Articles for Seniors

1. WHAT IS HEALTHY AGING?
2. DEPRESSION IN THE ELDERLY
3. FACTS ABOUT MENTAL HEALTH AND AGING

WHAT IS HEALTHY AGING?

After 15 years of working with seniors in a variety of settings, I have developed my own take on this tricky question. Since I’ve seen more than 100 nursing homes, I know that I personally never want to end up in one. Although there are many excellent, well-run buildings out there, I personally choose not to spend my last days in one. Whenever I encounter a “young” person of only 65 or so, I usually ask, “What are you doing here?” Typically their story includes facts about how they didn’t take care of themselves.

To that end I’ve asked myself, what do I need to do so that I can accomplish my goal of staying in my own home as I age? The answer is simply, “take good care of myself”. For me that means, proper diet, sufficient sleep, regular periods of relaxation and vacations, and exercise, exercise, exercise! I work out two times per week with a trainer and go to the gym four other times per week for aerobic exercise. I’ve become stronger than I’ve ever been and ever dreamed possible. I’ve lost fat and gained muscle. I eat a diet low in fat, lower in carbs, and higher in proteins. I take vitamins and drink almost no alcohol. In short, I feel good which motivates me to continue taking excellent care of myself. An added benefit is that no one realizes that I’m as old as I am, often underestimating my age by 10-20 years. That’s a real ego-booster! I’m proud to say that I’m a young senior myself and look forward to a very long, healthy and productive life.

DEPRESSION IN THE ELDERLY

It is not uncommon for depression in the elderly to go unrecognized. There are often subtle changes that frequently are attributed to something else including dementia yet depression is really the culprit. While most people can usually recognize the typical signs of depression such as sadness, hopelessness, isolation, tearfulness, and even suicidal thoughts or intention, other symptoms are much more prevalent for the elderly. Things like sleeping more including daytime naps, lack of energy, low motivation, appetite change up or down, not socializing as before, not doing previously enjoyed activities, decrease in self-care, non-compliance with medical care/medication, increasing difficulty in making decisions, mild paranoia/fearfulness/distrust or hallucinations, uncooperative or abusive behavior, irritability, increased angry outbursts, increased worry or anxiety, increased impulsive behavior, substance abuse, low self-esteem, focus on physical pain, focus on medical problems, talk of death or dying, and family/relationship problems. Moreover, normal grief reactions, such as would occur with the loss of a spouse or the repeated loss of close friends, must be differentiated from maladaptive depressive symptoms.

Clearly, because of the range of possible symptoms of depression, the need for a professional evaluation is critical, particularly since some of these symptoms could also be indicative of an underlying medical problem including infection or some type of emerging dementia. While medication for depression can be very helpful in particular cases of very severe depression, in most cases it should not be the first line of treatment. Medication will certainly make someone feel and function better but efforts should first be made to address and resolve the issues instead.

Consider the following example. An older person becomes concerned that they might fall while walking. They decide they should not walk as much so they will be safer. They then notice how difficult it is becoming to get around at all. They stop doing the things they enjoyed, such as gardening or going out with friends. They start watching television all day, frequently napping in front of the TV. They start reporting trouble sleeping at night so the doctor prescribes a sleeping pill and the person sleeps all night. However, they are a little groggy in the morning, they are still bored during the day, and getting weaker with every passing day. Thus, the downward spiral begins.

The solution, of course, is to simply get more exercise, either with Physical Therapy, a Seniors exercise program, or something at a gym, so that the risk of falling is reduced if not eliminated. The problem is that we all get used to doing things a certain way over the course of our lives and often times don’t recognize the need to change some of those patterns.

Sadly, seniors are more likely to go to their medical doctors to report their symptoms. They do not seek out psychological treatment because they don’t think they’re “crazy” and don’t understand what psychological treatment can really do. Their doctor may then prescribe an anti-depressant medication for them but not schedule any particular follow up appointments to monitor the medication’s effectiveness or side effects. As with any medication, interactions between various medications can be problematic as well as side effects from the medication itself.

Ideally, the first line of defense for seniors should be a mental health professional who specializes in geriatric care, such as a psychologist, whose services can be covered by regular Medicare plans under Part B, or a psychotherapist. If needed, the next step is a psychiatrist who works with the geriatric population. Again, these services can be covered by Medicare Part B but may require some co-payment. Psychiatrists generally do a very good job at following up with their patients and medications. There may, of course, be times due to insurance limitations or patient trust issues that the primary care physician needs to be utilized instead. In this case, it is extremely important that timely follow-up and monitoring be scheduled.

Depression in the elderly can be a significant problem but is often left untreated. It can lead to a serious impairment of a person’s level of functioning and quality of life. It is crucial that the symptoms be addressed in a timely manner with a qualified mental health provider. In most cases, the first step is beginning with talk therapy then later adding medication if needed. Depression should not be considered part of the “normal aging process”. The Golden Years should be just that for all of us but it may take a bit of extra work to insure that we truly enjoy our lives as we continue to age.

Facts about Mental Health and Aging

· Mental health problems are not a normal part of aging. Deep sadness that lingers may signal clinical depression. An anxiety disorder is different from normal worries. One in about 6% of older adults has a diagnosable depressive illness.

· Mental health is as important as physical health. Untreated mental disorders in older adults can lead to diminished functioning, substance abuse, poor quality of life, and increased mortality. Research shows mental illnesses can slow healing from physical illnesses.

· Healthy older adults can continue to thrive, grow and enjoy life! Reading, walking and socializing are just a few of the activities that many individuals enjoy at any age. Exercising your mind and body and maintaining social connections are good for your mental health, too.

· Mental health problems are a risk for older adults, regardless of history.

While some adults go through life managing a chronic mental illness, mental health problems can also appear late in life. Older adults without a history of substance abuse may abuse medications, alcohol or drugs.

· Suicide is a risk among older adults. Older adults have the highest suicide rate in the country. Those ages 85 and over have the highest suicide rate, those ages 75-84 have the second highest. Older adult's suicide attempts are more lethal. For those that are 65 and older, there is one suicide for every four attempts compared to on is every 20 attempts for all other ages groups.

· Older adults can be helped with the same success as younger people. 80% of older adults recovered from depression after receiving treatment that included both psychotherapy and anti-depressant medication.

· Older adults have specific mental health care needs. Changing bodies and chemistry, changes in family and friendships, and changes in living situations can all impact mental health. Sometimes helping solve basic problems like transportation can lower stress, improve community connection and improve outlook and mood.

OWL - The voice for Women Midlife and Older: www.mentalhealthweek.org/welcome.html

Philadelphia Mental Health and Aging Resource Guide, 2006: www.mhaging.org/guide

National Association for Social Workers: www.naswdc.org/practice/aging/050407.asp