














































2020_CSWR_Journal.indd


51 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

WHEN HOPE GROWS WEARY: TREATING 
HOPELESSNESS IN OLDER ADULTS

DANIELLA SPENCER-LAITT & AMANDA WEISS
Editors-in-Chief, Columbia Social Work Review

ABSTRACT
Hopelessness is associated with suicidal ideation and completion, poor 

physical health, and poor quality of life, and is an important and little-
discussed dimension of the experience of older adults. However, hopelessness 
is not an inevitable part of the aging process. The present paper analyzes the 
construct of hopelessness specifically in the context of the aging population, 
discusses measuring and treating hopelessness, and makes recommendations, 
based on existing models of care, for how targeted services can be created to 
address this problem. 

INTRODUCTION
“This whole town does look like whatever hope becomes after it begins 
to weary a little, then weary a little more. ” 
 -Robinson, Gilead

The septuagenarian pastor, John Ames, at the center of Marilynne 
Robinson’s Gilead (2004) reflects on a long life soon to be cut too short. Like 
the fictional town of Gilead, he embodies a gentle and genteel despairing. 
Ames concludes his narration by saying “hope deferred is still hope…I think 
sometimes of going into the ground here as a last wild gesture of love - I 
too will smolder away the time until the great and general incandescence” 
(Robinson, 2004, p. 247). The aging process poses many threats to the 
mental and physical health and psychosocial functioning of those aging. 
And hopelessness, as we will discuss in detail, is one of the most insidious.

In the face of transition to any new phase of life, physiological, 
pathological and psychological changes arise. For the aging population, 
disconnection from social and professional roles can occur and lead to, or be 
precipitated by, the experience of negative emotions—such as, hopelessness. 
This paper will consider the role of hopelessness in the experience of 
older adults, often concurrent with general feelings of depression or low 
mood, because of the pivotal role hopelessness plays in poor psychosocial 
functioning and the need for new, targeted interventions to address its 
prevalence in older adults.1 

 Many scholars have observed that study of the psychosocial challenges 
of older adults—from mental health issues to abuse—is about fifteen years 

1 A substantial literature already documents the feelings of hopelessness and helplessness 
among caregivers of older adults (see for example, Rzeszut, 2011; Lin, 2018; Jorgensen, 1992; 
Duxbury, Higgins, & Smart, 2011). But in this paper, we are interested in the other half of the 
care dyad–the cared for. 



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 52 

behind the study of parallel challenges in children and adults (Settersen, 
2005; Bardach & Rowles, 2012; Pedrick-Cornell & Geddes, 1982; Beach et al., 
2016; Barber, 2008). The study of interventions for hopelessness in seniors 
seems to be similarly limited in scope and rigor. Geriatrics and gerontology 
suffer a tendency to get bogged down in the weeds of semantic issues of what 
exactly constitutes old: We especially see this in industrialized countries 
where the mortality rate seems to be ever-increasing, as well as in life stages 
for which there seem to be no neat demarcations (the antithesis of which is 
the end of puberty and medical transition into adulthood). 

Even when scholars concur on what defines old, a tension exists 
between the idea that on the one hand, older adults have unique medical 
and psychological needs in which practitioners need to be well-versed, and 
that on the other hand, older adults may benefit from the same attention 
paid to nominally younger adults with similar challenges. There is even a 
significant scholarly debate over what objectives interventions intending 
to serve older adults should have. Some favor the notion of “healthy aging,” 
others prefer “productive aging” or “dynamic aging” (Martinson & Berridge, 
2015). In our opinion, the terminology is neither here nor there—because no 
definition of the best possible aging experience should include the cognitive 
and emotional experience of hopelessness.

This paper aims to transcend some of the conceptual and semantic 
challenges surrounding aging by 1) rejecting the false dichotomy of respect 
for unique aging processes and respect for the essential humanity of the older 
adult and 2) focusing on extant case studies and potential new approaches 
for intervention. Ultimately, age (relative, absolute, chronological, medical, 
or other) should only be relevant to the treatment of hopelessness insofar 
as it can usefully inform our understanding of why hopelessness arises, the 
consequences of hopelessness, and clinical treatment. Just as the popular 
and academic imagination have slowly come to understand memory loss 
as an abnormality in the aging process, we hope that practitioners and 
researchers will come to understand hopelessness as treatable rather than 
intractable. 

This paper will be divided into four parts. The first part will analyze 
the cognitive construct of hopelessness. The second will address the 
implications of hopelessness, including suicidal ideation, depression, 
vulnerability to abuse, and higher rates of physical illness. The third will 
address existing instruments and methods for measuring hopelessness. And 
finally, the fourth part will present case studies for how hopelessness can be 
addressed in the settings in which older adults most commonly come into 
contact with psychosocial services. In short, we argue that hopelessness 
is not incorporated as a key target in the treatment of older adults—but it 
should be—and that existing programs to promote older adult well-being 
could and should incorporate reducing hopelessness as an outcome.



53 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

PART ONE: WHAT IS HOPELESSNESS?
Hope and hopelessness can be slippery concepts (Hernandez & 

Overholser, 2020). Scholars have generally shied away from questions of 
whether “hope and hopelessness are polar opposites or separate constructs, 
so that conclusions of low hopelessness cannot be readily generalized to high 
hope” (Hernandez & Overholser, 2020, pp. 28-29). Cognitive theory defines 
hopelessness as having negative expectancies towards the future (Beck et al., 
1974). Along with suicidal ideation, hopelessness is positioned as a product 
of distortions in thinking including but not exclusive to catastrophizing, 
dichotomous thinking, and/or  overgeneralization (Uncapher et al., 1998). 
In depression, these distortions form part of a cognitive triad of negative 
thoughts of the self, the world, and the future (Uncapher et al, 1998). 
Hopelessness fits into this triad as a “determinant and a component of 
the depressive condition” (Beck, Steer, Kovacs & Garrison, 1985). That is, 
hopelessness is a construct that may be an antecedent to depression, and can 
be either acute (in response to a situation or event) or chronic (Uncapher 
et al., 1998). 

When hopelessness is chronic, it can exist as a cognitive schema that 
directs how a person navigates the world and interprets information. A 
hopelessness schema may be activated by life stress, reflect a conclusion that 
one’s situation cannot be changed, and/or lead to suicidal ideation (Wenzel 
& Beck, 2008). Those with a hopelessness schema or acute hopelessness 
may perceive no end to their suffering. Therefore, hopelessness is both 
theoretically and empirically associated with suicidal ideation even in 
the absence of depression or other psychiatric illness, with death seen as 
a solution to the absence of hope about existence or an end to intolerable 
distress (Uncapher et al., 1998; Wenzel & Beck, 2008). 

