Mental Health + Aging with Dr. Regina Koepp

A few days ago, I was interviewed for NPR’s Here & Now, and the host asked me about my “aging journey.” I felt a little flustered—not because it was a bad question, but because I’m 50. And when people ask me about aging, my mind goes straight to older adulthood: 65, 75, 85, 95 and beyond. So my answer didn’t land the way I wanted it to. I left the interview thinking, I wish I’d said that differently.

What I wish I’d said in the moment is this: when I talk about aging, I’m usually talking about older adulthood—the stretch of life that can span decades, roughly from 65 to 122. It’s not a single moment or an identity you suddenly “become.” It’s a long, dynamic developmental chapter, with real change, real challenge, and real growth over time.

And honestly, at 50, I don’t feel like I’ve lived enough of older adulthood to speak from deep personal experience about what it’s like. What I do know—because for the past 25 years I’ve been a geropsychologist to more than 1,000 older adults and their families—is this: when we’re in midlife and we imagine our older selves, we have to watch for the way fear can sneak in and write the story for us—because that fear can sell our future selves short, and it can miss the resilience, adaptability, and grace that so often grow with age.

The biggest thing I see middle-aged people get wrong

In midlife, we often project our fear and dread about aging onto older adulthood. We imagine later life through the lens of what scares us now—physical vulnerability, chronic illness, loss, dependence, mortality.

But what we often miss is this: many older adults become remarkably skilled at adapting. They grow in resilience, self-compassion, and wisdom about what matters. That doesn’t erase real challenges, but it does change how we navigate those challenges. 

Here's an example: AARP did a large aging survey of more than 2000 people and found that fear of death generally decreases with age. In other words, what feels terrifying in midlife may not feel the same once you actually arrive in later life.

Key Takeaways

• Aging happens across the lifespan; older adulthood is its own developmental period.
• Midlife fears can distort how we imagine later life.
• Older adults frequently develop stronger adaptation skills over time.
• Avoid overlooking older adults’ resilience by assuming your dread is their reality.

My invitation for you this week

If you’re in midlife, notice when you’re imagining older adulthood through your current fears. And if you’re a clinician, caregiver, or family member, practice holding this wider frame: Yes, aging can bring physical vulnerability. And it can also bring increased adaptability, clarity, and grace.

Timestamps / Chapters

00:00 — The NPR question that threw me off
01:00 — Two meanings of “aging” (lifespan vs. older adulthood)
02:10 — The midlife projection trap
02:30 – A research example: fear of death tends to decrease with age
03:10 – What we miss: adaptation, resilience, self-compassion
04:10 – Why Regina cringes at the midlife “aging journey” question
04:45 – This week’s tip: don’t project your stage onto theirs
05:05 – Closing and what’s coming next

Click here for all of the resources in this episode

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

When someone is living with both dementia and PTSD, their needs are complex—but support is still possible, and it can make a world of difference.

In this episode, I share what I’ve learned as a geropsychologist working with veterans and older adults navigating both cognitive impairment and trauma. You’ll discover:

• When trauma therapy can still be effective in the early stages of dementia.
• How dementia progression changes what’s possible for PTSD treatment.
• The importance of identifying and minimizing unique trauma triggers.
• Practical strategies to reduce distress at home or in memory care.
• Why moving someone because they’re “too difficult” can do more harm than good—and how to respond instead.

You’ll also hear real stories from my clinical work and gain trauma-informed approaches you can start using right away to improve quality of life for people living with dementia and PTSD.

If you’ve ever wondered how to balance mental health care with dementia care, this conversation will give you the clarity, compassion, and tools you need.

Click here to link to show notes and resources

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

Can Unresolved Trauma Increase Dementia Risk?

Trauma doesn’t just leave emotional scars—it can change the brain. And when post-traumatic stress goes untreated, the risk for dementia later in life rises.

In this episode of my mental health and dementia series, I explore how trauma and PTSD intersect with brain health. Drawing from decades of research and my years working with older veterans, I break down why unresolved trauma increases vulnerability to dementia disorders and what clinicians can do to help.

This conversation isn’t just about understanding risk—it’s about hope. Trauma treatment works at any age, and healing now doesn’t only restore quality of life today, it also protects the brain for tomorrow.

3 Key Takeaways from This Episode

1⃣ Trauma raises dementia risk.
Landmark studies show veterans with PTSD have double the risk of dementia, and depression or anxiety tied to trauma can increase dementia risk even decades later.

2⃣ The body keeps the score.
Trauma heightens cortisol and inflammation, which damage the heart and brain. What’s bad for the heart is bad for the brain.

3⃣ Treatment protects the brain.
Trauma therapy in older adulthood restores quality of life now and strengthens brain health and autonomy for the future.

