Introduction
Getting old is difficult enough without the added burden of mental and behavioral challenges. If depression, Alzheimer’s disease and other dementias send caregivers into a tailspin, just think how the sufferers must feel. Emotions for both can run the gamut from sadness and frustration to downright fear.
As an elderly person’s behavior becomes puzzling, strange and out-of-character, caregivers will face some daunting decisions. Armed with knowledge about the diseases and where to go for help can ease the trauma.
There are many illnesses that can cause mental,emotional and behavioral aberrations. Before caregivers jump to any conclusions, a complete health analysis is mandatory.
This offers numerous sites to assit caregivers in locating and accessing programs in North Carolina.
This website explores the transporation needs of elderly.
Another informative article on the mental health crisis of the elderly.
Depression In the Elderly is a Serious Problem
Depression is often not recognized in nursing home residents and goes untreated in 80% of the senior population.
The effects of senior depression may be just as harmful as smoking, obesity, or hypertension.
Senior depression can lead to suicide. Seniors have the highest suicide rates in America.
Recognizing and Treating Depression in the Elderly.
FACTS on Mental Health of the Elderly
Statistics
Between 15-25% of elderly people in the U.S. suffer from significant symptoms of mental illness. 236 elderly people per 100,000 suffer from mental illness While nearly 25% of elderly persons suffer from symptoms of mental illness, many do not seek care. Of the direct costs for treating mental illness, less than 1.5% is spent on behalf of the elderly. The highest suicide rate in America is among those aged 65 and older. Approximately 6,100 elderly in America kill themselves each year. One million elderly people in the U.S. are afflicted by severe organic mental disorders. Two million elderly suffer from moderate organic disorders.
Categories of Mental Illness
Depression
Depression, the most common mental disorder, afflicts about 5% of the elderly. Symptoms include: feelings of worthlessness, hopelessness, helplessness, inappropriate guilt,prolonged sadness or unexplained crying spells, jumpiness or irritability,loss of interest in and withdrawal from formerly enjoyable activities,family, friends, work or sex.intellectual problems such as loss of memory, inability to concentrate, confusion or disorientation thoughts of death or suicide
loss of appetite, or drastic increase in appetite persistent fatigue and lethargy, insomnia or drastic increase in sleep
aches and pains, constipation, or any unexplainable physical problems.
Dementia is characterized by confusion, memory loss, and disorientation. In America, only 15% of elderly people suffer from dementias. Dementia can be caused by: complications of chronic high blood pressure, blood vessel disease or strokes.
Pseudodementias
It is possible that elderly people will become forgetful, disoriented and confused due to a quickly reversible condition that is totally unrelated to dementia.Depression can resemble dementia, while medications or malnutrition could trigger the symptoms of dementia.
Factors that could mimic dementia:
Medications: With the increasing amount of medications being taken by the elderly combined with their slow metabolism, the medications reach toxic levels quickly. The drugs can interact causing confusion, mood changes and other symptoms of dementia.
Malnutrition caused by poor eating habits: Poor eating habits can upset the way the brain functions. Without proper nutrients, pernicious anemia, a blood disorder caused by the inability to use vitamin B, can cause irritability, depression or dementia.
Diseases of the heart or lungs: The brain requires a great deal of oxygen to function properly. When diseased lungs do not draw enough oxygen into the blood, or when a diseased hurt fails to pump enough blood to the brain, the lack of oxygen can affect the brain’s functions.
Diseases of the adrenal, thyroid, pituitary or other glands: These glands regulate emotions, perceptions, memory and thought processes. When they do not function properly, the mental processes are affected.
Alzheimer's Disease
Described in 1907, Alzheimer’s disease is the fourth leading cause of death in America. An adult’s chances of developing the illness are one in 100. The chances of family members of a person suffering from Alzheimer’s increase fourfold. One million elderly people are severely afflicted with Alzheimer’s, while two million are moderately affected.
Alzheimer’s is a slow and gradual disease that begins in the part of the brain which controls the memory. As it spreads to other parts of the brain, it affects a greater number of intellectual, emotional and behavioral abilities.
