Outlook: Newsletter of the Society of Behavorial Medicine

Summer 2019

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Mindful Aging: A Pathway toward Improved Health and Quality of Life

Katarina Friberg-Felsted, PhD & Elizabeth Orsega-Smith, PhD; Aging SIG


As the United States’ aging population continues to grow, enhancing quality of life in this patient cohort has become an area of emphasis, evidenced in part by the National Institutes of Health’s call to improve the biological and psychological health of this population.1 New avenues are being used to explore innovative and effective ways of improving older adults’ physical and mental health outcomes. The connection between the mind and body is germane to many biopsychosocial processes. Mindfulness, as defined by Jon Kabat-Zinn, the founder of Mindfulness-Based Stress Reduction, means “paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally."2 This behavior is linked to changes in areas of the brain responsible for affect regulation and how we react to stressful impulses, influencing body functions from heart rate to immune function.3 Mindfulness has proven effective in treating many mental and physical health outcomes, decreasing symptoms and increasing quality of life.4,5,6,7

These areas of research are relevant across SBM membership – they influence both aging and complementary and integrative therapies and address social determinants of health, health inequities, and diversity initiatives. These areas of research are also prioritized in The National Center for Complementary and Integrative Health’s 2016 Strategic Plan, which includes objectives related to mind-body connection.

  • “advance understanding of the mechanisms through which mind and body approaches affect health, resilience, and well-being”
  • “conduct studies in ‘real world’ clinical settings to test the safety and efficacy of complementary health approaches, including their integration into health care”8

Mindfulness interventions to treat older adults’ physical and psychological conditions may be particularly advantageous for this population. Typical pharmaceutical treatments often used as first line of treatment can present a higher risk to an older adult.9,10 Medication trials typically exclude those over 65, and as such, drug reactions in an older adult patient may be unexpected, and patients may not respond the way clinical trials have shown them to. Further, polypharmacy is a higher concern in an older population, with potential drug interactions providing unexplored and unwanted side effects. Finally, some medications tend to show reduced efficacy with long-term use.11

It appears that mindfulness, or being in the present moment, is something that older adults may be more accepting of than younger adults, due to their ability to maintain emotional functioning.12,13 Consequently, studies show that their level of mindfulness are higher than the younger population.14 A review of the literature shows that mindfulness-based interventions in older adults found that most interventions have been conducted in community–dwelling older adults who were referred by health professionals or interested in gaining mindfulness training on their own.15 These interventions targeted symptoms with psychological distress ( i.e. depression, stress), physical illness (i.e. chronic obstructive pulmonary disease , diabetes) or pain. Other applications of mindfulness in older adults include relationships with cognitive and emotional well-being, protection against stress, mood states, and successful aging.16,17,18,19  It has also been suggested that traditional mindfulness based interventions should be modified to meet the needs of older adults ( i.e. shortened length of interventions, altered delivery of programs) and expand its application to examine the impact on other age –related diseases.15

One innovative area for mindfulness application is urinary incontinence in older adult women.20,21,22 Urinary incontinence presents in two disparate ways: stress urinary incontinence (SUI) and urge urinary incontinence (UUI).  While stress urinary incontinence, typically caused by poor muscle tone, can often be successfully addressed with physical therapy or general lifestyle behavior changes, urge urinary incontinence is often idiopathic and refractory. Preliminary research has shown UUI responsive to mindfulness.20,21,23 The mechanism for this may be a reduction in catastrophizing the event and learning to respond to stimuli in the accepting and non-judgmental way as learned through mindfulness training.20,21,24,25

Older adults deserve better treatment options leading to improved health related quality of life. Mindfulness training may be a pathway towards better health and improved quality of life in this older adult population.

 

