The Impact of Life Transitions �on the Mental Health of Older Adults

Section 1: Psychological Well-Being in Later Life

How do we view the experience of growing older?

• Common misconceptions about aging
• Portrayal of older adults in media
• Changes in relationships, routines, or independence
• Internalized shame about older age

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A New Concept of Aging | Monitor on Psychology

As we age, a number of significant shifts can occur

• Retirement
• Loss of loved ones
• Changes in function
• Caregiving
• Dependence on others
• Financial challenges
• Relocation, possibly to a long-term care facility

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• Home safety & maintenance
• Transportation
• Medication management
• Meal preparation
• Connection with others
• Help with activities of daily living (ADLs)

Safely aging in community may require support for various health-related needs

Functional decline as we age-�What is "normal"?

• Cognitive changes: short-term memory, slower reaction times
• Physical changes: increase in chronic conditions, mild vision or hearing impairment
• Despite challenges, many U.S. community-dwelling older adults report their health to be "good" or "excellent"

Older Adults' Health and Age-Related Changes | American Psychological Association

Depression is often overlooked in older adults

• NOT a normal part of aging
• Presents differently than in younger patients- fatigue, cognitive changes
• Impact of stigma
• Screening tools may not give the full picture
• No one-size-fits-all treatment option

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How Common is Depression in Older Adults? | National Council on Aging

How do life transitions impact mental health?

• Uncertainty
• Difficulty coping
• Stress
• Anxiety
• Grief
• Depression
• Substance misuse

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• Supporting older adults to adapt can assist them in navigating these transitions and maintaining their psychological well-being

This concludes Section 1.

Section 2: Individuality & Relationships

Retirement

• Sense of purpose
• Previous job satisfaction
• Economic status
• Changes to mandatory retirement age
• Answering the question "What do you do?"
• Reflection on legacy

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The Effects of Retirement on Sense of Purpose in Life: Crisis or Opportunity? | American Psychological Society

Experiences of Loss

• Important relationships often shape sense of self
• Loss of a loved one can disrupt everyday life and routines
• Bereavement can impact levels of frailty, dependence, and social isolation in older adults

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A Qualitative Exploration of Bereavement in Later Life | OMEGA Journal of Death and Dying

Psychosocial Development: Erikson's Integrity vs. Despair

• Reconciling past events (positive and negative)
• Death: acceptance or anxiety
• Age can bring a clearer sense of self: Wisdom
• Sense of confidence often motivates behaviors

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Live well and die with inner peace: The importance of retrospective need-based experiences, ego integrity and despair for late adults’ death attitudes | Archives of Gerontology and Geriatrics

Social Connection & Health

• Social isolation is a lack of desired contact with others
• Loneliness is less structural and more subjective
• A lack of social connection can impact an older adult’s physical & mental health
• Life transitions increase the risk for these experiences

Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System | NASEM

Care-giving & Care-receiving

• Experiences of informal caregiving vary significantly, as do the needs of caregivers and recipients themselves
• Transition to or from caregiving may be gradual or abrupt
• Older adults are at higher risk of caregiver strain, which can impact their health and sense of self

The Journey of Aging: Life Transitions During the Second Half of Life | AARP

This concludes Section 2.

Section 3: Patient-Centered Support

Age-Friendly Healthcare

• Aligns with an older adult's care preferences and health outcome goals
• Identifies signs of mental health or cognitive concerns
• Considers other factors that could impact mentation, such as changes in mobility or medication

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Guide to Using the 4Ms in  the Care of Older Adults in Hospitals and Ambulatory Care Practices | Institute for Healthcare Improvement

Considerations for Depression Screening

• ALL older adults should be screened for depression in primary care settings
• The Patient Health Questionnaire (PHQ-9) is a recommended screening tool for adults of all ages
• The Geriatric Depression Scale (GDS) uses yes/no questions for ease of use

Depression Assessment Instruments | American Psychological Association

Considerations for Anxiety Screening

• Limited evidence on effectiveness of anxiety screening in patients over the age of 65
• The Geriatric Anxiety Inventory (GAI) aims to differentiate between anxiety and somatic symptoms
• May require multimethod clinical assessment

Assessment of anxiety in older adults: a review of self-report measures | Society for Applied Research in Aging

Possible Treatment Options

• Group Cognitive-Behavioral Therapy (CBT)
• Psychotherapy
• Second-generation antidepressants (SSRIs, SNRIs, or NDRIs)
• Physical activity
• Often a combination of the above

Depression Treatments for Older Adults | American Psychological Association

Protective Factors in Response to�Life Transitions

• Social support & community involvement
• Coping skills
• Self-reflection
• Positive thinking
• Healthy lifestyle behaviors
• Utilizing available resources

• Supporting older adults to adapt can assist them in navigating these transitions and maintaining their psychological well-being

Effective Referrals to Community Resources

• Identify patient preferences and goals first
• Involve informal caregivers in care planning conversations and follow up
• Make connections with local aging services providers
• Provide warm handoffs through enabling services

Strategic Partnerships | National Council on Aging

We appreciate your completion of this module. 

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Thank You!

This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.