Clinical Geriatrics

Dr. Lantz is Chief of Geriatric Psychiatry, Beth Israel Medical Center, First Ave @ 16th Street #6K40, New York, NY 10003; (212) 420-2457; fax: (212) 844-7659; e-mail: mlantz@chpnet.org.

Case Presentation
Mrs. D is a 72-year-old widowed woman who was referred for psychiatric evaluation by her primary care physician, Dr. B. Mrs. D is a retired school librarian who worked until three months ago, when her school district had to downsize the library program due to budget problems. She was overwhelmed by the budget cuts and was devastated that the library program that she had worked more than 40 years to create was going to be drastically reduced. Mrs. D was well known to many families and children due to her devotion to the library and the reading programs she had offered for students who needed assistance, which included a program for children with learning disabilities that became a model for other schools.

Following her retirement, Mrs. D started seeing Dr. B frequently with multiple somatic complaints. Dr. B is fond of Mrs. D, as she had helped one of his sons improve his reading skills to above grade level even though his son’s teacher felt that he had a severe reading disorder. Dr. B performed a thorough physical examination and laboratory tests but found no abnormalities. When Dr. B explained to Mrs. D that her health was quite good, she became angry and hostile. She demanded that Dr. B write a letter to the school board in order to reinstate the library program, and he readily agreed. Mrs. D then became even angrier, stating that if people like Dr. B had taken an interest in the community, she would still have a job. Dr. B suggested that she look into volunteer work, given her talents as an educator and her knowledge of libraries and books. She left his office, slamming the door behind her.

Mrs. D returned one week later accompanied by two of her three daughters. They are very concerned about their mother’s anxiety about her future, her fears that she will not have enough money to live on, and her anger. Both daughters are teachers who live nearby and report that Mrs. D is secure financially. Mrs. D has been a widow for the past 10 years and coped well with the loss of her husband. Following his death, she devoted even more time to her job and worked even harder to expand the school library program. Now Mrs. D is spending most of her days writing letters to the school board, teachers, families, and newspapers about the library closings. She often does not leave her house due to episodes of anxiety that occurred when she tried to go out shopping or to a bookstore. She has refused invitations from friends to meet for lunch. Mrs. D admits to Dr. B that she “cannot get the anger out of my head” regarding her forced retirement and feels that the school district just wanted to get rid of her. Dr. B offers her a prescription for an antidepressant medication and suggests that she see a psychiatrist. Mrs. D refuses the medication but agrees to see the psychiatrist. 

Discussion
Aging is associated with multiple stressors, ranging from death of loved ones to coping with chronic medical conditions and loss of roles, including those related to occupations and family life. Older adults frequently must cope with a series of stresses at a time in their lives when uncertainty, life changes, and impairment in physical and mental health status make this task even more challenging.1,2