MENTAL HEALTH
ISSUES IN LATER
LIFE
Common Mental Health Disorders
Mental Illness in Later
Life
• Can cause problems with thoughts,
feelings, and behavior
• Causes needless physical and emotional
suffering
• Can be treated effectively when
diagnosed
• Is everyone’ s responsibility
http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
Who is at risk?
• Elderly community members who:
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Live alone
Are economically disadvantages
Have no relatives or friends nearby
Have experienced recent losses
Have been ill or have a progressive or chronic
illness
• Have experienced a head injury causing loss of
consciousness
http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What should I look for?
Physical Appearance
1.
2.
3.
4.
5.
Dirty clothing or skin
Body odor
Uncombed or dirty hair
Unshaven
Inappropriate clothing for the
weather/situation
6. Underclothing worn over outer clothes
http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What should I look for?
Emotional State
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Anxious, nervous, fidgety
Lack trust, suspiciousness, blaming
Angry, hostile, irritable
Rapid mood changes
Statements such as “no one cares,” or “I’m all
alone”
http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What should I look for?
Personality Change
The person’s usual character or personality may
seem different than earlier years…
a.
b.
c.
d.
Decreased social contacts
Sloppy appearance
Lack of eye contact or excessive staring
Excessive orderliness (to cover memory loss) or
preoccupation with health
http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What should I look for?
Living Conditions
1.
2.
3.
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6.
Walks not shoveled, lawn not mowed
Neglect of pets or farm animals
Little or no food
Old newspapers or dirty dishes lying around
Calendar on wrong month
Shades drawn, garden/flowers neglected
http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What can I do?
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Express sincere concern
Demonstrate kindness
Listen; be supportive and gentle
Use calm tone of voice and manner
Exhibit a non-judgmental attitude
Refer the person for help or contact a family
member
http://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
Common Mental
Health Disorders
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Depression
Anxiety
Substance Abuse
Co-occurring Disorders
Dementia
Delirium
Suicide
Depression
Definition: A psychiatric disorder characterized by
an inability to concentrate, insomnia, loss of
appetite, feelings of extreme sadness, guilt,
helplessness and hopelessness, and thoughts
of death. Also called clinical depression
(www.answers.com)
Prevalence: 3.8% of people over the age of 55
residing independently in the community suffer
from major depression in any given year
(www.surgeongeneral.gov)
Symptoms of
Depression
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Difficulty falling asleep
Sleep more than usual
Feel tired all of the time
Feel less energetic than
usual
• Feel nervous or unable to
sit still
• Experience an increase
or decrease in appetite or
weight
• Feel sad or blue most of
the day nearly every day
• Have trouble making
decisions
• Think about suicide
• Have problems
concentrating
• Be irritable
• Lack motivation
• Lose his or her temper
more easily than usual
• Lose interest in things
that he or she used to
enjoy
Risk Factors for
Depression
• Personal history of :
 Chronic medical
illnesses,
 Chronic pain
 Loss of physical
functioning
 Prior depressive
disorders
 Recent significant loss
 Multiple recent
stressors
• Social isolation
• Family history of:
 Recurrent depression
 Bipolar disorder
 Alcohol abuse or
dependence
(www.positiveaging)
Anxiety Disorder
Definition: A psychiatric disorder involving
the presence of anxiety that is so intense
or so frequently present that it causes
difficulty or distress for the individual
(www.answers.com)
Prevalence: 11.4% of the population over
the age of 55 suffers from an anxiety
disorder in any given year
(U.S. Department of Health and Human Services)
Symptoms of Anxiety
– Excess or undue worry or
fear
– Fatigue
– Disturbed sleep
– Jumpiness, jitteriness,
trembling
– Muscle aches, tension
– Dizziness,
lightheadedness
– Gastrointestinal upset
– Dry mouth, sensation of a
lump in the throat, choking
sensation Clammy hands,
sweating
– Racing heartbeat, chest
discomfort
– Shortness of breath, or the
feeling of being smothered
– Numbness or tingling of
hands, mouth, or feet
Risk Factors for
Anxiety
– Personal history of:
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Depression
Anxiety disorder
Chronic medical illness,
Loss of significant
person during
childhood
• Cognitive impairment
• Alcohol
abuse/dependence
• Social isolation
– Family history of:
• Alcohol abuse
• Anxiety disorders
• Mood disorders
– Other factors:
• Female gender
• Exposure to traumatic
event
(www.positiveaging)
Substance Abuse
Definition: Chronic or habitual use of any chemical
substance to alter states of body or mind for
other than medically warranted purposes.
