PSYC 636 Week 5 DB Forum 3 Example

Discussion Board Forum 3: Thread and Two Replies

PSYC 636 Geropsychology, Discussion Board Forum 3 (thread and two replies)

Thread by [Student Name]

The prompt, the older adult described and the classmates' posts are composites standing in for the course's own forum; Scripture, the textbook and the journal articles are real and described from their published sources; the requirements follow Liberty's public course guide for PSYC 636.

Thread

Frank is eighty-one. His wife died last spring, and he now sees his physician every few weeks for back pain. He has not mentioned that he sleeps four hours a night, that he has stopped attending church or that he keeps a loaded handgun in his nightstand. Whitbourne and Whitbourne (2017) explain that depression in later life often presents through physical complaints, fatigue and withdrawal rather than open sadness, and that older adults use mental health services less than younger adults, partly because of stigma and partly because providers attribute symptoms to aging.

The stakes are high. Older men have the highest suicide rates of any group, and their attempts are more often lethal. Luoma et al. (2002) pooled 40 studies of contact with providers before suicide: a large share of those who took their own lives had visited a primary care clinician within the final month, and that share was higher among older adults than younger ones. The physician's office, in other words, is where people like Frank can be reached, often by a doctor who already knows his history and whom he trusts more than any stranger with a counseling degree.

Research shows that reaching them can work. In the PROSPECT trial, Bruce et al. (2004) placed depression care managers in primary care practices to help physicians recognize depression, recommend treatment and follow patients over time. Depressed older patients in those practices showed faster declines in suicidal ideation and depressive symptoms than patients receiving usual care. The intervention did not require new clinics or specialists, only a trained staff member who kept treatment from stalling, which makes it realistic for ordinary practices.

Psalm 71:9 records a prayer not to be cast away or forsaken in old age when strength fails (English Standard Version Bible, 2001/2016). Frank may feel exactly that. A physician who asks him directly about mood, sleep and safety, and a care manager who follows up, may be how that prayer is answered. Should routine depression screening be required at every primary care visit for adults over 75?

Reply to Megan

Megan, your focus on firearms is essential, because older men who can easily reach a firearm face sharply higher risk. Whitbourne and Whitbourne (2017) note that older adults who die by suicide often use highly lethal methods, which leaves little chance for rescue. That makes means safety a prevention strategy in its own right. For Frank, a physician or counselor could ask whether he would let his son store the handgun temporarily, or keep it locked and unloaded, framing the request as a way to get through a hard season rather than as an accusation. Bruce et al. (2004) showed that steady follow-up by a care manager makes such conversations possible, because trust builds over repeated contacts. Family members, pastors and friends can also help by asking directly and offering to hold firearms during periods of grief or illness. None of this requires taking away a man's rights; it asks for distance between a dark night and a loaded weapon.

Reply to Darnell

Darnell, you observed that men of Frank's generation often see emotional problems as weakness, and that may explain why he talks only about his back. Luoma et al. (2002) reported that recent visits to mental health specialists were much rarer than recent primary care visits among people who later died by suicide, which fits your point: older men will go to the doctor but not to a therapist. Bringing mental health care into the family doctor's practice, as the PROSPECT model did, sidesteps that stigma. Language matters too; asking about sleep, energy and whether life still feels worth living may open a conversation that the word "depression" would close. Whitbourne and Whitbourne (2017) also describe how treatment works well for older adults once they engage, which gives physicians every reason to keep asking. A pastor who notices that Frank has stopped coming to church could reinforce that message, since many older men trust clergy more than clinicians.

References

Bruce, M. L., Ten Have, T. R., Reynolds, C. F., III, Katz, I. I., Schulberg, H. C., Mulsant, B. H., Brown, G. K., McAvay, G. J., Pearson, J. L., & Alexopoulos, G. S. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A randomized controlled trial. JAMA, 291(9), 1081-1091. https://doi.org/10.1001/jama.291.9.1081

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159(6), 909-916. https://doi.org/10.1176/appi.ajp.159.6.909

Whitbourne, S. K., & Whitbourne, S. B. (2017). Adult development and aging: Biopsychosocial perspectives (6th ed.). Wiley.