Innovating Mental Health Treatment for Older Adults

KEYWORDS:

• Aging
• mental health
• mindfulness
• PTSD
• trauma
• memory skills
• computer training
• reminiscence
• financial exploitation
• telephone therapy

Fellow clinical gerontologists: One of the things I have always valued about Clinical Gerontologist is its focus on clinical application, and its openness to articles spanning the range from efficacy, effectiveness, to program evaluation. Each of these methods is important for moving the field forward. As clinicians, we know that it is extremely rewarding to provide clinical care for older adults. Mental health treatments are often effective and, in addition to the expertise of the clinician, draw from the expertise of the older adult built on decades of adaptation and resilience. Our evidence base related to mental health interventions for older adults is robust in some areas, but still being developed in other areas. This issue focuses on reviews, original articles, and clinical comments in a number of innovative areas in which we are growing our evidence base.

Our first review describes seven randomized controlled trials (RCTs) using mindfulness-based approaches in older adults (Hazlett-Stevens, Singer, & Chong, 2019), supporting its use for treating symptoms of anxiety and depression, along with health conditions such as insomnia. The authors conclude that large-scale RCTs are needed to truly map the benefits and limits of mindfulness-based interventions. A second review comes from our own group at VA Boston, focusing on late-life post-traumatic stress disorder (PTSD) (Pless Kaiser, Cook, Glick, & Moye, 2019). Presently there are only four published RCTs of psychotherapy for late-life PTSD with older adult samples, and little research to guide complex issues related to PTSD in the setting of comorbidities (e.g., cognitive changes, pain) or PTSD at the end of life. Our review summarizes the literature in the areas of epidemiology, assessment, and treatment, drawing from the literature as well as commentary of experienced clinicians.

Next, we move to original research and program evaluation which focus on well-being. First, Bartholomaeus and colleagues describe two RCTs (N = 58; N = 68) in which they trained community staff to deliver an 8-week well-being intervention to older adults in South Australia (Bartholomaeus, Van Agteren, Iasiello, Jarden, & Kelly, 2019). Second, Friedman and colleagues describe their multi-site implementation (N = 169) of their 6-week well-being intervention in the United States (Friedman et al., 2019). In both studies, gains were seen in some domains of well-being, particularly for those with lower well-being at the start (Bartholomaeus et al., 2019), and sustained over 6 months (Friedman et al., 2019). Both of these reports are important for expanding our intervention framework beyond symptom reduction to consider improvements in well-being.

We have three articles that target cognitive outcomes. Clinical Gerontologist focuses on behavioral health, including cognitive health and function. For example, in 2018 our journal presented results of 12-week memory skills group RCT (with the full treatment manual included as an online supplement!) (O’Connor et al., 2018). In this issue, we hear about an 8-week memory skills group for N = 101 older adults with PTSD which enhanced life satisfaction and cognitive self-efficacy in pre-post comparisons (Tyrrell, Shofer, & Trittschuh, 2019). A second study provides a qualitative examination of markers of cognitive reserve in N = 15 older adults undergoing a reminiscence interview (Colombo, Balzarotti, & Greenwood, 2019). This study provides clinicians and researchers a framework for thinking about the concept of cognitive reserve during life review interventions. Finally, Rouse, Small, and Faust (2019) describe their 12-session cognitive training RCT in which they varied the level of social interaction, finding that the level of social interaction influenced cognitive outcomes.

We close with three clinical comments examining innovative approaches to important problems. We often hear that financial exploitation of older adults is a growing concern, although our work to move the needle on prevention and intervention has been disappointing. In our first clinical comment, Lichtenberg and colleagues provide us an approach for intervention in financial exploitation. They describe their “SAFE” intervention for older adults after financial exploitation, describing its application in four cases (Lichtenberg, Hall, Gross, & Campbell, 2019). Another important area of innovation of particular relevance for older adults is the delivery and evaluation of telephone-based interventions. Here, Wuthrich and Rapee describe pilot results (N = 6) of a 10-week telephone-delivered RCT of cognitive behavioral therapy for anxiety and depression in adults with Parkinson’s disease (Wuthrich & Rapee, 2019). They establish the feasibility, acceptability, and preliminary evidence for efficacy. Yet another area of innovation is in the use of community peers for service delivery. In our final paper, we hear about a narrative interview intervention administered to N = 53 hospital inpatients by three volunteers, which found an increase in positive affect and satisfaction by those participating in the interview (Rybarczyk et al., 2019).

Disclosure statement

No potential conflict of interest was reported by the authors.