Polypharmacy refers to the use of multiple drugs by a patient. This occurs when the patient uses too many forms of medication or when the patient uses more drugs that are prescribed than needed. It also occurs when all the medications to be used by the patient are clinically prescribed, but there are many pills to take. It is also referred to as pill burden. Polypharmacy is most common in elderly people, and it has adverse effects like reaction to drugs and increase in drug costs. Polypharmacy is common in elderly people suffering from depression and anxiety. The effects of Polypharmacy have forced clinical officers to provide alternative interventions to treat depression, and anxiety. An alternative intervention to treat depression and anxiety among the elderly is psychosocial therapies. This paper analyzes if psychosocial interventions are effective in treating anxiety and depression among the elderly.
Use of medication to treat patients suffering from depression has many side effects. The patient takes a lot of pills that are not required. The patient also uses many forms of drugs. This causes adverse effects like reaction to drugs and increase in cost of drugs. The medication is not effective like psychosocial therapy as it does not address the main cause of the problem. Psychosocial interventions are more effective in treating depression and anxiety among the elderly as they address the course of the problem (Gabbard, Beck & Holmes, 2007).
There are several articles that researchers have used to show how psychosocial therapies or intervention are effective in treating depression among the elderly (Gabbard, Beck & Holmes, 2007).The research question is in elderly patients with anxiety and depressions are psychosocial therapies effective in treating the disorder than medication. The article used to carry the research is the Future of Psychosocial Treatments for Elderly Patients.
Another article is a randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults (Klausner & Alexopoulos, 1999). This article analyzes whether existing knowledge about the use of psychosocial interventions among the elderly patients. It also discusses directions for future practices that can help improve health care among the elderly. Geriatric disorders occur as a result of several factors. They occur where the patient has mental illness, disability or has no enough psychosocial therapies (Klausner & Alexopoulos, 1999). Most researchers argue that, psychotherapy reduces psychopathology and physical complains. Psychotherapy is effective in treatment of depression. Psychosocial interventions are expected to be more important in treatment of psychiatric disorders like depression than medications.
Mental illness among elderly people increases the risk of psychopharmacotheraphy. This is either directly or through interaction with drugs. It can also increase the risk of psychopharmacotheraphy when the patient does not comply well. This reduces the effectiveness of the process. Psychosocial interventions and psychotherapy can help elderly patients suffering from depression, and anxiety cope with many situations. For example, psychosocial therapies can help the patient cope with stressors like loss of loved ones (Klausner & Alexopoulos, 1999). Most elderly patients with depression and anxiety are treated by primary care physicians. The primary care physicians help recognizes symptoms of depression and anxiety. The primary care physician may not recognize the symptoms of the disorders as they are complicated by attitude of the patients and other factors. Psychopathology interferes with the outcome of medical illness. This is because it worsens the outcome, and encourages disability.
This makes recognition and treatment of mental disorders to have different outcomes. The impact of psychopathology should be addressed by delivering psychotherapy in primary environment. This will provide information for designing good health care system for old people in the community. The study carried out in the article shows that psychosocial intervention is effective in treating elderly patients with depression and anxiety. Different types of psychosocial therapies were used to carry out the study. The psychosocial interventions were more effective in treating depression and anxiety than medication (Sable1 & Jeste1, 2001).Researchers have found five psychosocial interventions effective in treating depression and anxiety among the elderly. The psychosocial therapies include cognitive behavioral therapy and brief psychodynamic therapy.
Other psychosocial interventions include interpersonal therapy, reminiscence therapy and psycho education therapy (Sable1 & Jeste1, 2001). Cognitive behavioral therapy is aimed at changing the patient’s thoughts and skills. It also helps modify the emotional state of the patient. Psycho education interventions are administered in group formats (Gabbard, Beck & Holmes, 2007). The interventions are aimed at reducing symptoms of depression among the elderly patients. In the study, the elderly patients were administered psycho education therapy in groups. The interventions helped reduce the symptoms of depression among the patients. Depressed adults were assigned to get cognitive therapy and alprazolam. The researchers combined cognitive group therapy and placebo and used placebo alone (Gabbard, Beck & Holmes, 2007). The interventions given to the group gave different results.
