We are dying older and having fewer children meaning that our population is ageing. Growing older is something to celebrate as it represents survival and the experience we gain over the years brings wisdom and scope for reflection. However, age-related changes such as increased physical frailty, poorer physical health, increased risk of cognitive decline, loss of former roles and bereavements, particularly when experienced within societies which stigmatise rather than value ageing, can result in increased psychological distress. This psychological distress can lead to new mental health conditions or aggravate pre-existing conditions experienced throughout the life course. Despite this potential for increased psychological distress and mental health problems in later life, we know that older people have poorer access to psychological therapies and interventions. Mental distress in later life is overly medicalised with older people being more likely to be prescribed medications as treatment rather than being offered psychological therapies (Age UK, 2024). This is particularly concerning as older people are more likely to experience harmful side effects from psychotropic medications than younger people (Chandramouleeshwaran et al., 2024; Corvaisier et al., 2024). The reasons for this age-related bias in the provision of psychological therapies are multifaceted, but research suggests that ageism plays a role. For example, stereotypical views that old people don't like to talk about mental health and that talking about past trauma will be too distressing discourage health care professionals from offering therapy in later life (Berry et al., 2020). It is also problematic that evidence-based therapies such as cognitive behavioural therapy have also traditionally been developed for and tested with working-age adults. In fact, many past therapy trials specifically excluded adults over the age of 65 years due to concerns that age may complicate therapy delivery and by inference impact on the quality of evidence generated. Thankfully, this ageist approach has been recognised by funders of research and ethics committees meaning researchers need to make a much stronger case if they want to apply an upper age limit to their studies. Including older people in psychological therapy research trials will increase representativeness and the generalisability of findings across the life span. The inclusion should not, however, overlook the fact that people in later life do have unique needs which require consideration within the delivery of therapy and possible adaptations. On a basic level physical, sensory and cognitive declines may impact on the mode and format of delivery. On a broader level, it is also important for therapists to be aware of how age differences impact on the therapeutic relationship, the potential influence of different cohort experiences and beliefs and how age-related changes in role and function can impact on distress. Considerations and adaptations of this nature are explained in more depth in the papers within this special section. It is also noteworthy that this section, is entitled ‘therapeutic approaches to working with people in later life’ to capture the breadth of psychological work with this group. For some older people traditional one-to-one therapy may not be possible or desirable but it may still be possible for psychological practitioners to support the person's psychological needs through working with their wider care teams. In the first paper in this special section, Polly Kaiser and co-authors argue that ageism is one of the last socially accepted prejudices and highlight key areas of age discrimination and inequality in mental health services. The paper is a powerful reminder of the existence of age inequality and the impact of ageism on the mental health of older people. It encourages us all to take action to tackle these issues and provides practical suggestions and resources to support this endeavour. The second paper and third paper in the section focus on therapies for specific conditions affecting people in later life. The second paper by Elizabeth Tyler and Aaron Warner focuses on bipolar disorder in later life. The authors present a literature review of studies reporting on psychological therapies developed specifically for older adults with bipolar disorder and discuss adaptations to psychological therapies that may benefit this population. They argue that the development of tailored psychological treatments for older people with bipolar disorder may help reduce the significant inequalities in mental health care that they currently face. The third paper by Georgina Charlesworth and co-authors also presents a review of the literature, but the focus here is on therapies for anxiety and depression for people affected by dementia and their carers. This scoping review of meta-analyses concludes that behavioural activation, CBT-informed interventions and mindfulness-based interventions are effective in reducing symptoms of depression. Whereas psychoeducation and mindfulness-based interventions are effective in reducing anxiety in carers of people affected by dementia, with more limited evidence about what is helpful for reducing anxiety in people with dementia themselves. The fourth and fifth papers in the section focus on specific forms of therapy and how they have been applied to people with mental health problems in later life. The fourth paper by Sophie Jeffery and co-authors focuses on systemic therapy. The authors argue that family and systemic therapies have been slow to extend into the field of later life despite the potential importance of systemic issues and the benefits of this approach for this group. They present a variety of service models of systemic therapy that are being offered to older people and their families across the United Kingdom and summarise theories and techniques found to be particularly valuable. The fifth paper by Rebecca Poz and Catriona Craig focuses on compassion-focused therapy for older people and argues that this approach is particularly well suited to helping people navigate challenges associated with ageing. The paper summarises studies evaluating compassion-focused therapy in later life and although there is limited evidence of effectiveness due to a lack of high-quality trials there is good evidence that older people value the approach and report benefit. The authors also provide recommendations for adapting Compassion Focused Therapy for older people and those living with dementia. The final paper in the section by Sophie Trees and co-authors focuses on a psychological approach that can be used with staff working with people with dementia in care homes. It is an important addition to the section as it demonstrates how psychological approaches for later life move beyond the therapy room and one-to-one sessions. The paper presents a study evaluating Communication and Interaction Training which trains care home staff in how to apply person-centred principles to effectively reduce or negate distress in people living with dementia in a non-invasive manner. The authors present data which suggests the course is effective in enhancing health care professionals' perceived confidence, communication skills, sensitivity and ability to meet the care needs of people living with dementia. In bringing this special section together, a clear message emerges that ageism continues to shape who is offered therapy and whose distress is medicalised rather than understood. Yet the papers in this section demonstrate that change is possible. Collectively, they challenge outdated assumptions about ageing and show that older people can and do benefit from a broad range of therapeutic approaches when these are thoughtfully adapted and delivered with an appreciation of the social, relational and health contexts of later life. They also remind us that psychological work in later life extends beyond traditional one-to-one models, encompassing systemic approaches, work with carers and interventions that equip care staff to respond compassionately and effectively to distress. Katherine Berry: Conceptualization. The author declares no conflicts of interest. There is no data associated with this paper.
Katherine Berry (Mon,) studied this question.