recurrent Major Depression: A Randomized Controlled Trial In Patients Older Than 59 Years." Journal of the American Medical Association 281 (1999): 39–45.
SCOGIN, F., and MCELREATH, L. "Efficacy of Psychosocial Treatments for Geriatric Depression: A Quantitative Review." Journal of Consulting and Clinical Psychology 62 (1994): 69–74.
SHEIKH, J. I., and CASSIDY, E. L. "Treatment of Anxiety Disorders in the Elderly: Issues and Strategies." Journal of Anxiety Disorders 14 (2000): 173–190.
SNELL, F. I., and PADIN-RIVERA, E. "Group Treatment for Older Veterans with Post-Traumatic Stress Disorder." Journal of Psychosocial Nursing and Mental Health 35 (1997): 10–16.
TERI, L., and MCCURRY, S. M. "Psychosocial Therapies." In The American Psychiatric Press Textbook of Geriatric Neuropsychiatry. Edited by C. D. Coffey, J. L. Cummings, et al. Washington, D.C.: American Psychiatric Press, 1994. Pages 662–682.
ZARIT, S. H., and KNIGHT, B. G., eds. A Guide to Psychotherapy and Aging: Effective Clinical Interventions in a Life-Stage Context. Washington, D.C.: American Psychological Association, 1976.
ZEISS, A. M., and BRECKENRIDGE, J. S. "Treatment of Late-Life Depression: A Response to the NIH Consensus Statement." Behavior Therapy 28 (1997): 3–21.
Additional topics
Medicine EncyclopediaAging Healthy - Part 3Psychotherapy - Depression, Anxiety Disorders, Dementia, Barriers To Treatment