 In older adults at the end of their life, the cognitive theory 
of hopelessness should supplement an understanding of transient 
and situation-related hopelessness (that is, state, as opposed to trait 
hopelessness). According to Sullivan (2003), some people facing the end of 
their life suffer a transient hopelessness which is better characterized as a 
type of complicated grief. This characterization has important implications 
for the treatment of this hopelessness, which may be more supportive or 
focus on the restoration of meaning and creation of connections to family, 
friends, religion and community if there is no underlying depressive etiology. 

 That said, hopelessness at the end of life is relatively well-studied. 
The literature on this topic may yet inform studies of treating and addressing 
hopelessness in seniors. Though we should acknowledge that aging or being 
old is not the same as dying or being close to death, key similarities would 
appear to exist between treating hopelessness at end-of-life, including the 
role of acceptance rather than denial of circumstances (cf. Hernandez & 
Overholser, 2020; Sullivan, 2003). Notwithstanding his focus on end-of-
life care, Sullivan (2003) presents a broadly applicable conceptualization 
of hopelessness. He writes: 



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 54 

“In medicine, hope is often reduced to the issue of prognosis or chance 
for survival. In psychiatry, hopelessness is often reduced to a symptom 
of major depression. Yet hope and hopelessness at the end of life are not 
simply medical or psychiatric problems. They encompass nearly all that 
human culture and spirituality have to offer.” (Sullivan, 2003, p. 393)

Hopelessness, especially for the aging population, encompasses more than a 
situational response or a component of Major Depressive Disorder (MDD).

PART TWO: THE EFFECTS OF HOPELESSNESS
In a general clinical population of adults, hopelessness has proved to be 

a better predictor of suicidal intention than the severity of depression (Beck 
et al., 1993). Hopelessness is also a useful construct in evaluating the risk 
of suicide completion. In a longitudinal study of adult patients hospitalized 
with suicidal ideation, hopelessness was the only metric that significantly 
differentiated suicide completers from suicide non-completers (Beck et 
al., 1985). Completed suicide is also associated with hopelessness in adult 
outpatients (Beck et al., 1990). These findings support the view, derived from 
cognitive theory, that hopelessness is not a proxy for mere depressed mood 
in adult populations (Uncapher et al., 1998). 

Numerous studies have also demonstrated the relationship between 
hopelessness and suicidal ideation in older adults. Dennis et al. (2005) 
found that life events are not singularly precipitating factors for suicidal 
actions in older adults: rather hopelessness discriminates between those 
who commit self harm and those who do not. Dennis et. al’s study also 
highlights the fact that the self harm group was more likely to have a poor 
social network, be lonely, and lack supportive services. While no analysis 
was undertaken to examine the direct correlation between hopelessness and 
poor social network, loneliness, or lack of supportive services, a connection 
between these variables may exist, exacerbating the psychosocial stressors 
for hopeless older adults. Neufeld and O’Rourke’s (2009) study of 117 older 
adults found that hopelessness was the strongest predictor of suicidal 
ideation of the variables studied at 83%.  Meanwhile, Szanto et al. (1997) 
found that in a sample of older adults coping with grief, a typical experience 
of later life, participants who endorsed active or passive suicidal ideation 
were also more likely to endorse hopelessness. 

We should also note that the factors that buffer against hopelessness in 
adults operate differently in older adult populations. Reasons for living are 
expectancies that might reduce risk of suicide; these include coping beliefs, 
responsibility to family, and moral objectives (Britton, Duberstein & Conner, 
2008). Britton, Duberstein and Conner (2008) found while ordinarily, 
individuals with more reasons for living have lower levels of hopelessness, in 
older adults, responsibility to family may increase the association between 
hopelessness and suicidal ideation due to perceived burdensomeness. 
This reveals the need for thorough psychosocial assessment of hopeless, 
depressed, or potentially suicidal patients since clinicians cannot assume 
that reasons for living are protective. However, there are other factors 
unique to older adults that  may be protective and contribute to the reduction 



55 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

of hopelessness and depression severity scores,  including but not exclusive 
to frequent practice of prayer and meditation (but not church attendance) 
(Cruz et al., 2009). 

Findings correlating suicidal ideation and hopelessness in older adults 
are notable given middle-aged and older adults are at higher risk of suicide 
than younger adults, and likelier to complete suicide when attempting it 
(Piscopo, 2017). Table 1 shows suicide completion rates per 100,000—
highest among middle-aged and older adults.

Table 1.
Suicide rates completion per 100,000, by age group, in 2018 
(Data from Suicide Prevention Resource Center [SPRC], 2020)

Age in Years Suicides per 100,000
65+ 17.5

45 - 64 20
25 - 44 17
15 - 24 14.5

Table 2, meanwhile, shows dimensions of suicidal behavior separate 
from the completion of suicide. The trend here would seem to be reversed—
suicidal thoughts and suicide attempts are less common among middle-aged 
and older adults. One possible interpretation of these data is that correlates 
of suicide are likelier to be lethal among middle-aged and older adults.

Table 2.
Suicide rates completion per 100,000, by age group, in 2018 
(Data from Suicide Prevention Resource Center [SPRC], 2020)

Age in Years

Suicidal thoughts in 
the past year, annual 
averages per 100,000, 

2009-2014

Suicide attempts in 
the past year, annual 
averages per 100,000, 

2009-2014
65+ 1.6 0.2

60 - 64 2.5 0.2

55 - 59 3.5 0.4

50 - 54 3.6 0.3

45 - 49 4.2 0.5

40 - 44 3.8 0.5



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 56 

35 - 39 3.9 0.5

30 - 34 3.9 0.5

26 - 29 4.6 0.5

18 - 25 6.9 1.2

It is worth noting, here, that the data fail to elucidate the variability of risk 
within age ranges post-65—and significant variability would seem to exist.2 
A recent study suggested that the risk of suicide and the methods of suicide 
vary considerably between the age groupings of 65-74, 75-84, and 85+ (Koo, 
Kolves, & De Leo, 2017). Among adults 65 and older, suicide completion rates 
were retrospectively observed to progressively increase with age—but men, 
who have higher suicide rates than women on average in the Western world, 
drove that trend (Koo, Kolves, & De Leo, 2017).

While many correlates with suicide, such as psychiatric disorder, male 
gender, being White, widowhood, lower socioeconomic status, social isolation, 
and stressful life events certainly exist in the older adult population (Lynch, 
Cheavens, Morse, & Rosenthal, 2004), hopelessness is a characteristic that is 
amenable to change. That said, arguably, questions of hopelessness in older 
adults have focused too heavily on the dichotomy between life and death, and 
specifically on suicidal ideation. This positions the purpose of life as survival, 
and may mean that a person facing the end of their life has little reason for 
hope since they cannot survive. As Sullivan (2003) notes, there are other bases 
for hope aside from survival, such as hope for salvation, dignity, or comfort. 

