One of the most contentious issues faced by families of aging relatives is the decision about future care, especially as dementia takes hold and living alone becomes risky. It is one that fractures families, reviving old hurts and resentments between parents and children and siblings. With increased social mobility and smaller families, it is common for one person to be left with full-time responsibility with others claiming that while they would like to help it is clearly impossible at a distance. While they may visit and attend to their parent this can also fuel difficulties when they are framed as the favored and special child who has done so much, diminishing the local carer. When this sibling has their own family and is managing the storms of adolescence it is little wonder that carers suffer higher rates of both anxiety and depression. Admission to care becomes a major question but this too carries risks.
The Consequences for Older People
A key restraint for families choosing full-time care is the fear that their parent will be unhappy, especially if they have been admitted against their will. Visits are particularly harrowing where the parent begs to be allowed to return home and the child must refuse.
The Australian Government Institute of Health and Welfare 2024 report states that based on the Cornell Scale for Depression, for those who entered residential aged care who were 65 years and over, 62.5% had mild symptoms and 16% major symptoms of depression. This is most often treated with antidepressant medication.
What About Therapy?
Recognising the availability of suitable psychological approaches to depression in this population, Davison (et al 2024) reviewed the literature on studies which compared treatments with elements of cognitive behavioural therapy, behavioural therapy, and reminiscence therapy with treatment as usual or those controlled for effects of attention. The results were disappointing, with low-certainty evidence that psychological therapies were more effective than non-therapy controls in reducing symptoms of depression compared with usual care, and with no effect on anxiety.
Is there Another Way?
It takes little imagination to explain why this may be so. Removal from home, family and friends is depressing and approaches which fail to address the entire system must surely have limited success. However, our field, with a few notable Australian exceptions, (Tisher, M. and Dean, S. 2000 and Cordukes et al 2024), has been less interested in this life phase. Working with older clients, presenting issues often revolve around past mistakes and the need to repair while there is still time and ongoing fracture which hold the family in an earlier life phase condemning the elderly person to the endless role of mediator and judge. Such matters inevitably cloud questions of proper care and respect for the aging person and leave them vulnerable and isolated. With the rare exception where childhood abuse or violence has proved irresolvable, despite best efforts, gathering the whole family with a view to supporting and releasing the older adult to live with care and dignity must surely be preferable.
Cordukes, K., U’Ren, G., Katz, E. C., & McIntosh, J. E. (2024). Working with adult families of origin: On the nature of rupture and repair. Australian and New Zealand Journal of Family Therapy, 45, 279–291. https://doi.org/10.1002/anzf.1600
Davison,T. Bhar,S., Wells,Y., Owen,P., You,E., Colleen Doyle,C., Steven J Bowe,S. and Leon Flicker, L. Psychological therapies for depression in older adults residing in long-term care settings (Review) Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Miriam Tisher,M.and Dean,S (2000) Family Therapy with the Elderly Education Update Australian and New Zealand Journal of Family Therapy.
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