Mental Health in the Aging Population
The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Because mental health is essential to overall health and well-being, it must be recognized and treated in all Americans, including older adults, with the same urgency as physical health. For this reason, mental health is becoming an increasingly important part of the public health mission.
Public health agencies can incorporate mental health promotion into chronic disease prevention efforts, conduct research, collaborate with partners to develop comprehensive mental health plans, and enhance coordination of care. The challenges for public health are to identify risk factors, increase awareness about mental disorders and the effectiveness of treatment, remove the stigma associated with mental disorders and receiving treatment for them and improve access to mental health services.
Mental health and well-being are as important in older age as at any other time of life. Older people face special physical and mental health challenges which need to be recognized. As people age, they are more likely to experience several conditions at the same time.
It is estimated that 20% of people age 55 years or older experience some type of mental health concern. The most common conditions include anxiety, severe cognitive impairment (dementia), and mood disorders (such as depression or bipolar disorder).
Mental health issues are often attributed as a factor in cases of suicide. Older men have the highest suicide rate of any age group. Men aged 85 years or older have a suicide rate of 45.23 per 100,000, compared to an overall rate of 11.01 per 100,000 for all ages.
Mental health problems are under-identified by health-care professionals and older people themselves, and the stigma surrounding these conditions makes people reluctant to seek assistance.
Older people with depressive symptoms have poorer functioning compared to those with chronic medical conditions such as lung disease, hypertension or diabetes. Depression also increases the perception of poor health, the utilization of health care services and costs.
There may be multiple risk factors for mental health problems at any point in life. Older people may experience life stressors common to all people, but also stressors that are more common in later life, like a significant ongoing loss in capacities and a decline in functional ability. In addition, older people are more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement. All of these stressors can result in isolation, loneliness or psychological distress in older people, for which they may require long-term care.
Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome.
Older adults are also vulnerable to elder abuse - including physical, verbal, psychological, financial and sexual abuse; abandonment; neglect; and serious losses of dignity and respect. Current evidence suggests that 1 in 6 older people experience elder abuse. Elder abuse can lead to physical injuries, as well as serious, long-lasting psychological consequences, including depression and anxiety.
The Geriatric Mental Health Foundation lists several potential triggers for mental illness in the elderly:
- Alcohol or substance abuse
- Change of environment, like moving into assisted living
- Dementia-causing illness (e.g. Alzheimer’s disease)
- Illness or loss of a loved one
- Long-term illness (e.g., cancer or heart disease)
- Medication interactions
- Physical disability
- Physical illnesses that can affect emotion, memory and thought
- Poor diet or malnutrition
SYMPTOMS OF MENTAL ILLNESS
As our loved ones’ age, it’s natural for certain changes to occur. Regular forgetfulness is one thing, however; persistent cognitive or memory loss is another thing and potentially serious. The same goes for extreme anxiety or long-term depression. Caregivers should keep an eye out for the following warning signs, which could indicate a mental health concern:
- Changes in appearance or dress, or problems maintaining the home.
- Confusion, disorientation, problems with concentration or decision-making.
- Decrease or increase in appetite; changes in weight.
- Depressed mood lasting longer than two weeks.
- Feelings of worthlessness, inappropriate guilt, helplessness; thoughts of suicide.
- Memory loss, especially recent or short-term memory problems.
- Physical problems that can’t otherwise be explained: aches, constipation, etc.
- Social withdrawal; loss of interest in things that used to be enjoyable.
- Trouble handling finances or working with numbers.
- Unexplained fatigue, energy loss or sleep changes.
CHALLENGES IN DIAGNOSIS
There are several reasons why mental illness is underdiagnosed among seniors. Findings suggest that older adults themselves were much less likely to perceive a need for mental health care than younger adults. As a result they may be less likely to bring up concerns with their primary care provider.
“Ageism” and perceived stigma regarding mental health care may play a role as well. Many seniors and their family members may incorrectly believe that depression is normal with aging.
Additionally, many older people grew up in an era when discussing psychiatric issues was frowned upon. Elderly patients may attribute their moods to physical impairments or other illnesses. Several of the symptoms of depression and anxiety, poor sleep, small appetite, memory and concentration problems are also markers of simply getting older.
Too often, changes in mood, interest, activity level and personality are incorrectly attributed to aging, and the possibility of a mental illness is not considered.
Many older adults have multiple health problems requiring multiple medications which can affect mood. It can be difficult to diagnose depression and other mental health concerns from coexisting medical conditions or medications that might cause symptoms mimicking depression and other mental health symptoms.
Prompt recognition and treatment of mental, neurological and substance use disorders in older adults is essential. Both psychosocial interventions and medications are recommended.
Training all health providers in working with issues and disorders related to aging is essential.
Effective, community-level primary mental health care for older people is crucial.
With the combined efforts of caregivers, family, friends and mental health professionals, we can help ward off mental illness in our older loved ones and make sure they are on the right track to healthy aging.