Older adults and the ‘medication versus therapy’ debate…
Contrary to popular belief, attitudes to psychological help seeking are often positive in the older adults, with research suggesting that older adults may be more open to psychological help than their younger counterparts. However, older adults are often particularly sensitive to stigma associated with mental illness, and subsequently fail to seek appropriate support. This is especially true for males, who often experience more stigma for help seeking than females. This may be a result of stereotypical gender roles, which dictate that men should remain stoic, not needing help for mental illness, further reinforcing the public and internal stigma of seeking help for mental illness. Consequently, somatic (physical) complaints often disguise underlying psychological discomfort, which unfortunately means that mental health needs can go undetected. Therefore, attitudes toward and education about psychological help seeking are in need of significant change.
Findings suggest education about mental health and psychological intervention can assist in improving attitudes toward, and willingness to engage in, psychological help seeking; education that can be provided by General Practitioners and Geriatricians. Current treatment practices indicate the use of medications, such as antidepressants or mood stabilisers to treat mental illness; however, there are several aspects to take into consideration before ruling out alternative forms of treatment, such as psychological intervention. Medication can be an effective measure for reducing mental health symptoms, yet common disorders such as depression and anxiety have been shown to respond well to psychological intervention, which in many cases significantly reduces the risk of relapse, even after the discontinuation of therapy.
So why is psychological help (intervention) so important in older adults?
According to recent literature, the application of cognitive therapy for the treatment of mental illnesses, such as depression, can foster continuing symptom relief and reduce the risk of relapse. This is due to the nature of cognitive therapy, which aids individuals to identify maladaptive thought processes, thus providing individuals with the appropriate skills to help them cope with, adapt to and participate effectively in everyday life. It is important to consider the role that therapeutic interventions may play in sustaining symptom relief for individuals experiencing mental illness. It can be used as both a preventative and a protective measure.
Research suggests in a number of cases psychological intervention is as, if not more effective than the use of pharmacological intervention (medication). Nonadherence to medication is high in the older adults population, with literature documenting rates of >30% of individuals failing to follow a course of pharmacological treatment. Psychological therapy, on the other hand, has generally high rates of treatment compliance and has been evidenced to improve depressive symptomatology and functional outcomes in the older adult population, often improving rates of pharmacological adherence, and improving overall quality of life for the individual. Health professionals are therefore encouraged to consider psychological intervention in the treatment plan for older adult patients presenting with persistent physical complaints or mental health concerns.
[1.] Mackenzie, C. S., Scott, T., Mather, A., & Sareen, J. (2008). Older adults’ help-seeking attitudes and treatment beliefs concerning mental health problems. The American Journal of Geriatric Psychiatry?: Official Journal of the American Association for Geriatric Psychiatry, 16(12), 1010–1019. http://doi.org/10.1097/JGP.0b013e31818cd3be
[2.] Conner, K. O., Copeland, V. C., Grote, N. K., Koeske, G., Rosen, D., Reynolds, C. F., & Brown, C. (2010). Mental health treatment seeking among older adults with depression: The impact of stigma and race. The American Journal of Geriatric Psychiatry, 18(6), 531-543. DOI: 10.1097/JGP.0b013e3181cc0366
[3.] Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 58(1), 5-14. DOI: 10.1037/0003-066X.58.1.5
[4.] Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54(1), 40-50. DOI: 10.1037/0022-0126.96.36.199
[5.] Helmes, E., & Gee, S. (2003). Attitudes of Australian therapists toward older clients: Educational and training imperatives. Educational Gerontology, 29(8), 657-670. DOI: 10.1080/03601270390225640
[6.], [7.] DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms. Nature Reviews. Neuroscience, 9(10), 788–796. http://doi.org/10.1038/nrn2345
[8.], [9.], [10.] Pampallona, S., Bollini, P., Tibaldi, G., Kupelnick, B., & Munizza, C. (2004). Combined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review. Arch Gen Psychiatry, 61(7):714–719. doi:10.1001/archpsyc.61.7.714