Working With The Aging: The Case Of Francine ✓ Solved

Working With the Aging: The Case of Francine Francine is a 70

Working With the Aging: The Case of Francine Francine is a 70-year-old Irish Catholic female. She worked for 40 years as a librarian in an institution of higher education and retired at age 65. Francine has lived alone for the past year, after her partner, Joan, died of cancer. Joan and Francine had been together for 30 years, and while Francine personally identifies as a lesbian, she never came out to her family or to her colleagues. When speaking to all but her closest confidantes, Francine referred to Joan as her "best friend" or her "roommate." Francine’s bereavement was therefore complicated because she did not feel she could discuss the true nature of her partnership with Joan. She felt that there was little recognition from her family, and even some of her close associates, of the impact and meaning of Joan’s death to Francine. There is a history of alcohol abuse in Francine’s family, and Francine abused alcohol from late adolescence into her mid-30s. However, Francine has been in recovery for several decades. Francine has no known sexual abuse history and no criminal history. Francine sought counseling for ongoing depressed mood, lack of pleasure or enjoyment, loneliness and isolation since Joan’s death, and renewed drinking. She was concerned about returning to alcohol dependence. Strengths included capacity to form intimate relationships, successful work history, long-term sobriety, and insight into contributing factors. Goals were to feel less depressed, reduce or stop drinking, and feel less isolated. Her primary care physician diagnosed moderate clinical depression and recommended antidepressants, but Francine preferred counseling. The therapist used behavioral activation (BA) to reengage her in pleasant activities, starting with 5 minutes daily and increasing over weeks. Progress was monitored with weekly PHQ-9. For alcohol, therapist reconnected her with prior coping strategies, identified triggers and motivations, and Francine began attending Alcoholics Anonymous (AA), including meetings for older women and lesbians, and worked with a sponsor. To reduce isolation, she increased social networks, spent time with family, friends and AA sponsor, visited an LGBT center and support group for bereaved women, attended senior center activities three times a week, and volunteered at the local library weekly. Over several months, Francine stopped drinking, increased involvement in rewarding activities, reported feeling less lonely, and PHQ-9 scores decreased. After 16 weeks she felt she no longer needed counseling; her physician found depression lifted and no antidepressant indicated. She was equipped to recognize future relapse signs and sources of support.

Paper For Above Instructions

Introduction

This paper analyzes the clinical case of Francine, a 70-year-old lesbian woman presenting with moderate depression, complicated bereavement, and renewed alcohol use after long-term recovery. The analysis addresses assessment, diagnosis, intervention selection (including behavioral activation and mutual-help participation), monitoring, cultural and ethical considerations, and recommendations for relapse prevention and long-term wellness. Evidence-based literature on late-life depression, behavioral activation, substance-use interventions for older adults, and LGBT-specific concerns informs the analysis (Alexopoulos, 2005; Ekers et al., 2014; Kroenke et al., 2001).

Assessment and Diagnostic Considerations

A comprehensive assessment for Francine should include standardized symptom measurement, substance-use screening, medical evaluation, and psychosocial assessment. The use of the PHQ-9 as a weekly outcome measure was appropriate because it is validated for screening and monitoring depressive severity in primary care and mental health settings (Kroenke, Spitzer, & Williams, 2001). Medical causes of depression were appropriately ruled out by primary care. Given the recent loss of a long-term partner, clinicians should consider persistent complex bereavement disorder or complicated grief when symptoms interfere with functioning and do not follow normative bereavement trajectories (Shear, 2015). Concurrent alcohol use raises the possibility of a substance-induced mood disorder or dual diagnosis; careful screening with tools such as AUDIT and clinical interview is recommended (Babor et al., 2001; NIAAA, 2020).

Evidence-Based Interventions Applied

Behavioral activation (BA) is an empirically supported treatment for depression that focuses on increasing engagement in positively reinforcing activities to counter avoidance and withdrawal. Meta-analytic evidence shows BA produces significant improvements in depressive symptoms comparable to other cognitive-behavioral therapies (Ekers et al., 2014). Implementing a graded activity plan beginning at five minutes daily and increasing over weeks is consistent with BA principles and with adaptations for older adults (Ekers et al., 2014).

Addressing relapse risk for alcohol use involved reconnecting Francine with previously effective coping strategies and mutual-help participation. Engagement in Alcoholics Anonymous and sponsorship is supported by observational and quasi-experimental studies showing mutual-help organizations can improve abstinence rates and support long-term recovery (Kelly, Humphreys, & Ferri, 2020). The clinician’s focus on triggers, motivations, and re-establishing social support are consistent with evidence-based relapse-prevention approaches (NIAAA, 2020).

