9 - Aging & Mental Health Flashcards
Landscape of Mental Health and Aging
- By the year 2050 one in six persons will be 65+ years of age (UN)
- health needs change across the lifespan…e.g. 25 vs. 65 this also extends to the older adult e.g. 65 vs. 85
- Mental health and well-being are as important in older age as in other times of life (MHCC)
- Ratio of older to ‘working’ age group a potential concern
Background
- Older adults face health, support, and environmental barriers that limit their ability to achieve the best mental health and care outcomes
- there is insufficient data on risk level or how many are experiencing mental health concerns/ conditions
- future research on mental health care is needed
- many older adults living on their own say they have a need for mental health care
- many 65 and older have reported feeling social isolated
- Delays in diagnosis increase as people age
- 1/4 of older adults screened positive for depression
- very few older adults access health services for mood or anxiety disorders
Is Aging Linear?
- Some individuals age prematurely due to complex, multiple, and chronic health problems or socio-economic circumstances
- aging is loosely associated with a person’s age in years”
What SDOH’s affect Mental Health of older people?
- stigma against mental illnesses
- mental health care disparity
- flawed criminal justice system
- homelessness
- aging-related social determinants: ageism, workforce shortage, and social isolation/loneliness
What is Ageism?
Ageism: stereotypes, prejudices and attitudes and behaviour against the older adults
- this view of aging can be internalized by older individuals and enacted
- Ageism causes inequalities and has detrimental effects on the
individual, community and society
Effects of Stigma
- Stigma against mental disorders is greater in later life
- Mental illness stigma can lead delay seeking care
ex. Depression, delirum or dementia (3ds) - do not seek care b/c of stereotypes
Why is Accessing Care Difficult?
- The geriatric mental health workforce is small (even in high-resourced countries)
- the number of psychiatrists trained in geriatric psychiatry has not increased
What is the Impact of Loneliness?
- Cognitive impairment
- Physical attributes/health
- behavoiurs
- Loneliness is more common in people with severe mental disorders (ie. schizophrenia)
Loneliness is associated with:
- Alcohol and drug abuse, suicidality, poor nutrition, sedentary lifestyle, inadequate sleep, and worsening physical functioning
What strategies can reduce negative MH outcomes?
1) Wisdom
- Wisdom is associated with positive outcomes, including better overall physical and mental health, happiness, and lower levels of depression and loneliness
- Intergenerational activities (grandparents’ help in raising grandchildren) have been found to benefit both the generations biologically, cognitively and psychosocially
2) Resilience
- Resilience is associated with better health and functioning as well as greater longevity in all age groups, but especially in older adults
What is the importance of having a meaning of life in terms of MH?
- there is a link between purpose in life and better physical, psychosocial and over all health outcomes, including social engagement, in older adult populations
- Meaning in life may can be a protective factor against suicide
What is Life review therapy?
- an individual or group story-telling intervention with a focus on integrating life stories through different phases in life
What are the most common mental illnesses?
- mood and anxiety disorders are most common?
Mental Illness: Persistent feelings of sadness, hopelessness, and/or loss of interest or pleasure in previously enjoyable activities for 2 weeks or more
- For older adults, depression includes cognitive and physical changes, memory problems, disturbed sleep, decreased energy or excessive tiredness, decreased appetite, and thoughts of suicide
Depression
Depression in older adults is associated with:
- physical disorders and frailty
- mild cognitive impairment
- social determinants of health (e.g. major role transitions, bereavement, loneliness and social isolation)
- exposure to poly-pharmacy
- heightened risk for suicide
- brain aging
- dementia & suicide risk
- Late-life depression can cause caregiver burden for family members
Insomnia
Insomnia
- a symptomatic manifestation of major depression
- also a risk factor for incident and recurrent depressive episodes
- Persistent insomnia (insomnia disorder) heightens the risk for chronic relapsing and requires independent clinical attention to optimize outcomes
6 Ways to Prevent Depression
1) Monitor your mood daily
2) Develop a daily routine
3) Connect with others daily
4) Small acts of kindness
5) Actively look for 5 positive or pleasurable events each day
6) Schedule a pleasurable or joyful activity every day – whether you want to or not
Mood and anxiety disorders
- suicide rates are alarmingly high for older men
- People 65 and older have the highest rate of hospitalizations for anxiety disorders
Substance Misuse
- Substance use disorders are often overlooked as causes of problems for older adults
- elders, 65+ have higher levels of illicit drug use and prescription drug misuse than other age cohorts
- 15-30% of people with major late-life depression have an alcohol use problem
- Older adults are more vulnerable to effects of alcohol on cognition, emotions, and balance
- Substance misuse can result in acute and longer-term cognitive impairment, depression, or anxiety and may contribute to: FALLS
- Prescribed medications (e.g. chronic pain or sleep difficulties) can also cause substance dependence and complications similar to those of alcohol misuse
Treatment for Substance Use
- Most valuable long-term intervention: Group support for abuse and addiction is the
- Groups such as Alcoholics or Narcotics Anonymous can help older adults with a substance use disorder by reducing isolation, shame and stigma
- team-based collaborative care models provide an evidence-based and scalable way for health system to implement prevention and personalized care
- telemedicine and integration of peer-support specialists, counsellors, and community health workers bridge the gap created by the lack of MH professionals
Persistent Psychotic Disorders
- includes Schizophrenia and delusional disorders
- While the overall prevalence of older adults affected by such disorders is low (1 – 2%), the individuals affected require significant support
- Predictors of sustained remission include greater social support, being (or having been) married, higher level of cognitive/personality reserve, and early initiation of treatment
- Patients with very chronic illness, severe symptoms including disorganized thinking and behaviour, resistance to treatment, and brain abnormalities are at higher risk of poor prognosis
- the clinical course of schizophrenia is stable
- there is often improvement in psychotic symptoms with age
- more hospitalizations in elders with schizophrenia are due to physical rather ad psychological problems
MH Promotion and Prevention Strategies for Healthy Aging
- Measures to reduce financial insecurity and income inequality
- Programs to ensure safe and accessible housing, public buildings and transport
- Social support for older adults and their carers
- Support for healthy behaviours
- Health and social programs targeted at vulnerable groups
MH Promotion Strategies
1) Prompt Recognition and Treatment
- of MH conditions and neurological and substance use conditions
2) Integrated Care
- that is community-based and focused on long-term care of adults living with MH conditions
3) Mix of mental health interventions
- interventions alongside supports that address health, personal care, and social needs of individuals
4) Positive agin should be promoted
- resilience, wisdom, and prosocial behaviours must be highlighted and promoted
