Professional Articles – AGE IN ACTION

Musings: Food for Thought

Food is as necessary as water for survival. Perhaps that is why it is so often used as a metaphor for life. Yet we say, “Man cannot live by bread alone.” Given its fundamental nature, food is often juxtaposed with lofty ideals. Presumably, we could starve for our ideals given the right circumstances.

We all have associations and memories (as Proust famously observed upon biting that madeleine) attached to taste and smell. These associations tie us to a place, a moment in time; they even evoke a face long gone. (My grandmother, early mornings with cocoa, oatmeal with cream and brown sugar.)

In a time of abundance, we can take food for granted. There is so much of it and in such variety. We’re a culture that worries about obesity and overeating, with diabetes on the rise and other ills. An entire industry exists to undo the effects of overeating. There is a vast literature, both popular and scientific, devoted to these issues. Food can come to be seen as the enemy. Eating disorders are not the subject here. These issues have been addressed many times over. Were the disorders easily amenable to treatment, solutions would have been found long ago.

Grandma Hobbies: A Pathway to Health and Happiness

The concept of self-care has become an increasingly popular and accepted phenomenon in American society. Many adults are trying to prioritize recreational tasks, leisure activities, and hobbies to promote their well-being. Included in this culture shift is the promotion of “grandma hobbies” (Lascala, 2025). Under this category are activities such as knitting and sewing, crochet, birdwatching, gardening, baking, coloring, and reading. Behavioral activation – choosing to engage in activities to improve health – has many benefits for older adults (Janssen et al., 2023). Various psychological studies have supported the theory that these “grandma hobbies,” specifically, can increase mental and emotional well-being. Of course, these practices and their benefits can be applied to all of us, though “grandmas” may lead us by example.

Knitting, sewing, and embroidery are all projects that involve motor skills, focus, and a sense of accomplishment. These hobbies can be practiced in an individual setting as well as in a social setting. Knitting among peers has been shown to increase one’s sense of belonging, and the act itself helps one to achieve a sense of competence (Nordstrand, Gunnarsson, & Häggblom- Kronlöf, 2024). The calming effect for those who engage in this hobby can lead to reductions in anxiety, depression, stress, and pain (Nordstrand et al., 2025). These simple tasks can also increase self-efficacy and a sense of control in one’s life when one feels a lack of control elsewhere (Nordstrand et al., 2025). The repetitive movements of the hands and focus on the task have been shown to create a meditative state among knitters, resulting in reduced anxiety, heart rate, and cortisol levels (Meehan, McCulloh, & Schlamb, 2025).

Mental Health and Aging in Prison

Older adults are one of the fastest-growing groups in correctional systems, with the U.S. older incarcerated adult population growing by 79% between 2000 and 2009 (Williams et al.,2012). This number is expected to increase in the future, due to the aging population, a trend of longer prison sentences, and a reduction of parole or early release because of more stringent “tough on crime” laws (Skarupski et al., 2018). Although older adults are traditionally defined as individuals aged 65 and older, correctional systems often classify incarcerated individuals as “geriatric” at 55 years of age because incarceration is often associated with accelerated aging (Garrido & Frakt, 2020). As a result of the growing geriatric prison population, correctional facilities now house an increasing number of individuals who experience age-related medical conditions and have complex mental health needs. Despite this shift, prisons remain environments that are generally designed for younger populations, which can create structural and psychological challenges for older inmates (Williams et al., 2012).

Older adults experience substantial mental health challenges that are often complex and insufficiently addressed. More than 20% of individuals aged 55 and older may suffer from mental health problems (Lima et al., 2019). Common issues facing older adults, including bereavement, social isolation, increased health problems and costs, and limited (and less flexible) finances after retirement can add to older adults’ psychological burden and contribute to the deterioration of mental health (Ratnakaran, 2023). Despite this need, mental health conditions in older populations are not always clearly diagnosed, as existing diagnostic frameworks and systems may not adequately capture how psychiatric and psychological disorders function in older adults, leading to overlooked or improperly treated conditions (Jeste et al., 2005). Inaddition, older adults may underutilize mental health services due to a range of barriers, including stigma, lack of perceived need for treatment, cost, limited access, and mistrust of providers (Egan, 2021; Lavingia et al., 2020; Thorp, Sones, & Cook, 2011). As a result, there is a gap between the prevalence of mental health needs in older adults and their access to effective treatment.