In addition, while hopelessness predicts suicidal ideation in the absence 
of depression, hopelessness is also a better indicator of depression in older 
adults than depressed mood (Joiner et al., 2007). As hopelessness increases 
in severity, dysthymia and major depressive disorder (MDD) are more 
likely and hopelessness is associated with high rates of double depression 
(dysthymia plus MDD) in older adults (Joiner et al., 2007). There is evidence 
that hopelessness mediates the relationship between quality of life and 
emotional distress in older adults (Scogin et al., 2016). Morthland et al. (2016) 
hypothesized that in a sample of rural adults, hopelessness results in poor 
motivation and hinders participation in both relationships and activities of 
daily life.

2 The population of American older adults is large and diverse. In 2016, 49.2 million Ameri-
cans were 65 or over (Roberts, Ogunwole, Blakeslee, & Rabe, 2018). Of those, 28.7 million fell 
between the ages of 65 and 74 (inclusive), 14.2 million fell between the ages of 75 and 84 (in-
clusive), and  6.3 million were 85 years or older (Roberts, Ogunwole, Blakeslee, & Rabe, 2018). 
Various researchers have pointed to the importance of, at minimum, differentiating between 
the younger old (sometimes listed as 75 to 84) from the oldest old (sometimes listed as 85 and 
older—see for example, Von Humboldt & Leal (2015). 



57 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

The literature has further established that hopelessness can be 
symptomatic of underlying problems. The fields of law, medicine, and social 
work all treat hopelessness as a symptom or possible indicator of elder abuse 
and neglect (Bergeron, 2006; Imbody & Vansburger, 2011; Katz, 1979-1980; 
Nerenberg, 2013).3 And, emerging evidence suggests that hopelessness 
is positively correlated with severity of medical disease and mortality, 
particularly in terms of cardiovascular disease (Dunn et al., 2014; Sullivan, 
2003).  Higher levels of hopelessness have been associated with higher levels 
of pain (Yildirim et al., 2009) and lower functional status (VanServellen et al., 
1996). All of this demonstrates the need to screen for hopelessness in order 
to avoid negative impacts on quality of life and physical health. 

At this point in the discussion, we would also like to note that the findings 
on hopelessness in older adults are not well studied for ethnic or cultural 
variations. In a study of the association between depressive symptoms and 
hopelessness in older adults, Assari & Lankarani (2016) compared White 
and Black populations of older adults, with race operating as the moderator. 
The study revealed that the association between depressive symptoms and 
hopelessness is weaker in Black older adults than in White older adults 
(Assari & Lankarani, 2016). The authors explain this finding by hypothesizing 
that despite higher rates of poverty, more severe depression, and less access 
to healthcare, Black older adults are likely to have higher levels of religious 
observance and social support, buffering against hopelessness and boosting 
resilience (Assari & Lankarani, 2016). Importantly, the authors did not 
measure the moderating effect of religious observance across racial groups, 
despite religious observance being a proven buffer against hopelessness in 
older populations. Therefore, it is impossible to generalize about the relative 
rates of hopelessness in different racial or ethnic groups based on the available 
data.

PART THREE: MEASURING HOPELESSNESS
There are several instruments utilized for the measurement of 

hopelessness in older adults, most notably the Beck Hopelessness Scale 
(Beck, Weissman, Lester & Trexler, 1974) and the Geriatric Hopelessness 
Scale (Fry, 1984). Despite practice guidelines urging the use of assessment 
measures that are either developed for, or modified for use with older 
adults (American Psychological Association, 2014), the Beck Hopelessness 
Scale (BHS), developed for use with adult psychiatric patients, is the most 
commonly used measurement in studies of late-life hopelessness (Neufeld, 
O’Rourke, & Donnelly, 2009). 

The BHS is a 20-item true/false scale based on affective, motivational 
and cognitive dimensions. While the BHS is used widely, few studies have 
measured its measurement invariance (and consequent utility for intergroup 
comparison) in large community representative samples (Kliem, et al., 2018).  

3 Hopelessness can also be the result of elder abuse. See Podnieks, 2006. 



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 58 

Hence, the BHS may not capture the dimensions of hopelessness specific to 
older adults since it was not designed for use with this population. Kliem et 
al. (2018) conducted the only investigation of the psychometric properties of 
the BHS in a large representative Western community sample, and concluded 
that its psychometric properties were mostly sound, with a need for further 
research in variance between ethnic and cultural groups. They did not, 
however, report findings on the utility  of the BHS according to age-based 
classifications.The BHS was only recently validated for use with a sample of 
older Spanish adults in a study by Satorres et al., (2018). It also demonstrated 
strong psychometric properties for use with older adults in studies conducted 
by Fraser, Burnell & Salter (2014), Duberstein et al. (2001) and Szanto et al. 
(1998), respectively. 

 Conversely, psychometric research has generally indicated 
acceptable internal consistency and construct validity for the Geriatric 
Hopelessness Scale (Heisel & Flett, 2005), yet the instrument has low 
predictive validity for suicidal ideation or behavior (Trenteseau et al., 1989).4  
Notably, the GHS performed poorly in a sample of community residing adults, 
although these findings did not specifically focus on the construct validity of 
hopelessness (Hayslip et al., 1991). Heisel & Flett (2005) partially supported 
Hayslip et al. (1991)’s findings that the GHS is better suited to institutionalized 
seniors as it does not distinguish well between mental health patients and 
non-mental health patients. However, the GHS performed well in reliability 
and construct validity (Heisel & Flett, 2005). 

Further important questions remain surrounding the utility of standard 
measures of hopelessness such as the BHS and GHS specifically in the very 
elderly population, who may be cognitively impaired (Neufeld, O’Rourke, & 
Donnelly, 2009). Perhaps even more importantly, older adults are less likely 
to self-report emotional distress, with those who see physicians more likely 
to focus on somatic symptoms unless specifically asked about factors such 
as suicide ideation (Neufeld & O’Rourke, 2009). This demonstrates the need 
for direct and specific questioning about hopelessness in this population by 
social workers and other service providers who come into contact with older 
adults, in addition to the use of psychometric instruments. 

PART FOUR: MODELS FOR  
HOPELESSNESS TREATMENT?

Often, wrongly, hopelessness is seen as inevitable, natural, or untreatable 
in older adults (Uncapher et al., 1998; Kjølseth, Ekeberg, & Steihaug, 2010). 
However, many modalities have shown promise, including goal-focused 
group psychotherapy (see for example, Klausner et al., 2000); life review 
therapy (Serrano et al.,, Latorre, Gatz, & Montanes, 2004); problem-solving 
therapy (Choi, Marti, & Conwell, 2016); and various cognitive and behavioral 
approaches (Brown et al.,, Brown, Bhar, & Beck, 2008; Lynch Morse, 
4 Note that an association between GHS scores and suicidal ideation in older men receiving 
health care was reported by Uncapher et al. (1998) 



59 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

Mendelson, & Robins, 2003). Hernandez and Overholser (2020), meanwhile, 
single out a few therapies as relatively ineffective for the treatment of 
hopelessness, including dignity therapy, physical exercise, and educational 
programming.

