Themes of Gerotranscendence in Narrative Identity Within Structured Life Review

GeroPsych ◽  
2020 ◽  
Vol 33 (2) ◽  
pp. 77-84
Author(s):  
Sharlene L. Jeffers ◽  
Ricco Hill ◽  
Miriam F. Krumholz ◽  
Cynthia Winston-Proctor
Keyword(s):  
Older Adults ◽  
Narrative Identity ◽  
Developmental Stages ◽  
Life Story ◽  
Late Life ◽  
Well Being ◽  
Life Review ◽  
Late Life Depression ◽  
Clinical Narrative ◽  
The Life Course

Abstract. Narrative identity is a person’s internalized and evolving life story. It provides a person with some degree of unity and purpose over the life course. It is shaped by the themes, plots, and images available within an individual’s culture. Research in narrative gerontology finds that positive themes within narrative identity in late life are sparse because of a pervading “narrative of decline,” which may contribute to prevalence of late life depression. Structured Life Review (SLR) is an effective intervention to manage depressive symptoms in older adults. It relies on clinician-guided storytelling and themes drawn from Erikson’s developmental stages to foster positive narrative identity. In this theoretical review, the authors explore gerotranscendence-related themes to inform narrative identity through SLR, the goal being to advance the argument that gerotranscendence can adaptively navigate negative narrative themes. It should be considered within clinical narrative practice to improve psychological well-being for older adults.

Life Review in Pastoral Counseling: Background and Efficacy for Use with the Terminally III

2003 ◽  
Vol 57 (3) ◽  
pp. 281-292 ◽  
Author(s):  
Robert G. LeFavi ◽  
Marcia H. Wessels
Keyword(s):  
Older Adults ◽  
Pastoral Counseling ◽  
Life Story ◽  
Terminally Ill ◽  
Well Being ◽  
Life Review ◽  
Systematic Theology ◽  
Spiritual Needs ◽  
Traumatic Death ◽  
Spiritual Assessment

Research continues to confirm that sharing one's life story through the process of life review enhances psychological well-being and increases life satisfaction. Although researchers have outlined techniques and activities that may be used in life review with older adults, little work has focused on the use of life review methods with terminally ill patients. Additionally, researchers have suggested that life review can take on the form of a spiritual assessment; and that such spiritually oriented life reviews may enhance a sense of meaning and foster reconciliation as one approaches dying. In this article, the authors provide a brief review of the research on and the practice of life review. Further, by merging concepts of life review with systematic theology, they offer a sample instrument—using the example of one faith framework—with which pastoral caregivers can better approach the spiritual needs of patients and facilitate a less traumatic death in the terminally ill.

scholarly journals Late-Life depression and the counseling agenda: exploring geriatric logotherapy as a treatment modality

2013 ◽  
Vol 6 (1) ◽  
pp. 94-101
Author(s):  
John Henry Morgan
Keyword(s):  
Treatment Modality ◽  
Life Story ◽  
Behavioral Therapy ◽  
Late Life ◽  
Well Being ◽  
Self Esteem ◽  
Medical Intervention ◽  
Depression Symptoms ◽  
Late Life Depression ◽  
Curative Care

The counseling agenda established for dealing with late-life depression is often followed in consort with pharmacotherapy which has proven clinically to be quite effective in reducing and, in many cases, relieving symptoms of low self-esteem and anxiety. Whereas conventional medical intervention concentrates on the reduction of depression symptoms, psychotherapeutic modalities such as cognitive-behavioral therapy have proven somewhat effective in creating a more stabilizing experience of existential contentment, offering a deeper sense of well-being rather than simply symptom reduction. Geriatric logotherapy has come forth with an emphasis upon existential contentment drawn from accessing what is called the “life story window” wherein the therapist assists the patient in exploring the past in search of the “happy memory.” Since palliative rather than curative care is the therapeutic agenda in late-life counseling, this logotherapeutic approach has produced a treatment modality worthy of further exploration with particular attention to reminiscence and life review studies.

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 67-76
Author(s):  
Grace C. Niu ◽  
Patricia A. Arean
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Brain Plasticity ◽  
Late Life ◽  
Aging Population ◽  
The United States ◽  
Future Research ◽  
Evidence Based ◽  
Late Life Depression ◽  
Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

scholarly journals Sex in Late Life: Assessing Adults’ Expectations and the Role of Healthcare Professionals

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 313-313
Author(s):  
Jill Naar ◽  
Raven Weaver ◽  
Shelbie Turner
Keyword(s):  
Older Adults ◽  
Sexual Health ◽  
Health Behaviors ◽  
Healthcare Professionals ◽  
Late Life ◽  
Sexual History ◽  
Growth Curve Models ◽  
The Us ◽  
Sexual Health Behaviors ◽  
The Life Course

