Geriatric Therapy: How to Help Older Adults With Depression

As life expectancies continue to increase in industrialized countries, so too will the prevalence of emotional and psychiatric disorders such as depression among older people.

Fortunately, there are many effective therapeutic approaches and activities aimed at enhancing resilience among the elderly.

This article will describe geriatric therapy in general, applicable treatment options, the issue of depression among older people, helpful activities, and useful resources.

Consistent with the idea that “aging is not lost youth but a new stage of opportunity and strength” (Betty Friedan, n.d.), the information and tools provided herein will aid individuals in enjoying a high level of health and satisfaction throughout their lifespan.

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What Is Geriatric Therapy?

Geriatrics is “a branch of medicine that deals with the problems and diseases of old age and the medical care and treatment of aging” (Geriatric, n.d.).

Geriatric mental health therapy is focused on the psychological and emotional needs of individuals over the age of 60. Geriatric mental health is a burgeoning area in need of attention, as nearly one out of five elderly Americans experience at least one mental health disorder (Institute of Medicine, 2012).

According to the World Health Organization (WHO, 2017), around 15% of the geriatric population worldwide has a mental health disorder.

The high rates of psychological problems among older people are related to declining health and mobility, cognitive impairment, financial stress, chronic pain, elder abuse, and loneliness (WHO, 2017).

The outcomes of these risk mechanisms are disproportionate rates of depression, anxiety, and substance use issues among the elderly (WHO, 2017). And since adequate mental health treatment is less likely among older people with psychiatric problems (Bartels, 2002), accessing and treating mental health issues among geriatric populations is of immediate importance.

Fortunately, there are various effective approaches to treat mental health disorders among the elderly.

How to Help Older Adults With Depression

Depression represents one of the most prevalent and serious mental health issues faced by the elderly.

For example, in a study examining the prevalence of depression among seniors, Djernes (2006) reported the following:

1. In private households, rates of depression were between 0.9% and 9.4%
2. In institutional settings, rates of depression were between 14% and 42%

Predictors of geriatric depression included lack of social contacts, somatic illness, functional impairment, cognitive impairment, female gender, and history of depression (Djernes, 2006).

In a related study, significant risk factors for geriatric depression included poor self-rated health status and chronic disease (Chang-Quan et al., 2010).

Clearly, treatment approaches and lifestyle choices aimed at reducing depression among the elderly are needed.

Meta-analyses show a paucity of research focused on the impact of psychotherapy for the treatment of depression among the aged, but also suggest that treatment approaches aimed at enhancing illness management, quality of life, and daily living activities represent key target areas for geriatric mental healthcare (Mackin & Areán, 2005).

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9 Therapy Intervention Ideas

Empirical research supports the efficacy of multiple types of mental health therapy among older people. Here are nine examples:

1. Interpersonal Therapy (IPT)

This therapeutic approach is a short-term, structured process in which the practitioner and client work on identifying the client’s underlying problems and developing effective coping strategies.

Interpersonal Therapy, which has been found effective to treat depression, is implemented in the following three phases (Miller, 2008):

1. Exploration of the client’s difficulties and how they are affecting them
2. Identification of positive coping strategies and ongoing review of how they are working during treatment
3. Consolidation of the benefits of the client’s new coping strategies and preparation for the client to continue using them following treatment

Unfortunately, there is a lack of scientific studies specifically investigating the effects of IPT on older individuals, with most research only addressing IPT combined with medication (Mackin & Areán, 2005).

Of the few studies specifically addressing IPT, preliminary findings suggest that IPT may be a highly promising approach for older clients suffering from suicidal ideation and depression (Heisel, Duberstein, Talbot, King, & Tu, 2009).

Similarly, according to their extensive literature review, Bartels et al. (2004) found that IPT was effective specifically for the treatment of depression among older individuals.

Additionally, based on his comprehensive review, Miller (2008) posits that IPT is easily adaptable to older populations and may be especially useful for grief management and the development of coping skills for the transition to long-term care.

