Effects of Life Transitions on Older People
Late life is commonly a period of transitions (for example, retirement or relocation) and adjustment to losses.
Retirement is often the first major transition faced by older people. 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 (for example, because of health problems or job loss). Appropriate preparation for retirement and counseling for retirees and families who experience difficulties may help. Many employers and community agencies offer retirement planning services.
Relocation may occur several times during old age. For example, people may move to retirement housing with desirable amenities, to smaller quarters to reduce the burden of property upkeep, to a different community for better weather or to be close to family members, to a relative's home, or to a residential care facility. People who respond poorly to relocation are more likely to be living alone, socially isolated, poor, and depressed. Men often respond less well than women.
Because of financial, social, and other complications, some older adults feel they must remain in problematic homes or neighborhoods despite the desire to relocate. Often, older adults may find that social workers can assist them in assessing their options for relocation or home modification.
Much of the stress seems to arise when people feel they lack control over the move and do not know what to expect in the new environment. For older people who have memory loss, a move away from familiar surroundings may intensify confusion and dependence on others and lead to frustration. Many moves happen suddenly, but even a little preparation can help decrease the stress of relocating. People who are moving should be acquainted with the new setting well in advance, if possible. Touring future surroundings and meeting potential neighbors can be very helpful.
Bereavement affects many aspects of an older person's life. For example, social interaction and companionship decrease, and social status and financial circumstances may change. Older people may experience a decline in their own health after the death of a close family member or friend. The death of a spouse affects men and women differently. In the 2 years 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.
Some sleep disturbance and anxiety are normal in people who are grieving. These effects usually resolve in months without drug treatment. If grief is prolonged or overwhelming, if people become unable or unwilling to carry out even essential daily activities, or if they speak of suicide, evaluation and treatment by a doctor are necessary. If the doctor diagnoses depression, people may be referred to a mental health practitioner. At times, antidepressant drugs may be helpful.
Screening for depression is an important part of a doctor visit. Caregivers and health care practitioners should look for symptoms of depression and be aware that bereaved people are at high risk of suicide and declining health. Older adults make up 13% of the population but account for 20% of all suicides, and the rate of suicide among older men is 5.25 times higher than among older women. Older adults often do not give warnings about suicide and seldom seek mental health treatment. Doctors are less likely to offer treatment for depression to older patients than to younger patients. Although older adults attempt suicide less often than those in other age groups, they have a much higher completion rate due to high likelihood of using firearms in the attempt (used in 71.3% of completed suicides among older adults) as well as more health problems and frailty, avoiding interventions, and lower likelihood of living with others who might detect and respond to suicide attempts. Thus, the risk of suicide completion among older adults with suicidal ideation is very high.
Timely screening for depression and suicidal ideation is essential. Older people may need counseling and supportive services (for example, support groups for widows), as well as drugs for anxiety or depression, to help with difficult transitions.