What You’ll Learn in This Episode:

• Why PTSD symptoms often reemerge in older adulthood, especially after retirement, health changes, or loss.
• The science behind how trauma affects brain physiology—cortisol, inflammation, and cardiovascular health—and why that matters for dementia risk.
• Landmark studies linking PTSD, depression, anxiety, and racism-related stress to dementia.
• Why trauma often goes undetected in older adults—and how ageism can stop clinicians from asking the right questions.
• Five trauma-informed strategies to support older adults, reduce suffering now, and protect brain health for the future.

Click here to see the show notes and get all resources mentioned in this episode. 

Download your free Trauma Informed Care Guide here

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

Last week, a therapist told me about her client, an 82-year-old woman who hadn’t had more than 6 hours of sleep in years. “It’s just part of getting older,” the woman sighed. But here’s the truth—fatigue isn’t a normal part of aging, and chronic sleep problems may be quietly raising her risk for dementia. As professionals, we can no longer shrug off insomnia in older adults. The stakes are simply too high.

In this episode, I reveal the powerful connection between chronic sleep problems and dementia risk—and why ignoring insomnia symptoms can have lasting consequences for brain health.

Here's What You'll Learn In This Episode:

• Why half of older adults report insomnia symptoms (even if they don’t meet full diagnostic criteria)
• How sleep architecture changes with age—and why that’s not the same as insomnia
• The role of deep sleep in clearing beta amyloid, consolidating memory, and regulating emotions
• Three major research studies linking short sleep duration to higher dementia risk
• Five practical steps you can take to assess and improve sleep in older adults
• Why Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard, especially for people 65+
• The dangers of common over-the-counter sleep aids for older adults
• How collaborating with primary care and sleep medicine providers can change outcomes

As professionals, we hold the keys to better brain health in aging—often starting with something as simple, yet essential, as quality sleep.

Click here to go to show notes and get resources on sleep and aging. 

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

If you’ve ever been told that “a little wine is good for you,” you might want to hear what the latest science says—especially when it comes to the aging brain.

In this episode, I share compelling new research showing that even moderate alcohol use in midlife and later life may significantly increase the risk of dementia. I’ll walk you through why alcohol use in older adults often goes undetected, how it impacts brain health, and the exact screening tools and questions I use—and that you can use too—to spot red flags early.

This isn’t about scare tactics. It’s about equipping you with the facts, the tools, and the confidence to support safer, healthier aging. Whether you’re a therapist, care manager, or simply someone who wants to protect your own brain health, you’ll come away knowing why there may be no safe level of alcohol when it comes to dementia prevention.

What You’ll Learn in This Episode:

1⃣ The brain changes alcohol accelerates—from memory loss to neurotransmitter disruption.
2⃣ Why “invisible” alcohol misuse often goes undetected in later life—and how to spot it.
3⃣ Three screening tools every clinician should know: SMAST-G, AUDIT-C, and CAGE Questionnaire.
4⃣The good news: Older adults can recover—and often have better treatment outcomes than younger adults when care is tailored to them.

Click here to get all of the resources mentioned in this episode here

If you enjoyed this episode, please subscribe, leave a review, and share it with a colleague or friend. Together, we’re building a movement for mental health and aging—because there is no expiration date on healing, transformation, and growth.

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

Anxiety increases dementia risk by 24% (about the same rate as diabetes) —but treatment for anxiety corrects this. Learn why early detection and treatment in older adults is critical to brain health.

In this episode, I unpack the groundbreaking connection between anxiety and dementia. You’ll learn why anxiety is not a normal part of aging—and why your role as a therapist, social worker, psychologist, or aging life care expert is critical in reducing long-term cognitive decline.

You’ll walk away with four actionable steps you can take to make a meaningful difference in the lives of older clients—and possibly prevent dementia in the process.

This isn't just about reducing symptoms. It's about restoring dignity, peace of mind, and protecting brain health—now and for years to come.

Here’s what you’ll learn:
✅ How anxiety affects the aging brain and increases dementia risk
✅ Why anxiety is often missed or misdiagnosed in older adults
✅ How to screen, normalize, and treat anxiety in therapy
✅ The importance of collaborative care and early detection
✅ How you can adapt your practice to better serve older clients

👉 Get the full list of research and clinical tools I mention here: https://www.mentalhealthandaging.com/podcast/anxiety-dementia-what-therapists-must-know/

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

The Hidden Link Between Depression and Dementia

Every time I sit with a client and help them move through depression, I know I’m not just helping them feel better in the moment—I may also be protecting their brain years down the road. That’s not just a hope—it’s science.

In this episode, I’m diving into the powerful link between mental health treatment and dementia prevention. So many therapists don’t realize that untreated depression in midlife and later life increases the risk of dementia. But here’s the hopeful truth: when we treat depression, we don’t just reduce suffering—we may delay or even prevent cognitive decline.

