"Before Deciding It's Too Late"—Psychotherapy from Age 65 Reexamines the Remaining Time in Life

"At this age, what could possibly change now?"

What was once considered a future possibility in youth has somehow turned into a reason for giving up. The distance from family, years of patience, unspoken feelings. Problems that were thought to be solved by time often resurface at unexpected moments.

Featured by Germany's WELT is gerontologist Eva-Marie Kessler, who is involved in psychotherapy for the elderly. The introduction of the published article raises the question, "Is it too late for change as we age?" and explores the potential of psychotherapy after the age of 60.

This question is not directed solely at the elderly. At 40 or 50, people draw a line in their lives, thinking "it's too late now." But is that line truly immovable? Starting from the issues raised in the original article, let's consider insights from published research and communications on elder care.

*Note: The full text of the original article is not available for review, so this article is not a full translation or reconstruction. It is an independent commentary based on the introduction that could be confirmed, and the following considerations or examples are not presented as statements by Kessler.

Are We Setting a Deadline for Mental Change Based Solely on Age?

"People become stubborn as they age." When this perspective is assumed, even when the elderly express their concerns, it is often dismissed as just their personality.

However, the existence of long-held beliefs and the potential for relief through support are separate issues.

A study published in the UK in 2021 analyzed data from over 100,000 users of psychotherapy services. Adjusted analyses showed that those aged 65 and over had better outcomes on recovery and improvement indicators than those aged 18–64, and were less likely to drop out of treatment.

However, this is an observational study of those who utilized treatment. There remain biases in participants and unmeasured factors. It does not prove that all elderly individuals improve more than younger ones. Still, it provides a reason to reconsider the assumption that "psychotherapy is useless for the elderly."

When we hear about changing one's life, we often imagine changing jobs, living arrangements, or relationships all at once. However, the value of change cannot be measured by its external magnitude.

Being able to refuse a request. Communicating difficult feelings to family. Spending a little less time blaming oneself for past failures. These changes also have meaning in supporting daily life.

"A Life Without Regrets" Can Become a New Burden

When discussing the end of life, the phrase "live without regrets" often accompanies the conversation. However, setting a goal of leaving no regrets can lead to continuously grading past choices.

If only I hadn't chosen that job. If only I had spent more time with family. If only I had voiced my desires.

When thinking this way, the current self possesses more information than at the time. Are you judging your past self solely on outcomes, forgetting about income, family circumstances, societal atmosphere, and whether you had someone to consult with at the time?

What is needed here is not the task of making all choices seem right or forcibly forgiving someone.

"What was I trying to protect at that time?"
"What did I truly desire?"
"Is there a part of that desire that can be addressed in my current life?"

By reexamining these questions, regrets can be read not as a verdict on one's entire life, but as clues to understanding current hopes.

For example, if you regret not contacting an old friend, what you might want to regain is not the past itself, but the time to talk freely with someone. Even if you can't recreate the same relationship, there may be room to fulfill that wish in another form.

This is not a method for quickly finding answers. It is a way of thinking that keeps questions aimed at the past open to today's life.

To Support the Mind, We Must Also Consider Living Conditions

As expectations for psychotherapy rise, there is something that must not be forgotten. We must not reduce life's difficulties to mere issues of personal mindset.

The WHO lists factors affecting mental health in old age, such as bereavement, changes in income or roles due to retirement, isolation, decline in physical function, and ageism. Support must include not only mental interventions but also living environments, transportation, social connections, and caregiver support.

For someone who wants to go out, a residence with only stairs or inconvenient transportation can be real barriers. For someone who wants to talk to people other than family, the absence of nearby gathering places is not easily changed by mindset alone.

Before encouraging someone to "stay positive," we should check whether conditions allow for positive actions.

Listen to what the person wants and specifically identify what makes it difficult. From there, consider whether family cooperation, welfare support, or medical care is needed. Life's freedom is not determined by willpower alone.

Voices from the Field on Social Media—Balancing Protection and Respecting Personal Will

Direct responses on social media to the original WELT article could not be confirmed in a form that could be cited. Therefore, this section introduces public communications on related themes that could be confirmed. These do not represent opinions on the article or trends across social media as a whole.

On LinkedIn, Maja Katharina Kessler-Gisiger reflects on the meaning of knowing each resident's life in elder care, reaffirming the purpose of working there. She also notes that during the pandemic, she could not find a satisfactory answer to balancing safety and respecting personal autonomy.

In the same communication, she touches on the need for long-term psychiatric care for the elderly, which took seven years to establish a specialized department. Note that the scope of confirmation is based on excerpts from posts displayed in search results, and the full text of individual posts or comment sections has not been confirmed.

From the communication of one individual, it is not possible to gauge public opinion. However, it is clear that work supporting the latter half of life involves questions that cannot be answered by merely ensuring "safe living."

How much do those around know about what the person values? Are restrictions set for safety undermining the person's enjoyment or dignity? Are the conveniences of the supporters replacing the person's wishes?

