Mental Health and the Elderly

Stress from caregiving, loss of independence, grief, and poor health are some of the reasons why mental health and the elderly is an important topic for healthcare professionals working in the geriatric population.

It is anticipated that by 2030, older adults will account for 20% of the nation’s population. Thus, the need to address mental health and the elderly population will increase simply by virtue of the census growth. During the normal process of aging, older persons encounter stressors that may trigger both appropriate and distorted emotional responses. Two of the most stressful unplanned life events include declines in health and loss of loved ones. According to The American Institute of Stress:

• The elderly patient experiences immune system impairment with the progressive decline of the ability to resist infection.
• The stress of caring for a spouse or loved one with dementia delays wound healing and has effects on fighting inflammation.
• Alzheimer’s caregivers have significantly reduced telomere length – a basic indicator of cellular aging – as well as telomerase activity – a measure of cellular capacity for ongoing replication.
• Caregivers also have double the rate of severe depression. Research demonstrates that depression in caregivers can increase the risk of death by as much as four times when compared with non-depressed individuals.

Mental Health and the Elderly Adult

Good mental health is not simply the absence of diagnosable mental health problems. On the contrary, good mental health is characterized by a person’s ability to fulfill daily activities, to cope with life’s unexpected tragedies, to express emotions, and to form and maintain good relationships with others. With this in mind, there are four ways healthcare professionals can promote good mental health in seniors:

1. Social Support. Having strong social support is a must for the majority of older adults. Close friends and family members not only provide a shoulder to lean on to during hard times, but also improve lifestyle and cognitive status. People who are socially active are less likely to have depression, anxiety, or other mental health disorders. And, a lack of social support has been strongly linked to the development of Alzheimer's disease. Therefore, the healthcare professional should encourage the geriatric patient to seek avenues of social support – spending time with family, church, support groups, participating in games or hobbies with others (sewing, cooking, bingo, etc.), or finding other community-based services. Support for the senior with health issues can also include senior living centers, adult day care centers, or assisted living facilities.

2. Routine Exercise. Exercise is proven to have positive effects on feelings of depression, anxiety, and isolation in older adults. Regular exercise sessions improve muscle strength and endurance of geriatric patients, making them able to perform their functional activities. This increased independence gives adults a sense of confidence and promotes happy feelings. Group exercise sessions are also a great option for senior citizens as they not only provide exercise but social interaction. Many community centers provide group exercise sessions for seniors at no charge.

3. Comfort During Grieving. Coping with the death of a loved one can be difficult for anyone, but a senior adult can experience greater grief due to compounding issues such as poor health, loss of independence, or loss of an emotional support system (peers have passed or adult children live out of town). It is important that healthcare providers listen to older patients and support them during their grieving process. Keep in mind that you may be the only person they can talk to! And, while therapists may not be able to provide the direct help they need, they can identify and refer seniors to the appropriate disciplines. Loneliness and grieving are the most difficult aspects for aging adults, especially those who have been caregivers for their loved ones for many years. After the loss of a loved one, it becomes very difficult for the caregiver to move on. They often experience feelings of guilt or remorse. Allowing patients to express their feelings and encouraging grief counseling are beneficial.

4. Therapeutic Treatment. Regular psychological sessions including bereavement counseling or psychotherapy achieve positive results for the majority of senior adults suffering with grief, anxiety, or other mental health issues. Sometimes, pharmacological help may be needed for a short period of time. Research also suggest approaches such as stress reduction, relaxation techniques, and cognitive behavioral therapy have positive effects on mental health. In summary, there are a variety of options for promoting good mental health in the elderly adult. But above all, listening is the key first step to effective intervention.

References:

1. Older Adults and Mental Health: Issues and Opportunities. Department of Health and Human Services Administration on Aging.
2. Schuch, B., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P. B., Veronese, N., Solmi, M., Cadore, E. L., Stubbs, B. Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias. Revista Brasileira de Psiquiatria. 2016; 38: 247-254.
3. Reid, C., Eccleston, C., Pillemer, K. Management of chronic pain in older adults. British Medical Journal. 2015; 350.
4. Jaremka, M., Andridge, R.R., Fagundes, C. P., Alfano, C.M., Povoski, S. P., Lipari, A.M., Agnese, D.M., Arnold, M.W., Farrar, W.B., Yee, L.D., Carson III, W.E.,
5. Bekaii-Saab, T., Martin Jr, E.W., Schmidt, C.R., Kiecolt-glaser, J.K. Pain, Depression, and Fatigue: Loneliness as a Longitudinal risk Factor. Health Psychology. 2014; 33(9): 948-957.