Working with Seniors: Health, Financial, and Social Issues

Chapter 4: Mental Health, Loss, and Grief in Later life

For many years Mr. Nyang joked with his daughters, Mia and Amy, about his poor memory. However, they recently started to worry that something was seriously wrong. Their father stopped going out, which he attributed to his arthritis pain; he lost all interest in food; and he acted dazed a lot of the time. He also stopped joking about his memory problem, which seemed to be getting worse. “I’m 84 years old—I’m just slowing down,” he snapped at his daughters.

Mia and Amy went to a seminar on dementia held at a local hospital, and they came away certain that their father was suffering from Alzheimer’s disease. Mia made an appointment for Mr. Nyang with a geriatric psychiatrist. During the appointment the psychiatrist asked a number of questions about Mr. Nyang’s history and mood, when the symptoms began, and whether he had a history of depression. She also gave him a mental status examination. The doctor recommended that Mr. Nyang have further tests and try taking a low dose of an antidepressant medication for four weeks.

A month later Mia and Amy escorted their father to the psychiatrist for a follow-up visit. Mr. Nyang told the doctor that he was feeling a little better after a month of medication, and the doctor reported that the results of Mr. Nyang’s tests did not indicate dementia. Mr. Nyang did not have Alzheimer’s disease. These facts confirmed what the psychiatrist had suspected: Mr. Nyang was suffering from a major depressive episode. The psychiatrist continued to treat Mr. Nyang’s depression, and he slowly felt better. The daughters felt tremendous relief when their father started joking about his memory again.

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Mr. Bernstein, 76 years old, spent the early years of his retirement playing handball in his neighborhood park with neighbors half his age. He enjoyed the respect and admiration his younger friends had for him for the agility and skill he maintained at his age. He also enjoyed mentoring these friends as they shared stories between games.

Then Mr. Bernstein hurt his back while lifting a box. The injury kept him off the court for six weeks. When he returned to the game, he found that he was out of shape and could not play as well as he had played prior to the injury. Despite attempts to rebuild his strength, Mr. Bernstein struggled with the game and eventually stopped playing due to fears of having another injury. He was embarrassed that he could not keep up with others. Believing that he had lost not only his ability to play, but also the respect of his neighbors, Mr. Bernstein stopped going to the park. He felt discouraged at the loss of roles as athlete, community member, and mentor. Mr. Bernstein is now at a crossroads, facing the challenge of finding other roles that will utilize other strengths, or continuing on the path toward feeling bad about himself.

Introduction

As the stories here demonstrate, later life presents seniors with a number of challenges. Such challenges include adapting to changes in physical, functional, recreational, and social status and transitions to new roles. In addition, many seniors have the challenge of giving or receiving care. They must also confront the realities of physical limitations and death. Despite these challenges, most seniors have the personal and social resources to understand and deal with them.

Many seniors also develop wisdom, or expertise in the pragmatics of life, which research demonstrates is more prevalent among older adults than younger adults (Baltes, Smith, & Staudinger, 1992). Wisdom comes through experience and provides many older adults with tools for coping with challenges in later life.

Despite late-life problems, many older adults report feeling more self-confident, better adjusted, and more accepting than when they were younger. Further, the experience and expression of both positive and negative emotions tends to be less intense for older adults, which may account for their improved emotional control in later life (Fillip, 1996). In short, the vast majority of older adults function very well in their later years.

At the same time, some older adults develop mental disorders. This chapter will review the major mental health problems that older adults may face, and what can be done to address these problems. This chapter will also review the many losses of later life and associated bereavement and grief.