Effects of Life Transitions

Late life is commonly a period of transitions (eg, retirement, relocation) and adjustment to losses.

Retirement is often the first major transition faced by the elderly. Its effects on physical and mental health differ from person to person, depending on attitude toward and reason for retiring. About one third of retirees have difficulty adjusting to certain aspects of retirement, such as reduced income and altered social role and entitlements. Some persons choose to retire, having looked forward to quitting unpleasant work; others are forced to retire, eg, because of health problems or job loss. Appropriate preparation for retirement and counseling for families and retirees who experience difficulties may help.

Relocation may occur several times in old age, eg, to smaller quarters after selling the family home, to retirement housing to reduce the burden of upkeep, and to a nursing home. Some experts contend that such moves cause relocation trauma; however, recent studies find little or no evidence of increased mortality or other indications of trauma, especially among persons prepared for the move. Physical and mental status are significant predictors of relocation adjustment, as is thoughtful and adequate preparation. Persons who respond poorly to relocation are more likely to be living alone, socially isolated, poor, and depressed. Men respond more poorly than women.

The stress of relocation correlates inversely with the degree of perceived control over the move and the predictability of the new environment. Patients should be acquainted with the new setting well in advance. For the cognitively impaired elderly person, a move away from familiar surroundings may exacerbate functional dependence and disruptive behavior.

Bereavement affects many aspects of an elderly person's life. For example, social interaction and companionship decrease and social status changes. The death of a spouse affects men and women differently. In the 2 years after the death of a wife, men tend to have increased mortality rates, especially if the wife's death was unexpected. For women who lose a husband, the data are less clear but generally do not indicate increased mortality rates.

Health care practitioners should look for symptoms of stress and depression after a patient has been bereaved. Hasty treatment with antidepressant drugs should be avoided, because these drugs may interfere with the process of grieving and adjustment; however, caregivers and health care practitioners should be aware of the high risk to the bereaved patient of suicide and potential for declining health status. Counseling and supportive services, such as support groups for widows, may facilitate difficult transitions. Prolonged, pathologic grief usually requires psychiatric evaluation and treatment.