Edith appeared depressed when we met.  At 79, she was isolated and in ill health.  Her recent fall had increased her fears of dependency, and she resented having to stay at her daughter's home. Dr. A. had referred her to me, concerned about her chronic complaints and unhappiness. He told me, "I am in over my head with Edith. Nothing I do seems to help." (A rare physician! He was able to acknowledge the benefits of psychotherapy, and knew that when ALL interventions failed, it could be indicative of a depression, or underlying emotional factors.)

Due to severe osteoporosis, Edith was in pain much of the time; unable to tend her garden. "I can't bend down to weed anymore, and my back hurts to much to plant new things. My garden is dying..." Edith had spent much of her time watching TV or listening to the radio.  It didn't matter what was on. She just wanted to hear human voices. 

She was terrified of falling again. She had learned from the National Osteoporosis Foundation that:

Each year, about one-third of individuals 65 years of age or older will fall, and some will be disabled by the broken bones that can follow.
In many cases, a fall can be precipitated by medications such as sedatives, muscle relaxants, and blood pressure drugs that can cause dizziness, lightheadedness, or loss of balance. When two or more medications are used in combination, these side effects may be aggravated. Falls also result from diminished vision, hearing, muscle strength, coordination, and reflexes and from diseases that affect balance.

Edith's daughter, Meredith, lived nearby, and had taken up the tasks of most of her mother's care. Both of Edith's sons lived on the East Coast and she had few friends.  Edith was isolated, unwilling for her remaining friends to see how stooped she had gotten. She had few outlets and felt alone.

"I miss my sister, Gwendolyn. She wasn't supposed to die first, she was my baby sister. The cancer just raced through her. By the time she went to the doctor, they opened her up, closed her back up again, and sent her home to die. She's been gone a year now. Now every time I turn around, it seems another old friend has died."

Edith hadn't been out at night for years, when her decreasing income had made it impossible to move from her home in a neighborhood which had gotten increasing dangerous. "The house is paid off. I can't pay rent; the property taxes are enough as it is. A mortgage? No, I wouldn't get anything for this house, in this neighborhood. And besides, my whole life has been in this house. I came here as a young bride; my children grew up here. I wouldn't know how to live anywhere else."

After a friend had gotten mugged, Edith stopped leaving her house during the day as well. She would only go to the corner grocery store when she was completely out of food, and would only get what she could carry. As an older, physically impaired woman, she felt very vulnerable. Sadly, there was truth to this; as a society we do not honor and protect our elders.