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Loneliness & Isolation

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The eyes do speak

The eyes do speak

Feelings of loneliness & isolation can lead to serious consequences for senior health. Understanding the causes and risk factors for senior isolation can help us prevent it.

My 30+ years of Healthcare Administration experience, particularly the 26 years of Geriatric Care, has taught me much above caring for older adults. However, researching for this article made me realize that although I wanted to focus on how Loneliness & Isolation is pertinent to older adults… it is equally applicable to all age groups. For the sake of relevance and theme of Eldercare, this article reviews the context of loneliness and social isolation in later life is that of “successful aging” and “quality of life”. The term “quality of life” includes a broad range of areas of life.

There is little agreement about a single definition of the term. Models of quality of life range from identification of “life satisfaction” or “social wellbeing” to models based upon concepts of independence, control, social and cognitive competence. However, regardless of how the concept of quality of life is defined, research has consistently demonstrated the importance of social and family relationships towards the achievement of “successful aging” and “quality of life”.

No one relishes the prospect of aging without a spouse, family members at their side or without friends to help them laugh at the ridiculous parts & support them through difficult times. Yet, that is just what many North American seniors face. As the baby boomer generation crosses the over-65 threshold and the overall population of older adults skyrocket many of our aging loved ones are still feeling alone in the crowd.

While living alone does not inevitably lead to social isolation, it is certainly a predisposing factor. Yet another important consideration is how often seniors engage in social activities. Statistics Canada reports that 80% of Canadian Seniors participate in one or more social activities on a frequent basis (at least monthly) – but that leaves fully one-fifth of seniors not participating in weekly or even monthly activities. Social contacts tend to decrease as we age for a variety of reasons, including retirement, the death of friends & family or lack of mobility.

Regardless of the causes of senior isolation, the consequences can be alarming and even harmful. Even perceived social isolation – the feeling that you are lonely – is a struggle for many older people. Fortunately, the past couple of decades have seen increasing research into the risks, causes, and prevention of loneliness in seniors.

Below are the major documented facts about senior isolation to help you stay informed:

Senior isolation increases the risk of mortality
According to a 2012 study in the Proceedings of the National Academy of Sciences, both social isolation and loneliness are associated with a higher risk of mortality in adults aged 52 and older.

One possible explanation: “People who live alone or lack social contacts may be at increased risk of death if acute symptoms develop, because there is less of a network of confidantes to prompt medical attention.” Efforts to reduce isolation are the key to addressing the issue of mortality, said the study’s authors.

Feelings of loneliness can negatively affect both physical & mental health
Regardless of the facts of a person’s isolation, seniors who feel lonely and isolated are more likely to report also having poor physical and/or mental health, as reported in a study using data from the National Social Life, Health, and Aging Project. Connecting seniors with social resources, such as senior centers, home care agency and meal delivery programs, is one way to combat subjective feelings of isolation.

Perceived loneliness contributes to cognitive decline and risk of dementia
Dr. John Cacioppo, a neuroscientist and psychologist at the University of Chicago, has been studying social isolation for 30 years. One frightening finding is that feelings of loneliness are linked to poor cognitive performance and quicker cognitive decline. We evolved to be a social species, says Dr. Cacioppo – it’s hard-wired into our brains, and when we don’t meet that need, it can have physical and neurological effects.

Social isolation makes seniors more vulnerable to elder abuse
Many studies show a connection between social isolation and higher rates of elder abuse, reports the National Center on Elder Abuse. Whether this is because isolated adults are more likely to fall victim to abuse, or a result of abusers attempting to isolate the elders from others to minimize risk of discovery, researchers aren’t certain. A critical strategy for reducing elder abuse is speaking up: abuse, neglect and exploitation often go unreported. As for prevention, maintaining connections with senior loved ones helps us ensure their safety.

LGBT seniors are much more likely to be socially isolated
LGBT seniors are twice as likely to live alone, according to SAGE (Services & Advocacy for GLBT Elders); they are more likely to be single and they are less likely to have children – and they are more likely to be estranged from their biological families. Stigma and discrimination are major roadblocks to support for LGBT seniors, but there are more and more community groups and online resources devoted to helping these elders avoid isolation.