If discussions about aging are confined to "how the person feels," these challenges faced by supporters become less visible.

Don't Dismiss Discomfort with "It's Just Old Age"

Reflecting on life and the discomforts requiring treatment or support may overlap but are not the same.

The U.S. National Institute of Mental Health lists signs related to mental discomfort in the elderly, such as changes in mood, appetite, and energy, sleep problems, difficulty feeling joy, concentration issues, persistent anxiety, or hopelessness. Noticing changes and consulting healthcare providers is the gateway to support.

From a family perspective, a decrease in conversation or refusal to go out might be easily interpreted as "due to age." However, the person may be struggling to find words to explain their distress.

Conversely, when seeing someone grieving, it is also important not to immediately assume illness. Grieving the loss of a loved one has its own timeline.

When reaching out, rather than ending with "cheer up," ask specific questions like "Are you sleeping well lately?" or "Is there a particularly difficult time of day for you?" After listening, if daily life continues to be affected, consider consulting a primary care physician together.

Before drawing conclusions on behalf of the person, try to understand what they are experiencing. This approach is necessary at any age.

There Is Hope, Yet Effects Cannot Be Universally Claimed

Regarding psychotherapy for the elderly, attention must be paid to the subjects and locations of research.

A Cochrane review of 19 studies involving 873 people living in long-term care facilities suggests that psychotherapy may reduce depressive symptoms. However, many studies are small-scale with methodological issues, and the certainty of evidence is rated very low. Uncertainties about long-term effects remain.

The situation differs between those using community outpatient services and those requiring daily support in facilities. A single research result cannot be directly applied to all elderly individuals.

Thus, the hope to convey is not "you will definitely get better," but rather "do not close off the possibility of receiving support based solely on age."

What is important is to proceed while considering the individual's condition, wishes, physical burdens, and available support. The form and pace of improvement can vary for each person.

Before Counting Remaining Time, Confirm One Choice Today

From here, this is a proposal as a consideration of this article, not a treatment procedure verified by research.

If reviewing life all at once feels heavy, first look at today's schedule. Is there time you have willingly included for yourself?

Taking on requests from others or acting for family are important activities if chosen with personal conviction. The issue is not prioritizing others per se, but rather always postponing the chance to confirm one's own desires.

"I'm actually tired."
"I want to spend today alone."
"I want to talk to that person after a long time."

Even words of that degree are fine. Even if you can't immediately act on your wishes, you can first acknowledge their existence within yourself.

Next, consider what is needed to realize those wishes. Is it time, money, or someone's help? By becoming specific, you can break down the problems hidden within the phrase "I can't do it" into manageable parts.

If touching on painful memories increases distress, there is no need to delve deeper alone. Seeking support is also an action chosen by your own will.

Don't Conclude Your Life Midway

The discussion about receiving mental support after the age of 65 is not about rejuvenation or erasing the past.

You can address the pain you feel today, starting now. You can express the hopes you couldn't voice before, in your current words. If there are conditions you can't change alone, consider seeking help.

When reflecting on life, unchangeable events certainly remain. However, you don't have to let those events alone determine everything from now on.

After thinking "If only I had done that then," ask yourself, "What do I want to value today?"

Even if the answer is small or not yet clear, being able to hold that question itself becomes a step toward not concluding your life midway.

Sources and Scope of Confirmation

1. WELT:
   https://www.welt.de/gesundheit/plus6a9e7ab0181cb962d4886722/psychologie-ich-therapiere-menschen-am-lebensende-diesen-rat-wuerde-ich-jedem-geben.html

2. Saunders et al. (2021), Journal of Affective Disorders: A study analyzing over 100,000 users of psychotherapy services in the UK. Referenced for treatment outcomes by age and limitations as an observational study.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC8411661/

3. WHO "Mental health of older adults": Referenced for explanations on lifestyle and social factors affecting mental health in older adults and supportive environments.
   https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

4. LinkedIn, Maja Katharina Kessler-Gisiger's public profile posts: Experiences on balancing protection and autonomy in elder care and establishing a psychiatric long-term care department. Excerpts from posts displayed in search results are referenced. Not direct responses to the original article; full posts, individual post URLs, and comment sections are unconfirmed.
   https://ch.linkedin.com/in/maja-katharina-kessler-gisiger-a0612a23a

5. U.S. National Institute of Mental Health (NIMH) "Older Adults and Mental Health": Referenced for signs of mental discomfort in older adults and consulting healthcare providers.
   https://www.nimh.nih.gov/health/topics/older-adults-and-mental-health

6. Cochrane "Are psychological therapies effective in reducing depression in older adults living in long-term care?": Review of 19 studies involving 873 people in long-term care facilities. Referenced for potential effects and low certainty of evidence.
   https://www.cochrane.org/evidence/CD013059_are-psychological-therapies-effective-reducing-depression-older-adults-living-long-term-care