For example, the group that received cognitive therapy showed greater improvement. The therapy helped the adults improve the mood and sleep efficiency. The group showed high sleep efficiency and better mood. The group that received placebo alone and Alprazolam alone did not show good results. The cognitive behavioral therapy was also used to treat other disorders like anxiety among the elderly patients and it had good results. The anxiety level among the patients went down. This showed that cognitive behavioral therapy can reduce stress among the patients instead of using medication (Gabbard, Beck & Holmes, 2007).Another psychosocial intervention that was used in the research is problem solving therapy.
Problem solving therapy focuses on solving family problems. The therapy is different from other therapies in that it emphasizes on the social situation of peoples problem. The therapy believes that people develop problems as a response to their social surrounding. In problem solving therapy, the therapist is required to solve one problem at a time. The therapist uses techniques that are specific to the situations. This makes it easy for the therapist to solve problems among the elderly patients (Gabbard, Beck & Holmes, 2007). The main objective of problem solving therapy is to solve problems and change the behavior of the patient. The therapist studies the symptoms of the patient and decides the technique to use to solve the problems. Behavioral solving therapy is aimed at changing the social situation of the person so as to bring change.
The researchers used the behavioral solving therapy to help elderly patients with stress and depression. The therapists studied depression symptoms among the patient. The symptoms made it easy for the therapists to use the right technique to treat depression. Behavioral solving therapy helped eliminate family problems and other stressors. It also helped the elderly change their behavior. This reduced the symptoms of stress and anxiety among the patients.The problem solving therapy assumes that lack of skills in social problem solving increases the susceptibility of depression among the elderly people in the society. Improving problem solving skills make elderly patients better, and it helps them cope with dificuity situations (Klausner & Alexopoulos, 1999).. This prevents them from developing psychopathology. Problem solving is effective in treating depression among patients with dispersion. Patients who have participated in problem solving therapy have reduced levels of depression.
This is because problem solving therapy helps eliminate symptoms of depression. The elderly patients showed better results than the patients who did not. Problem solving is effective in controlling depression and anxiety among the elderly patients as the patients are taught how to cope with problems. Thus, it is clear that psychosocial therapy is more effective in treating depression and anxiety than medication (Feldman & Christensen, 2003).Interpersonal psychotherapy also helps treat depression and anxiety among the elderly. Interpersonal psychotherapy mainly focuses on interpersonal content. It also focuses on developing interpersonal skills. Interpersonal psychotherapy assumes that interpersonal factors lead to development of psychological problems. The therapy is different from other therapies in that it emphasizes on interpersonal. It helps change a patient’s behavior so as to help him adapt to current roles and situation.
Most elderly people develop mental illness like depression due to isolation (Feldman & Christensen, 2003). Change of roles and interpersonal deficits. The interpersonal therapy is important as it helps eliminate such problems. Interpersonal psychotherapy is an important treatment for patients with late life depression. Late life depression can be linked to losses and social isolation (Feldman & Christensen, 2003).Studies have shown that interpersonal psychotherapy alone is effective in treating acute and continuation depression among elderly patients. It is also effective in treating elderly patients when combined with pharmacotherapy. In the study, interpersonal psychotherapy was used alone and it showed effective results. This is because it reduced the level of depression among g elderly patients. It also reduced the level of anxiety (Feldman & Christensen, 2003).
Then interpersonal psychotherapy was used with psycho education therapy and the outcome was good. The two therapies were able to reduce the level of depression among g elderly patients. It also helped in managing depression among elderly people. The study was also carried out using placebo and the results were not effective. The placebo did not treat depression in the positions effectively. Some patients still showed symptoms of depression even after being given placebo. Thus, the placebo was not effective in treating depression among the elderly people like interpersonal psychotherapy. The study shows that psychosocial therapies are more effective in treating depression and anxiety among elderly patients than medical interventions (Feldman & Christensen, 2003).The researcher also used psychodynamic psychotherapy to treat patients with depression. The objectives of psychodynamic psychotherapy vary from one patient to another. They depend on the medical health of the patient.
It is used on all elderly patients suffering from depression and anxiety. In patients without disability, psychodynamic psychotherapy aims at resolving interpersonal conflicts. It also helps solve disappointments and resolve patient’s achievements. In addition, psychodynamic therapy helps a patient cope with looses and other stressors. For patients who are not very old, psychodynamic psychotherapy helps the patient accept his or her physical limitations (Feldman & Christensen, 2003). It also helps eliminate fear of dependency by encouraging the patient to cope with the situation. Moreover, psychodynamic psychotherapy helps the patient t overcome interpersonal difficulties. Psychodynamic psychotherapy helped elderly patients with anxiety, and depression. It gave good results like behavioral therapies, and cognitive therapy.