References

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  2. Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. Hachette UK.
  3. Gallegos AM, Hoerger M, Talbot NL, et al. (2013) Toward identifying the effects of the specific
  4. components of mindfulness-based stress reduction on biologic and emotional outcomes among older adults. Journal of Alternative and Complementary Medicine, 19(10), 787-792.
  5. Creswell, J. D., Irwin, M. R., Burklund, L. J., Lieberman, M. D., Arevalo, J. M., Ma, J., . . . Cole, S. W. (2012). Mindfulness-based stress reduction training reduces loneliness and pro-inflammatory gene expression in older adults: A small randomized controlled trial. Brain, Behavior, and Immunity, 26(7), 1095-1101.
  6. Moss, A. S., Reibel, D. K., Greeson, J. M., Thapar, A., Bubb, R., Salmon, J., & Newberg, A. B. (2015). An adapted mindfulness-based stress reduction program for elders in a continuing care retirement community: Quantitative and qualitative results from a pilot randomized controlled trial. Journal of Applied Gerontology, 34(4), 518-538. doi:10.1177/0733464814559411
  7. Moynihan, J. A., Chapman, B. P., Klorman, R., Krasner, M. S., Duberstein, P. R., Brown, K. W., & Talbot, N. L. (2013). Mindfulness-based stress reduction for older adults: Effects on executive function, frontal alpha asymmetry and immune function. Neuropsychobiology, 68(1), 34-43.
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  10. Franco, I. (2011). The central nervous system and its role in bowel and bladder control. Current Urology Reports, 12(2), 153-157. doi:10.1007/s11934-010-0167-8
  11. Mannesse, C. K., Derkx, F., De Ridder, M., & van der Cammen, T. (2000). Contribution of adverse drug reactions to hospital admission of older patients. Age and Ageing, 29(1), 35-39.
  12. Kelleher, C. J., Cardozo, L. D., Khullar, V., & Salvatore, S. (1997). A medium-term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance. British Journal of Obstetrics and Gynaecology, 104(9), 988-993.
  13. Charles, S. T., & Carstensen, L. L. (2010). Social and emotional aging. Annual Review of Psychology, 61, 383–409. doi:10.1146/annurev.psych.093008.100448
  14. Urry, H. L., & Gross, J. J. (2010). Emotion Regulation in Older Age. Current Directions in Psychological Science, 19(6), 352–357. doi:10.1177/0963721410388395
  15. Hohaus, L. C. and Spark, J. (2013). Getting better with age: do mindfulness and psychological well-being improve in old age? European Psychiatry, 28(1), 1. doi:/10.1016/S0924-9338(13)77295-X
  16. Geiger, P. J., Boggero, I. A., Brake, C. A., Caldera, C. A., Combs, H. L., Peters, J. R., & Baer, R. A. (2016). Mindfulness-based interventions for older adults: a review of the effects on physical and emotional well-being. Mindfulness, 7(2), 296-307. 
  17. Fiocco AJ, Mallya S. The importance of cultivating mindfulness for cognitive and emotional well-being in late life. Journal of Evidence-Based Complementary & Alternative Medicine. 2015;20:35–40. 
  18. de Frias CM, Whyne E. (2015). Stress on health-related quality of life in older adults: the protective nature of mindfulness. Aging & Mental Health, 19, 201–206.
  19. Orsega-Smith E, Goodwin S, Ziegler M, Greenawalt K, Turner J, Rathie E. Aging and the Art of Happiness: Time Effects of A Positive Psychology Program with Older Adults. (2019) OBM Geriatrics, 3(1), 19. doi:10.21926/obm.geriatr.1901029.
  20. de Frias CM. (2013). Memory compensation in older adults: the role of health, emotion regulation, and trait mindfulness. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 69, 678–685.
  21. Baker, J., Costa, D., Guarino, J. M., & Nygaard, I. (2014). Comparison of mindfulness-based stress reduction versus yoga on urge urinary incontinence: A randomized pilot study with 6-month and 1-year follow-up visits. Female Pelvic Medicine and Reconstructive Surgery, 20(3), 141-146. doi:10.1097/spv.0000000000000061
  22. Baker, J., Costa, D., & Nygaard, I. (2012). Mindfulness-based stress reduction for treatment of urge urinary incontinence: A pilot study. Female Pelvic Medicine and Reconstructive Surgery, 18(1), 46-49. doi:10.1097/SPV.0b013e31824107a6
  23. Felsted, K.F., and Supiano, K. P. (2019a). Using mindfulness approaches to treat urinary urge incontinence in older adult women: A scoping review. Integrative Journal of Nursing and Health, 2(1), 42-50.
  24. Felsted, K. F., and Supiano, K. P. (in press, 2019b). Mindfulness-Based Stress Reduction Versus a Health Enhancement Program in the Treatment of Urge Urinary Incontinence in Older Adult Women A Randomized Controlled Feasibility Study Research in Gerontological Nursing. Thorofare, NJ: Healio.
  25. Boyes, A. (Jan 10, 2013). What is catastrophizing? Cognitive distortions. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/in-practice/201301/what-is-catastrophizing-cognitive-distortions
  26. Garland, E. L., Gaylord, S. A., Palsson, O., Faurot, K., Douglas Mann, J., & Whitehead, W. E. (2012). Therapeutic mechanisms of a mindfulness-based treatment for IBS: Effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. Journal of Behavioral Medicine, 35(6), 591-602. doi:10.1007/s10865-011-9391-z