MENTAL HEALTH ISSUES IN LATER LIFECommon 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 responsibilityhttp://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

Who is at risk?

• Elderly community members who:

• 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

consciousnesshttp://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

What should I look for?

Physical Appearance

1. Dirty clothing or skin

2. Body odor

3. Uncombed or dirty hair

4. Unshaven

5. Inappropriate clothing for the weather/situation

6. Underclothing worn over outer clotheshttp://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

What should I look for?

Emotional State

• 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 ChangeThe person’s usual character or personality may

seem different than earlier years…

a. Decreased social contacts

b. Sloppy appearance

c. Lack of eye contact or excessive staring

d. 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. Walks not shoveled, lawn not mowed

2. Neglect of pets or farm animals

3. Little or no food

4. Old newspapers or dirty dishes lying around

5. Calendar on wrong month

6. Shades drawn, garden/flowers neglectedhttp://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

What can I do?

• 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

memberhttp://www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

Common Mental Health Disorders

• 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

• 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: • 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 "co-occurring 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 Co-occurring 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

– 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 co-morbid 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 ElderlySuicide 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.ht

m

Risk Factors

• 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 LIFEDiagnostic 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

• 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