Polypharmacy and Placebo in Older Adults

Individuals who are 65 and older are a rapidly growing portion of the United States population. The growth of this group from 2010 to 2020 was the largest of any decade since 1880- 1890, growing five times faster than the total population (U.S. Census Bureau, 2020). Health issues are a common source of concern for older adults. Having more than one chronic illness is highly prevalent in older adults, with 73% being affected by multimorbidity (Schlitz, 2022).

Having multiple simultaneous conditions often requires several prescription medications to manage them. Polypharmacy, typically defined as the regular use of five or more medications at the same time, is very common in older adults (Pazan and Wehling, 2021). In 2024, older adults accounted for approximately one-third of outpatient spending on prescription medications in the United States, despite making up only approximately 14% of the total adult population (Varghese et al., 2024). Taking multiple medications for different conditions can lead to adverse outcomes. Common complications such as delirium, kidney failure, and low blood pressure are seen frequently in older adults (Varghese et al., 2024). The presence of these complications highlights the need for alternative interventions to reduce the negative impacts of polypharmacy in older adults.

Neurofeedback Therapy in Older Adults

As the U.S. population ages rapidly, expected to reach 83.7 million citizens over the age of 65 by 2050 (U.S. Census Bureau, 2014), some older individuals demonstrate a need for mental health intervention. Among a large, representative sample of older adults, 11.4% met criteria for a past-year anxiety disorder, 6.8% for a mood disorder, 3.8% for a substance use disorder, and 14.5% for at least one personality disorder (Reynolds et al., 2015). Polypharmacy (multiple medications) impacts up to 87% of older adults, and it can result in health and mental health complications (Nicholson et al., 2024). Non-pharmacological interventions can help individuals maintain healthy aging.

Neurofeedback therapy (NFB) is a form of electroencephalogram (EEG) biofeedback used to train participants’ brain waves through a process of operant conditioning (Hammond, 2007). Neurofeedback provides an alternative for patients seeking treatment without the use of medication, though the research findings regarding NFB for an aging population are equivocal. NFB interventions typically take the EEG data from the patient and provide audio or visual feedback, reinforcing the desired brain waves, theoretically training the brain to remain in these targeted states (Marzbani et al., 2016). Participants are aware of the desired brain state, with electrodes placed on different areas of the head to target specific symptoms. Treatment typically involves 2-40 sessions, though some studies included up to 100 sessions, and it is difficult to pinpoint a consistent dose of the traditional neurofeedback protocol (Marzbani et al., 2016). Cramer (2024) estimates that a typical neurofeedback session costs $100-200.

Grief and Loss Among Older Adults

“It was an amputation.”

“I don’t think I’ll ever get over losing my wife.”

“I can’t stop thinking about the things I didn’t say to her as she was dying…”

“It’s really okay that he died.”

“I haven’t moved anything. I don’t leave the house. His jacket is still hanging over the back of the chair in my living room.”

“Everything seems pointless.”

“I am lonely. I have no one to go through things with me anymore.”

“He died in my arms. It was so traumatizing.”

“I’m lonely. I miss having someone here to talk to about politics and interesting things.”

These quotes represent a range of thoughts and feelings expressed by bereaved seniors in my clinical practice. Their words speak for themselves. The experience of loss and grief among older Americans is a topic that is under-researched and minimally discussed in the literature and in our culture. It deserves our time and attention.

Wendy Tayer, Ph.D. is a geriatric psychologist and associate professor of psychiatry at UC San Diego Senior Behavioral Health. She is a long time member of SDPA and its Aging Issues Committee.

