Front Matter

Contributors

Preface

Acknowledgments

1 Introduction to Late-Life Depression

Art Walaszek, M.D.

2 Introduction to Late-Life Anxiety and Related Disorders

Lisa L. Boyle, M.D., M.P.H.

3 Assessment of Late-Life Depression and Anxiety

Rebecca M. Radue, M.D.

4 Suicide Risk Reduction in Older Adults

Lucy Y. Wang, M.D.

5 Management of Late-Life Depression and Anxiety

Anna Borisovskaya, M.D.

Elizabeth Chmelik, M.D.

William Bryson, M.D., Ph.D.

Matthew Schreiber, M.D.

Marcella Pascualy, M.D.

Samantha May, M.D.

Courtney Roberts, M.D.

6 Comprehensive Cultural Assessment of the Older Adult With Depression and Anxiety

Eileen Ahearn, M.D., Ph.D.

Index

Clinical Adjunct Professor of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

Psychiatrist, SeattleNTC, Seattle, Washington

Adjunct Clinical Professor of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

Acting Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington; Veterans Affairs Puget Sound Healthcare System, Seattle, Washington

Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington; Veterans Affairs Puget Sound Healthcare System, Seattle, Washington

Psychiatry Resident, Department of Psychiatry, Samaritan Health Services, Corvallis, Oregon

Associate Professor, Department of Psychiatry and Behavioral Sciences, University of Washington; Veterans Affairs Puget Sound Healthcare System, Seattle, Washington

Geriatric Psychiatrist, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin

Psychiatry Resident, Department of Psychiatry, UCLA–Olive View Medical Center, Los Angeles, California

Acting Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington; Veterans Affairs Puget Sound Healthcare System, Seattle, Washington

Professor of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington

We all want to age well. What this mean varies from person to person, so here’s my list: to have loving and respectful relationships with my family and friends; to live with meaning and purpose and in a way that is consistent with my values; to be emotionally, cognitively, and physically healthy; to be able to make choices that benefit my community, my family, and myself; and to be resilient in the face of the inevitable stressors of aging.

Depression and anxiety disorders threaten our ability to age successfully. Whereas sadness, grief, and worry are core parts of being a human, depression and anxiety disorders are not inevitable. But they are emotionally painful, physically uncomfortable, disabling, and potentially fatal. Suicide is a significant global health problem, especially among older adults, and depression contributes mightily to the risk of suicide.

Thankfully, we can identify people with late-life depression and anxiety, we can diagnose them accurately, and we can offer treatment that works. In other words, people suffering from these conditions can find relief, maintain their independence, and lower their risk of dying from suicide.

My coauthors and I wrote this book to provide health care professionals with evidence-based, pragmatic, and clear recommendations regarding the care of people with late-life depression and anxiety. Although we certainly wanted to be scholarly, we wrote in a conversational tone—as if we were all in a room together discussing how best to assess and help our patients. We believe that anyone involved in the care of older adults—primary care physicians, geriatricians, psychiatrists, neurologists, residents and fellows, medical students, psychologists, advanced practice providers, social workers, and nurses—will find this book useful.

The book begins with an overview of late-life depression (Chapter 1) and late-life anxiety (Chapter 2), including their public health impact, epidemiology, clinical presentation, and course, as well as consequences, complications, and comorbidities. We move on to the assessment of the depressed or anxious older adult in Chapter 3 and guide the reader from interviewing a patient to making the diagnosis. Given how important it is to assess and reduce the risk of suicide among older adults, we have devoted Chapter 4 to the topic. In Chapter 5, we try to answer the question “How can we best help our patients suffering from late-life depression or anxiety?” In other words, we review the evidence base and present recommendations regarding psychotherapy, medications, electroconvulsive therapy, complementary and alternative medicine, and other approaches. We close with the crucial topic of ensuring that health care professionals provide culturally sensitive care to racial/ethnic, sexual, and other minority elders (Chapter 6); we have also tried to weave this consideration into the narrative throughout the book. In each chapter, we list key points to provide readers with a quick summary of the content; provide online and other resources for patients, family members, and clinicians; and include plenty of figures to help illustrate the material.