Abstract Sexual activity contributes to quality of life throughout the lifespan. However, stigma about sex in late life influences older adults’ perceptions and healthcare professionals’ perceptions of older adults’ sexual health/behaviors. Using a multi-methods approach, we examined attitudes and knowledge about sexual health/behaviors in late life. Using longitudinal data from the Midlife in the US Study (Wave 1-3; N=7049), we ran age-based growth curve models to analyze changes in levels of optimism about sex in their future. We also piloted a survey with healthcare professionals assessing attitudes, knowledge, and awareness of policy about sexual health/behaviors among older adults. Adults’ expectations became less optimistic with increased age (β = -0.1, SE = 0.003, p < .0001). Men were more optimistic than women at age 20 (p = 0.016), but men’s optimism decreased over the life course at a faster rate than did women’s (p < .0001), so that from ages 40-93, men were less optimistic than women. Among healthcare professionals (N=21), the majority indicated never or rarely asking their clients about sexual history or health/behaviors; however, they indicated some knowledge about issues relevant to older adults (e.g., safe-sex practices, sexual dysfunction). Few indicated awareness about policies related to sexual behavior among residents (i.e., issues of consent, STIs). Among adults, there is a need to address declining optimism for expectations about sex in late life. Health professionals are well-situated to raise awareness and normalize discussions about sexual health, thus countering negative stigma and contributing to increasing optimism for expectations to remain sexually active.

scholarly journals Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

2021 ◽  
Vol 30 ◽  
Author(s):  
Shiyu Lu ◽  
Tianyin Liu ◽  
Gloria H. Y. Wong ◽  
Dara K. Y. Leung ◽  
Lesley C. Y. Sze ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Symptom Severity ◽  
Social Care ◽  
Late Life ◽  
Community Dwelling ◽  
Service Utilisation ◽  
Late Life Depression ◽  
Social Care Service ◽  
Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

scholarly journals Vascular lesions and functional limitations among older adults: does depression make a difference?

2014 ◽  
Vol 26 (9) ◽  
pp. 1501-1509 ◽  
Author(s):  
Celia F. Hybels ◽  
Carl F. Pieper ◽  
Lawrence R. Landerman ◽  
Martha E. Payne ◽  
David C. Steffens
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
White Matter ◽  
Functional Impairment ◽  
Functional Limitations ◽  
Late Life ◽  
Cognitive Status ◽  
Cerebral White Matter ◽  
Late Life Depression ◽  
Increased Risk

ABSTRACTBackground:The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.Methods:The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging.Results:In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression.Conclusions:These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

scholarly journals The relationships between brain structural changes and perceived loneliness in older adults suffering from late‐life depression

2017 ◽  
Vol 33 (4) ◽  
pp. 606-612 ◽  
Author(s):  
Emily L.L. Sin ◽  
Ho‐Ling Liu ◽  
Shwu‐Hua Lee ◽  
Chih‐Mao Huang ◽  
Yau‐Yau Wai ◽  
...  
Keyword(s):  
Older Adults ◽  
Structural Changes ◽  
Late Life ◽  
Late Life Depression

scholarly journals Cognitive Functioning and Late-Life Depression

2014 ◽  
Vol 20 (5) ◽  
pp. 461-467 ◽  
Author(s):  
Aaron M. Koenig ◽  
Rishi K. Bhalla ◽  
Meryl A. Butters
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Cognitive Functioning ◽  
Neuropsychological Assessment ◽  
Cognitive Deficits ◽  
Late Life ◽  
Cognitive Outcomes ◽  
Review Of The Literature ◽  
Late Life Depression ◽  
The Relationship

AbstractThis brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient’s symptoms. (JINS, 2014, 20, 1–7)

scholarly journals Longitudinal associations between late-life depression dimensions and cognitive functioning: a cross-domain latent growth curve analysis

2016 ◽  
Vol 47 (4) ◽  
pp. 690-702 ◽  
Author(s):  
A. Brailean ◽  
M. J. Aartsen ◽  
G. Muniz-Terrera ◽  
M. Prince ◽  
A. M. Prina ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Processing Speed ◽  
Memory Function ◽  
Somatic Symptoms ◽  
Late Life ◽  
Late Life Depression ◽  
Latent Growth ◽  
Depressed Affect ◽  
Over Time

BackgroundCognitive impairment and depression often co-occur in older adults, but it is not clear whether depression is a risk factor for cognitive decline, a psychological reaction to cognitive decline, or whether changes in depressive symptoms correlate with changes in cognitive performance over time. The co-morbid manifestation of depression and cognitive impairment may reflect either a causal effect or a common cause, depending on the specific symptoms experienced and the cognitive functions affected.MethodThe study sample comprised 1506 community-dwelling older adults aged ⩾65 years from the Longitudinal Aging Study Amsterdam (LASA). We conducted cross-domain latent growth curve analyses to examine longitudinal associations between late-life depression dimensions (i.e. depressed affect, positive affect, and somatic symptoms) and specific domains of cognitive functioning (i.e. processing speed, inductive reasoning, immediate recall, and delayed recall).ResultsPoorer delayed recall performance at baseline predicted a steeper increase in depressed affect over time. Steeper decline in processing speed correlated with a steeper increase in somatic symptoms of depression over time.ConclusionsOur findings suggest a prospective association between memory function and depressed affect, whereby older adults may experience an increase in depressed affect in reaction to poor memory function. Somatic symptoms of depression increased concurrently with declining processing speed, which may reflect common neurodegenerative processes. Our findings do not support the hypothesis that depression symptoms may be a risk factor for cognitive decline in the general population. These findings have potential implications for the treatment of late-life depression and for the prognosis of cognitive outcomes.

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