Week 9-Ageing and Mental Health Flashcards
What really constitutes ‘old age’?
■ Old age begins at 65 (World Health Organisation, 2002).
■ Some argue that chronological age is an arbitrary construct (i.e., where does it come from?)
■ Everyone matures and grows differently (i.e., is not a universal linear process) so why do we assume when ageing progresses and that its chronological?
■ Inconsistent terminology: ‘Old people’ (quite categorical), ‘elderly’/’older people’ (more progressive as it shows ageing and growth),
■ Many stereotypes and prejudices associated with ‘old age’ e.g., smelly, judgey etc.,
What are Two stereotypical images of older people? (BBC News, 2013)
- The lone pensioner, huddled in a chair by the fire trying to keep warm while using as little heating as possible who doesn’t see anyone for days on end.
- The active golf club member, allotment-keeper or busy grandparent.
-There’s a massive gap inbetween these two that we’re not capturing (i.e., may be people who do both, or neither and do their own thing)
True or false: older people are a growing group (WHO)
True (in theory there is disproportionate growth in Europe, Africa, South America etc., where some areas have a lot of old people, and others have a small proportion likely due to economics and healthcare).
True or false: Mental distress doesn’t end with age
True
■ Psychological problems presented by older people in a ‘typical’ UK health district
(Department of Health, 2005). 250,000 people in a typical health district, 45,000 elderly people where 4500-6750 have depression, 2250 have dementia, 900 people have psychosis etc.,
■ Lifetime prevalence of DSM-IV disorders in the National Comorbidity Survey (Kessler et al., 2005). Found anxiety was the most prevalent group but there are age group differences. The most prevalent in all is 30-44 years and least prevalence in 60 years+ (just because the prevalence is lower, doesn’t mean they aren’t at risk and don’t have unique challenges).
■ Prevalence of psychiatric disorders in 4 cohorts of community-dwelling US older adults (adapted from Reynolds et al., 2015). These disorders are prevalent for 85+ meaning attention is needed towards this group. The older we get, the more homogenisation of mental disorders we get (prevalence across disorders is more similar).
■ Prevalence of mental health problems among older adults admitted as an emergency to a UK general hospital (adapted from Goldberg et al., 2012). There is a significant difference between those with cognitive impairment and those without i.e, those with are more likely to develop disorders e.g., delirium
How should we approach ‘old age’?
■ Mental health in later life sits on the intersection of a range of interrelated concepts (Perspectives include: Psychology, Public Health, Gerontology= study of ageing+older people, Sociology, Health Studies)
■ This warrants a multidisciplinary approach to research.
■ Should also reflect the lives, experiences and perspectives of older people themselves.
What did Milne (2020) say about Mental Health?
‘Mental health in later life is complex, multi-factorial and an issue that cuts across time, place, cohort, social categories and individual experiences’
What does Local NHS data (2016/17) show regarding mental health prevalence in mental health?
■ Three older adults a week were newly diagnosed with a mental disorder.
– More than half were older men
– About a third were aged over 75
■ Likely to be many more who have yet to seek help (i.e., these statistics are likely underestimated).
What is a multidimensional lifespan approach regarding mental health in older people?
■ Older people face unique mental health challenges.
■ Changes in the following ‘forces’ can influence mental health and distress:
■ Biological forces
– Health problems can provide clues about underlying mental distress
■ Psychological forces
– Normative changes in psychological factors can mimic mental distress e.g., personality characteristics
■ Sociocultural forces
– Social norms and cultural factors influence behaviours and affect our interpretation of them e.g., how many friends and family who can support you, religion, migrant etc.,
■ Life-cycle factors
– Past experiences can influence behaviour e.g., becoming a carer, witnessing a loved one being diagnosed with a mental or physical health condition, divorce, bereavement, redundancy etc.,
Why are older adults at risk of mental distress? (Age concern and the Mental Health Foundation, 2006)
-The 5 key factors that affect the mental health and wellbeing of older people are:
1. Discrimination
2. Participation in meaningful activities
3. Relationships
4. Physical health
5. Poverty
What is Loneliness and health like in older people?
The Guardian (2014):
-Loneliness is twice as unhealthy as obesity for older people
-Loneliness is associated with more disease and kills more people (but an association)
inc.com (2018), based on Holt-
Lunstad et al., (2010):
-Loneliness is as lethal as smoking 15 cigarettes per day
What is the prevalence with Isolation, loneliness and health in older people?
-Social isolation is physically not having people around whereas loneliness is not having people nearby like family or friends so is the subjective appraisal of their aloneness (the problem is that these two terms are used as interchangeable when they’re not the same thing)
■ Increasing number of older people live alone (McCarthy & Thomas, 2004)
– 11% have < monthly contact with family and friends
– 50% report that TV is their main form of company (Griffin, 2010).
■ 6 – 13% of older people report being ‘often’ or ‘always’ lonely (Campaign to End Loneliness, 2011).
■ Loneliness and isolation increases risk of physical and mental health problems, including cognitive function and dementia (Hakansson et al., 2009).
What is the Lifespan approach
to dementia? (Livingston et al., 2020, in Lancet review)
■ Identified a range of modifiable unique risk factors for dementia in early life, midlife and later life.
■ In early life, less education was the biggest modifiable risk factor down the line.
■ In midlife, sensory impairments, brain damage, alcohol use and obesity changes the brain functioning and structure which can then lead to dementia down the life.
■ In old life, smoking and having diabetes contributed to dementia.
■ Interesting to consider overlap between mental health and dementia risk factors (i.e., how could we kill 2 birds with 1 stone and tackle both the physical and mental aspects for interventions?)
■ Very influential journal
What is the Mrs Go. case study? (Donnellan, 2017)
-She was 72 years old, married to her husband for 42 years and was his primary carer for 7 years where he had dementia, and the second interview point she was bereaved and had lost her husband for 8 months.
“Just down, always crying, my confidence had gone. I didn’t want to do anything, I didn’t do any housework, I didn’t wash up for three or four days, cause I couldn’t be bothered doing it.” (PSYCHOLOGICAL)
“These aches and pains… my blood pressure has always been high, and my friend used to say to me ‘it’s because of all the strain and stress of looking after [husband]’. So I thought right well my blood pressure will go down when he’s gone, but it didn’t, it went sky high.” (BIO/LIFE CYCLE)
How does the case of Mrs Go. raise a number of questions?
– Do these forces always indicate a problem?
– Which of the psychological ‘forces’ are symptoms and which are risk factors?
– How easy is it to assess and treat Mrs Go. for depression in the muddiness of caregiving, bereavement and physical health problems? Where do you begin?
What is Assessment?
■ A formal process of measuring, understanding and predicting behaviour.
– Gathering medical, psychological and sociocultural information
– Clinical interviews, observation, tests and examinations.
■ Does bereavement really have ‘special status’?
■ Kendler et al. (2008)
– Bereavement-related depression is similar to depression related to other stressful life events (i.e., it shouldn’t have special status)
– Questions the validity of the bereavement exclusion criterion
DSM-V.
■ Sikorski et al. (2014)
– Spousal bereavement associated with depressive symptoms but would not reach the threshold for major depressive disorder over time.
– Eliminating bereavement exclusion criterion unlikely to have effect on major depression as i. Prevalence is low, and ii. symptoms (more important) ≥ disorder.
