Physical Illness and Depression in Older Adults: A Handbook of Theory, Research, and Practice

371 Pages·2002·2.45 MB·English

by  David R. Shaffer (auth.)

Physical Illness and
Depression in Older Adults
THE PLENUM SERIES IN
SOCIAL/CLINICAL PSYCHOLOGY
Series Editor: C. R. Snyder
University of Kansas
Lawrence, Kansas
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Cognitive and Motivational Mechanisms
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PHYSICALILLNESSANDDEPRESSIONINOLDERADULTS
A Handbook of Theory, Research, and Practice
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Physical Illness and
Depression in Older Adults
A Handbook of Theory,
Research, and Practice
Edited by
GailM.Williamson
David R. Shaffer
University ofGeorgia
Athens, Georgia
and
Patricia A. Parmelee
Genesis Health Ventures
Kennett Square, Pennsylvania
Kluwer Academic Publishers
NewYork Boston Dordrecht London Moscow
eBookISBN: 0-306-47178-7
Print ISBN: 0-306-46269-9
©2002 Kluwer Academic Publishers
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To NELL MCEWIN,
mother of Gail Williamson,
and quintessential role model of combining femininity
with independence, achievement,
and overcoming adversity
to set one's sights on nothing less than the best
Contributors
KatherineL.Applegate, Department ofPsychiatry, Ohio StateUniversityCollegeof
Medicine, Columbus, Ohio 43210
Jamila Bookwala, Department of Psychology, Pennsylvania State University, Abington,
Pennsylvania 19001
Martha L. Bruce, Department of Psychiatry, Weill Medical College of Cornell Univer-
sity, White Plains, New York 10605
EricD. Caine, DepartmentofPsychiatry, UniversityofRochesterMedicalCenter, Roch-
ester, New York 14642
Jen Cheavens, Department of Psychology, University of Kansas, Lawrence, Kansas 66045
Mary Amanda Dew, Department of Psychiatry, Western Psychiatric Institute and Clinic,
University of Pittsburgh, Pittsburgh, Pennsylvania 15213
Ronald Glaser, Department of Medical Microbiology and Immunology, Ohio State
University College of Medicine, Columbus, Ohio 43210
Barry Gurland, Columbia University Stroud Center, New York, New York 10032
Sidney Katz, Columbia University Stroud Center, New York, New York 10032
Janice K. Kiecolt-Glaser, Department of Psychiatry, Ohio State University College of
Medicine, Columbus, Ohio 43210
Ellen J. Klausner, Department of Psychiatry, Weill Medical College of Cornel1 Univer-
sity, White Plains, New York 10605
Charles E. Lance, Department of Psychology, University of Georgia, Athens, Georgia 30602
M. Powell Lawton, Polisher Research Institute, Philadelphia Geriatric Center, 5301
York Road, Philadelphia, Pennsylvania 19141
Jeffrey M. Lyness, Department of Psychiatry, University of Rochester Medical Center,
Rochester, New York 14642
Adam W. Meade, Department of Psychology, University of Georgia, Athens, Georgia
30602
vii
viii CONTRIBUTORS
L. Stephen Miller, Department of Psychology, University of Georgia, Athens, Georgia
30602
Mark D. Miller, Department of Psychiatry, University of Pittsburgh School of Medi-
cine, Pittsburgh, Pennsylvania 15213
Benoit H. Mulsant, Department of Psychiatry, Western Psychiatric Institute and Clinic,
University of Pittsburgh, Pittsburgh, Pennsylvania 15213
Patricia A. Parmelee, Managed Care Division, Genesis Health Ventures, 148 West State
Street, Kennett Square, Pennsylvania 19348
Zachary M. Pine, Geriatric Division, Department of Medicine, University of Califor-
nia at San Francisco, San Francisco, California 94143
Bruce G. Pollock, Department of Psychiatry, Western Psychiatric Institute and Clinic,
University of Pittsburgh, Pittsburgh, Pennsylvania 15213
John W. Reich, Department of Psychology, Arizona State University, Tempe, Arizona
85287
Charles F. Reynolds III, Department of Psychiatry, Western Psychiatric Institute and
Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
Bruce Rollman, Department of Psychiatry, University of Pittsburgh School of Medi-
cine, Pittsburgh, Pennsylvania 15213
Ramesh Sairam, Department of Psychiatry, University of Texas Southwestern Medical
Center, Dallas, Texas 75235
Herbert C. Schulberg, Department of Psychiatry, Weill Medical College of Cornell
University, White Plains, New York 10605
Amy S. Schultz, Department of Psychology, Arizona State University, Tempe, Arizona
85287
Richard Schulz, Department of Psychiatry, University of Pittsburgh School of Medi-
cine, Pittsburgh, Pennsylvania 15213
David R. Shaffer, Department of Psychology, University of Georgia, Athens, Georgia
30602
C.R. Snyder, Department of Psychology, University of Kansas, Lawrence, Kansas 66045
Myron F. Weiner, Department of Psychiatry, University of Texas Southwestern Medi-
cal Center, Dallas, Texas 75235
Gail M. Williamson, Department of Psychology, University of Georgia, Athens, Geor-
gia, 30602
Jennifer L. Yee, Center for Social and Urban Research, University of Pittsburgh, Pitts-
burgh, Pennsylvania 15213
Alex J. Zautra, Department of Psychology, Arizona State University, Tempe, Arizona
85287
Foreword
Aging is inevitable-A "psychological recession" is not . . .
As I go about my daily life, I read and hear about the sometimes scary things that are
happeningtootherpeople. Asthe sayinggoes, badnews sells newspapers. ButIusu-
ally can take some solace in reasoning that this bad stuff assuredly will notoccur in my
life. After readingthis book, however, one message has gotten through–I cannot dis-
miss "those" olderpeopledescribedinthevarious chapters asbeingdissimilar tome.