Even so, “[c]ontrolled trials with hope/hopelessness as a primary 
objective are needed to more clearly demonstrate effectiveness” (Hernandez 
& Overholser, 2020, p. 1). Much research on interventions relevant to 
hopelessness has treated hopelessness as a secondary objective of the 
research and has been performed without a control group (Hernandez & 
Overholser, 2020). 

The research targeting reduction of hopelessness as a primary outcome 
is limited enough that we must turn to treatment programs targeting other 
problems of older adulthood as possible models of care. We have already 
discussed end-of-life care as a model for aging care in Part One (see again 
Sullivan, 2003) and we suggest that a key similarity between end-of-life 
care and aging care is setting. Notwithstanding cultural shifts and advocacy 
around minimizing the amount of time that end-of-life patients and aging 
clients spend in medical institutions, these two populations spend a great 
deal of time in hospitals. Likelier than not, this is where older adults may 
be most linked to mental health professionals as well as other health care 
(emergency department visits are the only time that many seniors leave their 
homes—see Rosen et al., 2016). This holds especially true for low-income or 
otherwise marginalized seniors without other forms of access to healthcare 
(Bazargan, Bazargan, & Baker, 1998; Fan et al., 2011; Counsell et al., 2007; 
O’Mahony et al., 2008). Hospitals are therefore a crucial site for prevention 
and intervention.

Hospital-based elder abuse prevention units, although technically 
specific in scope, offer a useful model for prevention, intervention, and 
provision of services for seniors in medical settings, and, we argue, should 
be extended to include reduction of hopelessness as an intervention target. 
New York City has long been a leader in developing social services for older 
adults (Netherland, Finkelstein, & Gardner, 2011; Morken, 2012; see also for 
example, Vogel, Ransom, Wai, & Luisi, 2007)5 and Weill-Cornell Medical 
Center’s Vulnerable Elder Protection Team (VEPT) is one of the jewels in 
the crown. Following the interdisciplinary team model of care (already well-
established in hospice settings and in the treatment of severe refractory 
depression—see Oliver & Peck, 2006; Unützer & Park, 2012), VEPT includes 
doctors and social workers, and collaborates  with attorneys and other 
professionals (Rosen et al., 2018). VEPT works similarly to many hospital 
child protection teams;  elders coming through the emergency department 
(ED) with any signs of abuse (identified by other hospital professionals 
trained in identifying such signs) are immediately referred to VEPT for 
5 The NYC Department for the Aging is the largest of its type in the country (“Organization 
Profile,” n.d.), and Brooklyn District Attorney’s Office has a unique-in-the-nation elder abuse 
prosecution unit (Hynes, 2010). 



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 60 

wrap-around services and referrals (Rosen et al., 2018). The group meets 
regularly for case conferences, with a rotating cast of professionals involved 
in a given patient’s care (Rosen et al., 2018). Hospital-based senior health 
units can operate with similar principles of quick screening and referral and 
wrap-around care, and incorporate new services targeting hopelessness.

VEPT is a useful model for senior care targeting hopelessness for 
three additional reasons. First, hopelessness, like elder abuse, is typically 
comorbid with other conditions and challenges and treating comorbid 
mental health conditions concurrently can offer a better chance of success 
than targeting one condition in isolation (e.g. Stambaugh et al., 2007;  
Pringle et al., 2002; Furman & Jackson, 2002). Second, the model may 
actually be easier to implement for hopelessness than it is for abuse. As 
noted beforehand, hopelessness is relatively simple to test through a short 
question inventory or direct questioning, and may not entail the same level 
of extreme stigma associated with elder abuse (abused older adults are 
uniquely reluctant to report abuse—see Dyer, Connolly, & McFeeley, 2003; 
Lachs et al., 1998; Mosqueda & Dong, 2011). By the same token, hopelessness 
may be less intimidating for professionals to report or identify as well, 
because professionals who notice signs of abuse may hesitate to report 
because of fear of involvement with the legal system (Rosen et al., 2019)—a 
concern that should not be present with hopelessness. 

Third, VEPT is a crucial model for treating older adults who are 
marginalized and underserved for reasons other than their age—a lacuna 
in treatment programs and a limitation of many other treatment programs.6  
VEPT serves an elderly population that is multiply disadvantaged. Not 
only are ED-dependent patients likelier to be lower-income in general, the 
New York Presbyterian Hospital (NYPH) system serves an especially large 
group of socioeconomically marginalized New Yorkers. NYPH has the third 
most Medicaid discharges of any hospital in New York State (New York–
Presbyterian Hospital [NYPH], 2016). Sixty percent of NYPH inpatients 
are on public insurance (Medicaid or Medicare) (NYPH, 2016). In this way, 
VEPT succeeds in offering services to a normally underserved population. 

Outside of the hospital, a “public health” approach may be worthwhile 
in the prevention and treatment of elder hopelessness. Analogously to the 
implementation of interdisciplinary teams in hospitals, the Centers for 
Disease Control and Prevention has been funding programs that weave 
together health advocacy led by physicians and mental health initiatives 
led by psychologists, including in geriatric mental health care (Aldrich & 
Benson, 2013). The CDC-appointed Community Preventive Services Task 
Force has in the past recommended home- or clinic-based “depression care 
management” (DCM) for depression in seniors (Community Preventive 

6 Literature in psychology and social work has documented a lack of services for multiply 
marginalized older adults (for elder abuse issues specifically, see Walsh et al., 2011; for other 
issues of intersectionality in aging, see Finkenauer, Sherratt, Marlow, & Brodey, 2012; Espi-
noza, 2011;Brotman et al., 2015; Choi & Kimbell, 2008; Goins et al., 2006). 



61 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

Services Task Force [CPSTF], 2014 [2008]). In DCM, an elderly patient 
receives services, psychoeducation, and treatment (often, CBT) from a “care 
manager”—typically, a nurse practitioner or social worker—supervised by 
a psychiatrist (Aldrich & Benson, 2013; CPSTF, 2013 [2008]). Programs 
following this model have been studied through the Baylor University School 
of Medicine and the University of Washington (Aldrich & Benson, 2013). 
Both sets of programs proved effective in reducing MDD, at least in the short 
term (Casado et al., 2008; Quijano et al., 2007; Unützer et al., 2002; Unützer 
et al., 2008). 

The challenge that such community-based programs face is stigma and 
recruitment (Kobau et al., 2010; Snowden, Steinman, & Frederick, 2008). 
We would speculate that integrating a DCM program with a hospital team 
consultation and referral model akin to VEPT would address the stigma and 
recruitment issue while providing another venue for continued follow-up 
(which is sometimes absent in hospital-based interventions) with a patient 
experiencing hopelessness.