Social isolation in seniors is linked to long-term illness
In the Proceedings of the National Academy of Sciences study, illnesses and conditions such as chronic lung disease, arthritis, impaired mobility, and depression were associated with social isolation. Ensuring appropriate care for our loved ones’ illnesses can help prevent this isolation. For homebound seniors, phone calls and visits can be a critical part of connecting with loved ones. Others may find that moving to an assisted living community or obtaining home care arrangements mitigates both issues – the need for ongoing care, empathy and the desire for meaningful companionship.

Loneliness in seniors is a major risk factor for depression
Numerous studies over the past decade have shown that feeling loneliness is associated with more depressive symptoms in both middle-aged and older adults. One important first step is recognizing those feelings of loneliness, isolation and depression and seeking treatment – whether it’s on your own behalf or for the sake of a loved one.

Loneliness causes high blood pressure
A 2010 study in Psychology and Aging indicated a direct relationship between loneliness in older adults and increases in systolic blood pressure over a 4-year period. These increases were independent of race, ethnicity, gender, and other possible contributing factors. Early interventions for loneliness, say the study’s authors, may be key to preventing both the isolation and associated health risks.

Socially isolated seniors are more pessimistic about the future
According to the National Council on Aging, socially isolated seniors are more likely to predict their quality of life will get worse over the next 5-10 years, are more concerned about needing help from community programs as they get older, and are more likely to express concerns about aging in place.

The National Association of Area Agencies on Aging says community-based programs and services are critical in helping ward off potential problems and improving quality of life for older people.

Physical and geographic isolation often leads to social isolation
“One in six seniors living alone in the Canada & US faces physical, cultural, and/or geographical barriers that isolate them from their peers and communities,” reports the National Council on Aging. “This isolation can prevent them from receiving benefits and services that can improve their economic security and their ability to live healthy, independent lives.” Referring isolated older adults to senior centers, activity programs, and transportation services can go a long way toward creating valuable connections and reducing isolation.

Isolated seniors are more likely to need long-term care
Loneliness and social isolation are major predictors of seniors utilizing home care, as well as entering nursing homes, according to a 2004 report from the Children’s, Women’s and Seniors Health Branch, British Columbia Ministry of Health. The positive angle of these findings, says the report, is that using long-term health care services can in itself connect seniors with much-needed support. Particularly for seniors in rural areas where home care may not be viable, entering a care facility may provide companionship and social contact.

Loss of a spouse is a major risk factor for loneliness and isolation
Losing a spouse, an event which becomes more common as people enter older age, has been shown by numerous studies to increase seniors’ vulnerability to emotional and social isolation, says the same report from the British Columbia Ministry of Health. Besides the loneliness brought on by bereavement, the loss of a partner may also mean the loss of social interactions that were facilitated by being part of a couple. Ensuring seniors have access to family and friendship support can help alleviate this loneliness.

Transportation challenges can lead to social isolation
Life expectancy exceeds safe driving expectancy after age 70 by about six years for men and 10 years for women. Yet, 41% of seniors do not feel that the transportation support in their community is adequate.

Having access to adequate public transportation or other senior transportation services is key to seniors’ accessing programs and resources, as well as their feelings of connectedness and independence.

Family Caregivers of the elderly are also at risk for social isolation
Being a family caregiver is an enormous responsibility, whether you are caring for a parent, spouse, or other relative. When that person has Alzheimer’s disease, dementia, or a physical impairment, the caregiver may feel even less able to set aside his or her caregiving duties to attend to social relationships they previously enjoyed. This can trigger loneliness and depression. Seeking support, caring for yourself, and even looking for temporary respite care can help ward off caregiver loneliness and restore your sense of connection.

Loneliness can be contagious
Studies have found that loneliness has a tendency to spread from person to person, due to negative social interactions and other factors. In other words, when one person is lonely, that loneliness is more likely to spread to friends or contacts of the lonely individual. Making things even worse, people have a tendency to further isolate people who are lonely because we have evolved to avoid threats to our social cohesion. It’s a complicated situation, and simply telling seniors to engage in more social activities may not be enough. Considering our loved ones’ needs as individuals is a valuable first step to figuring out how to prevent or combat isolation.

Lonely people are more likely to engage in unhealthy behavior
A 2011 study using data from the English Longitudinal Study of Ageing (ELSA) found that people who are socially isolated or lonely are also more likely to report risky health behaviors such as poor diet, lack of physical activity, and smoking. Conversely, social support can help encourage seniors to eat well, exercise, and live healthy lifestyles. Living in a community situation can be an effective barrier to loneliness, and most senior communities specifically promote wellness through diet and exercise programs.

