Let’s Talk about Healthy
Aging and Caregiving
Kathryn Johnson, Ph.D. ATR, GMHS
November 2014
Mental Health
and Older Adults
 It is estimated that 20% of people age 55 years or older
experience some type of mental health concern.
 These include anxiety, severe cognitive impairment, and
mood disorders
 Older men have the highest suicide rate of any age
group. Men aged 85 years or older have a suicide rate of
45.23 per 100,000, compared to an overall rate of 11.01
per 100,000 for all ages.
CDC 2008
What is the THIRD AGE?
 FIRST AGE – childhood and adolescence
 SECOND AGE – time of childrearing and midlife
careers
 THIRD AGE – concept that began in Europe
and spread to the US. It is considered the
“age of usefulness.” Retired individuals are
ready and willing to use their expertise to help
their communities.
 FOURTH AGE – Physical decline and need for care
Third Age
 Growing population (baby boomers)
 Healthier and financially better off than preceding
generations
 View “old age” as beginning later, around age 80
 People are living longer so this time of life is more important
 Time of self-realization and high life satisfaction
 Fewer identify as “retired” rather they see themselves as
leaving career jobs to work at different jobs and devoting
themselves to community service
Erik Erikson
Life-span approach to development
 We don’t just develop as children and young adults
 The social environment combined with biological
maturation provides a set of “crises” that must be
resolved at each stage of development.
Erikson’s
th
8
Stage
Ego Integrity vs. Despair
 Individuals ideally develop a sense of acceptance of life
as it was lived and the importance of the people and
relationships that individual developed
 Ages 55+
 Basic strength: Wisdom
Ego Integrity
 EGO INTEGRITY is the successful outcome of this
stage
 Feeling of wholeness and completeness
 Satisfaction with achievements.
 Successfully adapted to triumphs and disappointments
Despair
 DESPAIR is the negative outcome of this stage
 The feeling that one has made many wrong decisions, yet
time is too short to find an alternate route to integrity.
 Death is hard to accept
 Overwhelmed with feelings of hopelessness, bitterness
and defeat
 May present as angry, argumentative, fault-finding
Depression during the
“Golden Years”
 The “Golden Years” are not always golden
 Grief – losing family, friends, loved ones
 Physical decline
 Disappointments – Reality ≠ expectations
 Depression is NOT a part of normal aging
Symptoms of Major Depression
 At least 5 symptoms for at least 2 weeks
Symptoms not due to substances or a medical condition & cause
impairment in function
①
②
③
④
⑤
⑥
⑦
⑧
⑨
Depressed mood most of the day, nearly every day
Diminished interest or pleasure in all, or almost all, activities
Significant change in weight or appetite (either  or )
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt
Trouble thinking, concentrating, or indecisiveness
Recurrent thoughts of death or recurrent suicidal ideation
Depression in Elders
 May manifest differently than in younger adults
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 memory problems or confusion
Social withdrawal
 appetite and weight loss
Vague complaints of pain
Sleep problems
Irritability or demanding behavior
Delusions/hallucinations
Moving slowly
 Help-seeking behavior
Onset of depression
 Elders often develop depression following major
medical illnesses or procedures such as:
 Heart attack
 Stroke
 Hip fracture
 Macular degeneration
 Procedures such as bypass surgery
5 tips for dealing with
difficult aging parents
① You have to put yourself first sometimes
② Know your limitations
③ Forget looking for praise, appreciation or recognition
when a parent has dementia
④ Love yourself for trying
⑤ Take breaks
Handling the stress
of aging parents
① Share the workload
② Make a plan
③ Join a support group
④ Take care of yourself
⑤ Know what you can and cannot change
What is Dementia?
 Dementia is not a specific disease
 Dementia is a general term for a decline in mental
ability severe enough to interfere with daily life.
 It is more than the decline that is expected with normal
aging
Types of Dementia
 Alzheimer’s Disease (most common ~ 60-80%)
 deposits of the protein fragment beta-amyloid (plaques) and twisted
strands of the protein tau (tangles) develop in the brain
 Vascular Dementia
 Also knows as multi-infarct or post-stroke dementia
 Lewy Body Dementia
 Lewy bodies are abnormal clumps of a protein (alpha-synuclein) that can
develop in the cortex.
 Other causes of Dementia include: Fronto-temporal dementia,
Parkinson’s disease, Huntington’s disease, Wernicke-Korsakoff
Syndrome, normal pressure hydrocephalus, etc.
Types of Dementia
 It is now believed that the majority of individuals with
dementia have MIXED DEMENTIA due to 2 or more
causes.
 A mix of Alzheimer’s disease and Vascular dementia is
most common
Dementia
 Diagnosis (medical tests, imaging, etc.)
 Treatment (medications, exercises, etc.)
 Questions?
What is Normal?
As we age, we can expect certain changes
 It may be difficult to remember recent events or details as well or
as quickly
 It make take a bit longer to do things
 Intellect is not lost!
 New learning is possible, though it may be slower
 Beginning in our 30s, our brain’s weight, the network of nerves,
and its blood flow begin to decrease 
 Our brains continue to adapt and grow new patterns of nerve
endings throughout the lifespan

What can I do?
 What is good for your body is good for your brain!
 Stay physically and mentally active
 Try new things
 Exercise
 Manage your blood pressure, cholesterol, etc
 Eat well and keep hydrated – there are modified guidelines
for older adults
 http://www.nutrition.tufts.edu/research/myplate-older-adults
Resources
 Model for caregiving

www.sharethecare.org
 Mental Fitness Resources
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Alzheimer’s Association, Maintain Your Brain:
www.alz.org/maintainyourbrain/overview.asp
AARP Games and Puzzles: www.aarp.org/fun/puzzles
Memory Fitness Institute: www.memoryfitnessinstitute.org/default.asp
 Stress Reduction
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Discovery Health Channel, Stress Management Center:
health.discovery.com/centers/stress/stress.html
AARP, Managing Stress: www.aarp.org/health/staying_healthy/stress
American Heart Association, Managing Stress:
www.americanheart.org/presenter.jhtml?identifier=360
American Federation for Aging Research, Infoaging.org: www.infoaging.org/l-stresshome.html
 Referrals and Information

Senior Services of King County www.seniorservices.org
 Dementia information & Support

Alzheimer’s Association (Western WA) http://www.alz.org/alzwa/