Psychological Interventions for Older Adults: Evidence-Based Treatments for Depression, Anxiety, and Carer Stress

Abstract

A wide range of psychological treatments have now been validated for use with older adults. This chapter reviews the evidence for a number of well-established approaches to anxiety and depression and how to implement these therapies with older clients, as well as noting some of their shortcomings. Evidence-based therapies include interpersonal therapy (IPT), cognitive behavioral (CBT) and problem-solving therapy (PST), and, to a lesser extent, reminiscence therapy and short-term psychodynamic therapy. Newer approaches are also emerging, including mindfulness-based approaches, and therapies delivered through the Internet or other electronic means. Evidence for efficacy is most robust for CBT, PST, and IPT for the treatment of depression. Some studies suggest that the treatment of anxiety is less successful, and some researchers have tried to improve the outcomes of anxiety treatment, with mixed results. The chapter also considers issues of particular concern to older adults, such as the stress of caregiving and the implications for therapy of cognitive impairment and comorbid physical illness. Despite the robust support for the efficacy of therapeutic interventions with older adults and the evidence that older adults prefer psychological to pharmacological intervention, older adults are less likely to receive psychological interventions than people of working age. Reasons for this include stigma, the challenges of recognizing and assessing anxiety and depression in older adults, and the lack of suitable services. The chapter concludes with a discussion of how psychological interventions can be made appropriate and available for older adults living in low and middle-income countries.