Psychological Interventions to Improve Wellness in Older Adults

Dear fellow clinical gerontologists

Issue three of 2023 features mental health interventions for older adults, focusing on a few of our “audience favorite” topics such as mindfulness, emotional regulation, integration of arts into therapy, and clinical cases. Our opening review considers 44 studies on the use of emotional regulation in older adults, confirming the established perspective that compared to younger adults, older adults are highly adaptive in regulating emotions to guide behavior, more so than younger adults (Sardella et al., 2022). The review extends previous reviews by considering difficulties in emotional regulation – older adults have fewer – and by describing ways emotional regulation relates to aging with chronic health conditions. The next two papers are reviews of mindfulness-based interventions in older adults. The first summarizes 17 studies that apply mindfulness interventions to chronic health conditions (Kayser et al., 2022), the second summarizes 4 studies examining mindfulness-based interventions for couples. Both reviews note that while results are promising, more high-quality randomized controlled trials (RCT) with low risk of bias are needed.

The first two original studies respond to this call with RCTs of mindfulness interventions. The first U.S.-based RCT (N = 62) compares mindfulness to an active control (brain health class). Both performed fairly equally in measured outcomes, although those in the mindfulness class reported better stress coping skills and more practicing of these skills (Lwi et al., 2022). The second U.K.-based RCT (N = 20) is important because it focuses on older adults living with mild dementia who were randomized to mindfulness-based cognitive therapy or treatment as usual (Noone et al., 2022). The mindfulness intervention was feasible but did not show improvements in mood, quality of life, or other outcomes compared to the control condition. Both these studies point to the importance of not overstating effectiveness as we continue to evolve precision-based medicine approaches to improve mental health in older adults. A third pilot RCT from investigators in Australia describes the feasibility, acceptability, and preliminary efficacy of cognitive-emotional intervention in older adults who are home-bound (Jesus et al., 2022), finding improvements in cognitive, emotional, and functional domains compared to a wait-list control. The authors note the need for future RCTs with an active control group and longer follow-up.

The next three studies examine the use of humanities and arts-based interventions to improve wellness in older adults by investigators in Japan, Portugal, and Israel, respectively. A life-story intervention (N = 43) was associated with improved cognitive and apathy scores in older adults with dementia (Asano et al., 2022). Adherence to a group singing intervention (N = 149; including relaxation exercises, vocal training, repertoire rehearsals, socialization, as well as performance) was associated with better mood and physical function (Galinha et al., 2022). Participation in a tele-drama intervention (N = 19; involving drama-based interventions such as imagination, role-playing, improvisation – delivered over the telephone) was a creative approach to enhancing well-being of older adults and positive attitudes of trainees as revealed in qualitative interviews (Dovrat & Keisari, 2023).

Three original research studies examine factors in mental health outcomes in special populations. Older veterans (N = 74) expressed their preferences for psychotherapy as compared to self-management for mental health concerns while recognizing the ease of access of self-management (Ma et al., 2022). Few studies focus on substance abuse and treatment outcomes in older adults; therefore, we are excited to have two papers in this area. Investigators in Turkey describe a retrospective cohort analysis of older adults (N = 136) treated in the smoking cessation clinic, reporting a 36% one-year quit rate; better outcomes were associated with combined pharmacological and behavioral counseling along with attendance at follow-up sessions (Zeren et al., 2022). Investigators in Belgium describe predictors of alcohol use in older men versus women, in which anxiety may be a larger factor for men and depression a larger factor for women (van Gils et al., 2022).

Three case-based papers provide the opportunity for rich description of psychotherapy work. Clinicians from Iran describe three older adults treated using cognitive-behavioral therapy for distress after children had moved out, colloquially referred to as the “empty nest.” The authors provide detailed visual tracking of resilience scores over time and interpret the findings in Iran’s cultural context (Kabiri et al., 2022). Clinicians from the U.K. describe their application of compassion-focused therapy for an older adult with functional neurological disorder, describing their approach and its impact on psychological outcomes and self-compassion (Zarotti et al., 2022). Finally, a clinician from Israel describes longer-term therapy integrating self-psychology and psychodynamic approaches for a woman in her 90s, noting impacts on the client as well as the therapist (Bar-Tur, 2023). These cases complement the reviews, randomized trials, and observational cohort studies within this issue to provide a more intimate view of the psychotherapy process. We thank all the authors for their hard work on these important contributions.