Week of May 22, 2002
In this hour, we explore The Golden Years? Mental Health and the Elderly. Guests include Dr. Ira Katz, director of the geriatric psychiatry program at the University of Pennsylvania; Dr. Mildred Reynolds, a retired psychiatric social worker who has, herself, been diagnosed with depression and is now on the board of the National Depressive and Manic-Depressive Association and an advocate for elderly people with mental illness; Dr. Ellen Langer, a professor of psychology at Harvard University and the author of Mindfulness and The Power of Mindful Learning; and English professor and writer Carolyn Heilbrun, author of The Last Gift of Time: Life Beyond Sixty.
To begin, we hear from a 77-year old woman from New York who suffers from depression. She asked us not to use her name, saying that, for her generation, the stigma surrounding mental illness is so great, even her friends don't know she has depression and is on medication. She says that when she is depressed, she cannot will herself to get out of bed and do the things she ordinarily loves to do, such as going to the ballet or the opera. Many people of her generation won't admit to depression, she says, since, in their day, they thought of mental illness as just meaning "crazy." Also, since their depression often begins after an illness or the loss of a loved one, they dismiss their symptoms, even when the symptoms persist longer than they should. The problem is, then these people don't go for help.
Next, host Dr. Fred Goodwin is joined by two guests who give an overview of the mental health issues affecting older people. Dr. Ira Katz is director of the geriatric psychiatry program at the University of Pennsylvania; Dr. Mildred Reynolds is a retired psychiatric social worker who has, herself, been diagnosed with depression. She's on the board of the National Depressive and Manic-depressive Association and works as an advocate for elderly people with mental illness.
Dr. Katz begins by saying that depression and dementia are common among the elderly. The rate of suicide also increases as people age, particularly among white males. In healthy older people, the rate of major depressive disorders is about 2-3%, which is actually lower than in the baby boomer and younger generations. However, depression dramatically increases in older people in the presence of physical illness. In primary care doctors' offices, the rate is 10%, and in nursing homes, it is 20-25%. He says we need to figure out how to deal with these issues now, since we are facing a kind of double jeopardy -- as the baby boomer generation ages, there will be more older people, and they will be more vulnerable to depression since they already face higher rates of the illness.
Dr. Reynolds then discusses some of the reasons depression often goes undiagnosed in older people. Many are hesitant to talk about depression, since her generation tended to see mental illness as a character flaw. She recalls her mother telling her to pull herself up by her bootstraps, and that sort of thing. She also says most older people are seen only by their primary care physicians, and we know that about half of the people with depression are not diagnosed in a primary care office. Dr. Katz adds that there are serious consequences to missing these diagnoses - about 75% of older people who kill themselves have seen a primary care doctor in the month before their death, and about 30% in the week before their death.
Dr. Reynolds discusses barriers to care, including stigma; providers who do not accept Medicare and Medicaid; patients who cannot afford their co-payments (for doctor visits or prescription medications); accessibility (for example, if there are stairs at the doctor's office); transportation (many older people no longer drive, but navigating public transportation can be difficult); and pride of independence -- older people often hesitate to ask for advice or for help getting to the doctor.
Dr. Katz adds that there are now new barriers to care -- we tend to think about barriers to getting treatment, but there are also barriers to completing treatment. Many primary care doctors lose focus on treatment for depression when other illnesses arise, or they do not try different medications if the first does not work. As a result, many older people discontinue treatment before they are well.
To contact Dr. Katz, please write to Dr. Ira Katz, Professor, Geriatric Psychiatry, University of Pennsylvania, 3600 Market Street, Rm. 810, Philadelphia, PA 19104. Or visit http://www.upenn.edu/.
To contact Dr. Mildred Reynolds or learn more about the National Depressive and Manic-depressive Association, please visit http://www.ndmda.org/.
After a short break, The Infinite Mind's Marit Haahr interviews writer Carolyn Heilbrun about her collection of essays, The Last Gift of Time: Life Beyond Sixty. Dr. Heilbrun is professor emerita of English at Columbia University and author of numerous books including Reinventing Womanhood, Toward a Recognition of Androgyny, and the now-classic Writing a Woman's Life, in which she took biographers and autobiographers to task for shoehorning women's lives into conventional molds. She also wrote the Amanda Cross mystery series.
Dr. Heilbrun discusses some of the pleasures of aging. She criticizes our youth-oriented culture for thinking of aging as just loss, rather than gain. Having been a professional, which was rare for women in her day, she felt a real opportunity for change when she retired. Also, once her children left home, it was almost a kind of rebirth. She wishes women, in particular, would stop focusing on trying to look young and would instead realize that life does not end when you're face starts to sag and men stop looking at you. Now age 76, she says she's stopped hurrying and started seeing things. She has also looked at every aspect of her life and decided to do only those things she really feels are worthwhile. Her wish is that older people would make living their lives sufficiently interesting that young people don't dread getting old.
To contact Dr. Heilbrun, please visit http://www.columbia.edu/.
Then, Dr. Goodwin speaks with Dr. Ellen Langer, a professor of psychology at Harvard University and the author of Mindfulness and The Power of Mindful Learning. They discuss how the way we think can change the way we age.
For twenty-five years, Dr. Langer has been studying what she calls mindfulness without meditation. She defines mindfulness as a way of thinking that revolves around noticing new things and taking in information with some uncertainty. She says much of what we think we know about being old we learned mindlessly when we were young, and this hampers our ability to age well. As a result, we may end up hampering ourselves. For example, if a young person hurts her wrist, she has the expectation that she is not supposed to be in pain, so she will go to the doctor and get it fixed. But, if an older person hurts her wrist, she may have it in her head that old people have aches and pains, and so she won't bother doing anything about it.
Dr. Langer has conducted several studies in nursing homes showing that older people who are engaged in mindful learning are more active, alert, and happy than those who are treated as they normally are in nursing homes (i.e. making few decisions for themselves, not caring for a living, changing thing, such as a plant, etc.). Most surprisingly, the mindful group also lived longer -- at an 18 month follow-up, twice as many people in the mindful group were still alive.
The advice for young and old is the same, she says. Mindfulness is not difficult -- it is the essence of humor, the essence of the things we do while at play. It relies on a healthy respect for uncertainty -- don't start off with the mistaken assumption that you know something so well that you don't have to look at it closely.
To contact Dr. Langer, please write to Dr. Ellen Langer, Department of Psychology, 33 Kirkland Street, William James Hall, Harvard University Cambridge, Massachusetts 02138. Or visit http://www.harvard.edu/.
Finally, commentator John Hockenberry offers his thoughts on our youth-oriented culture. He says that by pushing older people to the margins, we make even their mental illnesses seem unremarkable -- as if anyone who isn't young should be depressed. But, he says, "mental illness is not natural for anyone. It's not a feature of aging, like liver spots."
- Marit Haahr
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