421 -Mental Health & the Elderly
12 Key Points

Podcast is part of A La Carte Course:

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs.com
Podcast Host: Counselor Toolbox & Case Management Toolbox
– Review 12 key issues that either differ or often go overlooked in people over 65
Psychosocial Adjustment to Aging
– There are multiple psychosocial aspects to aging
– Integrity vs. Despair
– Loss of physical functioning
– Death of friends
– Changes in social relationships
– Frequent mental distress (FMD) may interfere with major life activities, such as eating well, maintaining a household, working, or sustaining personal relationships.
– 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
– Mood issues are not a consequence of normal aging
– Depression
– Situational (grief, life transitions)
– Vascular
– Bidirectional association between depression and cardiovascular diseases
– Elderly men have the highest rate of suicide of any age group
– When untreated, depression reduces life expectancy, worsens medical illnesses, enhances health care costs and is the primary cause of suicide among older people
– Both exercise and dietary interventions can promote mental health
– Almost half of older adults who are diagnosed with a major depression also meet the criteria for anxiety

Cognitive Decline
– It is often partly preventable
– Slowing or some loss of other cognitive functions takes place, most notably in:
– Information processing
– Selective attention
– Problem-solving ability
– Prevention and early intervention should focus on
– Encouraging different problem solving tasks (hobbies, puzzles etc.)
– Maintaining physical activity to improve blood flow
– Maintaining a good sleep routine (including addressing bladder issues)
Cognitive Health
– Dementia Risk Factors
– Smoking
– Alcohol use
– Hypertension
– Diabetes
– TBI from falls
– Dementia Interventions
– Physical activity
– Control of blood pressure
– Not smoking
– Social engagement
– Depression prevention/intervention
– Diabetes management
Chronic Health Conditions
– Medications
– Pain
– Increased injury risk
– Parkinson’s Disease
– 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
– Malnutrition
– Lack of Exercise
– Depression
– Horticulture Therapy shows great potential in enhancing mental health, cognitive functioning and physical health in the elderly

– Age-related physiological changes that can impact drug effects include the following:
– absorption: increasing gastric pH, decreasing absorptive surface
– distribution: decreasing total body water, lean body mass, and serum albumin
– metabolism: decreasing hepatic mass and blood flow
– excretion: decreasing renal blood flow, glomerular filtration rate, and tubular secretion.
– Some of the most common medicines likely to have adverse effects include anticoagulants, antibiotics, diuretics, hypoglycemic agents, benzodiazepines, opioids, NSAIDs

– Hormonal changes and other physiological changes associated with aging affect sexual interest.
– Erectile dysfunction is a problem in men increasing with age.
– Diabetes, cardiovascular, cancerous, and chronic respiratory diseases and also some medications can reduce sexual capacity and desire
– The most common causes for male erectile dysfunction are vascular diseases.
– Age is not a barrier to sexually transmitted diseases.
– In women lack of emotional wellbeing and a sense of intimacy during sexual intercourse can lead to reduced sexual interest
– The causes of malnutrition can stem from other health problems
– Seniors suffering from dementia may forget to eat
– Depression
– Alcoholism
– Dietary restrictions
– Reduced social contact
– Limited income
– Reduced mobility
– Dental problems
– Sleep needs do not decrease with age.
– Short and long sleep duration groups had increased prevalence of mental health issues by 66% and 26%
– Poor quality insufficient sleep is associated with poorer physical function and cardiovascular issues
– With ageing less slow wave sleep (deep sleep) is expected, along with more awakenings, and a tendency toward earlier sleep times.

– Causes of Sleep Problems
– Bladder control
– Neurological conditions
– Lung diseases (asthma, COPD)
– Chronic pain
– Sleep apnea
– Anemia
– Rapid eye movement sleep behavior disorder often represents the earliest sign of a Lewy Body Dementia.
– 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 support serves major functions, including
– Emotional support
– Informational support (e.g. advice and guidance)
– Instrumental support (e.g. providing rides or assisting with housekeeping)
– Adequate social support is associated with reduced risk of mental illness, physical illness, and mortality
– Retirement Blues
– Technology based interventions to reduce social isolation had a moderate, but short-term impact on reducing isolation.
– Social support interventions should focus on
– Connecting to the outside world
– Gaining social support
– Engaging in meaningful activities
– Boosting self-confidence
Life Satisfaction
– Life satisfaction is the self-evaluation of one’s life as a whole, and is influenced by socioeconomic, health, and environmental factors
– 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
– Different conceptualization of the problem
– Different idea of appropriate interventions
– Suspiciousness of strangers or “white coat syndrome”
– Different expressions of distress
– Limited resources

Treatment Principles

– Therapeutic interventions to encourage autonomy include
– Daily living skills
– Improving safety at home
– Provision of practical support and information including social and legal rights.
– Older people with mental illnesses (particularly depression or dementia) may take longer to respond to treatment
– Interactions between medication and comorbid physical illnesses (and their treatment) are also common.
– It is important to address coexistent physical and mental health issues
– 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