(www.answers.com)
Substances that are abused:
Alcohol
Nicotine
Narcotics
Benzodiazepine
Alcohol Abuse
Definition: A disorder characterized by the
excessive consumption of and dependence on
alcoholic beverages, leading to physical and
psychological harm and impaired social and
vocational functioning
(www.answers.com)
Prevalence: The prevalence of heavy drinking (12
to 21 drinks per week) in older adults is
estimated at 3 to 9 percent
(Liberto et al., 1992)
Symptoms of Alcohol
Abuse
• Increased consumption
and frequency of
consumption of alcohol
• Increased tolerance to
the effects of alcohol
• Confusion, disorientation,
blurred vision
• Gastrointestinal problems
(nausea, vomiting)
• Insomnia, unusual
drowsiness
• Lack of physical
coordination
• Malnutrition
• Slurred speech
• Urinary problems
(incontinence, retention)
• Withdrawal symptoms
(e.g., nausea, headache,
anxiety, depression,
sleeplessness) when one
drinks less than usual
Risk Factors for
Alcohol Abuse
– Having a mental health disorder; half of all
individuals with severe mental health
problems are also substance abusers
– Having an alcoholic parent
Benzodiazepine Abuse
Definition: a type of medication known as tranquilizers.
Familiar names include Valium and Xanax. They are
some of the most commonly prescribed medications in
the United States. When people without prescriptions
take these drugs for their sedating effects, use turns into
abuse
(www.emedicinehealth.com/benzodiazepine)
Prevalence: Older adults represent only 14% of the
U.S. population, yet they receive 27% of all
prescriptions for anxiolytic benzodiazepines and 38% of
hypnotic benzodiazepines
(www.positiveaging.org)
Benzodiazepine Abuse
• Symptoms of abuse
– Excessive daytime
sedation
– Ataxia (loss of the ability to
coordinate muscular
movement)
– Problems with attention
and memory
– Anxiety, agitation
– Impaired psychomotor
abilities
– Drug-related delirium or
dementia
• Risk factors for abuse
– Medical hospitalization is a
significant risk factor for
initiation and continuation
of benzodiazepines
(positiveaging.org)
Co-occurring Disorders
Definition: Dual diagnosis is a term that refers to patients
who have both a mental health disorder and substance
use disorder. It may be used interchangeably with "cooccurring disorders" or "comorbidity."
Prevalence: According to the U.S. Substance Abuse and
Mental Health Services Administration (SAMHSA), an
estimated 10 million people in the United States will
have a combination of at least one mental health and
one substance abuse disorder in any twelve-month
period
(www. minddisorders.com/Del-Fi/Dual-diagnosis.html)
Risk Factors of Cooccurring Disorders
• Having a mental health disorder; half of all
individuals with severe mental health
problems are also substance abusers
• Having a parent who was a substance
abuser and/or a parent who suffered from
a mood disorder
Dementia
Definition: Dementia is the term used to
refer to over 100 different illnesses that
lead to cognitive impairment
Prevalence: Dementia affects between 5
and 7 percent of adults over age 65 and
40 percent of those over age 85
(American Psychological Association, 1998)
Symptoms of Dementia
Marked loss of memory for
recent events
Losing items
Getting lost in ‘familiar’
places
Missing appointments
Loss of ability for abstract
thought; planning and
doing complex tasks
Trouble cooking, paying
bills, driving
Can’t understand books,
movies, or news items
Difficulty finding common
words and names
Substitution of
approximate phrases
Misidentifying people
Use of ‘empty phrases’
Difficulty inhibiting behavior
Impulsivity
‘Thoughtless’ comments
Socially inappropriate
behaviors
Risk Factors for
Dementia
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Age
Vascular disease
Diabetes mellitus
Female gender
Sedentary lifestyle
Low education level
Race/Ethnicity
• Increased risk among
African Americans and
Latinos, even when
controlled for
educational level
– HIV-positive status,
especially with comorbid hepatitis C
– History of:
• Cardiovascular
accident
• Alcohol abuse
• Head trauma
(www.positiveaging)
Delirium
Definition: Delirium is a condition of severe
confusion and rapid changes in brain function. It
is usually caused by a treatable physical or
mental illness
(www.healthscout.com)
Prevalence: 30% of older persons during medical
hospitalization and in 10 to 50% of older adults
during surgical hospitalization. Also, up to 60%
of residents in nursing homes may have
delirium
(www.positiveaging.org)
Symptoms of Delirium
• Altered awareness,
disorientation, clouding of
consciousness
• Impaired attention,
concentration, and
memory
• Inability to process visual
and auditory stimuli
• Increased motor activity
(e.g., restlessness,
plucking, picking)
• Anxiety, suspicion, and
agitation
• Misinterpretation,
illusions, delusions, or
hallucinations
• Speech abnormalities
• Reduced wakefulness;
sleep disturbance
(www.positiveaging.org)
Risk Factors for
Delirium
• Drug-drug or alcohol-drug interactions
• Benzodiazepine use prior to hospitalization
• Toxic effects of (or withdrawal from) alcohol;
elicit drugs; prescribed or over-the-counter
drugs (particularly psychoactive drugs,
including benzodiazepines)
(www.positiveaging)
Suicide
Occurrence
• Suicide took the lives of 30,622 people in 2001 (CDC
2004).
