Depression in older people : meeting the challenges of an ageing population

Abstract

This thesis has been conducted in part fulfilment of the Doctorate in Clinical Psychology. It comprises two parts: a systematic review and an empirical research study. These are two distinct articles both aiming to provide insight into the challenges of late life depression. Firstly, the ageing population will mean that mental health services are likely to see an increase in older people with depression, many of whom will have neurological conditions common in late life, including dementia, stroke and Parkinson’s disease. These conditions have a high risk of depression associated with them. Addressing depression can have a significant effect on quality of life and at present there is limited evidence for effective treatments for depression in neurological conditions. Researchers and therapists have previously been reluctant to conduct psychological therapy with this population, however, there is preliminary evidence that psychological therapies can be efficacious for this population. CBT is structured, goal focused and orientated in the present therefore may be easily adapted for the needs of people with neurological conditions and associated cognitive impairment. Chapter one presents systematic review of this literature, titled ‘Cognitive and behavioural therapies for the treatment of depression in people with dementia, stroke and Parkinson’s disease’. Secondly, depression in the general older adult population will also present challenges for mental health services. Psychological therapies have been shown to be equally effective for older people as they are for younger adults. However, there are a range of gerontological issues that must be considered when working with older people. For example, cohort beliefs, interpersonal role changes and physical health changes may all impact on the way an older person conceptualises their difficulties. In particular, depression in older people has been associated with negative attitudes about ageing. Cognitive theory states that attitudes are mood-state dependent and if negative or dysfunctional attitudes are modified, this can result in improvement in mood. Exploring the attitudes of older people with depression will aid our understanding of late life depression and may provide useful information on whether attitudes to ageing should be specifically addressed during therapy for depression. The current research study explores attitudes to ageing with a clinical sample of depressed older adults and compares attitudes with non depressed control participants. Chapter two outlines the full methodology used in the research study and chapter three contains the research study, titled ‘Attitudes to ageing and clinical depression in older people’, presented within a journal article format.