Too old to talk to someone?
Studies show older people do as well in psychotherapy as younger ones, but finding and paying for service can be discouragingly difficult
Three years ago, Janet Burns felt herself sliding into depression, a too familiar state. Burns, a retired federal worker living in Rockville, Maryland, grew up in a home she described as abusive, with an alcoholic father. Sometimes, she said, “I get into a slump and can’t get out.” Several times, psychotherapy had helped her regain her equilibrium.
Then her father died. “It brought up a lot of stuff I thought I had dealt with,” she said. Experiencing both guilt and relief, and feeling responsible for her mother and an ailing sister, she began to have anxiety, insomnia and exhaustion. “I needed some more help,” she decided.
Burns, 75, found a new counselor and saw her weekly for a couple of months, then every other week. “She helped me put this in perspective and lift the burden I was putting on myself,” Burns said. “She gave me some tools, mental exercises to do when the pressures were on.”
The coronavirus pandemic has brought fresh pressures.
Burns has had to largely suspend her volunteer work, and she and her husband have been unable to visit their children and grandchildren. She said she was handling it.
But, she added, it was reassuring to know that she could turn to her counselor again if necessary. “It’s like a safety net,” she said. “This is someone I trust, who knows my history, and that’s comforting. I wish everybody had it.”
Health experts and practitioners also wish that more older adults could access psychotherapy and other kinds of mental health care, especially now. Mental health problems have risen markedly during the pandemic, the Centers for Disease Control and Prevention has reported.
Loneliness and isolation have taken a toll on older people, and geriatric psychiatrists anticipate an increase in grief disorders.
“It makes their existing issues worse,” Mi Yu, a geriatric psychiatrist in Nashville, Tennessee, said of the pandemic’s effects. “All my patients seem to have experienced more distress and anxiety, and they’re requiring more frequent sessions.”
Experts have long reported that older people, particularly those older than 80, seem more reluctant to seek treatment for psychological disorders.
“The greatest generation are the pull-yourself-up-byyour-bootstraps group,” said Daniel Plotkin, a geriatric psychiatrist in Los Angeles. Acknowledging psychological problems still carries a stigma, particularly among rural residents and Black Americans.
Age bias can infect practitioners, too, Plotkin said. “The unfortunate attitude that most people have, including doctors, is that older people can’t change, that they’re stuck in their ways,” he said. In fact, he noted, studies have shown that older people do as well in psychotherapy as younger ones.
Practitioners may prefer to treat younger clients because they have decades ahead during which to reap the benefits. Yu recalled a woman in her 80s who sought therapy after her husband suffered a heart attack. Two dozen local practices turned her away, saying they didn’t accept patients her age.
“I was dumbfounded,” Yu said. “We actually find elderly patients are more open to therapy. They’re more reflective. Realizing that they have limited time left in life gives them a sense of urgency; they want to resolve something, and they don’t have time to lose.”
Yu worked with the woman for about a year, also prescribing antidepressants, until “she gradually was back to herself.”
But the woman’s experience demonstrates that even when older people decide to seek treatment, finding and affording therapy can prove discouragingly difficult.
Traditional Medicare covers individual and group psychotherapy, with no cap on the number of sessions; beneficiaries pay 20% of the authorized amount. It also covers treatment of alcohol and drug abuse and provides for free annual depression screening. Co-payments for Medicare Advantage beneficiaries vary from plan to plan.
But many mental health practitioners won’t accept Medicare, in part because the reimbursement is so low.
Moreover, although Medicare covers mental health treatment by a variety of providers, it won’t reimburse licensed professional counselors or marriage and family therapists.
With only 1,526 boardcertified geriatric psychiatrists practicing nationwide last year, that pool of 200,000 licensed counselors and marriage and family therapists could go a long way toward meeting the demand for care.
“They comprise about 40% of the mental health workforce, but they’re not eligible under Medicare,” said Matthew Fullen, a counselor educator and researcher at Virginia Tech.
Heidi Jelasic, 68, an administrative assistant in Royal Oak, Michigan, had been seeing a licensed professional counselor after a traumatic event with a neighbor and felt she was making good progress. Then, in April, she lost her job in a pandemic layoff, and with it, her employer health coverage.
That meant shifting to Medicare, which would not cover her counselor, and she could not afford to pay out of pocket.
“I’m on a shoestring,” she said. “I can’t afford it.”
In short order, she has endured job loss, pandemic fears and, in September, her mother’s death in a nursing home that had barred visitors.
“These are some of the most challenging months I’ve had in my whole life,” she said. “And I was unable to turn to my therapist.”