Prevention of Mental Disorders in Older Adults: Recent Innovations and Future Directions

By Leggett, Amanda; Zarit, Steven H. | Generations, Fall 2014 | Go to article overview

Prevention of Mental Disorders in Older Adults: Recent Innovations and Future Directions


Leggett, Amanda, Zarit, Steven H., Generations


As the world's population of older adults rapidly increases, more and more in this cohort will seek mental health care. Prevention is a promising approach to lower overall disease burden.

In the field of mental health, prevention efforts have the ability to decrease healthcare costs, reduce mental illness incidence, and enhance individuals' well-being and functioning. The National Institute of Mental Health (NIMH) lists in its Strategic Objective 2.3 the goal "to develop and test novel interventions that are targeted at pre-symptomatic or prodromal stages of illness, [and] are designed to preempt syndrome development..(NIMH, 2014). In some disciplines such as public health, prevention programs have been widely discussed and implemented, but innovations for preventing mental disorders lag behind, particularly for older adults, where the focus has been on sickness, disability, and disease treatment.

Traditionally, preventive efforts have focused on children and adolescents to promote positive health trajectories early in life (National Research Council and Institute of Medicine, 2009). However, mental health problems are common in older adults and associated with risk and protective factors that differ from those active in early life. Some factors, such as education and early-life socioeconomic advantage, cannot be modified in late life; however, more salient late-life factors, such as social support, sleep disturbance, and activity levels, are malleable in the later years.

As the global population of older adults expands, an increasingly large number will seek mental health care. We also know that current treatments are only partly successful. For example, approximately 20 percent to 30 percent of a person's years lived with disability due to depression can be avoided by using existing treatments, and treatments do not prevent the full burden of anxiety disorders (Andrews et al., 2004). Prevention efforts to stop mental health problems before they start is a promising approach to lower overall disease burden.

This article presents encouraging findings from existing preventive interventions in pharmacotherapy, psychotherapy, and psychosocial efforts. Much of this work addresses depressive and anxiety disorders, and interrelated areas of health, such as sleeping patterns. We conclude by providing suggestions for future directions of research and practice in geriatric mental health prevention.

First, we will review prevention terminology. As opposed to treatment, prevention targets individuals before the development of a disorder. Gordon (1983) labeled preventive interventions as universal, selected, and indicated, depending upon risk level of the targeted population. Indicated interventions focus on individuals who already show preliminary signs or subsyndromal symptoms of a disorder, but not severe enough for diagnosis; selected interventions target those at high risk; and, universal programs are aimed at an entire population. The Institute of Medicine adopted Gordon's terminology and added a category of more general mental health promotion (National Research Council and Institute of Medicine, 2009). We highlight some recent preventive interventions that fall into each of these categories, starting in the domain of pharmacological prevention.

Pharmacological Prevention

Positive effects of antidepressants for the treatment of depression are well-documented, even among the oldest old (Trappler and Cohen, 1998). While the majority of older adults recover from depression, many will relapse, but current or prior antidepressant use has been associated with a better prognosis (Denihan et al., 2000). Prophylactic antidepressant use has been trialled primarily for treatment maintenance and relapse prevention in older adults recently recovered from a major depressive disorder episode.

Reynolds et al. (2006) examined adults ages 70 and older with major depressive disorder who responded to combined psychotherapy and paroxetine (brand name: Paxil) treatment. …

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