• Suicide rates are generally higher than the national
average in the western states and lower in the eastern
and midwestern states (CDC 1997).
• In 2002, 132,353 individuals were hospitalized following
suicide attempts; 116,639 were treated in emergency
departments and released (CDC 2004).
• In 2001, 55% of suicides were committed with a firearm
(Anderson and Smith 2003).
(www.cdc.gov/ncipc/factsheets/suifacts.htm)
Groups At Risk
Males
• Suicide is the eighth leading cause of death for all U.S.
men (Anderson and Smith 2003).
• Males are four times more likely to die from suicide than
females (CDC 2004).
• Of the 24,672 suicide deaths reported among men in
2001, 60% involved the use of a firearm (Anderson and
Smith 2003).
Females
• Women report attempting suicide during their lifetime
about three times as often as men (Krug et al. 2002).
Groups At Risk
• The Elderly
Suicide rates increase with age and are very high among those 65
years and older. Most elderly suicide victims are seen by their
primary care provider a few weeks prior to their suicide attempt and
diagnosed with their first episode of mild to moderate depression
(DHHS 1999). Older adults who are suicidal are also more likely to
be suffering from physical illnesses and be divorced or widowed
(DHHS 1999; Carney et al. 1994; Dorpat et al. 1968).
• In 2001, 5,393 Americans over age 65 committed suicide. Of those,
85% (n=4,589) were men and 15% (n=804) were women (CDC
2004).
• Firearms were used in 73% of suicides committed by adults over
the age of 65 in 2001 (CDC 2004).
Groups At Risk
• Suicide rates are highest among
Whites and second highest among
American Indian and Native Alaskan
men (CDC 2004).
Source for suicide information:
http://www.cdc.gov/ncipc/factsheets/suifacts.htm
Risk Factors
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Previous suicide attempt(s)
History of mental disorders, particularly depression
History of alcohol and substance abuse
Family history of suicide
Family history of child maltreatment
Feelings of hopelessness
Impulsive or aggressive tendencies
Barriers to accessing mental health treatment
Loss (relational, social, work, or financial)
Physical illness
Easy access to lethal methods
Unwillingness to seek help because of the stigma attached to mental health and
substance abuse disorders or suicidal thoughts
Cultural and religious beliefs—for instance, the belief that suicide is a noble
resolution of a personal dilemma
Local epidemics of suicide
Isolation, a feeling of being cut off from other people
Protective Factors
• Effective clinical care for mental, physical, and
substance abuse disorders
• Easy access to a variety of clinical interventions
and support for help seeking
• Family and community support
• Support from ongoing medical and mental
health care relationships
• Skills in problem solving, conflict resolution, and
nonviolent handling of disputes
• Cultural and religious beliefs that discourage
suicide and support self-preservation instincts
MENTAL HEALTH
ISSUES IN LATER
LIFE
Diagnostic and Treatment Issues
Seeking Treatment
• Social stigma associated with mental
health problems prevent many people,
especially the elderly, from seeking
professional help
• For many people the initial entry point for
assessment of mental health concerns is
their primary physician or general
practitioner
Barriers to Detection
and Treatment
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Age-related changes
Illness
Attitudes of others
Denial
Alcohol or drug use
Health complaints
Stigma
Sharing Your Concerns
• Avoid talking to the person if they are
upset or under the influence
• Be gentle and kind
• Avoid a confrontational style
• Avoid using labels since they may carry a
heavy stigma
• Take into consideration the person’s age
and ability to understand
Sharing Your Concerns
• Be consistent and patient in your
expression of concern without exerting
undue pressure
• Be direct; treat the individual as an adult
• Give specific examples of behaviors that
concern you
• Use I statements as in “I am concerned
about you”
Sharing Your Concerns
• Be prepared with referral information
• Don’t be discouraged if the person is not
ready to accept your assistance
• Don’t worry if you don’t say things
perfectly, what is important is that your
message of concern is conveyed and your
willingness to help is expressed