CONCLUSION
Supposedly, the root of any solution lies in recognizing the problem. We 

suggest that this holds for older adult hopelessness and its sequelae (most 
concerningly, suicide). As scholars, we hope that the research community 
continues to study new treatment modalities specifically for the impact on 
elder hopelessness. Too few treatment trials performed with older adults 
consider hopelessness as a primary outcome measure and only a few 
more studies include it as a secondary measure (again see Hernandez & 
Overholser, 2020). When clinicians recognize hopelessness as a needless 
correlate of the aging process, they can redress it as such. This, along with 
public funding and policy interventions, will lay the groundwork for a 
successful response to hopelessness in an aging world.

Older adults are likely to be in a uniquely marginalized position, 
carrying with them some of the challenges that they had when younger and 
taking on the new struggles of growing old. Issues of concern to them deserve 
greater scholarly and clinical attention. In some sense, treating this single, 
albeit crucial aspect of their mental well-being is the least that (the broadly 
defined) we can do. 

To steal a phrase from twentieth-century German psychologist Erich 
Fromm, “rational despair” coexists alongside hopelessness (Fromm, 1973, p. 
436). In tackling hopelessness in older adults, we should ask: how fair is it to 
tell a patient with circumstances that might rationally cause him/her/them 
to lose hope, that he/she/they must simply feel, think, behave, or “construct 
reality” differently (Nevid, 2007)? (Criticisms such as these are far from 
new—see, for example, Kant, 2015; Gilbert, 2009.)  But once again, we can 
attempt to address a seeming paradox by suggesting that doing something 
to address suffering, beats doing nothing—and that psychological treatment 
is surely one part of an integrated interventional agenda.



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 62 

Despite all of the limitations discussed herein—whether conceptual, 
clinical, or research-related—enough is known about effective therapies for 
practitioners to begin attempting to treat. And more existing programs on 
older adult wellbeing (such as the VEPT and Baylor/Washington DCM case 
studies noted hitherto) could incorporate  reduction of hopelessness  as a 
goal or outcome. Aging is inevitable. Aging hopelessly is not.

 
ABOUT THE AUTHORS

DANIELLA SPENCER-LAITT is a second year Advanced Clinical 
Practice student specializing in health/mental–health and disabilities 
and the Co-Editor-In-Chief of the Columbia Social Work Review. She co-
founded WH SeniorLink to alleviate social isolation among older adults. 
She holds a BA in political science and an LLB with honors from the 
University of Western Australia, and previously worked as an attorney. 
Daniella’s research interests lie in the psychosocial experiences of grief 
and aging.

AMANDA WEISS is a second-year Advanced Policy Practice student 
specializing in the study of American politics, quantitative methods, and 
violence; a research fellow at SAFElab; and Co-Editor-In-Chief of the 
Columbia Social Work Review. She co-founded WH SeniorLink to alleviate 
social isolation among older adults. Amanda holds a BA magna cum laude 
from Columbia College of Columbia University, and she is starting a PhD at 
Yale University in fall 2020.

REFERENCES
Aldrich, N., & Benson, W. (2013). CDC Promotes Public Health Approach To Address 

Depression among Older Adults (pp. 1–16). Centers for Disease Control and 
Prevention. https://www.cdc.gov/aging/pdf/cib_mental_health.pdf

American Psychological Association (2014). Guidelines for Psychological Practice 
With Older Adults. https://www.apa.org/pubs/journals/features/older-
adults.pdf 

Assari, S., & Lankarani, M. M. (2016). Depressive Symptoms are Associated with 
more hopelessness among White than Black older adults. Front Public 
Health, 4, 82. doi: 10.3389/fpubh.2016.00082

Barber, J. W. (2008). The kids aren’t all right: The failure of child abuse statutes as a 
model for elder abuse statutes. Elder Law Journal, 16, 107-134.

Bardach, S. H., & Rowles, G. D. (2012). Geriatric education in the health professions: 
Are we making progress? The Gerontologist, 52(5), 607–618. https://doi.
org/10.1093/geront/gns006



63 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

Bazargan, M., Bazargan, S., & Baker, S. (1998). Emergency department utilization, 
hospital admissions, and physician visits among elderly African American 
persons. The Gerontologist, 38(1), 25-36.

Beach, S. R., Carpenter, C. R., Rosen, T., Sharps, P., & Gelles, R. (2016). Screening 
and detection of elder abuse: Research opportunities and lessons learned 
from emergency geriatric care, intimate partner violence, and child abuse. 
Journal of Elder Abuse & Neglect, 28(4–5), 185–216. https://doi.org/10.1080
/08946566.2016.1229241

Beck, A. T., Brown, G., Berchick, R., Stewart, B., & Steer, R. (1990). Relationship 
between hopelessness and ultimate suicide: A replication with psychiatric 
patients. American Journal of Psychiatry, 147, 190-195. https://doi.
org/10.1176/ajp.147.2.190

Beck, A. T., Steer, R. A., Kovacs, M., & Garrison, B. (1985). Hopelessness and 
eventual suicide: A 10 year prospective study of patients hospitalized with 
suicidal ideation. American Journal of Psychiatry, 142, 559-563. https://doi.
org/10.1176/ajp.142.5.559

Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of 
pessimism: The Hopelessness Scale. Journal of Consulting and Clinical 
Psychology, 42(6), 861-865. https://doi.org/10.1037/h0037562

Bergeron, L. R. (2006). Self-determination and elder abuse. Journal of Gerontological 
Social Work, 46(3–4), 81–102. https://doi.org/10.1300/J083v46n03_05

Britton, P. C., Duberstein, P. R., Conner, K. R., Heisel, M. J., Hirsch, J. K., & Conwell, 
Y. (2008). Reasons for living, hopelessness, and suicide ideation among 
depressed adults 50 years or older. The American Journal of Geriatric 
Psychiatry, 16(9), 736-741.

Brotman, S., Ferrer, I., Sussman, T., Ryan, B., & Richard, B. (2015). Access and equity 
in the design and delivery of health and social care to LGBTQ older adults: A 
Canadian perspective. In N. A. Orel & C. A. Fruhauf (Eds.), The lives of LGBT 
older adults: Understanding challenges and resilience (pp. 111–140). American 
Psychological Association. https://doi.org/10.1037/14436-006

Brown, G. K., Brown, L. M., Bhar, S. S., & Beck, A. T. (2008). Cognitive therapy for 
suicidal older adults. In D. Gallagher-Thompson, A. M. Steffen, & L. W. 
Thompson (Eds.), Handbook of behavioral and cognitive therapies with older 
adults (pp. 135–150). Springer.