We hope that our readers will find Late-Life Depression and Anxiety to be readable and helpful. And we hope that older adults who are suffering from depression or anxiety will benefit—and will age well.

Art Walaszek, M.D.

Madison, Wisconsin

April 2021

Eileen Ahearn: Many thanks to Dr. Art Walaszek for organizing and guiding this project. I am thankful for my wonderful colleagues at the William S. Middleton Memorial Veterans Hospital, including Dr. Lisa Boyle and Dr. Rebecca Radue. It is a privilege to work with them and to serve our aging veteran population.

 

Lisa Boyle: I would like to thank all of the wonderful mentors, residents, fellows, interprofessional team members, and patients I have learned from and been fortunate to work with over the past 20 years of my career at the University of Wisconsin, University of Michigan, University of Rochester, and the William S. Middleton Memorial Veterans Hospital. Specifically, my deepest gratitude for all the support over the years from Drs. Molly Carnes, Steve Barczi, Timothy Howell, Barbara Kamholz, Susan Maixner, Helen Kales, David Knesper, Michael Jibson, Jeffrey Lyness, Yeates Conwell, Carol Podgorski, Deborah King, Anton Porsteinsson, Paul Katz, Annie Medina-Walpole, P. J. Chen, E. J. Santos, Tom Caprio, Eileen Ahearn, Rebecca Radue, and Art Walaszek, and also to Teresa Swader and Daniel Goldman. I would like to acknowledge my family, who have supported me through all the highs and lows of my training and career as a physician and psychiatrist: my mother, Tzu-Yueh, who has been my biggest cheerleader; my dad, Daniel; my brother, Dan, and sister-in-law, Jennifer, and their three girls; and the bright lights in my life, my children, Lucille and Lloyd. I could never do any of this without all of your love and support and can never thank you enough for your patience and inspiration.

Anna Borisovskaya: My colleagues and I are grateful for the support of the University of Washington Department of Psychiatry and Behavioral Sciences, as well as the Veterans Administration Medical Center in Seattle, Washington. Geriatric Psychiatry faculty from both institutions were instrumental in encouraging our dedication to scholarship.

Rebecca Radue: Special thanks to my many mentors in geriatric psychiatry, including Lisa Boyle, Lynn Verger, Tim Howell, and especially to Art Walaszek for his mentorship and the opportunity to collaborate here. I also must thank my dear friend Rebecca Nierengarten for her advice and edits as I wrote, and my wife, Ashley, for supporting me through all my endeavors.

Lucy Wang: I would like to acknowledge my many mentors in geriatric psychiatry, some of whom include Elaine Peskind, Murray Raskind, Marcella Pascualy, and Debby Tsuang. I also consider it a privilege to work at the VA Puget Sound Health Care System, which has supported my clinical practice focused on older adults and sparked my interest in learning more about suicide risk reduction strategies in this important population.

Art Walaszek: Thank you to my wonderful co-authors—Eileen, Lisa, Rebecca, Lucy, and Anna and her colleagues at the University of Washington—for their commitment to this project, even as a pandemic raged. I learned a tremendous amount from reading and editing their chapters, which will benefit my patients and hopefully many other patients. I very much appreciate their patience with me and their collaborative spirit. I hope we can work together again.

I have been graced with many mentors and colleagues at the University of Wisconsin, both in Psychiatry and in Geriatrics, who have been instrumental in my writing about how best to relieve the suffering of older adults who have problems with mood, behavior, and cognition.

Thank you to Erika Parker, Laura Roberts, and John McDuffie at American Psychiatric Association Publishing for their continued support and their remarkable patience.

And my deepest gratitude to my always supportive family: Suzanne, Maddy, Lucy, Dewey, and even Percy.