421 -Mental Health & the Elderly
12 Key Points
Podcast is part of A La Carte Course:
https://allceus.com/member/cart/index/product/id/112/c/
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com
Podcast Host: Counselor Toolbox & Case Management Toolbox
Objectives
β Review 12 key issues that either differ or often go overlooked in people over 65
Psychosocial Adjustment to Aging
β There are multiple psychosocial aspects to aging
β Integrity vs. Despair
β Loss of physical functioning
β Death of friends
β Changes in social relationships
β Frequent mental distress (FMD) may interfere with major life activities, such as eating well, maintaining a household, working, or sustaining personal relationships.
β Older adults with FMD were more likely to engage in behaviors that can contribute to poor health, such as smoking, not getting recommend amounts of exercise, or eating a diet with few fruits and vegetables (11)
Emotional Health
β Mood issues are not a consequence of normal aging
β Depression
β Situational (grief, life transitions)
β Vascular
β Bidirectional association between depression and cardiovascular diseases
β Elderly men have the highest rate of suicide of any age group
β When untreated, depression reduces life expectancy, worsens medical illnesses, enhances health care costs and is the primary cause of suicide among older people
β Both exercise and dietary interventions can promote mental health
β Almost half of older adults who are diagnosed with a major depression also meet the criteria for anxiety
Cognitive Decline
β It is often partly preventable
β Slowing or some loss of other cognitive functions takes place, most notably in:
β Information processing
β Selective attention
β Problem-solving ability
β Prevention and early intervention should focus on
β Encouraging different problem solving tasks (hobbies, puzzles etc.)
β Maintaining physical activity to improve blood flow
β Maintaining a good sleep routine (including addressing bladder issues)
Cognitive Health
β Dementia Risk Factors
β Smoking
β Alcohol use
β Hypertension
β Diabetes
β TBI from falls
β Dementia Interventions
β Physical activity
β Control of blood pressure
β Not smoking
β Social engagement
β Depression prevention/intervention
β Diabetes management
Chronic Health Conditions
β Medications
β Pain
β Increased injury risk
β Parkinsonβs Disease
β Frailty Syndrome is a geriatric syndrome characterized by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve
β Malnutrition
β Lack of Exercise
β Depression
β Horticulture Therapy shows great potential in enhancing mental health, cognitive functioning and physical health in the elderly
Medication
β Age-related physiological changes that can impact drug effects include the following:
β absorption: increasing gastric pH, decreasing absorptive surface
β distribution: decreasing total body water, lean body mass, and serum albumin
β metabolism: decreasing hepatic mass and blood flow
β excretion: decreasing renal blood flow, glomerular filtration rate, and tubular secretion.
β Some of the most common medicines likely to have adverse effects include anticoagulants, antibiotics, diuretics, hypoglycemic agents, benzodiazepines, opioids, NSAIDs
Sexuality
β Hormonal changes and other physiological changes associated with aging affect sexual interest.
β Erectile dysfunction is a problem in men increasing with age.
β Diabetes, cardiovascular, cancerous, and chronic respiratory diseases and also some medications can reduce sexual capacity and desire
β The most common causes for male erectile dysfunction are vascular diseases.
β Age is not a barrier to sexually transmitted diseases.
β In women lack of emotional wellbeing and a sense of intimacy during sexual intercourse can lead to reduced sexual interest
Malnutrition
β The causes of malnutrition can stem from other health problems
β Seniors suffering from dementia may forget to eat
β Depression
β Alcoholism
β Dietary restrictions
β Reduced social contact
β Limited income
β Reduced mobility
β Dental problems
Sleep
β Sleep needs do not decrease with age.
β Short and long sleep duration groups had increased prevalence of mental health issues by 66% and 26%
β Poor quality insufficient sleep is associated with poorer physical function and cardiovascular issues
β With ageing less slow wave sleep (deep sleep) is expected, along with more awakenings, and a tendency toward earlier sleep times.
Sleep
β Causes of Sleep Problems
β Bladder control
β Neurological conditions
β Lung diseases (asthma, COPD)
β Chronic pain
β Sleep apnea
β Anemia
β GERD
β Rapid eye movement sleep behavior disorder often represents the earliest sign of a Lewy Body Dementia.
β In REM-SBD people act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep.
Social
β Social support serves major functions, including
β Emotional support
β Informational support (e.g. advice and guidance)
β Instrumental support (e.g. providing rides or assisting with housekeeping)
β Adequate social support is associated with reduced risk of mental illness, physical illness, and mortality
β Retirement Blues
Social
β Technology based interventions to reduce social isolation had a moderate, but short-term impact on reducing isolation.
β Social support interventions should focus on
β Connecting to the outside world
β Gaining social support
β Engaging in meaningful activities
β Boosting self-confidence
Life Satisfaction
β Life satisfaction is the self-evaluation of oneβs life as a whole, and is influenced by socioeconomic, health, and environmental factors
β Life dissatisfaction is associated with obesity and risky health behaviors such as smoking, physical inactivity, and heavy drinking (all which increase risk of dementia)
Cultural Differences Impacting Treatment
β Different conceptualization of the problem
β Different idea of appropriate interventions
β Suspiciousness of strangers or βwhite coat syndromeβ
β Different expressions of distress
β Limited resources
Treatment Principles
β Therapeutic interventions to encourage autonomy include
β Daily living skills
β Improving safety at home
β Provision of practical support and information including social and legal rights.
Summary
β Older people with mental illnesses (particularly depression or dementia) may take longer to respond to treatment
β Interactions between medication and comorbid physical illnesses (and their treatment) are also common.
β It is important to address coexistent physical and mental health issues
β Social engagement, physical activity, control of diabetes and hypertension, prevention of depression and developing a sense of life satisfaction are all associated with positive health outcomes and reduced risk of depression and dementia