Psychosocial Issues in Aging Flashcards
What % of the population is >65 today, what will it increase to in the next 25 years
- today: 13%
- in 25 years: 20%
List 8 prevalent psychosocial issues in older adults
- dementia
- anxiety disorders
- Suicide
- Sleep problems
- Hypochondriasis
- Substance/alcohol abuse
- Depression
- Behavioral disorders
Dementia
often accompanied by emotional disturbances, anxiety, paranoia, etc.
Anxiety disorders
- prevalence in geriatrics
- which type MC
- 6% older adults
- GAD usually (lots of life changes, retirement, etc.)
Suicide rate is highest in what population
older, white males
Substance dependence/alcohol abuse
- usually in form of rx medications
- 2-4% people >65
- 25% of Rx written for older adults in US
Depression
Often manifests as physical sx, easy to overlook
Behavioral disorders
- physical aggression, wandering, verbal outbursts
- can be from delirium, dementia, depression, or psychosis
List four psychological and social adjustments often have to be made
- Grief and loss
- “living losses”
- Other losses
- Work roll loss
What are living losses
- person is still here but everyone else has died
- lost place in community (retired, etc.)
What are examples of “other” losses
- loss of identity
- loss of lifestyle (have to diminish bc of income)
- loss of independence
Explain work role loss
- when loss work role, impact can be phenomenal if don’t have something to replace it
- important to prepare for the transition!!
Common feelings related to losses
- Sorrow, anger, loneliness, confusion, despair
- Society’s devaluation of older adults can be very devaluing…
- Feel like everyone views them as “stuck in the past”
Response to physical and functional changes
- can result in limitations that negatively affect quality of life and can contribute to increased health care costs (even if insured!)
- might have to chose between CT scan or new dentures
What is an important predictor of how someone will respond to physical and functional change?
a lot will depend on their personality, how they have reacted to stressors in the past
List 4 common changes in role/social relationship that occurs in older age
- Parenting parents
- Loss of work role
- Bereavement dt loss of spouse or other family member
- New duties and skills needed after loss of spouse (worse if gender roles were rigid)
Bereavement stats
- 800k widows ea year
- grief process is individual, can be associated with anxiety, depression, sleep issues, eating problems, crying, etc.
- Fam members ca be at diff stages of grief which can lead to family discord
At what point should depression be further evaluated after the loss of a spouse or family member?
If dx sx are still prevalent after 2 months might consider adjustment disorder vs. grief
Dealing with multiple losses
- Bereavement overload: if not enough time between losses to “recover”
- Personal losses
- Social losses
- Economic losses
- Emotional crisis of multiple losses
Example of social losses
- live in a new residence, assisted living, new city
- lose ability to drive, can’t visit friends
Emotional crisis dt multiple losses
- Can result in mental confusion, disorientation, withdrawal (be alert for this)
- Sense that everything that was meaningful has been taken away
- Can lead to suicidal thoughts
Grief characteristics of older adults vs. younger adults
- Identify with the dead person vs. feel guilt
- Replace emotional grief with somatic complaints - often wont’ talk about grief but have GI upset, multiple migraine headaches, etc.
- Might have a glorified image of the person who died…
- Might want to self isolate, might feel hostile to the rest of the world.
Factors that influence an older person’s ability to cope with a life stressor
- Age
- Number of losses in a time period
- Past experience with loss: If you’ve gotten through it once, can do it again
- Previous ways of coping of issues at different life stages
- Having and using a support system
- Having a sense of control over some of the factors relevant to the loss
- A positive relationship with the deceased person
- The person’s state of health
- Belief in a power greater than one’s self
Life changes that increase risk of depression
- Moving to new level of care
- Chronic pain or illness
- Children move away
- People close to you die
- Loss of independence
Common sx of depression in elderly
- Fatigue
- Appetite loss
- Trouble sleeping
- These are also part of physical illness and/or the aging process, can be easily overlooked
Physical illnesses related to depression
- Thyroid disorders
- Parkinson’s
- Heart disease
- Cancer
- Stroke
- Dementia
- Overuse of alcohol and other substances
Successful coping with aging depends on 6 things:
- Long-term lifestyle
- Ability to expect and plan for change
- The strength of relationships with others
- Willingness to stay interested in and involved with life.
- Talking about what will happen as you age and how you will deal with those changes will help adapt to the aging process.
- Helping patients cope with aging process will help with their sense of wellbeing!
Ways to help patients cope with the aging process
- Help them accept reality. If they need hearing aids, get them!
- Keep a positive attitude and encourage pt to continue to set goals and work toward those goals (never too old to achieve goals)
- See PCP regularly
- Make all medications known to all providers you see
- Get regular exercise, well-balanced diet (less fatty food)
- Remain socially active to prevent isolation!
