Behavioral Health Innovations for Older Adults

KEYWORDS:

• Mental Health
• Behavioral Health
• Psychotherapy
• Aging

Dear fellow clinical gerontologists

Providing mental health care to older adults can be creative and rewarding. In this issue, we present review papers and intervention development papers focusing on novel interventions to improve emotional well-being in older adults. Also included are a series of studies that aim to further parse discrete predictors of mental health in older adults, which may further inform future interventions.

We begin with three review papers. The first review paper describes 26 articles (23 studies) of “low intensity” interventions (self-help, psychoeducation, bibliotherapy, etc.) for older adults with mild-to-moderate mental health concerns (Cremers, Taylor, Hodge, & Quigley, 2022), finding improvements in mental health. The authors express enthusiasm for these approaches but urge caution about generalizability. The second review paper describes 32 articles (28 studies) of virtual reality interventions for persons living with Parkinson’s disease who experience anxiety (Thangavelu et al., 2022). The authors conclude that virtual reality interventions are feasible and potentially useful in this population. The third and final reviews in this issue is a major effort to synthesize mental health needs of older U.S. military veterans (Karel et al., 2022) considering prevalence and risk, utilization, intervention, and care delivery model studies. This paper will be a core resource for anyone seeking to understand mental health needs of veterans across mental health conditions.

Next, in this issue are smaller scale studies that examine innovative interventions using novel approaches such as mindfulness, meditation, nature, performance art, and visual art. In a pilot randomized trial (N = 19) mindfulness-based stress reduction (MBSR) led to increased relaxation, greater interpersonal connection, increased body awareness and changes in cholesterol (Gentile, Starnino, Dupuis, & D’Antono, 2022) in older adults at risk for coronary artery disease. In a non-randomized trial (N = 24) high rates of adherence were found in a 10 week “compassion mediation” program with improvements in satisfaction with life and rumination. The authors also present detailed participant feedback related to feasibility, impact, and age-appropriate modifications to guide a future randomized trial. In a charming paper about the potential value of nature-based activity for mental health, feedback from seven focus groups (N = 30) was used to develop and implement a 6-week pilot randomized trial (N = 11) for persons living in an assisted living facility (Lee, Cassidy, Tang, & Kusek, 2022). The intervention focused on connectivity with nature via a bird identification and appreciation group, demonstrating improvements in depression, affect, life satisfaction, and stress. Clearly, the work needs extension to a larger sample; the authors’ detailed descriptions provide a roadmap for others. Two final papers were contributed by new and emerging professionals in gerontology. In another novel intervention, 34 older adults completed either a “mirror game” (a synchronous movement exercise common to performance arts) or an exercise program (Keisari et al., 2022). Those in the “mirror game” group had enhanced performance on attention measures and measures of positive experience. The final paper in this section describes a program evaluation of an art-based intervention bringing together university students and older adults with dementia (Reel, Allen, Lanai, Yuk, & Potts, 2022), which increased social engagement.

When more intensive behavioral health care is required, where do older adults receive care? From 2012 to 2019 the proportion of mental health and substance use service facilities for adults that had a dedicated older adult program increased to around one-quarter of all programs (Choi & DiNitto, 2022). In their discussion, the authors discuss the importance of tailored programs and the need for more accessible and affordable programs. Like the earlier review paper on mental health in veterans, this paper provides a high-level review of care that can inform mental health-care policy and programming on a larger scale. Providing care to older adults will require age-appropriate programs and a prepared workforce. In a workforce study, graduate level mental health trainees’ (N = 488) negative bias toward older adults were magnified in those with higher aging anxiety and ageist attitudes (Caskie, Patterson, & Voelkner, 2022). The authors suggest that graduate programs work to address potential age-related biases in trainees.

The next set of papers looks at predictors of depression, anxiety, and insomnia. A large body of work has demonstrated relationships between frailty and depression. In this issue, Cho and colleagues (Cho et al., 2021) further parse these relationships in older adults (N = 796) who underwent geriatric assessments. They find recurrent falls predicted depression in men, whereas slow gait, weakness, and weight loss predicted depression in women. Similarly, Liu and colleagues (Liu, Wei, Peng, Xue, & Yang, 2022) further analyze relationships between loneliness and depression in older adults (N = 7,575). They find that life satisfaction mediates the relationship between loneliness and depression, with the availability of community recreational facilities unexpectedly boosting relationships between loneliness and depression in urban but not rural adults. This finding points to the complexity of addressing loneliness, a key variable in mental health receiving increased attention.

In a study to this point, more older adults reported loneliness during the pandemic (N = 2,910), perhaps not surprisingly. More unexpected is that loneliness was not attenuated by virtual contacts or social participation (Choi, Hammaker, DiNitto, & Marti, 2022). The authors emphasize the importance of in-person contact, and of making virtual contacts more similar to in-person contacts. Relatedly, a recent study sheds lights on potential difficulty with virtual contacts for some older adults. In older community dwelling adults (N = 71) technology-related anxiety but not social or trait anxiety was associated with smart phone use, suggesting a benefit from highlight tailored interventions for those experiencing technology-related anxiety (Mohlman, Tsang, Magee, Dalokay, & Basch, 2022).

Two papers considering insomnia are contributed by new and emerging professionals in gerontology. In older veterans (N = 83), insomnia was associated with PTSD and benzodiazepine dependence (Gutierrez et al., 2022). In comparing adults across all ages (N = 216), repetitive thought be it negative (rumination) or positive (savoring) was associated with insomnia across all age groups, suggesting that older adults may benefit from similar approaches to sleep management as used in younger adults (Tighe, Dautovich, Hilgeman, & Allen Rs Phd, 2022).

Ending on a positive note, our final paper reports on a quality improvement project to evaluate an “aging resiliently” group in 17 older adults across four group cohorts based on acceptance and commitment therapy (ACT) principles (Goetz & Hirschhorn, 2022). The group was well received, with participants reporting the self-reflection on values and social process of the group to be most helpful. We thank the authors of these papers for sharing their innovative approaches to care and their ongoing work to more deeply understand risk and protective factors for mental health in older adults. We look forward to future contributions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This material is the result of work supported with resources and the use of facilities at the VA Boston Healthcare System. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.