AAGP Session to Highlight Research on Resilience, Emotional Well-Being in Aging

Global population aging and the increasing burden of physical and mental disorders in older adults are some of the reasons to seek more effective approaches for the treatment and prevention of mental disorders to promote healthy and positive aging and independence in older adults.

The presidential session of the American Association for Geriatric Psychiatry (AAGP) at this year’s Annual Meeting will focus on basic, translational, clinical, and community models of resilience and well-being in aging adults with neuropsychiatric disorders. The title of the session is “Resilience and Well-Being in Older Adults With Neuropsychaitric Disorders.”

Interventions promoting resilience and emotional well-being and addressing social determinants of health and mental disorders can significantly improve outcomes of mental disorders in older adults and reduce the burden and cost of disease and disability for patients, caregivers, and society.

Recent insights from cross-species studies highlighting brain networks that promote emotional resilience have created new opportunities in research focused on emotional well-being and brain aging. Mind-body practices have been shown to improve emotional resilience and well-being and can be used for prevention of late-life neuropsychiatric disorders. Positive social determinants of mental health such as resilience, compassion, and wisdom at the family and community levels play an important role in improving well-being and the overall health of older adults.

Strong evidence shows that social determinants of mental health, including stigma, racism and other forms of discrimination, early-life adversities, social isolation, and disadvantaged neighborhoods have a significant adverse impact on overall health and longevity, especially in people with mental illness. Yet, positive social determinants have received relatively little attention in routine clinical care, community psychiatry, or public health care policies. A positive social determinant is not just an absence of adverse social factors; it is the presence of family- and community-level factors that promote resilience, compassion, and wisdom and provide social support.

During the session, F. Vankee Lin, M.D., will introduce the definitions of resilience and emotional well-being in aging research. Selective physiological decline occurs in the typical aging process, with advanced brain aging or extra pathologies leading to neurodegenerative diseases that influence every aspect of functional health and well-being. Yet later life can also be a time of resilience in which older adults are able to maintain normal, stable, or even exceptional functional health or well-being despite brain or other biological aging. Understanding why some cognitive and affective functions can remain normal in the face of the incidence and progression of brain aging is a critical objective of aging research, with the goal of developing therapeutic approaches to mitigate functional decline and brain aging-related diseases.

A newly developed neuro-physio-behavioral reactivity and reappraisal framework addressing mechanisms underlying resilience in aging will be discussed, covering two aspects: key brain regions (such as the ventromedial prefrontal cortex, insula, and basal ganglia) and brain circuits contributing to resilience in the aging brain; and autonomic nervous systems for responding and adapting to stressors across the lifespan.

Lin will also introduce the new Brain Aging Center, an NIH-funded research center promoting cross-species-based mechanistic research of emotional well-being. The center will be able to apply the resilience framework to understand the mechanisms of emotional well-being in old age, including individuals at risk for or with dementia, and identify intervention targets.

Helen Lavretsky, M.D., M.S., the president-elect of AAGP and an editorial board member of Psychiatric Times, will discuss recent advances in the understanding of resilience and well-being in the context of aging and will provide an update on resilience-building interventions using mind-body therapies for older adults with mood and cognitive disorders.

Past APA President Dilip Jeste, M.D., the co-editor of the book Positive Psychiatry from APA Publishing, will present data-based information on assessment and promotion of positive social determinants. For example, there have been studies of communities that have had remarkably low incidence of posttraumatic stress disorder (PTSD) following major social adversities, such as a war or a famine. While severe trauma often results in PTSD, some people demonstrate posttraumatic growth. Jeste will describe the Compassionate Communities movement that helps provide special care for disenfranchised groups in the local communities.

While loneliness is associated with worse health and higher mortality, wisdom has been shown to be inversely correlated with loneliness clinically as well as biologically. Wisdom training at a group level can help reduce loneliness and improve well-being. Randomized, controlled trials have reported improvement in well-being and an increase in specific components of wisdom through individual and group psychotherapies. Studies have also reported community-level interventions that reduced the adverse impact of racism by promoting diversity. Finally, an example of a broad structural and functional strategy to promote well-being in older adults is the Age-Friendly Communities movement initiated by the World Health Organization and AARP. Jeste will describe ways for practicing psychiatrists to assess and enhance positive factors including wisdom, social connections, posttraumatic growth, and well-being in their patients and families.

At the end of the session, attendees will be invited to participate in a discussion of how to forward the field of prevention of mental disorders in aging individuals by focusing on positive and protective psychological factors. ■