Volunteering can reduce social isolation and loneliness in seniors
We all know that volunteering is a rewarding activity, and seniors have a unique skill set and a richness of life experience to contribute to their communities. It can also boost longevity and contribute to overall mental health, wellbeing, and it ensures that seniors have a source of social connection. There are many opportunities tailor-made for seniors interested in volunteering

Feeling isolated? Take a class
A review of studies looking at various types of interventions on senior loneliness found that the most effective programs for combating isolation had an educational or training component: for instance, classes on health-related topics, computer training, or exercise classes.

Technology can help senior isolation – but not always
Even though modern technology provides us with more opportunities than ever for keeping in touch, sometimes the result is that we feel lonelier than ever. The key to finding technological interventions that really do help, says Health Quality Ontario, is matching those interventions to the specific needs of individual seniors. One simple strategy that does help: for seniors with hearing loss, simply providing a hearing aid can improve communication and reduce loneliness. Phone contact and Web-based support programs were less consistent in their effectiveness, but for some, they might provide a lifeline.

Physical activity reduces senior isolation
Group exercise programs, it turns out, are a wonderfully effective way to reduce isolation and loneliness in seniors – and of course they have the added benefit of being great for physical and mental health. In one study, discussed by Health Quality Ontario, seniors reported greater wellbeing regardless of whether the activity was aerobic or lower-impact, like stretching.

Loneliness & Isolation is neither inevitable nor irreversible. Getting the facts can help us better understand and prevent loneliness in the lives of our older loved ones, as they face the life changes of aging.

In reference to the beginning of the article, one can easily relate how this article is not to simply to understand, intervene and mitigate loneliness & isolation as it pertains to affecting the lives our older loved ones. Loneliness and isolation affects individuals in all age categories and the above points will go a long way in staving off those affects and achieving “successful aging” and “quality of life”.

In Our Care – Home Care Services, understand that care is not simply based on the physical support your older loved one may need… there are a broad spectrum built-in service components to achieve our overall goal… Enriching the lives of those we love and deliver care to.

Your loved one may not be direct family, but they’re part of the In Our Care family… therefore they are.

Please contact us today, to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at 

Senior Care: Depression in the Elderly

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DepressionamonelderlyDepression among the Elderly population

According to Health Canada, older Canadians are living longer, more independently, healthier, and more affluent than ever before. Todays seniors are physically more active, engaged with their families, in their communities, and are becoming international globetrotters.

They are challenging many of the negative stereotypes we hold about aging and showing us that life is for living with fortitude, vitality, and vigour.

However, it is true that some seniors struggle from time to time with mental illness. For seniors living in the community, it is estimated that 5% to 10% will experience a depressive disorder that is serious enough to require treatment. The rate of anxiety and depression increases dramatically to 30% to 40% for seniors living in an institutional setting.

The great news is that for most people with depression (over 80%) do respond well to treatment and achieve a complete and lasting recovery. Sadly, 90% will NOT seek needed help or their depression will be missed or ignored, denying them beneficial treatment for mental health problems.

Why aren’t seniors getting the help they need?

  • Depression in the elderly can be difficult to recognize. It can easily be overlooked as a symptom of another medical condition.
  • Family, friends and medical personnel often see depression as a normal part of the aging process and the inevitable result of the losses of life we all will experience.
  • Family, friends and medical personnel often see depression as a normal part of the aging process and the inevitable result of the losses of life we all will experience.
  • Many seniors were raised to be self-sufficient and stoic in the face of life’s challenges making them reluctant to complain about how they are feeling or ask to for help. They are used to working hard to solve their own problems and feel ashamed by their inability to cope.
  • Some seniors (and possibly even their friends and family) don’t know that depression is an illness and that treatment is available and works!

How do I know if its depression?