After all, "old person" is a term that can be applied to me in a few more years. On this
point, Ionceheardthefollowingrhetoricalquestionappliedtotheprejudiceactionsof
theTVcharacterArchieBunker: "Whatwouldhesayabout "those"PuertoRicans,if,
onhisnextbirthday,heknewthathewouldbecomeaPuertoRican?"Asto aging,we
bestpayclose attentionbecausewe soonwillbe "those" elders.
This is why the alarming facts of this book-that our elders often are experiencing
elevatedlevelsofphysicalillnessesanddepression–grabbedmebytheproverbialthroat.
So, too, should these facts alert America's baby boomers, because the talk of illness
and depression certainly takes some ofthe shine offtheir ensuing "goldenyears." As
the physical illnesses and dark shadows of depression creep into many elders' lives,
they are rendered far from painless, less than happy, and generally not too "golden." I
call this a "psychological recession," where large numbers of elders have lost their
goodhealth, aswellas theirpositiveoutlooks. To compoundmatters, apsychological
recessioninvolvestheelder'simplicitandsometimesexplicitcomparisonofthepresent
circumstances with those ofhis or heryounger days.
Physical illnesses and depression are serious: anyone who has experienced them
can testify to suchanassertion. Theytake awaylife's pleasures, rob simplejoys, and
leave us wondering about our purpose in being. And such physical problems and de-
pression do not impact just the one personwho "has" them. They spread, and soon
friends and loved ones also are engulfed by them. The "downer" grows–and so we
have a psychological recession for all those involved.
Whatcanwe dotobetterunderstandandhelpthewavesofagingpeoplewhoare
mired in such psychological recession? This question portends answers for the present
elders, aswell as thewaves offuture elders–people likeyou andme. For this reason,
this book both alarms and excites me. The alarm I already have sounded. As to the
excitement, inthe followingpageswe are treatedtonewinsightsaboutunderstanding
and lifting the veils from the illness and despondencyproblems. The thinkingin this
volume is catalytic and fresh, producinga reaction akin to that ofsolvinga problem.
After thoroughly describingthe depth andbreadth ofthe physical illness and depres-
ix
x FOREWORD
sion problems faced by elders, the present researchers share their insights and solu-
tions. They tell us what we now know, and provide an agenda for future research and
interventions. Thus, the editors and authors of this volume paint a realistic view about
how the forces of physical illness and depression can be understood and overcome.
In conclusion, there is bad and good news on these pages. The bad news is that
physical illness and depression may touch us in the senior years. The good news is that
these threats to our well-being can be understood and, in many, if not most instances,
changed for the better. As such,agingisinevitable; apsychologicalrecessionisnot.
C.R.SNYDER
Lawrence, Kansas
Preface
The population is aging. Baby boomers are approaching retirement age, and individu-
als over age 85 make up the single fastest-growing segment of the population. Our
society is faced with quickly finding answers to questions about longevity and quality
of life that, because they pertained to so few people, were not matters of urgency just
a few decades ago.
Historically, diagnosis and treatment of depression in elderly people was ham-
pered by mythical thinking. Depression was viewed as an unavoidable consequence of
the losses (e.g., declining health, retirement, and bereavement) that naturally accom-
pany advancing age. Epidemiological studies exploded this myth by indicating that
severe depression was not as widespread a problem in older adults as was commonly
believed.
Still, even clinically diagnosable depression typically went untreated. Among the
reasons were the difficulty of diagnosing depression when it is accompanied by physi-
cal illness and beliefs that available treatments for depression were not suitable for
and would not be accepted by elderly persons. In recent years, we have seen some
major breakthroughs. First, researchers and practitioners took note of the fact that,
although major depression is relatively uncommon in elderly adults, it is not necessary
for depressed affect to meet clinical diagnostic criteria to negatively impact quality of
life. Second, substantial strides have been made toward better methods for identifying
depressive symptomatology in this segment of the population. Third, research efforts
have clearly shown that the association between physical illness and depression is
bidirectional and complicated by numerous biological, social, and psychological fac-
tors. Finally, advances in pharmacological and behavioral therapies have produced
more suitable interventions, and current treatment strategies have been proven to be
both effective for and accepted by depressed older adults.
Professionals working at the intersection of physical illness and depression are an
interdisciplinary group that can model (albeit less than perfectly) cross-discipline co-
operation. From its inception, the idea for this handbook was to bring together in one
place a comprehensive sample of up-to-date work from various disciplines in an effort
to stimulate further theoretically based and intervention-oriented research.
In addition to introductory and final summary chapters, this handbook consists
xi