Public Health and the Elderly

A test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, and the helpless are the true gold mines of a culture J. Heschel

The field of family therapy has not fully explored the area of mental health issues with the elderly or their caregivers.  Some wonderful family therapists work with aging adults yet there is not a lot of literature to help guide therapists.  This post is not a critique of the family therapy field.  Nor will it highlight all the key public health areas that affect healthy aging.  Instead, I will use the next few posts to highlight just a few public health issues that therapists could address with families.

The Centers for Disease Control and Prevention published a report in 2007 called The State of Aging and Health in America.  This report examined 15 key health indicators across four areas; Health Status, Health Behaviors, Preventive Care and Screening, and Injuries.  In 2008, the CDC updated this report with the State of Mental Health and Aging in America.  This report examined 6 key indicators including Social and Emotional Support, Life Satisfaction, Frequent Mental Distress, Current Depression, Lifetime Diagnosis of Depression, and Lifetime Diagnosis of Anxiety Disorder.  If you are a researcher in the field of gerontology, these reports are vital to your research but there are some very interesting facts here for clinicians.   Here are some interesting points:

  • Adequate social and emotional support is associated with reduced risk of mental illness, physical illness, and mortality.
  • Life satisfaction is the self-evaluation of one’s life as a whole and is influenced by socioeconomic, health, and environmental factors.
  • Life dissatisfaction is associated with obesity and risky health behaviors such as smoking, physical inactivity, and heavy drinking.
  • Older adults with frequent mental distress were more likely to engage in behaviors that can contribute to poor health, such as smoking, not getting recommended amounts of exercise, or eating a diet with few fruits and vegetables
  • Anxiety, like depression, is among the most prevalent mental health problems among older adults. The two conditions often go hand in hand, with almost half of older adults who are diagnosed with major depression also meeting the criteria for anxiety.

Three points should be stressed.  First, the vast majority of the elderly are doing well.  Many aging adults report feeling supported, being satisfied with life, and do not struggle with depression or anxiety.  Next, it is important to stress that this is a population-based survey.  This means that clinical and non-clinical aging adults were surveyed.  Since we work with clinical populations, we should expect to see more reports of depression, anxiety, and lack of social support.  Lastly, we know that racial & ethnic health disparities occur across the life span & they can have a cumulative effect.  One way to improve health for aging minority adults is to improve health for minority groups. The State of Aging and Health in America reported, "The care of older adults who are chronically ill, poor, and members of an ethnic community is an increasingly urgent health priority" (p.3).

When family therapists are doing an initial interview, collecting information for an assessment, or doing a genogram we need to make sure that we are asking how aging adults in the family are doing (regardless of who the "client" is).  While the vast majority of the elderly have a positive outlook and social support, we need to make sure that those who do not get the help they need.  Below is a list of public health resources for additional information.  My next post will focus on caregivers and public health.  Please leave a comment, share a story, or offer some new resources.  Take care.



Administration on Aging

Center on an Aging Society

Centers for Disease Control and Prevention

Center for Medicare & Medicaid Services

National Institute of Aging

US Department of Health and Human Services

This post was originally posted in June 2010 at

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