Depression is more than just feeling sad. It affects the whole person including their feelings, thinking and their physical health. It also lasts a long time. It’s important to know what to watch for. Anxiety and slowing of thoughts are common symptoms. For many seniors depression is often expressed through many vague complaints of physical aches and pain. The most common symptoms of depression include:

Physical changes

  • Changes in appetite – a resultant weight loss or weight gain.
  • Sleep disturbances – trouble falling asleep, staying asleep or sleeping too much.
  • Some seniors (and possibly even their friends and family) don’t know that depression is an illness and that treatment is available and works!
  • Sleep, when it comes, does not restore and refresh. People often report feeling worse in the morning with the mood -lifting as the day goes on.
  • Decreased energy, with feelings of weakness and physical fatigue.
  • Some people experience agitation with restlessness and have a need to move constantly.
  • Phantom pains, headaches, muscle aches and pains, with no known physical cause.
  • Stomach upsets – constipation.

Changes in thinking

  • Thoughts may be confused or slowed down which makes thinking, concentrating or remembering information more difficult.
  • Decision-making is difficult and  or often avoided.
  • Obsessive ruminations, a sense of impending doom or disaster.
  • Preoccupation with perceived failures or personal inadequacies leading to a loss of self-esteem.
  • Becoming harshly self-critical and unfairly judgmental.
  • In extreme cases, there can be a loss of being in touch with reality, perhaps hearing voices (hallucinations) or having strange ideas (delusions).
  • Persistent thoughts of death, suicide or attempts to hurt oneself.

Changes in feeling

  • Loss of interest in activities that were once a source of pleasure.
  • Decreased interest in and enjoyment from sex.
  • Feelings of worthlessness, hopelessness, and excessive guilt.
  • Deadening or an absence of feelings.
  • Sense of overwhelming or impending doom.
  • Feeling sad, and down that may be worse in the morning, lifting as the day goes on.
  • Crying for no apparent reason.
  • Irritability, impatience, anger and aggressive feelings.

Changes in behaviour

  • Withdrawal from social and leisure activities.
  • Failure to make important decisions.
  • Neglecting duties such as housework, gardening, paying bills.
  • Decrease in physical activity and exercise.
  • Reduced self-care such as personal grooming, eating.
  • Increased use of alcohol or drugs (prescription and non-prescription).

Why is it important to treat depression in the elderly?

  • Depression throws a dark cloud over our emotional well-being, draining away pleasure, and robbing people of hope, further isolation, and despair.
  • Depression tends to last much longer in the elderly and can result in unnecessary or premature placement in institutional care.
  • If depression is not managed, it can compromise the treatment of other conditions and can increase the risk of prolonged disability or early death.
  • Untreated depression can also leave seniors more vulnerable to developing other serious health conditions such as heart disease, infections and immune disorders.
  • Depression can make people feel angry, irritable and anxious. This can rob families of the pleasure of their loved one’s company and place an additional burden on care providers.
  • The risk of suicide in elderly is high and it is particularly high for depressed elderly men.

What factors can increase the risk of depression in the elderly?

  • The presence of other illnesses, which compromises their ability to get around and be independent.
  • Some medications or the interaction between medications are associated with depression.
  • Living with chronic or severe pain.
  • Living alone without a supportive network of friends, social interaction, and family.
  • The recent death of a loved one or fear of own death.
  • A previous history of depression or family history of depressive disorder.
  • A past history of suicide attempt(s).

Illness increases the risk of depression

There are a number of medical conditions that are associated with depression in the elderly. Some are:

  • Heart problems including having a stroke
  • Low thyroid activity
  • A lack of vitamin B12 or folic acid
  • Low blood pressure
  • Rheumatoid arthritis
  • Cancer
  • Diabetes

Commonly prescribed medications are also associated with depression or making depression worse such as:

  • Blood pressure medications
  • Beta-blockers
  • Steroids
  • Digoxins
  • Sedatives

Treatments involving these medications may warrant a discussion with the treating physician to rule out their use as the cause of the depression. Don’t stop medications without advice as a sudden discontinuation can have serious health consequences when the body struggles to adjust.

What can we do to help our loved one overcome depression?

Medication

Usually relief is felt within a few weeks of starting medications, however it can take longer for older people to feel better. Sleep and appetite are usually the first to improve. Don’t expect a complete recovery right away. It usually takes about ten to twelve weeks to lift out of depression. Often those close to you who will see an improvement in your mood before you begin to feel it.

Build social supports

The paradox of depression is that at a time when you most need to draw people close – you may want to avoid contact with others. However, most people find that the support of family, caregivers, friends, participation in a self-help group, or talking with a professional counselor can be very helpful in overcoming depression. Dealing with social isolation is an important part of healing and can help prevent further episodes of depression. Many conducted studies show that being part of a supportive family, being part of a religious group or being active in your community is an important part of health, wellbeing and improved quality of life.

