While most have good mental health, many older adults are at risk of developing mental disorders, neurological disorders or substance use problems as well as other health conditions such as diabetes, hearing loss, and osteoarthritis. Furthermore, as people age, they are more likely to experience several conditions at the same time.
Statistics (WHO, 2017)
- Globally, the population is aging rapidly. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double, from 12% to 22%. This is an increase from 900 million to 2 billion people over the age of 60.
- Mental health and well-being are as important in older age as at any other time of life.
- Mental and neurological disorders among older adults account for 6.6% of the total disability (DALYs) for this age group.
- Approximately 15% of adults aged 60 and over suffer from a mental disorder.
- The most common mental and neurological disorders in this age group are dementia and depression, which affect approximately 5% and 7% of the world’s older population, respectively.
- Anxiety disorders affect 3.8% of the older population, substance use problems affect almost 1%.
- Approximately a quarter of deaths from self-harm are among people aged 60 or above.
Normal Lifespan Transitions of the Older Adult
Accepting one’s life
Maintaining cognitive functioning
Redirecting energy toward new roles
Developing a point of view about death
Coping with physical changes
Developing a psychohistorical perspective
Traveling uncharted territory
How Age Affects Mental Health – Integrity Versus Despair (Erikson & Erikson 1997)
- Earlier psychosocial crisis have been successfully resolved, the mature adult develops the peak of adjustment; integrity.
- He trusts, he is independent and dares the new.
- He works hard, has found a well – defined role in life, and has developed a self-concept with which he is happy.
- He can be intimate without strain, guilt, regret, or lack of realism; and he is proud of what he creates – his children, his work, or his hobbies. If one or more of the earlier psychosocial crises have not been resolved, he may view himself and his life with disgust and despair.
TIPS: How to Age Successfully
- Avoid disease
- Maintain social contacts & supports
- Maintain high cognitive function (puzzles/mind games/reading) and physical activity (walking, sports, gardening, etc)
- Be willing to find new and flexible solutions to the demands of daily life
- Utilize community supports (Senior centers, church
- Share your feelings
- Connect to others
Maintaining Mental Health in Older Adults
- Maintain contact with family and friends
- Continue activities with a have brought pleasure, but adjust for limitations
- Deal with health issues by adapting and accepting
- Find comfort in memories of the past and engage in activities in the present
What age does mental illness symptoms appear?
Possible to develop at any time in life
- Suicidal Thoughts
- Substance Use or Abuse
Typically develops early in life
- Bipolar Disorder
- Personality Disorders
Do mental health issues get worse or improve with age?
- What we know about aging and mental health vs mental illness – we all age but some individuals age well and others have difficulties.
- The importance of early intervention and treatment – the earlier a mental illness is diagnosed and treated the likelihood of recovery is high.
Common Mental Health Disorders and Older Adults
Symptoms: Alzheimer’s causes a gradual decline in memory, thinking and reasoning skills. Symptoms depend on the stage of the disease:
Early symptoms include:
- Misplacing items
- Forgetting the names of places and objects
- Repeating themselves regularly, such as asking the same question several times
- Becoming less flexible and more hesitant to try new things
Middle- stage symptoms include:
- Increasing confusion and disorientation
- Obsessive, repetitive or impulsive behavior
- Delusions (believing things that are untrue)
- Problems with speech or language (aphasia)
- Disturbed sleep
- Changes in mood, such as frequent mood swings, depression and
- feeling increasingly anxious, frustrated or agitated
- Difficulty performing spatial tasks, such as judging distances
Later symptoms include:
- Difficulty changing position or moving around without assistance
- Considerable weight loss – although some people eat too much and put on weight
- Gradual loss of speech
- Significant problems with short and long- term memory
(Data from: Focus Medica)
Delirium is a sudden onset of mental confusion causing changes in behavior. It is important to know that delirium is not dementia and older people are at greatest risk.
- Had delirium in the past
- Has memory problems
- Problems with sleep
- Problems with hearing
- Takes more than 5 medications
What does Delirium look like?
- Restless and upset
- Slurred speech
- Not making sense
- Mix-up days and nights
- Sleepy, then alert
- Cannot concentrate
- More alert than normal
- Not knowing where you are
- Trouble staying awake
What causes Delirium?
- Not taking medication
- Surgery with anesthesia
- High/low blood sugar
- Sadness or feelings of despair
- Unexplained or aggravated aches and pains
- Loss of interest in socializing or hobbies
- Weight loss or loss of appetite
- Feelings of hopelessness or helplessness
- Lack of motivation and energy
- Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
- Loss of self-worth (worries about being a burden, feelings of worthlessness or self-loathing)
- Slowed movement or speech
- Increased use of alcohol or other drugs
- Fixation on death; thoughts of suicide
- Memory problems
- Neglecting personal care (skipping meals, forgetting meds, neglecting personal hygiene)
Depression vs. Sadness
- While depression and sadness might seem to go hand and hand, many depressed seniors claim not to feel sad at all.
- May complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or worsening headaches, are often the predominant symptom of depression in the elderly.
Causes of Depression among Older Adults
Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to your body image due to surgery or sickness.
Loneliness and Isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or a loss of driving privileges.
Reduced Sense of Purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities you used to enjoy.
Fears – Fear of death or dying; anxiety over financial problems or health issues.
Recent Bereavement – The death of friends, family members, and pets; the loss of a spouse or partner.
Medical Conditions that may Cause Depression among Older Adults
- Parkinson’s disease
- Heart disease
- Thyroid disorders
- Vitamin B12 deficiency
- Dementia and Alzheimer’s disease
- Multiple sclerosis (MS)
Medications that can cause or worsen depression include:
- Blood pressure medication (e.g. clonidine)
- Beta-blockers (e.g. Lopressor, Inderal)
- High-cholesterol drugs (e.g. Lipitor, Mevacor, Zocor)
- Tranquilizers (e.g. Valium, Xanax, Halcion)
- Calcium-channel blockers
- Medication for Parkinson’s disease
- Sleeping pills
- Ulcer medication (e.g. Zantac, Tagamet)
- Heart drugs containing reserpine
- Steroids (e.g. cortisone and prednisone)
- Painkillers and arthritis drugs
- Estrogens (e.g. Premarin, Prempro)
- Anticholinergic drugs used to treat GI disorders
Suicide and Older Adults
- Though the elderly (age 65 and older) comprise about 13% of the U.S. population, they account for over 18% of all suicides.
- Contact the National Suicide Prevention Lifeline Call 1-800-273-TALK (1-800-273-8255)
Signs of Possible Suicidal Ideation
- Withdrawal from relationships
- Putting closure on those relationships, saying goodbye, expressing guilt or regrets
- Writing or revising a will or giving away possessions
- Saying “ I have nothing to live for, it would be better if I were dead. I don’t care if I wake up…”
Prevention, Wellness, and Disease Management
- Lifestyle changes
- Brain games
- Smoking cessation
- Manage weight
- Manage blood pressure, cholesterol, etc
- Medication compliance