If you’re a therapist, this episode is a call to action. You have more power than you think to shape not just your client’s emotional well-being, but their cognitive future. I’ll walk you through the research, the biology, and—most importantly—what you can do right now to support your older clients in living full, vibrant, and connected lives.

In This Episode, You’ll Learn:

• Why depression is a modifiable risk factor for dementia
• What the latest research says about treating depression and reducing dementia risk
• How therapy for depression improves mood, memory, and independence
• Why older adults are just as likely to benefit from therapy as other age groups
• How antidepressant treatment in people with mild cognitive impairment can delay dementia
• What you can do for clients already living with dementia and depression
• Why your role as a therapist matters more than ever—and how to make a difference

Visit the show notes here

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

If your 75-year-old client stops coming to therapy, it might not be them. It might be your approach.

In this episode, I explore why therapy must evolve, just like people, with age. I share five powerful ways to evolve your practice to better serve older adults. 

While many therapists are trained to work with adults in general, most graduate and continuing education programs focus on midlife or younger adulthood, often excluding older adulthood entirely. The result is a significant gap in care.

Therapy that resonates with younger adults can fall flat or even feel dismissive for older clients. When therapists don't adapt their approach, clients may feel unseen, misunderstood, or disengaged—not because they’re resistant, but because the therapy model doesn’t reflect their stage of life.

This episode will help you recognize what shifts with age, why it matters in clinical practice, and how to modify your work for more effective and compassionate outcomes.

What You’ll Learn

• Why traditional therapy methods may not land with older adults
• How perceived time left in life shifts therapeutic goals and priorities
• What therapists often misunderstand about aging and mental health
• How to center meaning, wisdom, and resilience in your sessions
• Five clinical adaptations you can start using right away

Want to learn more? Enroll in my upcoming 90min CE course on "Becoming an Aging-Informed Therapist" - Live July 22, 2025 

See the show notes here

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

Chronic pain increases the risk for depression and suicide. 

 The connection between chronic pain and depression is stronger—and more dangerous—than most professionals realize. In this powerful episode, Dr. Regina Koepp sits down with pain psychology expert, Dr. Jennifer Steiner, to uncover the complex and bidirectional relationship between chronic pain, depression, and suicide risk.

What You’ll Learn in This Episode:

• Why people living with chronic pain are twice as likely to experience suicidal thoughts and behaviors
• The true drivers of suicide risk in chronic pain—not just pain intensity, but emotional, relational, and financial strain
• How the brain’s stress response amplifies both physical pain and emotional suffering
• What research says about which comes first—pain or depression—and why it’s not always clear-cut
• How chronic pain affects sleep, cognition, and identity, creating a vicious cycle of distress
• The essential role of therapists trained in chronic pain in breaking this cycle
• What to look for in a therapist who can truly support someone living with chronic pain

Whether you’re a therapist, psychologist, social worker, or aging life care expert—this episode will transform the way you think about pain. Because treating chronic pain isn’t just about reducing discomfort… it’s about restoring dignity, function, and hope.

Click here to see show notes 

AttentionTherapists: 

• Download your free guide on the Depression-Pain Cycle 
• Become a sought after specialist with our Pain Psychology Certificate Course (14.5 CE Credits), where's you'll learn ACT and CBT for Chronic Pain, as well as strategies to address bias in pain care.

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

Chronic pain isn’t just physical—it's personal, emotional, and deeply misunderstood. And when it comes to older adults, the pain often hides in plain sight. In this episode, I sit down with pain psychology expert, Dr. Jennifer Steiner, to explore the invisible impact of chronic pain and what every therapist must understand to truly help older adults living with it.

You’ll walk away with a fresh perspective—and four critical psychological themes—that can transform the way you support older adults in your practice.

What You'll Learn in This Episode:

The real size of the chronic pain epidemic—and why it’s often underestimated in older adults

Common pain conditions affecting people 65+

Dr. Steiner’s personal journey from growing up with chronic pain to becoming a national leader in pain psychology

How chronic pain influences mental health, identity, relationships, and work

The 4 psychological themes every therapist must recognize when treating chronic pain:

1. The Body as an Obstacle
2. Pain is Invisible—and Real
3. Disrupted Sense of Self
4. Unpredictability of the Condition

AttentionTherapists:

• Download your free guide on the Depression-Pain Cycle 
• Become a sought after specialist with our Pain Psychology Certificate Course (14.5 CE Credits), where's you'll learn ACT and CBT for Chronic Pain, as well as strategies to address bias in pain care.

Click here to go to Show Notes 

Have a question for Dr. Koepp? Text us here.

PROFESSIONALS: Grab your free guide to working with older adults here
 

Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits