MENTAL HEALTH ISSUES IN LATER LIFE 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

MENTAL HEALTH ISSUES IN LATER LIFE 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 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 support Advocating 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

MENTAL HEALTH ISSUES IN LATER LIFE 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

MENTAL HEALTH ISSUES IN LATER LIFE 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