Casado, B. L., Quijano, L. M., Stanley, M. A., Cully, J. A., Steinberg, E. H., & Wilson, N. 
L. (2008). Healthy IDEAS: Implementation of a depression program through 
community-based case management. The Gerontologist, 48(6), 828–838. 
https://doi.org/10.1093/geront/48.6.828

Choi, N. G., & Kimbell, K. (2008). Depression care need among low-income older 
adults: Views from aging service providers and family caregivers. Clinical 
Gerontologist, 32(1), 60-76. https://doi.org/10.1080/07317110802474742 

Choi, N. G., Marti, C. N., & Conwell, Y. (2016). Effect of problem—solving therapy on 
depressed low—income homebound older adults’ death/suicidal ideation 
and hopelessness. Suicide and Life—Threatening Behavior, 46(3), 323–336. 
https://doi.org/10.1111/sltb.12195



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 64 

Community Preventive Services Task Force [CPSTF]. (2014). Improving Mental 
Health and Addressing Mental Illness: Interventions to Reduce Depression 
among Older Adults, HomeBased Depression Care Management. https://www.
thecommunityguide.org/sites/default/files/assets/Mental-Health-Home-
Based-Depression-Care-Management.pdf

Counsell, S. R., Callahan, C. M., Clark, D. O., Tu, W., Buttar, A. B., Stump, T. E., & 
Ricketts, G. D. (2007). Geriatric care management for low-income seniors: 
a randomized controlled trial. JAMA, 298(22), 2623-2633.

Cruz, M., Schulz, R., Pincus, H. A., Houck, P. R., Bensasi, S., & Reynolds III, C. F. 
(2009). The association of public and private religious involvement with 
severity of depression and hopelessness in older adults treated for major 
depression. The American journal of geriatric psychiatry, 17(6), 503-507.

Dennis, M., Wakefield, P., Molloy, C., Andrews, H., & Friedman, T. (2005). Self-harm 
in older people with depression: Comparison of social factors, life events 
and symptoms. British Journal of Psychiatry, 186(6), 538-539. https://doi.
org/10.1192/bjp.186.6.538

Dunn, S., Olamijulo, G., Fuglseth, H., Holden, T., Swieringa, L., Sit, M, Rieth, N., & 
Tintle, N. (2014). The State-Trait Hopelessness Scale: Development and 
testing. Western Journal of Nursing Research, 36(4), 552-570. https://doi.
org/10.1177/0193945913507634

Duxbury, L., Higgins, C., & Smart, R. (2011). Elder care and the impact of caregiver 
strain on the health of employed caregivers. Work, 40(1), 29–40.

Dyer, C. B., Connolly, M.-T., & McFeeley, P. (2003). The clinical and medical forensics 
of elder abuse and neglect. In R. J. Bonnie & R. B. Wallace, Elder mistreatment: 
Abuse, neglect, and exploitation in an aging America (pp. 339-381). National 
Academies Press (US). https://doi.org/10.17226/10406

Espinoza, R. (2011). The diverse elders coalition and LGBT aging: Connecting 
communities, issues, and resources in a historic moment. Public Policy & 
Aging Report, 21(3), 8-13. https://www.lgbtagingcenter.org/resources/pdfs/
PPAR%20Summer2011.pdf

Fan, L., Shah, M. N., Veazie, P. J., & Friedman, B. (2011). Factors associated with 
emergency department use among the rural elderly. The Journal of Rural 
Health, 27(1), 39-49.

Finkenauer, S., Sherratt, J., Marlow, J., & Brodey, A. (2012). When injustice gets old: 
A systematic review of trans aging. Journal of Gay & Lesbian Social Services, 
24(4), 311-330. https://doi.org/10.1080/10538720.2012.722497

Furman, R., & Jackson, R. (2002). Wraparound services: An analysis of community-
based mental health services for children. Journal of Child and Adolescent 
Psychiatric Nursing, 15(3), 124-130. https://doi.org/10.1111/j.1744-6171.2002.
tb00335.x

Fry, P. S. (1984). Development of a geriatric scale of hopelessness: Implications for 
counseling and intervention with the depressed elderly. Journal of Counseling 
Psychology, 31(3), 322-331. https://doi.org/10.1037/0022-0167.31.3.322



65 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

Gilbert, P. (2009). Moving beyond cognitive behaviour therapy. Psychologist, 22(5), 
400-403.

Goins, R. T., Williams, K. A., Carter, M. W., Spencer, S. M., & Solovieva, T. (2005). 
Perceived barriers to health care access among rural older adults: a 
qualitative study. The Journal of Rural Health, 21(3), 206-213.

Hayslip, B., Lopez, F. G., & Nation, P. (1991). Hopelessness in community-residing 
aged persons: A viable construct? Journal of Personality Assessment, 57(3), 
498-505. https://doi.org/10.1207/s15327752jpa5703_8

Heisel, M. & Flett, G. (2005). A psychometric analysis of the Geriatric Hopelessness 
Scale (GHS): Towards Improving assessment of the construct. Journal of 
Affective Disorders 87, 211-220. https://doi.org/10.1016/j.jad.2005.03.016

Hernandez, S. C., & Overholser, J. C. (2020). A systematic review of interventions 
for hope/hopelessness in older adults. Clinical Gerontologist, 1–33. https://
doi.org/10.1080/07317115.2019.1711281

Imbody, B., & Vandsburger, E. (2011). Elder abuse and neglect: Assessment tools, 
interventions, and recommendations for effective service provision. 
Educational Gerontology, 37(7), 634–650. https://doi.org/10.1080/153637
59.2011.577721

Joiner, T., Cook, J., Hersen, M., & Gordon, K. (2007). Double depression in older 
adult psychiatric outpatients: hopelessness as a defining feature. Journal of 
Affective Disorders 101(1), 235-238. https://doi.org/10.1016/j.jad.2005.03.019

Jorgensen, J. E. (1992). A dentist’s social responsibility to diagnose elder abuse. Special 
Care in Dentistry, 12(3), 112–115. https://doi.org/10.1111/j.1754-4505.1992.
tb00425.x

Kant, J. D. (2015). Towards a socially just social work practice: The liberation health 
model. Critical and Radical Social Work, 3(2), 309-319. https://doi.org/10.13
32/204986015X14320477877474

Katz, K. D. (1979-1980). Elder Abuse. Journal of Family Law, 18(4), 695-722.
Kjølseth, I., Ekeberg, Ø., & Steihaug, S. (2010). Why suicide? Elderly people 

who committed suicide and their experience of life in the period before 
their death. International Psychogeriatrics, 22(2), 209–218. https://doi.
org/10.1017/S1041610209990949