It also proved more effective than medications used to treat depression and anxiety.Another psychosocial therapy that was used in the research is reminiscence therapy. Reminiscence therapy was invented as treatment for depression, and anxiety among the elderly people. The therapy was based on the assumption that reflection of positive experiences in a patients life helps eliminate depression and lose of hope. It also assumes that reflections of negative experiences helps control depression and lose of hope. Reminiscence therapy reduces symptoms of depression among elderly patients (Feldman & Christensen, 2003). Most researchers have found the method effective in controlling depression among elderly patients. This is because it helps the patient eliminate symptoms of depression by reflecting on positive and negative experiences. Though, the method proved effective in controlling depression, it did not prove effective like behavioral therapy and other therapies.
This is because patients showed some symptoms of depression after some time. The method was considered effective than medication used to treat depression and anxiety. In addition to being effective than medication, the method was better than lack of treatment. It helped the elderly patients have a renewed life. They managed to cope with stressors like bereavement and isolation (Feldman & Christensen, 2003).The content of the article supports the idea that psychosocial interventions are more effective in treating depression and anxiety among the elderly than medication. This is because the psychosocial interventions used are aimed at helping the patient change his or behavior and help him cope with stressors. The interventions have no negative effects like medications used to treat depression and anxiety. Thus, they are more effective than medication (American Psychiatric Association, 2000).
Recommendation for future practice.
The psychosocial interventions can be more effective in treating depression, and anxiety. This is if the clinical officers combine the right techniques with recognized therapeutic to help the elderly. The literature review on psychosocial interventions suggests the following directions for future practice (King, B, C., & Colville J, et al, 2001). First, psychosocial interventions play an important role in helping patients with depression, and anxiety. The interventions are better than other techniques that are used to treat depression and anxiety. This is because the techniques are not effective as they are complicated by factors like the mood of the patient. Psychosocial interventions will help control depression, and anxiety if they are developed using the right combination. Most old people are expected to experience more stress and depression as they grow old. This is as result of isolation and lack of psychosocial interventions.
Psychotherapeutic intervention can help solve the problem by helping the elderly develop mechanism to cope with dificuity situations (King, B, C., & Colville J, et al, 2001).Researchers need to carry out more studies on standardized psychotherapies. This is to provide effective and satisfactory treatment to elderly patients. This is because most psychotherapy used today to treat depression and anxieties are only aimed at treating acute geatric depression, and anxiety. The psychotherapies include behavioral therapy, cognitive therapy and interpersonal therapy. Another therapy is problem solving therapy. Some of the psychosocial therapies can be effective in providing continuation and maintenance treatment to elderly patients if they are designed well. Since the therapies have different degrees of efficiency, researchers should combine the therapies to produce effective interventions.
For example, problem solving therapy is more effective than reminiscence therapy (King, B, C., & Colville J, et al, 2001).The objective of the psychosocial therapies should be expanded. This is because there are many causes of depression among the elderly people like disability and pain. The therapies should include pain management, and ways of solving disability among the elderly. This will help provide better care to the elderly persons. The interventions should promote health behaviors among the elderly patients. In addition to improving the objective of the psychosocial therapies, the interventions should incorporate roles of other groups. This is because the groups help elderly people overcome depression. The groups care for elderly people, and reduce the causes of depression among the elderly like isolation and bereavement.
These groups include self help group and counseling institutions (King, B, C., & Colville J, et al, 2001).The health care practitioners should increase the efforts to improve recognition and treatment of depression and anxiety in primary care. Elderly patients prefer to be treated by the physician. So the treatment methods and diagnoses should be improved. This will make it easy for many elderly people to access health care (King, B, C., & Colville J, et al , 2001).The psychosocial interventions should be integrated into primary care practices. This is by improving traditional methods used to educate primary care physicians about mental health. This will improve patient’s outcome, and the behavior of the physician. It will make it easy for the elderly patients to get intervention at the right time and also follow up (King, B, C., & Colville J, et al, 2001).
Barriers to change
There are several barriers in the students’ workplace that might prevent change. Lack of education will affect the student as he will not be able to carry the research and effect the change. This makes it dificuity to implement the change. It influences psychosocial interventions negatively as the patient and the student are not conversant with the requirements of the change. It also makes it dificuity to integrate psychosocial therapies in the health care to treat patients with depression and anxiety (American Psychiatric Association, 2000).To overcome this barrier, the student should be provided adequate knowledge on how to carry out the research. This will make it easy to effect the change. The patient should also be provided with the education to help make the research and change effective.
The patient and the student should be educated on how to use psychosocial interventions to help elderly patients suffering from depression and anxiety (American Psychiatric Association, 2000).Another barrier to the change is influence from other people. People might influence the change negatively and make it dificuity to implement. This is because people have different ideas and conflict of interest. Family members can influence implementation of psychosocial interventions in health care. This makes it dificuity to use psychosocial interventions to treat patients with depression and anxiety. To prevent the barrier the student should avoid conflict of interest so as to make the change effective (Diefenbach& Goethe, 2006).Another barrier to implementing change is lack of enough resources.
Implementation of psychosocial interventions requires some skills, and resources. The student may not have enough resources to implement the change. This makes the change ineffective. The student should identify the right resources to use for the change. He should plan well to ensure effective implementation of the change (Diefenbach& Goethe, 2006).Lack of corporation in the workplace can also hinder the change. The patients might not corporate with the student to implement the change. This makes it dificuity to implement psychosocial interventions. To overcome the barrier, there should be corporation between the person implementing the change and the patient (Diefenbach& Goethe, 2006).
Another barrier to the change is language barrier. Language barrier is the biggest challenge in carrying out any change (Diefenbach& Goethe, 2006). This is because there are many people in the society and student workplace and they have different languages and culture. Language barriers make research and implementation of change infective. This is because there is no corporation between the researcher, and the patient. Culture also influences implementation of change as people have different culture. This makes it hard to get the right information. To overcome language barrier, and cultural barrier, the student should encourage diversity in the research. He should use multiple languages when implementing the change and carrying out research (Klausner & Alexopoulos, 1999).
Physical interventions are more effective in treating depression and anxiety in elderly patients. The interventions do not have any side defects like medications. The interventions are easy to administer. Research has been carried out to determine if psychosocial therapies are effective in treating depression and anxiety in elderly patients. The studies were carried out using the various types of psychosocial therapies. Most of the therapies proved more effective than medication. For example, behavioral therapy is more effective than placebo.
Other interventions used in the research include interpersonal psychotherapy, reminince therapy, psychodynamic therapy and psycho education therapy. Patients showed better outcome when the interventions were used than when medication was used. The intervention improved the patient’s life by eliminating stressors that cause depression. For example, the interventions helped eliminate stressors as they provide behavioral change to the patient. Most patients were able to accept issues like isolation, disability and looses.There are recommendations that can be used by the clinical officers to improve health care services among the elderly patients.
The practices include, diversifying the objective of psychosocial therapies to include other factors that cause depression and anxiety like disability and pain management. In addition to diversifying the objectives, the practitioners have to improve psychosocial therapies by combining several therapies. The therapies have different strengths. The barriers in the student work place include language barrier, lack of education and skills. Other barriers include influence from other people, lack of resources, cultural diversity, and influence from other diseases. To overcome the barriers the student should have good skills, enough resources and plan well and encourage diversity.
American Psychiatric Association. (2000).Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DSM-IV).
Diefenbach,G, J., & Goethe, J. (2006). Clinical Interventions for Late-Life Anxious Depression
American Psychiatric Association.(1994). Diagnostic and statistical manual of mental disorders. 4th ed. Washington
Feldman,M,D., & Christensen,J,F.(2003).Behavioral Medicine in Primary Care. McGraw-Hill Professional
Gabbard,G,O.,Beck,J,S.,& Holmes,J.(2007).Oxford Textbook of Psychotherapy. PublisherOxfordUniversity Press
King, B, C ., & Colville J, et al. (2001). A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. J Consult Clin Psychol. Vol 69, page756–62.
Klausner, E,J.,& Alexopoulos,G,S.(1999).The Future of Psychosocial Treatments for Elderly Patients .American Psychiatric Association
Sable1, J, A .,& Jeste1,D,A.(2001) Anxiety disorders in older adults. Current Medicine Group LLC.Vol 3, Issue No. 4, Pages302-307