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Effects of Life Transitions on the Elderly

by Daniel B. Kaplan, PhD, MSW, Barbara J. Berkman, DSW, PhD

Late life is commonly a period of transitions (eg, retirement, relocation) and adjustment to losses.

Retirement is often the first major transition faced by the elderly. Its effects on physical and mental health differ from person to person, depending on attitude toward and reason for retiring. About one third of retirees have difficulty adjusting to certain aspects of retirement, such as reduced income and altered social role and entitlements. Some people choose to retire, having looked forward to quitting work; others are forced to retire (eg, because of health problems or job loss). Appropriate preparation for retirement and counseling for retirees and families who experience difficulties may help.

Relocation may occur several times during old age—eg, to retirement housing with desirable amenities, to smaller quarters to reduce the burden of upkeep, or to a residential care facility. Physical and mental status are significant predictors of relocation adjustment, as is thoughtful and adequate preparation. People who respond poorly to relocation are more likely to be living alone, socially isolated, poor, and depressed. Men respond less well than women.

The less control people perceive they have over the move and the less predictable the new environment seems, the greater the stress of relocation. People should become acquainted with the new setting well in advance. For the cognitively impaired, a move away from familiar surroundings may exacerbate functional dependence and disruptive behavior. Because of financial, social, and other complications, some older adults feel they must remain in problematic homes or neighborhoods despite their desire to relocate. Social workers can help such people assess their options for relocation or home modification.

Bereavement affects many aspects of an elderly person’s life. For example, social interaction and companionship decrease, and social status may change. The death of a spouse affects men and women differently. In the 2 yr after death of a wife, the mortality rate in men tends to increase, especially if the wife’s death was unexpected. For women who lose a husband, data are less clear but generally do not indicate an increased mortality rate.

With bereavement, some sleep disturbance and anxiety are normal; these effects usually resolve in months without drug treatment. In contrast, prolonged, pathologic grief is characterized by the following:

  • Symptoms that are typical of a major depressive episode and that last > 2 mo

  • Feelings of guilt about things not directly related to the loss

  • Thoughts of death unrelated to survivorship

  • Morbid preoccupation with worthlessness

  • Hallucinations other than hearing and seeing the decedent

Caregivers and health care practitioners should look for such symptoms and be aware that bereaved patients are at high risk of suicide and declining health status.

Timely screening for depression and suicidal ideation is essential. Counseling and supportive services (eg, support groups for widows) may facilitate difficult transitions. Short-term use of anxiolytic drugs can help patients with excessive anxiety. However, excessive or prolonged use should be avoided because it may interfere with the process of grieving and adjustment. Prolonged, pathologic grief usually requires psychiatric evaluation and treatment.

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