Talk therapy

Psychotherapy can be very helpful in dealing with losses, solving challenging problems or dealing with the social impact of depression. Cognitive therapy can help you look at your thought patterns, which may be negative and self-criticizing. It will also help you make the connection between your thoughts, feelings and behaviours. What you think affects how you feel and how you behave.

Electroconvulsive therapy (ECT)

ECT is a treatment that uses electrical impulses to change the chemical balance in the brain. It is often used as a treatment of last resort for those patients who have not responded well to other forms of treatment, who remain a suicide risk, or have other serious medical conditions that prevent the use of medication. It remains controversial, so it is important to do your research so you can make an informed decision.

What factors protect seniors from depression and build resilience?

Have you ever wondered why some people just seem happy or are able to weather the inevitable storms that life throws their way with wisdom and grace? So have researchers and they have learned a lot about what builds healthy resilience, makes for a happy engaged life and helps us cope during difficult times. Some of us are just blessed with a happy, easygoing temperament. The rest of us may have to work at it.

What have we learned about how to maintain good mental health throughout the life cycle?

The self-help mantra is, “Never get too angry, too lonely, too tired or too hungry”. This is really good advice for living a healthy balanced life. People who have experienced a mood disorder learn quickly how true this motto is. If your balance is off in one of these areas, it is important to take active steps to gain control of your health. Having strong family, friendships and community supports will go a long way in keeping you free from depression.

Health Canada reports that more and more elderly are spending time alone – going days at a time without seeing or talking to another person. This is not good for our mental health and can lead us to become too inward in our thinking. Changes in our social network are an inevitable part of life. Family members grow up, move away or get busy with their daily lives. Retirement takes us out of the mainstream of working life. As we age, death becomes an unfortunate companion robbing us of people we loved and cared for. Sickness can sap our strength and take away our vitality. All of these changes can cause us to lose valuable sources of support and connection. You may feel it is too late to build new friendships – that too much effort is required to add new interests and people into your social network. But it’s worth the investment. Research shows us time and time again that people with a well-developed social network have better physical and emotional health and an improved quality of life.

Tips for building social supports

Take the time to consider what you like. Start small – adding one new thing at a time. Be patient – it may take some research to find the activities that will suite you best. Become a risk taker – try doing something you have never done before. Buddy up with someone else in trying new things out. Lend a helping hand to others. There is nothing that builds confidence like helping others.

Become a joiner!

  • Check out the local community Centre for seniors clubs and social programs.
  • Join a book club, choir, bridge group, or gardening club.
  • Let your family know you would like to spend more time together. Be specific in your asking.
  • Rekindle a hobby or up a new hobby.
  • Become a mentor for a young person.
  • Volunteer your time.
  • Get involved in a political party.
  • Find out about how to get involved in your community.

Get physically active

Recent research has found that moderate exercise and weight lifting – yes lifting barbells – has a remarkable ability to treat depression in the elderly. In fact, moderate exercise has been found to be as effective in treating mild depression as medication. Strengthening your muscles has also been found to reduce the risk of falling and hip fractures – the number one reason seniors end up in institutional care.

An exercise program should include active movement to build balance and coordination, stretching to improve flexibility by moving your joints through their full range of motion, ways to strengthening your muscles, and, finally, activities to get your heart pumping. Consider joining a senior’s exercise program in your community to strengthen your social network as well as your body… Just do it!

Exercise your mind

Along with aging often come subtle changes in brain functioning. It may not seem as easy to remember names. Learning new skills can seem harder. But just like your body, a healthy nimble mind requires active exercise. Think of ways you can challenge your brain. Play chess, bridge, and computer games or do crossword puzzles. Consider taking an adult education course – anything that will exercise the grey matter.

Eat well

Diet plays an important role in preventing illness and keeping us well. The absence of essential minerals and vitamins is associated with many serious health problems including depression. Many elderly people neglect this important part of their health. If you live alone, it may not seem worth the effort to cook yourself a meal. Depression can also rob people of their appetite. Use the clock to tell you when to eat if your body doesn’t let you know when you are hungry. Restore balance by starting to keep track of what you are eating.