Klausner, E. J., Snyder, C. R., & Cheavens, J. (2000). A hope-based group treatment for 
depressed older adult outpatients. In G. M. Williamson, D. R. Shaffer, & P. A. 
Parmelee (Eds.), Physical Illness and Depression in Older Adults: A Handbook 
of Theory, Research, and Practice (pp. 295–310). Springer US. https://doi.
org/10.1007/0-306-47178-7_14

Kliem, S., Lohmann, A., Möble, T., Brähler, E. (2018). Psychometric properties and 
 measurement invariance of the Beck Hopelessness Scale (BHS): Results from 

a German representative population sample. BMC Psychiatry, 18(110), 1-11. 
https://doi.org/10.1186/s12888-018-1646-6

Kobau, R., DiIorio, C., Chapman, D., Delvecchio, P., & SAMHSA/CDC Mental 
Illness Stigma Panel Members. (2010). Attitudes about mental illness and 
its treatment: Validation of a generic scale for public health surveillance of 



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 66 

mental illness associated stigma. Community Mental Health Journal, 46(2), 
164–176. https://doi.org/10.1007/s10597-009-9191-x

Koo, Y. W., Kõlves, K., & De Leo, D. (2017). Suicide in older adults: differences between 
the young-old, middle-old, and oldest old. International Psychogeriatrics, 
29(8), 1297-1306. https://doi.org/10.1017/S1041610217000618

Lachs, M. S., Williams, C. S., O’Brien, S., Pillemer, K. A., & Charlson, M. E. (1998). 
The mortality of elder mistreatment. JAMA, 280(5), 428–432. https://doi.
org/10.1001/jama.280.5.428

Lin, M.-C. (2018). Elder abuse and neglect: Examining caregiver characteristics and 
perceptions of their elderly care receiver’s under-accommodative behavior. 
Journal of Family Communication, 18(4), 252–269. https://doi.org/10.1080
/15267431.2018.1489810

Lynch, T. R., Cheavens J. S., Morse, J. Q., & Rosenthal, M. Z. (2004). A model 
predicting suicidal ideation and hopelessness in depressed older adults: the 
impact of emotion inhibition and affect intensity. Aging & Mental Health, 
8(6), 486-497. https://doi.org/10.1080/13607860412331303775

Lynch, T. R., Morse, J. Q., Mendelson, T., & Robins, C. J. (2003). Dialectical behavior 
therapy for depressed older adults: A randomized pilot study. The American 
Journal of Geriatric Psychiatry, 11(1), 33–45. https://doi.org/10.1176/appi.
ajgp.11.1.33

Martinson, M., & Berridge, C. (2015). Successful aging and its discontents: A 
systematic review of the social gerontology literature. The Gerontologist, 
55(1), 58–69. https://doi.org/10.1093/geront/gnu037

Morken, L. (2012). New York City and Atlanta: Cities plan for the aging population. 
Age, 75, 84.

Mosqueda, L., & Dong, X. (2011). Elder abuse and self-neglect: “I don’t care anything 
about going to the doctor, to be honest....” JAMA, 306(5), 532–540. https://
doi.org/10.1001/jama.2011.1085

Neufeld, E. & O’Rourke, N. (2009). Impulsivity and hopelessness as predictors of suicide-
related ideation among older adults. La Revue Canadienne de Psychiatrie, 
54(10), 684-692. https://www.doi.org/10.1177/070674370905401005

Neufeld, E., O’Rourke, N. & Donnelly, M. (2009). Enhanced measurement sensitive 
of hopeless ideation among older adults at risk of self-harm: Reliability and 
validity of Likert-type responses to the Beck Hopelessness Scale. Aging and 
Mental Health, 14(6), 752-756. https://doi.org/10.1080/13607860903421052

Nerenberg, L. (2013). Communities respond to elder abuse. In. J. Mellor & P. Brownell 
(Eds.), Elder abuse and mistreatment: Policy, practice, and research (pp. 5-79). 
Routledge. https://doi.org/10.4324/9780203708262

Netherland, J., Finkelstein, R., & Gardner, P. (2011). The age-friendly New York 
City project: An environmental intervention to increase aging resilience. 
In B. Resnick, L. P Gwyther, & K. A. Roberto (Eds.), Resilience in Aging (pp. 
273–287). Springer.

Nevid, J. S. (2007). Kant, cognitive psychotherapy, and the hardening of the 
categories. Psychology and Psychotherapy: Theory, Research and Practice, 



67 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

80(4), 605-615. https://doi.org/10.1348/147608307X204189
New York Presbyterian Hospital [NYPH]. (2016). NewYork-Presbyterian Hospital 

2016: Community Service Plan/Community Health Needs Assessment. 
New York-Presbyterian | The University Hospital of Columbia and Cornell. 
https://www.nyp.org/pdf/communityserviceplan2016.pdf

Oliver, D. P., & Peck, M. (2006). Inside the interdisciplinary team experiences of 
hospice social workers. Journal of Social Work in End-of-Life & Palliative 
Care, 2(3), 7–21. https://doi.org/10.1300/J457v02n03_03

O’Mahony, S., Blank, A., Simpson, J., Persaud, J., Huvane, B., McAllen, S., ... & Higgins, 
P. (2008). Preliminary report of a palliative care and case management 
project in an emergency department for chronically ill elderly patients. 
Journal of Urban Health, 85(3), 443-451.

Organization Profile | Mission Statement. (n.d.). VolunteerMatch. https://www.
volunteermatch.org/search/org749464.jsp

Pedrick-Cornell, C., & Gelles, R. J. (1982). Elder abuse: The status of current 
knowledge. Family Relations, 31(3), 457–465. JSTOR. https://doi.
org/10.2307/584179

Podnieks, E. (2006). Social inclusion. Journal of Gerontological Social Work, 46(3–4), 
57–79. https://doi.org/10.1300/J083v46n03_04

Pringle, J. L., Edmondston, L. A., Holland, C. L., Kirisci, L., Emptage, N. P., Balavage, 
V. K., Ford, W. E., Etheridge, R. M., Hubbard, R. L., & Jungblut, E. (2002). The 
role of wrap around services in retention and outcome in substance abuse 
treatment: Findings from the wrap around services impact study. Addictive 
Disorders & Their Treatment, 1(4), 109–118.

Quijano, L. M., Stanley, M. A., Petersen, N. J., Casado, B. L., Steinberg, E. H., Cully, J. A., 
& Wilson, N. L. (2007). Healthy IDEAS: A depression intervention delivered 
by community-based case managers serving older adults. Journal of Applied 
Gerontology, 26(2), 139–156. https://doi.org/10.1177/0733464807299354

Roberts, A. W., Ogunwole, S. U., Blakeslee, L., & Rabe, M. A. (2018). The Population 65 
Years and Older in the United States: 2016 (ACS-38; American Community 
Survey Reports). Census Bureau. https://www.census.gov/content/dam/
Census/library/publications/2018/acs/ACS-38.pdf

Robinson, M. (2004). Gilead: A novel. Farrar, Straus and Giroux.
Rosen, T., Bloemen, E. M., LoFaso, V. M., Clark, S., Flomenbaum, N. E., Breckman, 

R., ... & Pillemer, K. (2019). Acute precipitants of physical elder abuse: 
qualitative analysis of legal records from highly adjudicated cases. Journal 
of interpersonal violence, 34(12), 2599-2623.