Targeting social isolation was essential. Interventions that increase social participation—senior center activities, volunteering, LGBT community engagement, and bereavement support groups—address risk factors for late-life depression and loneliness, which are themselves associated with morbidity (Courtin & Knapp, 2017). Tailoring group selection to Francine’s identities (older women, lesbian-specific groups) reduced barriers to connection and validated the meaning of her partnership with Joan, thereby addressing disenfranchised grief.

Monitoring, Outcomes, and Clinical Decision-Making

Weekly PHQ-9 monitoring enabled measurable tracking of depressive symptoms and informed treatment length. The clinician appropriately coordinated with primary care; medical follow-up confirmed symptom remission and guided medication decisions. This collaborative care approach aligns with guidelines for managing late-life depression, emphasizing stepped care and monitoring (Alexopoulos, 2005).

Outcome data—abstinence, increased activity engagement, reduced loneliness, and reduced PHQ-9 scores—support the effectiveness of the combined psychosocial approach in this case. Continued monitoring for relapse and recurrent depression is advisable given age-related risk factors and bereavement history.

Ethical and Cultural Considerations

Francine’s delayed disclosure of her sexual orientation and the need to describe her partner as a "roommate" or "best friend" reflect potential stigma and disenfranchised grief. Clinicians must maintain confidentiality, create an affirming environment, and be sensitive to identity-related barriers to disclosure and support (Fredriksen-Goldsen et al., 2014). Ethical practice requires honoring Francine’s self-identification, facilitating access to LGBT-affirming resources, and addressing family communication only with Francine’s consent.

Recommendations for Relapse Prevention and Long-Term Care

1. Continue periodic PHQ-9 monitoring (e.g., monthly for the first year) and plan brief "booster" sessions if scores rise (Kroenke et al., 2001).

2. Maintain engagement with AA or other mutual-help groups and sponsor contact, with active relapse prevention planning that identifies triggers and rapid-response supports (Kelly et al., 2020; NIAAA, 2020).

3. Encourage sustained social involvement—senior center activities, volunteering, and LGBT community participation—to reduce isolation and reinforce meaningful roles (Courtin & Knapp, 2017).

4. Provide psychoeducation about grief and normal versus complicated bereavement; consider targeted bereavement therapy if prolonged impairment or complicated grief emerges (Shear, 2015).

5. Coordinate with primary care for regular medical reviews and screening for cognitive decline, medication interactions, and other geriatric concerns that can impact mood and substance use (Alexopoulos, 2005).

6. Document and respect Francine’s preferences about disclosure; support family communication only with her consent and consider family psychoeducation if appropriate to facilitate recognition of the relationship’s significance.

Conclusion

Francine’s case illustrates best-practice, integrated psychosocial care for late-life depression complicated by bereavement and alcohol relapse risk. The therapist’s use of behavioral activation, incorporation of mutual-help supports, focus on social reconnection, and collaboration with primary care were evidence-based and culturally responsive strategies that produced meaningful symptom reduction and functional recovery. Ongoing monitoring, relapse prevention planning, and affirming care for Francine’s sexual identity remain central to sustaining gains.

References

• Alexopoulos, G. S. (2005). Depression in the elderly. New England Journal of Medicine, 352(3), 226–237.
• Babor, T. F., de la Fuente, J. R., Saunders, J., & Grant, M. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care (2nd ed.). World Health Organization.
• Courtin, E., & Knapp, M. (2017). Social isolation, loneliness and health in old age: a scoping review. Health & Social Care in the Community, 25(3), 799–812.
• Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., & Richards, D. (2014). Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLOS ONE, 9(6), e100100.
• Fredriksen-Goldsen, K. I., Kim, H.-J., et al. (2014). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. The Gerontologist, 54(Suppl 1), S1–S14.
• Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
• Kelly, J. F., Humphreys, K., & Ferri, M. (2020). Alcoholics Anonymous and other 12-step programs for alcohol use disorder: A review of effectiveness. World Psychiatry, 19(1), 47–45.
• National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2020). Drinking in later life: 5 things to consider.
• Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372(2), 153–160.
• Substance Abuse and Mental Health Services Administration (SAMHSA). (2018). Older adults behavioral health: Substance misuse and mental health issues. U.S. Department of Health and Human Services.