Week 4: Psychological Aging and Mental Health

Question 1

Mental Health

Answer 1

-Cognitive function: Changes in memory, attention, & processing speed
-Mental disorders: Depression, anxiety, cognitive impairments etc.

Question 2

Well-being

Answer 2

-Coping mechanisms: Strategies used to manage stress & life changes
-Resilience: Ability to adapt positively to adversity or significant life events
-‘Feeling good’ and ability to adapt to life’s changes and stresses

Question 3

Quality of Life

Answer 3

-Life satisfaction: Overall contentment & fulfillment with life experiences
-Purpose and meaning: A sense of contribution & meaningful engagement in daily activities & relationships

Question 4

Social Connections

Answer 4

-Social support: Relationships with family, friends, & communities
-Social isolation: The degree to which an individual lacks a sense of engagement with others

Question 5

Cultural Influences

Answer 5

-Cultural identity: The preservation and influence of one’s cultural background;
-Cultural competence: The ability to interact effectively with people from diverse cultural backgrounds

Question 6

Life Transitions

Answer 6

-Retirement: Adjusting to a new phase of life with changes to one’s routine, responsibilities, and identity
-Bereavement: Coping with loss and the associated grief processes

Question 7

Self-Identity and Autonomy

Answer 7

-Self-esteem: Maintaining a positive self-image and self-worth
-Autonomy: Maintaining independence and control over one’s life decisions

Question 8

Mental Illness

Answer 8

“… characterized by alteration in thinking, mood or behaviour – or any combinations thereof – associated with some significant distress and impaired functioning. Mental illnesses take many forms, including mood disorders, schizophrenia, anxiety disorders, personality disorders, eating disorders and addictions such as substance dependence and gambling”.

Question 9

Mental Illness vs. Mental Health

Answer 9

-Dual continuum model, shows mental health and illness are distinct, but can be connected (someone can have moderate mental health but high mental illness and vice versa)

While mental health refers to a state of mental, emotional well-being, mental illnesses are diagnosed conditions that affect thoughts and behaviours.

Question 10

Mental Health and Aging (stats)

Answer 10

-The prevalence of mental health problems in adults over the age of 65 ranges from 20-30%
-Depression is the most common mental health condition among older adults
-Sub-clinical depression and anxiety raises estimates of mental health issues to 40% for older adults
-Globally, ~25% of deaths from suicide are among people aged 60 or over, and male

Question 11

What Affects Senior’s Mental Health? (4 factors)

Answer 11

Physical Factors:
-exercise
-nutrition
-sleep
-illness

Social Factors:
-personal relationships
-meaningful activity/hobbies

Emotional Factors:
-self esteem
-self-knowledge
-coping skills

Spiritual factors:
-nature and meaning of one’s life
-religious beliefs
-balancing what can and cannot be changed

Question 12

Why are mental illnesses missed?

Answer 12

-In older adults, signs and symptoms often differ from those in younger people
-Older adults are less likely to self-identify problems or reach out for help
-Mental illnesses can accompany or stem from serious physical illnesses and disorders
-Depression can cause dementia, which can mask the depression*
-Environmental, Social, and Cultural factors can affect a person’s signs and symptoms of mental illnesses and willingness to seek treatment
-Caregiver stress and burnout
-There is a gap in diagnosing mental illness and being able to help people

Question 13

Older Adults, Dignity and Mental Illness

Answer 13

Important to consider the social determinants of health for the individual

*all the outside factors compromise the person’s dignity which can affect their willingness to access care and increases risk for developing mental illness

Question 14

Dopamine and Aging

Answer 14

-Reward-motivation system
-Motor control, decision- making and teaching, motivation, pleasure
-Declines with age

Question 15

Serotonin

Answer 15

-Boost when you feel significant and important
-Mood, memory, sleep, cognition
-Declines with age

Question 16

Norepinephrine

Answer 16

-Regulates blood pressure
-Memory formation and retrieval
-Stress and sleep regulation
-Can decrease with age

Question 17

Common Mental Health Disorders in Older Adults (9)

Answer 17

1. Depression *most common
2. Suicide
3. Anxiety Disorders
4. Dementia
5. Loneliness and Isolation
6. Delusional Disorders
7. Delirium
8. Paraphrenia- paranoid delusions
9. Concurrent Disorders- both mental illness and substance abuse disorder

Question 18

Depression and Aging

Answer 18

-Not a “normal” part of aging
-There is a distinct type of depression in late life which may be reactive - such as after long-term care admission
-Late onset depression often has a cognitive component, some memory impairment, which may be related to decreased blood flows or TIAs.
-Depressive symptoms are very similar to dementia, so the person is often labeled as having dementia

Question 19

Symptoms of Depression (8)