Rosen, T., Hargarten, S., Flomenbaum, N. E., & Platts-Mills, T. F. (2016). Identifying 
elder abuse in the emergency department: Toward a multidisciplinary team-
based approach. Annals of Emergency Medicine, 68(3), 378–382. https://doi.
org/10.1016/j.annemergmed.2016.01.037

Rosen, T., Mehta-Naik, N., Elman, A., Mulcare, M. R., Stern, M. E., Clark, S., Sharma, 
R., LoFaso, V. M., Breckman, R., & Lachs, M. (2018). Improving quality of care 
in hospitals for victims of elder mistreatment: Development of the vulnerable 



COLUMBIA SOCIAL WORK REVIEW, VOL. 18 | 68 

elder protection team. The Joint Commission Journal on Quality and Patient 
Safety, 44(3), 164–171. https://doi.org/10.1016/j.jcjq.2017.08.010

Rzeszut, S. M. (2017). The need for a stronger definition: Recognizing abandonment 
as a form of elder abuse across the United States. Family Court Review, 55(3), 
444–457. https://doi.org/10.1111/fcre.12295

Satorres, E., Ros, L., Melendez, J. C., Serrano, J. P., Latorre, J. M., & Sales, A. (2018). 
 Measuring elderly people’s quality of life through the Beck Hopelessness 

Scale: A study with a Spanish sample. Aging & Mental Health, 22(2), 239-244. 
https://doi.org/10.1080/13607863.2016.1247427

Scogin, F., Mortholand, M., DiNapoli, E., LaRocca, M., & Chapin, W. (2016). Pleasant 
events, hopelessness, and quality of life in rural older adults. Journal of Rural 
Health, 32, 102-109. https://doi.org/10.1111/jrh.12130

Serrano, J. P., Latorre, J. M., Gatz, M., & Montanes, J. (2004). Life review 
therapy using autobiographical retrieval practice for older adults with 
depressive symptomatology. Psychology and Aging, 19(2), 272. https://doi.
org/10.1037/0882-7974.19.2.272

Settersten, R. A., Jr. (2005). Linking the two ends of life: What gerontology can learn 
from childhood studies. The Journals of Gerontology: Series B, 60(4), S173–
S180. https://doi.org/10.1093/geronb/60.4.S173

Snowden, M., Steinman, L., & Frederick, J. (2008). Treating depression in older 
adults: Challenges to implementing the recommendations of an expert panel. 
Preventing Chronic Disease, 5(1), 5-7.

Stambaugh, L. F., Mustillo, S. A., Burns, B. J., Stephens, R. L., Baxter, B., Edwards, 
D., & Dekraai, M. (2007). Outcomes from wraparound and multisystemic 
therapy in a center for mental health services system-of-care demonstration 
site. Journal of Emotional and Behavioral Disorders, 15(3), 143–155. https://
doi.org/10.1177/10634266070150030201

Sullivan, M. D. (2003). Hope and hopelessness at the end of life. The American Journal 
of Geriatric Psychiatry, 11(4), 393–405. https://doi.org/10.1097/00019442-
200307000-00002

Szanto, Prigerson, Houck, Ehrenpreis, Reynolds (1997). Suicidal ideation in elderly 
bereaved: The role of complicated grief. Suicide and Life-Threatening 
Behavior, 27, 194-207. https://doi.org/10.1521/suli.34.4.350.53737

Trenteseau, J. A., Hyer, L., Verenes, D., & Warsaw, J. (1989). Hopelessness among 
later-life patients. The Journal of Applied Gerontology, 8(3), 355-364. https://
doi-org/10.1177/073346488900800306

Uncapher, H., Gallagher-Thompson, D., Osgood, N. J., & Bongar, B. (1998). 
Hopelessness and suicidal ideation in older adults. The Gerontologist, 38(1), 
62–70. https://doi.org/10.1093/geront/38.1.62

Unützer, J., Katon, W. J., Callahan, C., Williams, J., Hunkeler, E., Harpole, L., Hoffing, 
M., Della Penna, R., Noel, P., & Lin, E. (2002). Collaborative care management 
of late-life depression in the primary care setting: A randomized controlled 
trial. JAMA, 288(22), 2836–2845. https://doi.org/10.1001/jama.288.22.2836



69 | COLUMBIA SOCIAL WORK REVIEW, VOL. 18 

Unützer, J., Katon, W. J., Fan, M.-Y., Schoenbaum, M. C., Lin, E. H., Della Penna, R. D., 
& Powers, D. (2008). Long-term cost effects of collaborative care for late-life 
depression. The American Journal of Managed Care, 14(2), 95-100.

Unützer, J., & Park, M. (2012). Older adults with severe, treatment-resistant 
depression. JAMA, 308(9), 909–918. https://doi.org/10.1001/2012.
jama.10690

Van Servellen, G., Sarna, L., Padilla, G., & Brechy, M. (1996). Emotional distress in 
men with life-threatening illness. International Journal of Nursing Studies, 
33(5), 551-565. https://doi.org/10.1016/0020-7489(96)00011-9

Vogel, A., Ransom, P., Wai, S., & Luisi, D. (2007). Integrating health and social services 
for older adults: A case study of interagency collaboration. Journal of Health 
and Human Services Administration, 30(2), 199–228. 

Von Humboldt, S., & Leal, I. (2015). The old and the oldest-old: Do they have different 
perspectives on adjustment to aging?. International Journal of Gerontology, 
9(3), 156-160. https://doi.org/10.1016/j.ijge.2015.04.002

Walsh, C. A., Olson, J. L., Ploeg, J., Lohfeld, L., & MacMillan, H. L. (2010). Elder 
abuse and oppression: Voices of marginalized elders. Journal of Elder Abuse 
& Neglect, 23(1), 17-42. https://doi.org/10.1093/bjsw/bcm022 

Wenzel, A., & Beck, A. (2008). A cognitive model of suicidal behavior: Theory and 
treatment. Applied and Preventive Psychology, 12, 189-201. https://doi.
org/10.1016/j.appsy.2008.05.001

Yildirim, Y., Sertöz, O., Uyar, M., Fadiloglu, C., & Uslu, R. (2009). Hopelessness in 
Turkish cancer patients: The relation of hopelessness with psychological 
and disease-related outcomes. European Journal of Oncology Nursing: The 
Official Journal of European Oncology Nursing Society, 13(2), 81-86. https://
doi.org/10.1016/j.ejon.2009.01.001


