professional – AGE IN ACTION

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.

Healthy Aging Strategies

Having worked with aging adults for years, I often hear, “I expected to get older, but I did not expect to face physical decline.” This is not just about aging; it’s about adjustment and change. If you’ve seen the “Live to 100: Secrets of the Blue Zones” docuseries, you know that there are places around the world where people live long and enjoy their lives. What do the people in these Blue Zones do to achieve such remarkable results? According to some of the interviewees, four key factors contribute to healthy aging and longevity: sleep, diet, physical activity, and community.

Interestingly, Peter Attia, MD, in his book “Outlive,” focuses on the same factors of healthy aging. So, it’s out there. Information is accessible, and most people have heard about it. Let’s discuss lifestyle changes that support healthy aging.

Technology, Technophobia, and Older Adult Mental Health

While stereotypical narratives may suggest that older adults are unwilling, unable, or afraid to use technology, research has demonstrated that older adults are interested in and willing to use technologies (Mariano et al., 2021; Melenhorst et al., 2006; Mitzner et al., 2010). When considering the usage of novel forms of technology, older adults assess the costs and benefits, with the benefits ultimately informing their attitudes (Melenhorst et al., 2006; Mitzner et al., 2010). Negative stereotypes regarding older adults and technology may deter them from trying new technology, as they fear confirming these ageist notions (Mariano et al., 2021). This is particularly harmful, as older adults are a population that can significantly benefit from technology to improve their quality of life (Khosravi et al., 2016; Kruse et al., 2020; Sen et al., 2022).

Some older adults report technophobia – a dislike or discomfort with technology, such as computers and smartphones (Dong et al., 2025; Martin et al., 2019) – but much of this technophobia is driven by legitimate privacy concerns (Sun & Ye, 2023). Still, older adults are the fastest-growing group to use Facebook, with 32% of adults aged 65 and older using the platform despite privacy concerns (Kiger, 2018). The use of digital technology by older adults can help reduce social isolation, one of the most significant threats to life satisfaction among older adults (Khosravi et al., 2016; Sen et al., 2022). In addition to social media, the increased use of technology among older adults could facilitate access to telehealth, including videoconferencing psychotherapy (Backhaus et al., 2012), providing this population with accessible medical care that may reduce psychological distress (Kruse et al., 2020). Similarly, the emergence of advanced technology and artificial intelligence (AI) can aid in monitoring and maintaining the health of older adults, leading to significant improvements in physical well-being (Abadir et al., 2023). The use of technology by older adults to manage their health and medical needs can lead to a newfound sense of independence, increase their feelings of self-efficacy, and enhance their daily functioning (Abadir et al., 2023; Chen et al., 2023; Kruse et al., 2020). It appears that AI may exacerbate loneliness in older adults; however, loneliness seems to improve when the AI is embodied (e.g., robots or smart speakers) rather than disembodied (e.g., text-based chatbots; Dong et al., 2025).

Narrative Therapy for Older Adults

Older adults may face psychological challenges such as unresolved trauma, accumulated grief, and the stress of major life transitions such as retirement, declining physical health, and the loss of loved ones. These experiences can significantly impair emotional well-being and quality of life. Despite older adults demonstrating comfort with discussing mental health concerns, a substantial portion remain hesitant to seek care (Gerlach, 2021). Research on the efficacy of therapeutic interventions for this population remains limited, largely due to underrepresentation and a lack of longitudinal studies.

Narrative therapies, including Narrative Exposure Therapy (NET), Written Exposure Therapy (WET), Life Review Therapy, and Reminiscence Therapy, offer promising interventions for older adults. By integrating autobiographical material, these evidence-based therapies engage older adults in reflective and meaning-making processes that have been shown to yield therapeutic benefits, particularly in the context of grief, trauma, and identity transitions. These modalities additionally support emotional processing, foster autonomy, and help empower older adults to build resilience in the face of adversity.

Wrinkles of Laughter:

Humor Use in Therapy for a Happier and Healthier Life

The world is an uncertain and tumultuous place. History teaches us that chaos is a part of human life and that coping with that chaos results in better life outcomes. Victor Frankl (1946) discussed humor’s use in building resilience and giving rise to positive emotions when discussing his experience in concentration camps, noting that joking about their hardships helped build hope and morale. Many authors viewed humor as a form of tension relief (Bergson, 1911; Dewey, 1894; Freud, 1905, 1928; Gregory, 1924; Morreall, 1987). As we age, we might feel that our lives are becoming more chaotic and stressful because we are closer to facing mortality directly. Humor can make the dark times and light times brighter. Humor and laughter have shown benefits for mental health, chronic pain (including for older adults), chronic stress, caregiving, in social situations, and in building rapport with clients (Cadiz et al., 2024; Goodwin et al., 2024; Hayashi et al., 2015; Hirsch et al., 2010; Isen, 2003; Ko and Youn, 2011; Lyubomirsky et al., 2005; Messa & Baum, 2020; Moon et al., 2024; Nezlek & Derks, 2001; Osincup, 2020; Stiwi & Rosendahl, 2022; Tse et al., 2010).

Laughter develops in humans at around four months old; it is one of our first communication tools (Fogel et al., 1997). Humor can change as we age. Our different capacities, experiences, and knowledge can create different understandings of humor and different ways to express it. Spontaneous laughter and humor therapy can reduce pain and build tolerance to pain (Messa & Baum, 2020; Moon et al., 2024; Tse et al., 2010). Humor reduces epinephrine and cortisol levels, which contribute to a higher risk of heart disease, cancer, cognitive decline, and dementias (Hayashi et al., 2016; Kramer & Leitao, 2023; Oliveira & Arriaga, 2022; Samant et al., 2020). Several large studies and reviews showed significant benefits to mental and physical health in all ages of adults following interventions that involved humor and laughter, including improvements to insomnia, depression, anxiety, and cardiopulmonary outcomes (Hayashi et al., 2015; Hirsch et al., 2010; Ko and Youn, 2011; Messa & Baum, 2020; Stiwi & Rosendahl, 2022).

