To preserve a sense of control over the future is a way to
buffer the transition into the elder years. This is one of the most difficult
problems humans face in in western societies.
Growing old entails, the ability to learn tolerance for loss and to let
go of strings of power in the family and/or community. During retirement
preventing loss of identity is paramount. Loss of health and physical strength
are factors that contribute to the sense of loss of power and feeling of
mastery of the present and future. Seniors consult when they are depressed or
anxious due to these abrupt unpredictable changes in their lives.
When reaching the age of retirement people have at least
three decades of experience before them. With the advancement of years and age
seniors who retire may become severely depressed and anxious and require
immediate attention.
The elderly’s goal of treatment requires the therapist’s
skill and ability to stimulate senior’s curiosity and mindfulness and the
fortitude to recognize their need for attending to his/her
Mental state and Mental Functioning.
1) Throughout the evaluation of an elderly person a skillful
examiner considers the appropriate treatment to prescribe. This evaluation
includes assessment of the elderly in his historical and social-cultural context
in the past and present
2) A thorough disease
history of the patient, his nuclear and extended family, if it is possible a
genetic history obtained from his wife or significant others
3)exhausting blood workout and neurological imagery is
important
3) Cognitive evaluation and history of cognitive status.
4) Sleep history
5) Sexual history
6) Query about relationships to his children and conjugal
history
7) Diary of activities including sleep and meals
8) Permission to communicate with other medical
practitioners, lawyers etc. that the patient or the family had consulted
9) If pertinent:
permission to communicate and share with responsible family members the
findings of the evaluation.
The prescription of treatment will depend of the patient’s
ability to communicate and understand the reason for being treated and his or
her willingness to cooperate.
Objectives of Psychotherapy
·
To listen empathically to elderly expressions of
sorrow for loss and attend to support pride
in their accomplishments.
·
To stimulate in the patient a self and observing
self reflecting attitude that leads to insight and mindfulness.
·
To help the senior realize that he/she is still
the owner of their future and has new possibilities to develop new generative
mental functions. Support the development
of new interest: e.g.: start a hobby, volunteer in hospitals, museums, sport
events, etc. To the extent that it is feasible a retiree can still develop
creative grandparenthood with a new opportunity to rework their experiences of
their own parenthood and youth.
·
With the patient’s permission the family and/or
significant others can be invited to support and share in those therapeutic
encounters.
Therapeutic intervention involving family members
Objectives
·
To support and educate families members. Family
members often feel burdened by the demanding needs of their elderly.
·
Many senior retirees have reached early or are
in their way to achieve latter a new developmental stage. In those who have
matured to perform age appropriate tasks new anxieties may be the results of
new and unexpected demands on their lives. E.g.: unemployed children may return
to live at home with elderly parents posing new relationship conflict.
·
Education of family members regarding this
development stage including the needs and the task of growing old will help
them develop empathy for their declining years.
·
Cognitive decline in seniors poses increased
conflictual relationships in extended families and cultural derived encounters
that are psychologically conflictive.
·
Awaking feelings of love and compassion so that
grown children and grandchildren feel drawn to help the elderly.
·
Family participation can help the senior develop
a new ability to tolerate inevitable loss: of friends, family, work and significant
others.
·
The available and awareness of family support can
help the retirees in creating and maintaining social networks. that while working were a source of pride and
companionship.
·
To help support the family members who feel
shame, and are distant and appear unloving and help them to remedy the
frustration that brings sorrow, guilt, and express frustration apparent lack of
compassion for the elderly’s failings.
·
To address the loss of sexuality both in the
client and significant sexual partners. Medications may be indicated to address
this loss.
·
Open up hope and help the senior realize that
there are possibilities of new generative functions in old age. To develop a hobby, volunteering in
hospitals, museums, sport events, etc.
·
A retiree can still develop creatively
grandparenthood with a new opportunity to rework the experiences of their own
parenthood and youth.
·
To the extent that it is feasible cultures have already
developed protections. It behooves
the culturally sensitive Psychiatrist to learn those and provide this knowledge
to the family.
Culture can reinforce or prevent the sense of loss and the
loss of the locum of control suffered by the elderly. In modern western cities, the above risks and
loss of identity by elderly citizens is prevalent as compared with traditional
societies. Work and professions contribute in the young to have pride in their
working identity
Protective and
preventive factors prior to the experiences of the stress of loss.
a)
Help the patient that experiences loss due to
the imminence of retirement to take time before he or she re engages in new
activities to recognize Stress and then to make it so that it is predictable.
of retirement, illness and loneliness.
b)
Mourning and loss of spouse. The ability of the
therapist or physician to empathize with the senior’s feelings of emptiness
when mourning for a life companion is fundamental in Mental health.
c)
There are Psychotherapeutic and Pharmacological
tools to help regulate mood and prevent suicidal thoughts.
d)
Counseling and referring the elderly to use
ancillary therapies e.g. group therapy, physical exercise, appropriate diet, to
prevent continues deterioration is the task of a psychiatrist treating seniors.
More that two million of the 34 million American age 65 and
older suffer from some form of depression.
Risk of loss of attachments is a common dynamic activated in
the elderly. This is because when we face older age we need to work through the
awareness of the need to let go of the intensity of our demand for
relationships to objects and people, including the relationship to life itself.