IPT also represents a potentially effective add-on treatment component for individuals receiving pharmaceutical therapy (Miller, 2008).

2. Cognitive-Behavioral Therapy (CBT)

CBT is based on the assumption that “emotional disorders are maintained by cognitive factors, and that psychological treatment leads to changes in these factors through cognitive and behavioral techniques” (Hofmann & Smits, 2008, p. 621).

This approach addresses both behavioral and cognitive influences on an individual’s emotions in a particular situation. Bartels et al. (2004) suggest that CBT represents an effective treatment for depression among older clients.

Likewise, Holland, Chong, Currier, O’Hara, and Gallagher-Thompson (2015) investigated CBT as a way of promoting meaning among individuals with geriatric depression. The researchers found that CBT was effective in fostering enhanced positive world views, values, and purpose in life among participants with higher education.

3. Exercise training

Staying physically active is essential for older populations, as it fosters emotional wellbeing, physical health, and longevity. Exercise training is also important for preventing injury.

Hauer et al. (2001) examined the impact of a three-month exercise program aimed at improving strength, mobility, and balance among geriatric participants with a history of falls.

The results showed that exercise was linked to increased functional motor performance, strength, and balance – effects that continued at three-month follow-up (Hauer et al., 2001).

Along these lines, in a literature review examining randomized controlled trials focused on exercise treatments among the elderly, exercise was found to represent a beneficial approach for treating depression among this population (Sjösten & Kivelä, 2006).

4. Occupational Therapy (OT)

OT is an approach that involves “the use of purposeful activity or intervention designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain or restore the highest possible level of independence” (Punwar & Peloquin, 2000, p. 5).

Research has supported the efficacy of OT among older individuals. For example, according to a systematic review of OT approaches among patients in acute geriatric wards, several studies reported higher degrees of functionality in terms of daily living skills (Cuevas-Lara et al., 2019).

5. Animal-Assisted Therapy

Pets have an amazing way of calming anxiety and promoting compassion and tenderness.

Many older people enjoy cats, dogs and other pets without realizing the many ways in which their non-human pals enhance emotional wellbeing. This idea is borne out in the substantive research.

For example, Vrbanac et al. (2013) examined the impact of dog companionship among geriatric nursing home residents. The authors found that participation in the program was associated with reductions in loneliness.

Overall, having a pet is a fun way for older individuals who are fond of animals to greatly improve their own quality of life, as well as that of their furry companion.

Read more about this in our article Pets & Wellbeing: 15 Benefits of Emotional Support Animals as well as this fascinating read on Animal Therapy.

6. Music Therapy (MT)

A person need not possess any musical talent to enjoy the benefits of music. For example, Okada et al. (2009) examined the impact of Music Therapy among elderly participants with dementia and cerebrovascular disease.

The treatment group received MT once a week over 10 times. Patients in the MT group experienced increased parasympathetic activity and reduced congestive heart failure events, which are the most common cause of death among seniors (Okada et al., 2009).

Similarly, in a randomized controlled trial, institutionalized geriatric patients with mild depression underwent a group singing intervention. Those who received the intervention showed significantly lower depression and loneliness than controls after three weeks (Mathew, Sundar, Subramaniam, & Parmar, 2016).

7. Laughter Therapy

Laughter is the sun that drives winter from the human face.

Victor Hugo

It is often said that laughter is the best medicine, a notion that is consistent with the research literature. For example, in a study by Lee, Seo, Lee, and Jung (2016), a laughter therapy program was implemented in order to promote healthy aging among the elderly.

Participants received 60 minutes of laughter therapy for 10 weeks. Those in the treatment group enjoyed reduced stress and more successful aging relative to the control group.

Another study looked at the impact of laughter on sleep, cognition, and depression among elderly individuals. The researchers found that participation in laughter therapy was associated with improvements in sleep quality and insomnia, as well as depression symptoms (Ko & Youn, 2011). Considering these findings, seeking out that which makes you laugh is not only fun, but healthy too.