Symptoms of Alzheimer’s disease begin slowly and progress in stages to include the following:
- loss of recent, short-term memory
- mild personality changes, such as increased apathy, or social withdrawal
- decrease in ability to think abstractly, handle money, work with numbers when paying bills, understand what they read, or organize their day
- irritability, agitation, loss of neatness in appearance
- confusion, disorientation, (for example,, patients often forget the time and date, where they live or recent events)
Ultimately, patients become erratic in mood, uncooperative, incontinent, stop conversing, become unable to care for themselves. As of yet, there is still no known cause of Alzheimer’s disease. Patients with Alzheimer’s have inappropriate levels of the enzyme choline acetyltransferase, which is important in memory loss and disorientation. Until a cause is found, there is still no cure for Alzheimer’s disease.
What about the Future?
It is estimated that the number of mentally ill elderly will grow from 4 million in 1970 to 15 million in 2030; an increase of 275%.
In the year 2011, the first of the post-war "baby boom" generation will reach the age of 65.
By 2030, the number of people aged 65 and older will grow from 20 million to 40 million.
The medical community will not be able to support the growing number of mentally ill elderly in the future. As of now, there are 2425 board-certified geriatric psychiatrists and 200-700 geropsychologists. By 2030, there will be a need for at least 5000 of each specialty.
What Can You Do
If someone you know or love is experiencing these symptoms, do not ignore it.
Seek medical and psychiatric evaluations so that they can receive treatments as soon as possible.
Contact associations that provide organized support groups, educational materials and insurance information for Alzheimer’s sufferers and their families.
SUBSTANCE ABUSE AND THE ELDERLY
Substance dependence and abuse doesn’t have an age limit. Unfortunately, when we think of substance dependence, we might think more of younger people than the elderly. While the vast majority of elderly men and women do not have a problem with substance use, there is a significant number whose use becomes problematic.
This use might be problematic in the sense of the physical consequences of chronic use as is seen with alcohol and some prescribed medications. Or, the problem could rest with case management difficulties. It is difficult to motivate a client to make health management changes when what they have been using is effective and fast. The client is thinking of quick symptom relief and we are considering symptom relief as well as reducing the side effects of treatment. It can be a bit of a juggling act to balance symptom relief with the minimization of negative side effects, including substance dependence or abuse.
Another problem associated with substance use is our attitude towards the problem. Clients who are experiencing substance dependence and/or abuse can be difficult to manage. We might feel that we are caught in a revolving door – periods of improvement and compliance followed by periods of deterioration. It is difficult to keep motivated to work with these clients when they seem so uninterested in the treatment plan. Everyone involved with the client, including the client, can become very discouraged.
Discouragement is frequently part of the emotional context when working with substance dependent clients. This might form part of the general mental health problems experienced by the client. Some clients develop dependency or abuse as part of their ineffective attempt to manage mental health problems. A drink or pill will numb the mental health symptoms. Other clients develop mental health problems because of the substance use. It’s hard to stay mentally stable when one’s life is turning into chaos.
In this cycle, it is difficult to achieve improvement without addressing both the mental health and substance use issues. Unfortunately, there often has been some “buck passing” in the sense that the mental health and addiction specialists would refer to each other, without either dealing with the client. A decision would be made that one problem had to be resolved prior to treatment being initiated for the other. The result would be that a client who was having difficulty organizing their recovery would receive no treatment.
With the exception of those clients whose mental illness would prevent effective interventions until treated, it is likely best to treat both issues at the same time. This might be organized by:
Collaborating with mental health and addictions specialists to organize an effective treatment plan. We don’t need to treat these clients in isolation; there are allied professionals whose expertise is available. Considering harm reduction as a strategy for developing improved compliance. Harm reduction strategies do not mean that we are saying to a client that it is O.K. to continue to use. It does mean that we are recognizing the client’s ambivalence to abstinence and that we can perhaps move them in that direction by accepting where they “are at”. On the other hand, it might not be in the best interest of the client to abstain (e.g. pain management medications) and we need to work at reducing the risk for harm while continuing to treat the condition.Adjusting our attitude so that we are better able to treat the client. Their success or lack of is not a reflection of our abilities. Substance dependence and abuse is a difficult problem to address. The client is not being noncompliant to make your day bad; it is the nature of the beast. Don’t take it personally!
- Submitted by:
Randy Harris, MSW
Community Geriatric Mental Health Services
Calgary Health Region
Chapter 1. The Impact of Substance Use and Abuse by the Elderly: The Next 20 to 30 Years
Samuel P. Korper,* Ph.D., M.P.H.
Ira E. Raskin, Ph.D.
An Introduction to the increasing problem of substance abuse in the elderly population.
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