Jill A. Stoddard, Christopher Barmann, Eric Lenze, and Julie L. Wetherell
By the year 2050, the number of adults over the age of 60 will reach an estimated two billion, representing the fastest-growing segment of the population. Although anxiety and mood disorders are common among older adults, consensus is lacking as to the most appropriate treatments. In an effort to optimize treatment strategies for older adults, this chapter focuses on a thorough review of outcome literature investigating the use of pharmacotherapy and psychotherapy within three treatment domains: combination, sequential, and augmentation. The preponderance of evidence has lent support to the notion that combining psychosocial and medical treatments results in better outcomes for older adults with anxiety and mood disorders. However, there is a clear need for additional randomized, controlled trials further investigating optimal treatment strategies addressing mental health in late life.
M. Robin DiMatteo, Tricia A. Miller, and Leslie R. Martin
This essay examines issues relevant to the accurate assessment of patient adherence to recommendations for health behavior change and/or the management of medical conditions, including long-term chronic diseases. Both conceptual and methodological issues are discussed. The importance of accurate assessment in both clinical practice and research is examined, as well as the consequences of conceptual and measurement biases. The role of assessments of current adherence in predicting future behavior is examined, as is the essential distinction between assessing adherence as a behavior and assessing the predictors and consequences of adherence. The potential challenges of various approaches to assessing adherence accurately are examined, focusing particularly on self-report; measurement scales for adherence are presented; and innovative techniques are discussed for assessing adherence using technologically based formats. Effective communication is emphasized as the most important and salient element relevant to adherence assessment, linking patient adherence assessment with effective communication in the clinical setting.
Maria E.A. Armento and Melinda A. Stanley
Older community-dwelling adults generally do not receive mental health care in equal proportion to need, and this reflects a global phenomenon. A number of studies have begun to look at the effectiveness of treatment for late-life depression and anxiety in non-mental health settings where older adults receive services, in particular primary care and community-based service settings. Mental healthcare in non-traditional settings has the possibility of increasing reach and accessibility of treatment for older adults. Continued research is needed to expand this care through continued implementation in primary care and community settings and, potentially, beyond. As this area continues to broaden, so does the possibility of reaching many older adults who are experiencing anxiety and depression, thereby increasing their overall quality of life.
Ian A. James
There is an increasing interest in the use of cognitive-behavioural therapy (CBT) for people with dementia, with RCT protocols currently being developed for the treatment of anxiety. Because anxiety, and other psychiatric conditions, may be contributing factors in ‘behaviours that challenge’ (BC), such work is important. However, overall CBT is less well developed in the treatment of BC. This chapter first examines the nature of BC and then looks at the key CBT principles being used to reduce problematic behaviours. While this initial section is short on an evidence base, there already exists a healthy literature on the use of CBT for carers. As this chapter will show, when working with people with severe dementia, the therapeutic work is often conducted via professional carers and staff. The research with carers is diverse in focus, looking at maintaining carers’ well-being and/or providing support to reduce both the incidences of BC and the likelihood of institutionalization of the person with dementia.
Nancy A. Pachana
Clinical geropsychology benefits from a global perspective in a variety of ways. Gerontological theories and interventions may find new applications and expressions when tested in different cultural settings, and the sharing of datasets internationally expands their utility. Importantly, the training of health professionals, and particularly mental health professionals, to cope with increasing numbers of geriatric patients globally, is lagging. In this chapter, some of the ways in which clinical geropsychology has matured into an international field are explored, with reference to the chapters in this Oxford Handbook of Clinical Geropsychology where appropriate.