For more in this, read this article about laughter yoga for a practical way to encourage laughter as a therapy.

8. Art Therapy

Being creative through art therapy is another great way to enhance healthy aging.

Research supports the benefits of art therapy among the elderly. For example, in a study examining the impact of art therapy among older Korean–Americans, the intervention was associated with improved self-esteem, reduced negative emotions, and lower anxiety (Kim, 2010).

Similarly, in their meta-analysis, Masika, Yu, and Li (2020) reported that visual art therapy was associated with improved cognitive function, and reduced depression and anxiety.

Lastly, in a study in which informal art therapy was implemented among low-income seniors, participation was linked to reduced resistance in terms of accessing and using important social services (Rodriguez, 2018).

9. Reminiscence Therapy (RT)

Reminiscence Therapy, also known as Life Review Therapy, involves having individuals discuss past experiences and events using various prompts (e.g., photos) as memory triggers (Subramaniam & Woods, 2012).

Although often used to improve memory among dementia patients, RT may also be helpful for enhancing mood among older people. RT is useful as both an individual or group therapy, and as a standalone or adjunct approach.

Research suggests that RT is a viable approach to treat depression among the aging. For example, among elderly depressed women in an assisted living facility, those who took part in RT experienced significantly lower depression symptoms after the three-week intervention (Jones, 2003).

RT has also been found to reduce depression among older people when combined with antidepressants (Lynch, Morse, Mendelson, & Robins, 2003).

A Look at Geriatric Group Therapy

Geriatric group therapy is an excellent way for older people to feel a sense of support and camaraderie with others dealing with similar issues.

Group therapy may also help to reduce social isolation. The limited research available suggests that group therapy is a good option for older people with depression (Agronin, 2009; Tavares & Barbosa, 2018).

Here are five examples of studies showing evidence for the benefits of group therapy among older people:

• In their systematic review, Tavares and Barbosa (2018) reported that of nine identified studies, eight found significant reductions in depression among depressed seniors participating in group therapy. The authors further noted that group therapy was effective across participant qualities, protocols, and settings.
• Husaini et al. (2005) examined the effect of group therapy among depressed elderly women in Tennessee. Participants underwent 12 group therapy sessions that included a range of components such as grief therapy, exercise, social skill development, and preventive health behaviors. They found significant reductions in depression symptoms among Caucasian participants with at least moderate depression.
• Chiang, Lu, Chu, Chang, and Chou (2008) examined the impact of a life review group program on life satisfaction and self-esteem among the elderly. The program was intended to enhance self-integration and adaptation among older individuals. The study included elderly Taiwanese men from a veterans’ home. Participation in the group intervention was associated with significant improvements in both self-esteem and life satisfaction.
• Nilsson and Nygård (2003) examined the effects of an occupational group therapy program among elderly individuals living in a pre-discharge community rehabilitation center. The group therapy comprised five sessions intended to promote mutual sharing and reflection. Participation in the group program was linked to increases in adaptation and reflection among elderly people awaiting hospital discharge.
• Werner, Wosch, and Gold (2017) looked at the effects of group music therapy and recreational group singing among elderly nursing home residents in Germany. Participation in the group music therapy was associated with significant reductions in depressive symptoms, results that were still evident 12 weeks later.

11 Helpful Activities

There are many things older individuals can do on their own to promote positive wellbeing.

Here are 11 examples:

