Eldercare: Mental Health, March 1998
Reality Shift--When--and when not--to worry about your senior's mental health.
Thursday, March 5, 1998
"Dad''s so forgetful lately--it''s a sign of aging."
Howoften have we heard these kinds of comments? How often have we used them ourselves?
The facts are that elderly people, as a group, are at greater risk of mental disorders and their complications than are younger people. From 15 to 25 percent of Americans aged 65 or older suffer significant symptoms of mental illness.
Depression and dementia are the most common ailments.
About 10 percent of older Americans suffer from mild to severe organic brain disorders, such as dementia or Alzheimer''s Disease. Up to one-third of older Americans suffer from clinical depression.
Whereas there is no cure for dementia, most clinical depression can be treated. Yet few seniors seek such treatment, for a variety of reasons.
First, this is the tail end of the Depression generation, the generation that believed in pulling itself up by its bootstraps. Mental illness is seen as a sign of weakness. This generation is less likely to seek help for emotional problems than are their children.
Second, there is a general lack of awareness. Many older people brush off the symptoms of depression or dementia as "inevitable" signs of getting older. They are much less likely to call what they feel "depression." Their families, even their doctors, may misunderstand the signs of treatable mental illness, or think there''s nothing that can be done.
Lastly, seniors themselves may feel ashamed of their increasing symptoms, and try to hide them, both to preserve their own sense of self-worth, and out of a real fear that Medicare, insurance policies, retirement communities or employers will discriminate against them.
Whatever the reasons, although nearly 25 percent of elderly persons suffer from symptoms of mental illness, less then four percent of the patients in community mental health centers and just two percent of the patients in private practitioners'' offices or hospitals are elderly. Less than two percent of the direct cost of treating mental illness is spent on the over-65 age group. Elderly mental health is simply not a priority in our society.
Depression is one of the most prevalent problems faced by seniors, yet one of the most under-diagnosed.
Licensed clinical social worker Martin Skerritt of Community Hospital of the Monterey Peninsula''s Behavioral Health Services notes that it is difficult to pinpoint clinical depression in the elderly because it is so often complicated by other physical and emotional factors. Grief, perceived or real threats to independence, recent widowhood, the frequent deaths of friends, loss of mobility, multiple medical problems and growing difficulty in hearing and seeing all affect an elderly person''s mood and state of mind.
Treatable depression that goes undiagnosed can threaten a person''s physical health. A depressed senior may forget to take his medication on time, or refuse to participate in rehabilitative exercises, or neglect reporting a new ailment to his physician. "He may feel, ''Why bother?''" Skerritt notes. In addition, depressed seniors are more likely to suffer strokes, fail to manage diabetic conditions, and are prime candidates for suicide.
Monterey psychiatric RN Linda Weesner of the Monterey Mental Health Network urges families to watch elderly relatives for the typical signs of depression. If an elderly person is more withdrawn than usual, not bathing frequently, not eating well, experiencing sleeping disorders or complaining of digestive problems, and if these symptoms last for more than two weeks, they should consult a physician or mental health center for evaluation.
Distinct changes in long-standing habits are also a clue, Weesner says. One of her clients noticed that her 62-year-old mother, a meticulous ironer, was now only ironing her blouses halfway. Another older woman, who had prepared homemade jams for decades, was forgetting to put the pectin in her jars. "Look for small changes in things a person knows how to do well," Weesner says. "Don''t be concerned about forgetting where you put the car keys now and then."
The signs of depression can be very subtle. Maybe Mom stops walking the dog twice a day, and cuts back to a few times a week. Maybe Dad stops going to his Elks meetings.
Sometimes, changes in medication can cause depression. The body''s metabolism changes with age, and elderly people are much more susceptible to certain side effects of high-blood pressure medication, for example. Or an elderly person may be taking the wrong medication, or the wrong dose of the correct medication, simply because she can''t see the label properly.
It''s important to realize that clinical depression can be treated, in the elderly as well as the young. Skerritt points out that the issues complicating an elderly person''s depression may be long-term, such as grief following a spouse''s death, or frustration at increasing arthritic pain, but the symptoms can often be mitigated through therapy, support groups, and anti-depressant or anti-anxiety drugs.
But depression can only be treated if it''s noticed, and if the senior wants to be helped. "Such things as memory loss caused by depression can be treated," Skerritt says. "So don''t just brush it off."
Dementia and Alzheimer''s Disease
"I''m getting so senile." That''s another common complaint elderly people use to excuse all kinds of aberrant behavior, from forgetting a phone number to calling their children by the wrong names.
It is true that one in 10 older Americans will suffer from some form of dementia, with the odds increasing as the years pass. It''s also true that dementia cannot be reversed or halted, once it takes hold.
But sometimes what seems to be dementia may really be something else, something that CAN be cured. If your usually garrulous father becomes more and more withdrawn in company, and now sits silently at the dinner table, ignoring the conversation around him, it may be that he is hard of hearing and is too ashamed to admit it. A simple visit to the doctor and a hearing aid might help.
Increased anger, a real symptom of Alzheimer''s, may simply be the result of an older person''s frustrated response to her diminishing physical capabilities. If Mom explodes in anger because she can''t understand a book she''s reading, don''t immediately assume her arteries are hardening.
More often, many things are going on at once. Increased dementia is often accompanied by depression, as the elderly person realizes that her world is spinning out of control and she is powerless to stop it. Depression that goes untreated can even exacerbate the symptoms of dementia. That''s why it''s so very important to seek medical evaluation.
Respecting privacy and preserving individual dignity as much as possible goes a long way towards relieving the emotional side effects of advancing dementia, Weesner says. If an elderly person needs help getting dressed, ask him to choose what he wants to wear rather than choosing it for him. Squeeze the toothpaste onto the toothbrush--a physical task some elderly seniors find daunting--, but don''t brush Mom''s teeth for her if she can still do it herself.
Finally, an elderly person''s deteriorating mental health affects his or her family members, particularly the children. "Children go through lots of emotional anxiety as they watch their parents deteriorate," Weesner says. "The person they depended on for so long is no longer there. They can feel great anger at the loss. Emotions run the entire gamut."
Local Mental Health Resources for the Elderly
&bul; senior centers run by your city
&bul; SHARE program (for stroke rehabilitation)
&bul; SAFE program (for dementia)
&bul; private mental health providers and physicians
&bul; CHOMP''s Behavioral Health Services, 625-4606 or 771-2460
&bul; Natividad Medical Center 755-4111 n