1. Mental Health In Older Adults: Lunch and Learn
Hosted by: The Center for Volunteer Caregiving
Presented by: Robert H. Pollock MSW, LCSW

2. Objectives of Presentation
Review of the human life cycle stages
Definition of Mental Illness, Personality Disorder
Older Adult Facts
Elder Abuse
Elder Competency
Risk Factors for Mental Illness, and Symptoms of Mental Illness
Mental Health Goals / Interventions – Individual & Community
Integrated Care Model
Attitudes Towards the Elderly

3. The Human Life Cycle Stages
Pre-birth
Birth
Infancy (0-3)
Early Childhood (3-6)
Middle Childhood (6-8)
Late Childhood (9-11)
Adolescence (12-20)
Early Adulthood (20-35)
Midlife (35-50)

4. The Human Life Cycle Stages-continued
Mature Adulthood (50-80)
Late Adulthood (80+)
Death and Dying

5. One Definition of Mental Illness
A mental illness is a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis.

6. One Definition of a Personality Disorder
A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. Personality disorders usually begin in the teenage years or early adulthood, and usually persist throughout life.

7. Older Adults: Facts
Older adults are more likely than any other age group to have complex health conditions, substance use disorders and cognitive impairments
Loss is common: loss of – spouse, friends, physical functioning, independence, purpose
Purpose affects overall health, including mental health, physical health and substance use
Healthcare providers and older adults often mistake depression for a natural response to aging. This can lead providers to not screen for or treat depression
Older adults do not seek help
Older adults go to see their Primary Care Physician, to get all of their medications and help for their physical illnesses

8. Elder Abuse Physical abuse Sexual abuse Domestic violence
Psychological abuse
Financial abuse
Neglect
Self-neglect
Elder abuse is a serious problem, with an estimated 8-10% of older adults experiencing abuse
Only 27% of hospital emergency departments have elder abuse protocalls

9. Pediatrics and Eldercare
As some adults age, they may begin to rely more on spouses, adult children, grandchildren and other loved ones for assistance with daily living activities and navigating the health care system
Unlike the pediatric population, where parents legally and functionally act as caregiver and decision maker for their child, caregiver relationships for older adults are much less straightforward and obvious
In conditions like dementia, capacities are slowly lost and there is often not a clear point at which older adults require surrogate decision-makers
Advance Directives are very important
Wills and Living Wills are very important

10. Some Basics About Geriatrics
Changes of the brain
Changes of the body
Changes of many levels of functioning
Changes of tolerance in medication, alcohol, foods

11. Causes and Risk Factors for Senior Mental Illness
Physical disability
Long-term illness (e.g., heart disease, cancer)
Dementia-causing illness (e.g., Alzheimer’s disease)
Physical illnesses that can affect thought, memory, and emotion (e.g., thyroid or adrenal disease)
Change of environment, like moving into assisted living
Illness or loss of a loved one
Medication interactions
Alcohol or substance use
Poor diet or malnutrition

12. 10 Symptoms of Mental Illness
1. Sad or depressed mood lasting longer than two weeks
2. Social withdrawal; loss of interest in things that used to be enjoyable
3. Unexplained fatigue, energy loss, or sleep changes
4. Confusion, disorientation, problems with concentration or decision- making
5. Increase or decrease in appetite; changes in weight
6. Memory loss, especially recent or short-term memory problems
7. Feelings of worthlessness, inappropriate guilt, helplessness; thoughts of suicide
8. Physical symptoms that can’t otherwise be explained: aches, constipation, etc.

13. 10 Symptoms Continued
9. Changes in appearance or dress, or problems maintaining the home or yard
10. Trouble handling finances or working with numbers

14. Mental Health Goals / Interventions
Healthy adjustment to stage of life
Acceptance of loss – letting go
Explore for and treat “Survivor Guilt”, which is often present when the elderly person has survived one of their children
Explore for and treat a deep sense of guilt wishing a loved one would die
Involvement in life activities as fully as possible
Reminiscence therapy – discussion of past activities, events, experiences with another person or group, usually with the aid of tangible prompts such as photographs, household and other familiar items from the past such as music, old movies

15. More Interventions Explore spirituality
All preparations for death are completed to a satisfactory level
Acceptance of how a person has lived their life
What is their legacy
What are they proud about in their life
What are they not proud about in their life, and acceptance of this
The bucket list
Do they want to talk about death / the after life? Do they have an opinion about this
What is their meaning of life

16. Integrated Care Model One person to act in the role of “Case Manager”
A team approach in which all relevant providers share information about the elderly person
The team also provides for the caregiver and other important people (family, friends), so the entire team does not disappear when the elderly person dies
Making sure nothing is “slipping through the cracks” about the over all care and well-being of the elderly person
Exercise needs to be included – it is not only healthy for the body, but for the emotional well-being of every person

17. More Interventions
Healthy Ideas – is a national model with measurable results and demonstrated benefits for older adults, service providers and community mental/behavioral health practitioners
Senior Reach – is an award winning, innovative collaborative between Jefferson Center for Mental Health, Seniors’ Resource Center, and Mental Health Partners, and is having a profound impact in the community and has proven highly successful in decreasing depression, anxiety, feelings of hopelessness and social isolation among seniors. Their mission is to support the well-being, independence and dignity of older adults by educating the community, providing care management and mental health services, and connecting older adults to community resources

18. More Interventions
Enhance Wellness – Seniors looking for assistance in managing needs such as physical activity, weight management, mental stimulation, nutrition, medication management or depression/anxiety have a resource in the Enhance Wellness program.

19. Attitudes Towards the Elderly
America – present-day attitudes about the elderly is very poor, and treated with little respect
Some Cultures Respect Their Elders
Aging isn’t just a biological process – it’s also very much a cultural one
The Elderly are treated with high respect among the Native American elders, in China, Greece, Korea, and Romans

20. Something to work Towards
Good Mental Health is Ageless
Questions?