In the realm of aged care, where chronic diseases and end-of-life challenges often dominate, traditional medical approaches sometimes fall short in addressing the holistic needs of older adults. Conditions such as cancer, dementia, depression and anxiety can erode quality of life, leaving individuals and their families searching for more compassionate and effective options.
Inspired by Adam Woods’ thought-provoking piece, The Pill We Won’t Prescribe, which highlights the potential of psilocybin to alleviate existential terror in cancer patients, this article delves into alternative treatments. Woods’ article paints a vivid picture of how we sedate older people into oblivion rather than offering pathways to peace. Readers are encouraged to explore it for its compelling insights into the ethical dilemmas of current practices.
Alternative treatments, particularly those involving psychedelics and mind-body approaches, are gaining traction as research uncovers their potential to treat not just symptoms but the underlying emotional and psychological burdens of disease. These methods challenge conventional thinking by integrating the mind, body and spirit, offering hope for improved outcomes in aged care settings.
Psychedelic substances, long stigmatised, are emerging as powerful tools in treating mental health issues prevalent among older adults. Psilocybin, the active compound in magic mushrooms, has shown promising results in reducing anxiety and depression in cancer patients, with effects lasting years from a single supervised dose.
Studies from leading institutions indicate that psilocybin-assisted therapy can restore a sense of meaning and connection, especially for those facing terminal illness. In aged care, where over-reliance on sedatives is a documented issue, this could represent a shift towards more humane interventions. Research suggests that psychedelics may be particularly valuable for older adults with treatment-resistant depression, given the higher prevalence and poorer response to traditional treatments in this group.
Beyond psilocybin, other psychedelics offer promise. Ketamine, an anaesthetic with dissociative effects, is already used off-label for treatment-resistant depression in older adults. Administered in controlled settings, it can provide rapid relief from depressive symptoms, often within hours, and is being explored for palliative care in conditions such as ALS and early dementia. Its value lies in the quick onset, which is crucial for elderly patients needing immediate relief from existential distress.
MDMA, commonly known as ecstasy, enhances feelings of openness and reduces fear responses, making it suitable for post-traumatic stress disorder and end-of-life anxiety. Clinical trials suggest MDMA-assisted psychotherapy can lead to long-lasting improvements in mood for elderly patients experiencing chronic distress.
Lysergic acid diethylamide, or LSD, is another classic psychedelic showing efficacy in alleviating existential distress at the end of life. Early research indicates it may assist with generalised anxiety disorder and mood disorders in older populations, with effects comparable to psilocybin.
Ayahuasca, a brew containing DMT, has been studied for its antidepressant properties and potential role in dementia palliative care, addressing psychological, social and spiritual needs. While data on older adults is limited, these therapies appear generally well tolerated in controlled settings, though more age-specific research is required. Their potential value includes reducing fear of death and improving attitudes towards dying.
Substances such as 5-MeO-DMT are also gaining attention for their ability to induce profound mystical experiences that may ease end-of-life anxiety. Preliminary research suggests possible improvements in quality of life and attitudes towards death, though further study is essential before considering application in aged care.
Ibogaine, derived from the iboga plant, has shown potential in treating addiction and trauma-related disorders, with some proposed applications in palliative settings for reducing suicidal ideation and PTSD symptoms. However, safety concerns, including cardiac risks, may limit its suitability for frail older adults.
Mescaline, sourced from peyote cactus, has historical use in spiritual contexts and emerging evidence for mood enhancement. Clinical data in aged care remains sparse, suggesting cautious and research-based exploration of its therapeutic value.
Cannabis and its derivative cannabidiol, or CBD, also warrant consideration. CBD, non-psychoactive and legal in certain regulated forms in Australia, has been linked to relief from chronic pain, arthritis, inflammation and anxiety in older adults. Some seniors report using CBD for pain management, sleep issues and mood disorders, with possible benefits for dementia-related agitation. Its appeal lies in its relative accessibility and lower psychoactive risk compared to THC-dominant cannabis, although potential medication interactions require careful monitoring in aged care environments.
In residential facilities, where residents often grapple with isolation and loss of purpose, psychedelic-assisted therapies could potentially reshape approaches to diseases such as Alzheimer’s. Early research suggests possible improvements in cognition, reductions in agitation and enhanced quality of life through mechanisms such as neural plasticity and emotional resilience. However, these treatments require structured clinical frameworks with preparation, supervision and integration to ensure safety and ethical delivery.
Shifting focus to non-pharmacological methods, mind-body approaches emphasise the interconnectedness of physical and mental health. These approaches draw on the understanding that trauma and chronic stress can manifest in the body.
Bessel van der Kolk’s influential book, The Body Keeps the Score, explores how traumatic experiences reshape the brain and body, advocating for therapies that restore balance. The book argues that recovery involves bottom-up healing, engaging the body through practices such as yoga and mindfulness rather than relying solely on talk therapy.
In aged care, this perspective is particularly relevant for addressing chronic pain, dementia-related behaviours and emotional distress associated with life transitions.
Yoga and tai chi combine gentle movement with breath work and meditation. Research suggests these practices may improve balance, reduce falls, enhance mood and support cognitive function in older adults. Mindfulness-based interventions, including meditation, have also been associated with improved emotional regulation and potential slowing of cognitive decline in some individuals with dementia.
These low-impact activities promote successful ageing by strengthening psychological resources and social participation, helping to counter isolation in residential care settings.
Applying van der Kolk’s ideas, aged care programs might also explore creative therapies such as theatre, music, sports or neurofeedback to support neural flexibility and foster connection. For conditions such as PTSD or prolonged grief, which affect many elderly Australians, these methods may offer a pathway towards greater agency and emotional stability.
While promising, alternative treatments face significant barriers in Australia, including regulatory constraints, funding limitations and workforce training gaps. Most psychedelics remain tightly controlled substances, although limited authorised prescribing pathways now exist under specific conditions. Ketamine clinics operate in some settings, and regulated medicinal cannabis products are accessible through established frameworks.
Mind-body practices, while generally more accessible, require trained facilitators and organisational commitment to integrate meaningfully into aged care models.
Further research is essential to substantiate benefits for older populations. Clinical trials must include older adults and address safety considerations for those with multiple chronic conditions, cognitive impairment or polypharmacy.
Alternative treatments, including psychedelic-assisted therapies and mind-body approaches, present a compelling opportunity to rethink how we manage disease and distress in aged care. Emerging evidence suggests potential benefits in reducing anxiety, depression and existential suffering, though rigorous research remains crucial to confirm efficacy and safety in elderly populations.
By embracing innovation alongside evidence-based safeguards, aged care can move beyond symptom management towards approaches that prioritise dignity, meaning and emotional wellbeing. As Woods’ article suggests, perhaps the real challenge is not whether these therapies have value, but whether we are prepared to reconsider what compassionate care truly looks like.
