This story was originally reported and published by the Seattle Times, and is republished here with permission.
There’s a dark joke that the best time to start shoplifting is when you move into older age, Anya Johnston said, because no one pays attention to you.
Johnston doesn’t actually shoplift, but they do feel “increasingly invisible anywhere I go” — especially in medical settings.
Johnston, a Tri Cities-area resident who is 65, said they were diagnosed in their 50s with attention-deficit/hyperactivity disorder, after being told for years that they were experiencing depression.
Despite pleading with doctors, Johnston said they found it hard to get attention and care for their mental health concerns, since they exist in multiple margins of society: They’re older and trans. “I certainly didn’t feel heard, not at all believed,” Johnston said.
Johnston’s feelings are not uncommon for their age: While people of all ages may report feeling ignored and dismissed in medical and mental health settings, the sentiment is particularly prevalent among older adults, experts say. Health care providers often carry implicit biases that slip through and affect patients, even when their medical education has trained them otherwise.
For older people, said Douglas Lane, a clinical psychologist in geriatric psychology, ageism plays out often in one of three ways: They may be infantilized by providers. Providers can also be dismissive, assuming that older people can’t be suicidal or have intimate relationships. Other times, issues among older people get normalized as a so-called routine part of aging.
“Well of course they’re frail. Of course they’re depressed. Of course they don’t remember things as well as they used to,” Lane said, referencing negative stereotypes of older people.
Heidi Weispfenning, a 63-year-old who lives in Renton, said as she got older, she felt more and more like “everybody assumes that I’m completely stupid,” even though she grew up in a medical family.
“To be treated like a child because I have gray hair is just infuriating,” she said.
If this sounds familiar, here are some tips that aging adults, their loved ones and health care providers can use to ensure older people get the mental health care they need.
Understand how aging does — and does not — affect you
Ageist stereotypes are all around in culture, but they can also be within ourselves. Aging adults as well as medical providers often normalize physical ailments and mental health challenges as a regular part of the aging process when that doesn’t have to be the case.
People will say, “I guess this is what old age is supposed to be like,” said Whitney Carlson, the medical director of the geriatric psychiatry clinic at Harborview.
It’s not a normal part of aging to be sad. Medical providers should give people hope that it doesn’t have to stay that way, Carlson recommends. Remind them that people have felt better once they got help, and that that person can, too.
These negative views of aging often come from our own fears, Lane said. Medical providers should understand how they can protect their patients from negative emotions that come with a providers’ own feelings about aging and death.
How to talk to doctors
In every medical appointment or counseling session, remember that you are entitled to quality care regardless of your age.
There are cues you can use to determine whether a doctor may be a good fit. Is the doctor looking in your eyes? Do they seem like they’re in a hurry? Do they give you the time you need and let you ask questions?
Tracy Bell, a licensed mental health counselor in Seattle who is also a senior herself, said she recommends asking to record an appointment. For her, “it’s so much easier to listen if I don’t have to worry about remembering what you’re saying.”
A provider may say that they put information in chart notes, but recordings allow you to play the conversation over again and pick up on what you missed and ask others for their opinions.
Mary O’Leary, a senior planner at Seattle’s Aging and Disability Services, suggests bringing an advocate, like a friend or family member, as a “second set of eyes and ears” who can ask questions on your behalf.
Still, with shortages in health care providers, medical staff may have limited time for patients, so it’s important to mention the biggest need first. Lane recommends being specific in your language and using terms that will get the provider’s attention.
“Rather than saying, ‘I’m kind of down,’ say, ‘I think I’m depressed. Can you conduct a depression screening interview with me?’ ”
Patients who feel like their provider is dismissing their concerns as a part of getting older can respond, “That may be true for some people, but it’s not for me, and this is not how I usually am,” Carlson said.
She also reminds people that it’s OK to ask again or get a second opinion. “It’s OK to question your doctor.”
It’s also OK to want to avoid taking medication, something common among older people who may be taking lots of other pills.
Medication may help someone talk about issues more easily, sleep at night or not cry every day, she said. But if you don’t want to take medication, ask about other options to address your concerns.
Older patients may also need extra encouragement to talk about mental health. Stigma around getting mental health treatment has decreased dramatically in recent decades, but older patients may not be as well versed in recognizing depression in themselves, for example.
They may also believe that it is selfish to work on yourself and need to develop a mentality toward encouraging self-care.
Cultural backgrounds may also influence a patient’s perspective and approach.
For example, Regina Yeh, a clinical social worker in Seattle, said she often hears reservations about questioning health care providers among her older Asian clients. “It’s about honor and humility, and there’s some cultural norms and expectations that just don’t fit the Western medical model,” she said.
What to understand about therapy
People of all ages can benefit from therapy, Bell said. Her clients often think, “I should not be having this problem at this age.” But core wounds can surface at any time.
They may never have had an occasion or enough impetus to address unresolved issues. Those issues can stay repressed until an event comes up, often a significant transition like the death of a partner or retirement.
“Suddenly, you have to question things that you’ve never really let yourself look at before,” Bell said.
Carlson reminds people that “you don’t have to cover anything you don’t want to” in therapy, but that it may help provide tools you can use to “have the best life you can moving forward.”
Another factor to consider when looking for therapy is insurance coverage. Carlson recommends starting the search with your insurer, which should keep a list of in-network therapists.
It can be hard, but not impossible, to find a therapist who accepts Medicare. One alternative option to get mental health care, Bell said, is to search within primary clinics, especially in larger medical settings. They often employ social workers with psychological training who can conduct counseling and help patients get a consultation with a psychiatrist.
Getting beneath the surface
If you’re concerned about your loved one, pay attention to warning signs. For example, they may begin withdrawing by not participating in their faith community or not attending their grandchild’s basketball game as usual. If they start saying things like, “I’m a burden,” or “If I didn’t wake up tomorrow morning, I wouldn’t care,” get help.
However, among older adults, issues that appear to be psychiatric may actually be physical or cognitive problems.
“Sometimes, when people get to the moderate stages of dementia, they will have symptoms that look like mental illness, but what they’re really having is a memory problem, and then they’re also becoming fearful and delusional,” Carlson said.
If someone says, “Nothing tastes good. My energy level is gone. I feel tired all the time,” those could be symptoms of depression, Lane said, but they could also be symptoms of a thyroid disorder, for example. By listing all your symptoms, you give a provider access to more information and they can give you a more accurate diagnosis.
Strengths and vulnerabilities
Most conversations around geriatric mental health tend to focus on vulnerabilities. Indeed, older people are more likely to get abused and financially scammed.
However, older people also have stronger resilience levels, having had more experience moving through tough life events and more awareness of joyful times, which can make them better at psychological and existential coping, Lane said.
“Old age isn’t just about pathologies or challenges,” he said. “It’s also about having a unique set of assets to work with and meeting those challenges.”
Becca Levy, a Yale professor and author of the book “Breaking the Age Code,” said older people possess strengths that can be particularly helpful for therapy, like their ability to review their lives and solve conflicts.
“There’s some research that suggests that older people have increasing wisdom and emotional intelligence and that they can be flexible and innovative in their thinking,” Levy said.
Content from the the Seattle Times Mental Health Project is underwritten by the Ballmer Group, a national organization focused on economic mobility for children and families. This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and the The Silver Century Foundation.
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