Losses in Late Life

I have been a geriatric psychiatrist for the past 14 years and over these years I have observed patients dealing with late life issues. These issues take a toll on the emotional and mental health, often resulting in psychiatric illnesses. A common theme for geriatric patients is losses in life. The intensity/severity of the loss may vary and it impacts each individual differently depending on the significance of the loss to the person and how they perceive it. The event has to be significant and traumatic enough to disrupt their baseline functioning.

Depending on the individual’s perception, the loss may be very devastating like losing a spouse, child, significant other, or their home. A homeowner experiences raising their families, empty nest syndrome, and having to give up their home in later life due to financial obligations. These financial obligations could be to fulfill the need for long-term residence, whether it’s a nursing home, assisted living, or a personal care home placement. Or it may be less intense, like gradually losing their independence, physically and mentally.

The meaning of loss to an older individual relates to its importance in their life and the ability to deal with the loss appropriately utilizing positive coping, family support, prior functioning including level of education, and previous employment. To note, the patient’s current socioeconomic status can also either facilitate or hinder their ability to deal with the losses they encounter.

The most common theme of psychiatric illnesses stemming from these life losses is depression, anxiety, and even psychotic illnesses.

The physiology of aging of an individual leads to cognitive decline or deficits. The decline or deficits further masks the prompt identification of these illnesses, resulting in delayed diagnosis, required appropriate treatment therefore impeding the recovery process. Clinical data has shown that folks that score lower on cognitive testing tools like Folstein and MoCA – are more vulnerable to the above mentioned illnesses and are slipping mentally, culminating into depression and anxiety.

So prompt identification of the warning signs and symptoms of mood or any changes from the individual baseline is crucial as timely intervention not only a carries good prognosis, but also lessens the burden of mental illness not only on the effected individual but also on the loved ones /care givers. Different treatment options are available including a broad range of pharmacotherapy, psychotherapy, and physical needs. Also, addressing any addiction issues because it is often found that alcohol is commonly used to self-medicate.

It is pertinent that patients receive professional support that includes problem-targeted counseling, case management services, utilizing cognitive-behavioral therapy and dialectical behavior therapy, day programs, and cultural sensitivity. I highly recommend for an individual to meet annually with their primary care providers and seek expert help as needed.