This book focuses on psychological therapies for emotional disorders in later life. The book is aimed at mental health professionals working with older people. The book is divided into four parts with chapters by many authors from a range of disciplines.
In part 1, the authors provide a fascinating lifespan perspective on normal ageing with a discussion of Erickson's stage model, Paul Baltes' selection, optimizations and compensation theory (SOC) and the stage theory of cognition of Schaie and Willis. In the latter theory, there is support for the idea that older people are less likely to ‘waste time’ on tasks that are meaningless to them! There is a thoughtful review of the normative changes in cognition, personality, emotion and motivation with ageing.
In part 2, the ‘meat’ of this book, the authors challenge the Freudian assertion that older people lack the mental plasticity to change or benefit from psychotherapy. They present empirical data on the efficacy of cognitive behavioural therapy (CBT) in depression. The authors support the idea that CBT may be particularly relevant to older people because older people are more focussed on the ‘here and now’, CBT is problem-focused and skill enhancing. Specific issues related to giving therapy to older people are addressed. These include the need to socialize the elderly patient to therapy so that a working contract can be established, the need to recognize sensory and cognitive changes that can make communication difficult and the need to sometimes use a slower pace of therapy as older people need more time to learn new techniques. The authors quote studies of efficacy of CBT particularly in combination with antidepressants at preventing relapse. The considerations of the various therapies are supported and made interesting for the reader with the use of case histories and examples of therapeutic formulations and management. The authors acknowledge that psychodynamic approaches are not as thoroughly supported by empirical research findings. Qualls introduces the concept of ‘caregiver family therapy’. This therapy encourages and supports carers to recognize and manage the care needs of both the patients with dementia and their carer. It seemed akin to the kind of support provided by our memory clinic staff and community psychiatric teams in the UK.
In part 3, the authors discuss the assessment and psychological treatments of common emotional disorders in later life with an overview of the evidence base for psychological therapies for depression but with very little mention of drug treatments. The chapter on the assessment and treatment of anxiety in later life provides a balanced view with discussion of both pharmacological and psychological options for treatment. There is a fascinating chapter on insomnia in later life (which I read in the small hours of the morning!). Fifty to sixty percent of older adults report trouble sleeping with complaints increasing as age advances. Insomnia is an independent and treatable risk factor for first episode and recurrent late-life depression. There is a useful chapter on late life bereavement. A somewhat trenchant view of life is summarized by the fact that men either remarry or die within 2 years of the loss of their spouse!
In the final part of the book special problem areas in late-life emotional disorders are discussed. We are reminded that although the rates of suicidal behaviour are highest in young woman, rates of death by suicide are highest on older men. However, seniors especially men are particularly reluctant to seek and engage in mental health treatment in part to stigma and sex role socialization. In the chapter on dementia-related affective disturbance, the authors favour the use of psychosocial treatments and specific behavioural interventions (such as the Seattle protocol) are explained. There is a useful set of conclusions for carer interventions. Active interventions such as skills training have been demonstrated to be superior to passive intervention (e.g. group-led psychoeducation).
This book provides useful and important insights into psychological approaches to the assessment and treatments of emotional disorders. My suggestion is that the title of the book should be altered to emphasize that it is about the ‘psychological’ assessment and treatment of emotional disorders in later life as there is little coverage of the biological aspects or pharmacological approaches to these disorders.