Answer 19

1. Sleep- Change in sleep patterns such as daytime napping, being unable to fall asleep, and/or being unable to stay asleep. Feeling fatigued, even with sleep, can also be a factor
2. Interest- Lack of interest or pleasure in life’s daily activities, anhedonia, physical limitations and pain limiting activities that they once enjoyed
3. Guilt- Feeling like a burden, worthlessness, grief and loss, compounding life stressors, changes in roles & responsibilities, and feeling sad without a reason
4. Concentration - Fears about cognitive decline and memory loss, and acute stress. Medical conditions that may occur independent of depression or alongside depression that can contributing to issues with concentration and memory
5. Energy- Changes in energy (i.e., lethargy and fatigue), increase in angry, aggressive, agitated, or irritable energy
6. Appetite- Changes to appetite, unintended weight gain or loss, increased or decreased sense of hunger and satiety, change in normal eating patterns or preferred foods, and/or changes to perceptions about what foods are digestible or cause them digestive problems
7. Psychomotor– Reduced activity, like energy, feeling that they have slowed down, or a sense of restlessness
8. Suicide- Feelings of hopelessness, helplessness, and sadness can lead individuals to consider suicide as a possible option. Thoughts of death and of being better off dead may start or increase. Suicidal thoughts, a history of suicide attempts, having a plan, having a means to carry out that plan, and the lethality of the plan

Question 20

Late-life depression

Answer 20

-A depressive disorder developed at the beginning of old age
-A serious and life-threatening disorder which affects every 1 in 5 individual in a lifetime
-Typically characterized by an atypical cluster of symptoms (i.e., somatic symptoms, anxiety, and psychotic symptoms)
-Less likely to be characterized by sadness
-Underdiagnosed and inadequately treated
-Becomes challenging to distinguish it from dementia (due to overlapping symptom profiles) especially when depression affects the cognition and is presented as ’pseudodementia’

Question 21

Depression in late life factors (5) how can they contribute to complexity of diagnosing, which are most preventable?

Answer 21

1. Poor social networks
2. Altered identity/role
3. Reduced coping abilities
4. Reduced inhibition of negative material
5. Disability

-Medical illness, disability, change of personality, etc. can all influence each other and hide symptoms of depression and other diseases, including Alzheimer’s and dementia, which also can contribute to dementia)
*Overlap of symptoms (dementia, frailty, etc.)
-Older people also may be less inclined to get help and feel guilty or embarrassed, so they don’t get diagnosed
-Family and friends can notice more changes and identify depression (isolation leads to not being diagnosed)
-Important for health care providers to emphasize social support and relationships, and acknowledge the overlap of symptoms when diagnosing

Preventable:
-Loneliness/ isolation and poor social networks I think are the most preventable because you can change that (join community events, organizations, visit friends and family more, live with family or in old age home)

Question 22

Delirium

Answer 22

Delirium is an acute change in mental status causing shift in cognitive functioning, reduced environmental awareness, altered attention, and behaviour changes

Question 23

Types of Delirium (3)

Answer 23

1. Hypoactive – withdrawn, reduced speech and activity, apathy, unawareness *hardest to prevent and diagnose
2. Hyperactivity – increased activity, irritability, restlessness, combativeness
3. Mixed – fluctuations in psychomotor activity

Question 24

Delirium Outcomes Short-Term (7) vs. Long-Term (5)

Answer 24

Short:
1. Falls
2. Pressure injuries
3. Aspiration pneumonia
4. Distress
5. Prolonged hospital stays
6. Long-Term care admission
7. Increased risk of mortality

Long:
1. Functional and cognitive impairment
2. Dementia
3. Post-traumatic stress symptoms
4. Sleep disturbances
5. Increased risk of mortality

Question 25

Risk factors of Delirium (11)

Answer 25

1. Age (>75 years)- Aging is associated with physiological changes, such as alterations in neurotransmitter function and increased vulnerability to stressors contributing to higher susceptibility to delirium for those aged 75 years and older
2. Comorbidity- The presence of multiple medical conditions increases the physiological burden on the body, making it more susceptible to disruptions in cognitive function, thereby heightening the risk of delirium
3. Illness severity- Severe illnesses can trigger systemic inflammatory responses and metabolic imbalances, both of which can contribute to delirium
4. History of delirium- Previous episodes of delirium may indicate an underlying vulnerability or sensitivity to factors that precipitate delirium, making recurrence more likely
5. Dementia- Individuals with dementia have compromised cognitive reserve and are more susceptible to delirium, especially when faced with additional stressors, such as infections (e.g., UTI) or changes in their environment (e.g., noises)
6. Depression- depression may alter neurotransmitter levels and cognitive function, predisposing individuals to delirium during acute medical events or hospitalizations
7. History of transient ischemia or stroke- Vascular events can lead to cerebral damage and increase the risk of delirium, particularly in the presence of cumulative vascular insults
8. Frailty & Functional Impairment- Frail individuals often have reduced physiological reserves, making them more susceptible to the physiological stressors that can trigger delirium. Limited functional abilities may restrict an individual’s capacity to cope with
   stressors, contributing to the development of delirium
9. Unmanaged pain-Inadequate pain control can cause physiological stress and exacerbate delirium in vulnerable individuals
10. Hearing and Visual impairment- Impaired vision may lead to disorientation and difficulties in processing information, potentially increasing the risk of delirium, particularly in unfamiliar environments. Communication challenges due to hearing impairment can lead to confusion and misunderstandings, contributing to the development of delirium.
11. Sleep deprivation- Lack of adequate sleep interferes with cognitive function and increases
    vulnerability to delirium, particularly in hospital settings where disruptions to sleep are common.

