MENTAL HEALTH ISSUES IN LATER

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Overview

The Aging Population

• Nationally adults, 65 and older, comprise approximately 13% of our population

• By 2030, older adults will account for 20% of the nation’s people

• The fastest growing segment will be the 85 and older, those who often need the greatest amount of services, including mental health services

Mental Health Disorders among Older Adults• Estimated that one-quarter of

today’s older adults experience some mental health disorder, including dementia

– (Dept. of Human Services, p. 3).

• “It is estimated that by 2030, more than 15 million older adults will suffer a mental illness”

– (U.S. Department of Health and Human Services, p.10).

Differences by Gender

• Women live an average of seven years longer than men, making them more vulnerable to disabilities and chronic illnesses

• Females are more likely to provide care to others, yet as they age their need for care will increase

What Does This Mean?

• It is unlikely that mental health services will increase at a rate that will meet future needs

• It is unlikely that the stigma of mental illness will decrease in the future

Mental Health and Aging• Most older adults have good

mental health

• Older adults experience an increased frequency of life events that are losses rather than gains

• Poor physical health is a key risk factor for mental disorders

– (AoA Report, 2001, p. 23.)

Losses for Older Adults

• Death of a family member or friend

• Retirement• Failing Health• Relocation from their home

Changes of Normal Aging• Cognitive changes

– For the disease-free older adult, the greater issue is often delayed ability to retrieve information

• Physical changes

Taste Smell Touch Vision Hearing

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Family & Community Involvement

Family Support

• Family members are often the first line of support for elders

• Family members have long-term connections with older relatives

• When the quality of the relationship is strong, a family member may find it easier to discuss mental health issues with an elder

• If family is not present, community members may face these same issues

Barriers to Supporting an Elder with Mental Health Needs• Health and mental health concerns of

their own• Think mental health problems are

normal part of aging• Distance away; don’t notice changes

– older persons says he/she is “fine”

• History of difficult relationship– prevents discussion of concerns feelings

• Family doesn’t know where to turn for help

Building Relationships

• Skills to deal with difficult times• Capacity to make important

decisions• Support each other

Communication

• Family patterns develop over time

• Positive or negative• Negative

– Sarcasm, put downs, criticism

Good Communication

• Listen• Clearly understand message

sent• Restate or rephrase• Negative communication

– Unwilling to share feeling and problems

Listening

• Don’t make assumptions• Avoid presenting a solution• Attend to how the person is

feeling

Appreciation

• Express appreciation for past and present

• More willing to share feelings/anxieties

Time Together

• Creates opportunities for communication and appreciation

• Reduces loneliness and isolation• Physical activities help reduce

stress

Commitment

• To understanding– the aging process– the elder’s health conditions– how best to provide supportAdvocating for the elder with health

care and other professionals– Dealing openly with difficult issues– Sticking together even when there

is disagreement

Dealing with Lack of Cooperation• Loss of control• Feelings of inadequacy and

frustration• Being uncooperative is a way of

getting back a sense of control

Gain Cooperation

• Consider capabilities– Activities and decisions in which the

elder can still participate

• Inclusion in the decision-making process– Choice, preferences

• Facilitate accomplishments– More time

• Remove barriers to independence

Dealing with Family Members• Involve family members• Keep family members informed

– Less likely to complain

• Share information especially with those who are far away

• Include the older person in the discussion whenever possible

• Find a role for each family member • Work to maintain communication

and appreciation

Focusing on the Issue

• What is the specific issue that needs to be addressed?

• What are possible solutions?• What else do we need to know?

What resources are available?• Positives and negatives of each

solution?• Feelings and concerns of each

family member?

Dealing with Critical Family Members• Try to understand their real concerns; listen

carefully– Guilt? Fear? Worry?

• Try not to personalize critical comments• Keep all family members informed about

changes in the elder’s status and care needs• Perhaps have someone outside the family lead

or facilitate conversation• Lay ground rules for good communication• Share how the negative comments make you

feel and listen to the concerns of others• Critical people can become supportive over

time

History of Not Getting Along with the Elder• Work to improve relationship—

communication, appreciation, time together

• Time and patience• Family therapy

Important Tasks for Caregivers• Enhance elder’s continued interaction and roles

– Avoid taking away things the elder can do and wishes to do

• Facilitate continued involvement and contributions- Family, church, community or other interests

• Assess elder’s abilities and learn about help that can be provided to support involvement

• Allow independence and control• Caregivers also need to maintain personal

independence in the face of a dependent family member– Network of care– Maintain friendships and activities– Respite care

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Special Concerns

Factors Influencing Mental Health• Important factors influencing

the likelihood of mental health problems – gender– race – ethnicity– social isolation– economic status – generational experiences

Impact of Gender on Mental Health• Women outlive men; greater

numbers of older women means they will outnumber men in most settings, including mental health care

• Women are more likely to seek help for mental health concerns than men at all ages

• Men can be harder to diagnose with depression than women.

Men and Mental Health Issues• 20: Percentage of men over 50

estimated to have depression or chronic low mood

• 30: Percentage of men with depression who seek treatment for their condition

• 90: Percentage of men treated for depression whose condition is significantly relieved

Ethnicity, Race, and Culture• Different ethnic and cultural

groups – experience mental health very

differently than middle class white America

– have different ideas about aging

• Individuals from minority groups must deal with challenges of living in a population of a white majority

Cultural Considerations

• Many homosexual and bisexual individuals report experiencing lifetime and day-to-day encounters with discrimination

• Activity limitations increase the risk for depression

• The stigma of mental illness can intensify in a rural community

• People who are isolated and lonely may take less care of their health and not seek help when they are ill

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Dealing with Mental Health Issues

Difficulty Discussing Mental Health Concerns• Reluctance discussing feelings

and emotions• Fear of serious illness leading

to denial

Selecting a Mental Health Provider• Have training and qualifications

to treat the illness• Comfort level with the provider• Availability

– Timely appointment– Location

Finding a Mental Health Provider• Many people find a health care

professional through referral; a friend, relative, or primary physician

• You may want to ask the provider is he or she has experience working with older patients

• You can look in your clinic’s provider directory or in the yellow pages of your phone book

• If you are covered by an Employee Assistance Program (EAP) or an Indian Health Services you might begin your search with either of these to agencies

How can I manage my condition?• Talk to your doctor about all medications you

are taking (prescription and non-prescription, vitamins, and herbal supplements or teas)

• If your doctor prescribes medication for your mental health condition, take your medication(s) exactly as your doctor prescribed them

• Don’t skip doses, cut down, or stop taking them when you feel better; – it can be tempting to discontinue taking your

medication if you feel it’s not working or if it is working and you feel better- but it is problematic to do so.

How can I manage my condition? (continued)

• You may want to keep a daily journal to track your mood and feelings so that you can share these with your doctor and/or counselor

• Keep all of your appointments with your doctor or counselor so that they may treat your illness effectively

• Educate yourself about your condition and learn how to take an active role in your own recovery

Taking good care of yourself• Work on reducing or managing your stress• Take care of your physical body

– Get plenty of rest (most people need 7-8 hours of sleep per night)

– Eat healthfully (for more information visit www.mypyramid.gov)

– Stay or get connected to your community you may want to

• Volunteer• Join an organization or club• Take a class

– Try to incorporate some physical activity into your life

• Make a list of activities you enjoy such as gardening, walking, swimming, tennis, riding bicycle, and so forth and try to do one of these enjoyable activities each day

Impact on Others

• Family may be the informal support of older adult.

• Must serve as historian for an older adult who has limited memory.

• Family provide care