1. Stay physically active.
   Maintaining an active lifestyle is essential for both physical and emotional health. Ideas for older folks include resistance or weight training to maintain lean muscle mass and joint stability, swimming, walking, yoga, and dancing. Also, by checking out a local senior center or joining a gym, seniors will find many options for staying active.
2. Stay mentally active.
   The importance of remaining sharp increases as we age. There are plenty of ways to stimulate the mind, such as puzzles, crosswords, books, and games.
3. Be social.
   Loneliness and isolation represent significant issues for the elderly. These problems may be diminished by getting involved in social activities, such as playing games (e.g., chess) or taking classes with other seniors. Joining community groups or book clubs also promotes social interaction.
4. Do gardening.
   For many, gardening is a relaxing and creative way to spend time outdoors. If you don’t have a yard, community or deck/patio gardens offer excellent alternatives.
5. Spend time with animals.
   Whether you prefer cats, dogs, rodents, or some other type of critter, they will improve your mood. Dog companionship brings the added benefits that come along with regular walks: exercise and social opportunities.
6. Live your passions.
   It is NEVER too late to do the things you love. Painter Grandma Moses didn’t begin her artistic career until the age of 78. So, find what you love and embrace it, no matter your age.
7. Be creative.
   Art represents another way for seniors to be both creative and social. There are endless ways for older people to be creative, such as drawing, painting, pottery, cooking, knitting, beading, sewing, and photography.
8. Enjoy music.
   Music has a way of inspiring and soothing the soul. It also brings wonderful memories to the forefront. So, turn the music up, and if you are a singer or musician, keep those gifts alive throughout your lifetime.
9. Help others.
   Altruism helps people think less of their own problems by focusing on the needs of others. There are endless ways to give to one’s community, many of which are doable for elderly individuals.
10. Get involved in local politics.
    Involvement in politics is a great way for older people to play a key role in personally meaningful causes. There are many ways to help, such as working with campaigns or polling centers.
11. Go on fun outings.
    Enjoying fun activities enhances happiness, intellectual growth, and social interaction. There are all sorts of outing possibilities for older folks, such as movies, museums, parks, comedy clubs, and shopping.

PositivePsychology.com’s Relevant Resources

PositivePsychology.com boasts several excellent resources for enhancing wellbeing among older people. Here are four examples:

What Is Positive Aging? is a comprehensive article providing a ton of information aimed at ways to promote positive aging. It describes what positive aging looks like, relevant research findings, useful examples, positive aging theories and tips, helpful books, and so much more.

Realizing Your Meaning is an article containing examples of how individuals may better realize their meaning in life, along with inspiring quotes and useful tools. The article is particularly relevant to older individuals, as it contains a section specifically aimed at helping readers to find meaning as they age.

Our article on Savoring in Psychology is designed to help readers enhance savoring – attending, appreciating, and enhancing positive experiences that occur in one’s life (Bryant & Veroff, 2007).

Although not specifically aimed at older people, it contains tips and resources that nonetheless apply to this group. It includes a psychological description of savoring, numerous benefits, and useful exercises, interventions, books, quotes, and tools from PositivePsychology.com.

A note on savoring the past is also included, as recalling past events is a powerful way to re-experience positive emotions (Speer, Bhanji, & Delgado, 2014).

Positive Reminiscence is an exercise designed to promote the skills of savoring and building positive emotions. It contains the following three steps:

1. Think about a positive past event. Consider an event that brought great joy or a sense of accomplishment. Look at inspiring reminders, such as photos.
2. Savor. The next step involves taking a few moments to relive a moment from the above event, including event details and associated positive feelings.
3. Relive the experience. Last, relive the experience while avoiding analytical thoughts about the event.

Overall, this exercise supports individuals in enjoying greater positivity in life by savoring pleasant events from the past. You can access a pre-prepared version of the Positive Reminiscence exercise, together with over 450 more practitioner resources, with a subscription to the Positive Psychology Toolkit©.

17 Self-Compassion Exercises

If you’re looking for more science-based ways to help others develop self-compassion, this collection contains 17 validated self-compassion tools for practitioners. Use them to help others create a kinder and more nurturing relationship with the self.

A Take-Home Message

There has never been a better time to age gracefully.

The tools and information provided here support older individuals in engaging in health-promoting activities, as well as research-guided treatment options.

It is essential to remember that:

“Age is inevitable. Aging isn’t.”

Marv Levy

The sooner older individuals embrace the many resources and tips aimed at healthy aging, the more they will be able to make the most of their golden years.

We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free.