*There are ways to reduce risk of delirium in individuals

Question 26

Factors Reducing Risk of Delirium (4)

Answer 26

1. Cognitive reserve: The capacity of the mature adult brain can buffer the effects of neurological disease or injury
2. Social support and interactions: Regular visits from care partners help to reduce the burden of cognitive impairment and provide comfort with frequent reorientation
3. Environmental influences: Exposure to natural daylight can support the promotion of regular circadian rhythms and healthy sleep cycles
4. Pain management: Appropriate and consistent pain assessments should be conducted to ensure pain is adequately controlled and severity is monitored, especially if communication becomes difficult with delirium.

Question 27

Delirium Distress (7 Symptoms)

Answer 27

Fear, anger, frustration, hopelessness, loss of control, embarrassment, guilt.

Question 28

Intersection of Delirium & Mental Health Conditions

Answer 28

-Unfortunately, some of the populations most vulnerable to delirium are older adults who have dementia, depression, and acute psychiatric syndrome
-Each of these syndromes can co-occur with delirium, which makes it hard to diagnose and treat
-When an individual with pre-existing dementia develops delirium, it is called delirium superimposed on dementia

Question 29

Loneliness

Answer 29

-“a state of solitude or being alone”
-“the perception of being alone and isolated that matters most” and is a state of mind
-Typically thought to be a subjective, negative feeling related to the deficient social relations
-Reported to be more dangerous to health than smoking

Question 30

High degree of loneliness consequences (8)

Answer 30

-Suicidal ideation
-Para-suicide
-Alzheimer’s disease
-Dementia
-Negative effects of immune system
-Negative effects of cardio-vascular system
-Increased risk of hospitalization
-Increase risk of long term care facility placement

Question 31

Types of Loneliness (3)

Answer 31

1. Developmental Loneliness- Lack of balance between individualism and
   innate desire to relate to others
2. Internal Loneliness- The perception of being alone. Associated with low self-esteem & worth
   *more prevalent in society
3. Situational Loneliness- Socio-economic and cultural milieu. Effected by the environment.

Question 32

Interventions for Loneliness (5)

Answer 32

1. Activity involvement
2. Volunteer roles
3. Developing and keeping quality relationships
4. Pharmacological management of physical ailments
5. Staying in contact with family and friends

Question 33

Social Isolation

Answer 33

Definition: “a state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts and they are deficient in fulfilling and quality relationships”

-Social isolation is a major and prevalent health problem among community-dwelling older adults, leading to detrimental health conditions
-Prevalence of social isolation in community-dwelling older adults indicate that it as high as 43%

Leads to numerous detrimental health effects in older adults including:
-Increased risk for all-cause mortality
-Dementia
-Increased risk for rehospitalization
-Increased number of falls
-These effects can be avoided through prevention and mitigation efforts if detected early
-Patient care efforts should be focused on assessing and improving physical, mental, AND social well-being.

Question 34

Impacts of Social Isolation (4)

Answer 34

1. Health behavioural- don’t adhere to medical treatment and have risky behaviours/habits, including substance abuse, low exercise, etc.
2. Psychological- increase loneliness, suicide and depression, cognitive decline
3. Physiological- predictor of mortality from heart disease and stroke, decreased infection resistance
4. Other outcomes- all cause mortality, risk off falls, rehospitalization and institutionalization

Question 35

Interventions for Social Isolation

Answer 35

There is no one-size-fits-all approach to addressing social isolation or loneliness. Tailor programs to individual needs, including specific populations and/or degree of loneliness experienced. Fakoya et al., (2020)

Social prescribing programs can enable primary care providers to refer patients to a range of local nonmedical services. Group-based social activities, support groups with educational elements, recreational activities, and training or use of technology were most effective. Paquet et al., (2023)

A patient-centered approach is essential for any effective intervention such as: social facilitation, exercise, psychological therapies, health and social services, animal therapy, befriending, and leisure and skill development. Manjunath et al., (2021).