Psychosis in Older Adults

In the most recently revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR; American Psychiatric Association, 2022), psychosis is indicated as a cluster of “psychotic features” which generally include a loss of touch with reality, delusions, hallucinations, disorganized thoughts, specific behaviors, and negative symptoms such as blunted affect, alogia, and avolition (American Psychiatric Association, 2022; World Health Organization, 1992). Late-onset psychosis, defined by the onset of a psychotic episode after the age of 40 (Howard et al., 2000), is more prevalent than many would guess and causes significant distress to those afflicted and their caregivers.

Current estimates suggest that older adults have a 23% risk of developing psychotic symptoms in their lifetime (Reinhardt & Cohen, 2015). This does not typically include mild cases of psychosis that are easily missed or patients in nursing homes and hospitals, because these individuals are not usually included in population surveys. Individuals who develop psychosis in late life outnumber those who had longstanding, early-onset psychotic disorders and aged into late adulthood (Tampi et al., 2021). Psychosis in late life is also associated with elevated morbidity and mortality (Talaslahti et al., 2015).

Older Survivors of Sexual Violence: Countering Ageism and Systemic Invisibility

Despite growing awareness of sexual violence as a pervasive societal issue, the lived experiences of older adults remain conspicuously marginalized in research, policy, and clinical frameworks. While intersectional approaches to gender-based violence have reshaped advocacy and scholarship, age continues to be sidelined in these discourses. This oversight reinforces systemic invisibility and eclipses the compounded vulnerabilities of older women, whose realities are shaped by the convergence of structural ageism and systemic sexism. Such gaps undermine efforts to design equitable interventions that address gendered violence across the lifespan.

Nearly half of older adults report lifetime sexual victimization, with 8% experiencing it in the past year (Nobels et al., 2023). Contrary to enduring stereotypes, advanced age does not confer protection; in fact, physiological changes, cognitive decline, and social isolation often heighten vulnerability. However, fewer than 6% of survivors seek help and even fewer receive care tailored to age-specific needs (Nobels et al., 2023). Systemic underreporting is driven by a constellation of generational stigma, mobility limitations, dependency on caregivers (who may be perpetrators), and pervasive myths suggesting that older adults are asexual (Cook et al., 2011).

Third-Wave Cognitive Behavior Therapies and Older Adults

The global average lifespan was 73.3 years in 2024, and the older adult population is estimated to rise to 1.4 billion in 2030 (World Health Organization [WHO], 2025). While the population is aging, mental illness remains highly prevalent. In the United States, in 2021, 57.8 million adults reported having a mental illness, 14.1 million adults reported having a serious mental illness, and 19.4 million adults reported having a co-morbid substance use disorder and mental illness (National Alliance on Mental Illness [NAMI], 2023). There is a paucity of research on the intersection of older adulthood and mental health.

Older adults face unique mental health challenges due to aging, chronic health conditions, cognitive decline, identity disturbance, and changes in interpersonal functioning. Ageism, internalized stigma, and generational perceptions of psychological treatment are additional factors that likely contribute to the ambivalence older adults may feel about seeking help for mental health issues (Elshaikh et al., 2023). This situation poses risks: Elevated levels of anxiety in older adults, for instance, heighten the risk of coronary heart disease (Kubzansky et al., 1998) and suicide (Pearson & Brown, 2000). Despite the risks associated with medications for older adults and the proven effectiveness of behavioral treatments (Thorp et al., 2009), psychopharmacological treatment has been prioritized over behavioral interventions in this population despite the risks of medications in older adults and the strong efficacy of behavioral treatments for older adults (Thorp et al., 2009).

Cognitive-behavioral therapy (CBT) is the most widely accepted, evidence-based treatment for some psychiatric disorders (American Psychological Association [APA], 2017b). CBT focuses on how thoughts, feelings, and behaviors are connected and how they can influence each other (Beck et al., 1979). CBT works by increasing adaptive behaviors (as through behavioral activation and exposure therapy), challenging distorted thought patterns, and encouraging adaptive coping mechanisms (Beck & Fleming, 2021; Beck, 1963). Psychosocial therapies have shown reduced levels of attrition, greater reduction in symptom severity, and lower risk of recurrence compared to pharmacotherapy (Van Etten & Taylor, 1998; Thorp et al., 2011).