Tips for healthy eating:

  • Consider taking a multi-vitamin every day.
  • Build variety into your diet.
  • Keep healthy foods easily available.
  • Choose whole grain and enriched grain products.
  • Choose fresh foods over manufactured foods.
  • Choose dark green and orange vegetables more often.
  • Lower the fat level in your milk and choose leaner cuts of meat.
  • Consider poultry, fish, dried beans and lentils as an alternative to red meat.
  • Drink plenty of water.
  • Take care in your use of alcohol.
  • Strive for a healthy body weight.
  • Use Canada’s Food Guide as your reference to healthy eating.

Express your feelings

Recent research suggests that the ability to express your feelings clearly and directly has a positive and beneficial effect on mental health, life satisfaction and personal well-being. Talking about concerns helps you organize your thinking and clarify your thoughts. Keeping a personal diary is helpful even if you never share these thoughts with others. It can also help you gain insight into your moods by tracking what is going on in your life and how you are feeling. In this way you can take steps to address problems before they become overwhelming.

Feed your soul

Having a strongly held belief system has been found to be one of the protective factors for good mental health. If you are not currently involved with a religious group, consider finding a place of worship in your community that makes you feel welcome. If you don’t have strong religious beliefs or a group to which you hold affiliation, try learning more about different religious groups. Perhaps by exploring other beliefs you will find a spiritual home. But spirituality is not confined solely to religion. Many people find great conform in art, nature, theatre, and other pursuits.

Music soothes the savage breast – singing ignites the soul

There is nothing more stirring than listening to music – except perhaps playing it or singing along. In fact, music can help to sooth anxious nerves and lift your spirit. Consider joining a choir or sing along to your favourite tunes. Just make sure you add a dose of music to your day.

Turn loneliness into solitude and know the difference

Too much time alone can leave us feeling distant, isolated and lonely. This can worsen feelings of depression. We all have our own comfort level about how much time we like to be with others. Pay attention to how you are spending your time. If you are spending too much time alone, take steps to add balance. That said, finding comfort in one’s own company is also an important part of a happy healthy life.

Care for a pet

Looking after a pet is a big responsibility and a lot of work. But boy, is it worth it. Scientists have looked closely at the effect that pets have on our health. They have found that seniors who live with and care for pets have better physical health and mental well-being than those who don’t. They are also better able to cope with stress and are more physically and socially active. Pets have even been found to lower blood pressure. Having a pet has also been found to reduce the risk of suicide in people when they are depressed. Their unconditional love and affection provides valuable company, keeps you active and helps to draw others to you.

Keep a positive attitude

Being thankful is a cornerstone of emotional well-being. In fact, some research suggests that maintaining a positive outlook on life can boost your immune system and protect you from illness. Sickness and loss has a nasty way of dominating the thinking of people as they age. While your aches and pains and past surgeries are of pressing concern and interest to you – they may not make good conversation for others. Try to avoid dwelling too much on the negatives of life. Instead take time to count your blessings. Seek out positive people. Broaden your network to include people of different ages and backgrounds. Get out of the rut of daily life by trying new things. Become a great conversationalist by sharing stories. Keep up on current affairs and popular shows. Share with others what you like and what you value. Make sure to take an interest in their views too. Listen actively to what they say and ask questions. Everyone has a fascinating story to tell if you just take the time to ask. Focusing on positive communication helps to bring people close and helps you keep your thinking open to new ideas.

Laugh out loud and laugh a lot

Research again shows us that there is powerful healing in laughter. It changes our brain chemistry in a positive way and helps us look at problems in new and creative ways. So – go rent a Marx Brothers film or whatever brings a smile to your face.

Ask for help if you need it

Don’t be afraid to ask for help. It is a sign of strength, health and maturity. Working through concerns with a professional can bring out new ideas and offer a fresh perspective in solving problems. Having help can help you stay in charge of making your own decisions.

 

 

The above tips are gatherings from various sources, but for more in-depth information on some of the aforementioned topics, I offer the following readings:

Beating the Senior Blues: How to Feel Better and Enjoy Life Again, by Leslie Eckford and Amanda Lambert, New Harbinger Pub. 2002

There is an excellent review of depression treatments for older adults from the US Surgeon General at

Health Canada produces an interesting monthly newsletter updating readers on recent research related to the elderly. Division of Aging & Seniors

Wherever You Go There You Are: Mindfulness Meditation in Everyday Life by Jon Kabat-Zinn

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by Jon Kabat-Zinn