Later-Life Transitions:

Becoming Caregiver to a Family Member

In 2023/2024, the SDPA Aging Issues Committee produced six ninety minute Zoom presentations entitled Later-Life Transitions Luncheon Series. Topics covered in this series included Retirement, Loss of Physical Capabilities, Moving to a Senior Facility, Becoming Caregiver to a Family Member, Loss of a Spouse/Partner and The Final Transition. We are presenting a summary of the material covered in each of the six series presentations in installments .

The fourth topic Becoming Caregiver to a Family Member was facilitated by Kenneth S. Dellefield, Ph.D. and Marjorie Coburn, Ph.D. on February 16, 2024. Below are some of the key points made during the presentation.

BECOMING CAREGIVER TO A FAMILY MEMBER

A majority of older adults are called upon at some point to provide care to their family members, most commonly to elderly parents or to spouses/partners who are declined in health or physical capability. This is particularly true today with costs of outside care skyrocketing. This article focuses on the challenges of providing care to spouses/partners particularly.

Most older adults prefer to have their spouses be their caregivers given the relational foundations and the expectation of reciprocity and there can be many benefits to providing care. Helping a spouse/partner can improve the mental health of the caregiver and can deepen the relationship. Time spent with the spouse/partner may increase opportunities for intimate communication and reflection on a shared life together. There may be a sense of purpose and gratification in helping and being needed. Caregiver duties can increase self-worth and compensate for losses in other lifetime roles/occupations. There is evidence that providing care for more than 14 hours per week may predict greater longevity for the caregiver and can relieve stress. These benefits accrue, however, only if caregiver burdens fall within reasonable limits.

Trauma and PTSD in Older Adults

Older adults constitute a growing proportion of the United States population. By 2050, it is projected that adults aged 65 and older will comprise 82 million of the population – a 47% increase from 2022 (U.S. Census Bureau, 2018). In the United States, 90% of older adults have experienced a traumatic event in their lifetime (Norris, 1992). Considering the prevalence of trauma in this increasingly growing population, clinicians working with older adults must remain well-informed of the implications of trauma in aging. Roughly 2-4% of the older population meets criteria for posttraumatic stress disorder (PTSD; Acierno et al., 2007) and 7-15% exhibit clinically significant symptoms (Kaiser et al., 2025); symptoms can last more than 50 years after a traumatic event (Thorp et al., 2011). However, there is a paucity of research on older adults with PTSD.

Several developmental factors in older age can explain why symptoms of PTSD may increase in later life. These include loss, retirement, increased health problems, reduced income, cognitive impairment, decreased social support, and other stressors that may make it more difficult to cope with memories associated with trauma (Thorp et al., 2011). Individuals who once turned to avoidance-based coping strategies (such as substance use or overcommitting oneself to work) may find that these strategies are no longer available or effective.

Successful Aging and Subjective Aging

In the United States, by 2034, older adults will outnumber children, and by 2060 older adults will represent nearly one quarter of the population (U.S. Census Bureau, 2018). An understanding of what contributes to successful aging will therefore have a significant impact. Historically, the concept of successful aging has been operationalized by objective markers such as the freedom from disease and disability, high physical and cognitive functioning, and social and productive engagement (Rowe & Khan, 1997). Recent research has aimed to determine subjective interpretations of what constitutes successful aging in order to provide a holistic perspective of aging that better accounts for lifestyle factors and psychological functioning (Jeste et al., 2010; Jeste et al., 2013). These elements include greater physical activity, fewer medical conditions, and absence from disability, arthritis, and diabetes (Depp & Jeste, 2006). In regard to psychological functioning and lifestyle factors, greater cognitive ability, increased social supports, the absence of depression, higher levels of education, productive engagement, access to wellness resources, valued relationships, religious activity, and high perceived meaningfulness were associated with successful aging (Depp & Jeste, 2006; Sunsanti et al., 2020). While physical health impairments and medical concerns are more prominent in the older adult population, psychological factors such as optimism and resilience have been shown to be more important for defining self-identified successful aging than physical functioning (Jeste et al., 2013). Similarly, psychiatric illnesses have been found to directly impact biological aging trajectories by diminishing psychosocial factors (e.g., variables related to lifestyle, psychological health, and social functioning) that would otherwise reduce risk of morbidity and mortality (Harmell et al., 2014).

May 2024

Roominations

We all have dreams where we find ourselves wandering through familiar rooms. Often these rooms existed in our distant past and they now serve as entry to a memory, for they create the ambience of a time gone by. Sometimes the rooms we dream of, and their locations are totally unfamiliar but, in their particularity, reveal something important or new to us.

So, in our waking lives we find ourselves shaping and being shaped by our immediate environment, the rooms in which we work and live. We all have a need for a certain degree of privacy. Some people call it private space and even visualize a space within themselves that is inaccessible to anyone. I see that space within as akin to a room. We often call it euphemistically our inner space, or inner world. We carry it with us wherever we go. Some people experience their most intensely private even profound moments outdoors on a mountaintop or watching the sun set.

How we locate ourselves in the world, cast anchor, and settle in a place is our story. The spaces we live in are usually extremely important to us. The reasons are complex and varied, but I’ll name a few. We see our homes as extensions of ourselves. They reflect something about us, about our identity. They can project an image about us…even if we’d rather they didn’t.