Nationally adults, 65 and older, comprise approximately 13

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MENTAL HEALTH ISSUES IN LATER LIFE

• Overview

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The Aging Population

• Nationally adults, 65 and older, comprise
  approximately 13 of our population
• By 2030, older adults will account for 20 of the
  nations people
• The fastest growing segment will be the 85 and
  older, those who often need the greatest amount
  of services, including mental health services

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Mental Health Disorders among Older Adults

• Estimated that one-quarter of todays older
  adults experience some mental health disorder,
  including dementia
• (Dept. of Human Services, p. 3).
• It is estimated that by 2030, more than 15
  million older adults will suffer a mental
  illness
• (U.S. Department of Health and Human Services,
  p.10).

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Differences by Gender

• Women live an average of seven years longer than
  men, making them more vulnerable to disabilities
  and chronic illnesses
• Females are more likely to provide care to
  others, yet as they age their need for care will
  increase

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What Does This Mean?

• It is unlikely that mental health services will
  increase at a rate that will meet future needs
• It is unlikely that the stigma of mental illness
  will decrease in the future

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Mental Health and Aging

• Most older adults have good mental health
• Older adults experience an increased frequency of
  life events that are losses rather than gains
• Poor physical health is a key risk factor for
  mental disorders
• (AoA Report, 2001, p. 23.)

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Losses for Older Adults

• Death of a family member or friend
• Retirement
• Failing Health
• Relocation from their home

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Changes of Normal Aging

• Cognitive changes
• For the disease-free older adult, the greater
  issue is often delayed ability to retrieve
  information
• Physical changes
• ? Taste ? Smell
• ? Touch ? Vision
• ? Hearing

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MENTAL HEALTH ISSUES IN LATER LIFE

• Family Community Involvement

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Family Support

• Family members are often the first line of
  support for elders
• Family members have long-term connections with
  older relatives
• When the quality of the relationship is strong, a
  family member may find it easier to discuss
  mental health issues with an elder
• If family is not present, community members may
  face these same issues

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Barriers to Supporting an Elder with Mental
Health Needs

• Health and mental health concerns of their own
• Think mental health problems are normal part of
  aging
• Distance away dont notice changes
• older persons says he/she is fine
• History of difficult relationship
• prevents discussion of concerns feelings
• Family doesnt know where to turn for help

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Building Relationships

• Skills to deal with difficult times
• Capacity to make important decisions
• Support each other

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Communication

• Family patterns develop over time
• Positive or negative
• Negative
• Sarcasm, put downs, criticism

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Good Communication

• Listen
• Clearly understand message sent
• Restate or rephrase
• Negative communication
• Unwilling to share feeling and problems

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Listening

• Dont make assumptions
• Avoid presenting a solution
• Attend to how the person is feeling

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Appreciation

• Express appreciation for past and present
• More willing to share feelings/anxieties

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Time Together

• Creates opportunities for communication and
  appreciation
• Reduces loneliness and isolation
• Physical activities help reduce stress

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Commitment

• To understanding
• the aging process
• the elders health conditions
• how best to provide support
• Advocating for the elder with health care and
  other professionals
• Dealing openly with difficult issues
• Sticking together even when there is disagreement

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Dealing with Lack of Cooperation

• Loss of control
• Feelings of inadequacy and frustration
• Being uncooperative is a way of getting back a
  sense of control

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Gain Cooperation

• Consider capabilities
• Activities and decisions in which the elder can
  still participate
• Inclusion in the decision-making process
• Choice, preferences
• Facilitate accomplishments
• More time
• Remove barriers to independence

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Dealing with Family Members

• Involve family members
• Keep family members informed
• Less likely to complain
• Share information especially with those who are
  far away
• Include the older person in the discussion
  whenever possible
• Find a role for each family member
• Work to maintain communication and appreciation

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Focusing on the Issue

• What is the specific issue that needs to be
  addressed?
• What are possible solutions?
• What else do we need to know? What resources are
  available?
• Positives and negatives of each solution?
• Feelings and concerns of each family member?

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Dealing with Critical Family Members

• Try to understand their real concerns listen
  carefully
• Guilt? Fear? Worry?
• Try not to personalize critical comments
• Keep all family members informed about changes in
  the elders status and care needs
• Perhaps have someone outside the family lead or
  facilitate conversation
• Lay ground rules for good communication
• Share how the negative comments make you feel and
  listen to the concerns of others
• Critical people can become supportive over time

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History of Not Getting Along with the Elder

• Work to improve relationshipcommunication,
  appreciation, time together
• Time and patience
• Family therapy

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Important Tasks for Caregivers

• Enhance elders continued interaction and roles
• Avoid taking away things the elder can do and
  wishes to do
• Facilitate continued involvement and
  contributions
• - Family, church, community or other interests
• Assess elders abilities and learn about help
  that can be provided to support involvement
• Allow independence and control
• Caregivers also need to maintain personal
  independence in the face of a dependent family
  member
• Network of care
• Maintain friendships and activities
• Respite care

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MENTAL HEALTH ISSUES IN LATER LIFE

• Special Concerns

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Factors Influencing Mental Health

• Important factors influencing the likelihood of
  mental health problems
• gender
• race
• ethnicity
• social isolation
• economic status
• generational experiences

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Impact of Gender on Mental Health

• Women outlive men greater numbers of older women
  means they will outnumber men in most settings,
  including mental health care
• Women are more likely to seek help for mental
  health concerns than men at all ages
• Men can be harder to diagnose with depression
  than women.

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Men and Mental Health Issues

• 20 Percentage of men over 50 estimated to have
  depression or chronic low mood
• 30 Percentage of men with depression who seek
  treatment for their condition
• 90 Percentage of men treated for depression
  whose condition is significantly relieved

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Ethnicity, Race, and Culture

• Different ethnic and cultural groups
• experience mental health very differently than
  middle class white America
• have different ideas about aging
• Individuals from minority groups must deal with
  challenges of living in a population of a white
  majority

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Cultural Considerations

• Many homosexual and bisexual individuals report
  experiencing lifetime and day-to-day encounters
  with discrimination
• Activity limitations increase the risk for
  depression
• The stigma of mental illness can intensify in a
  rural community
• People who are isolated and lonely may take less
  care of their health and not seek help when they
  are ill

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MENTAL HEALTH ISSUES IN LATER LIFE

• Dealing with Mental Health Issues

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Difficulty Discussing Mental Health Concerns

• Reluctance discussing feelings and emotions
• Fear of serious illness leading to denial

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Selecting a Mental Health Provider

• Have training and qualifications to treat the
  illness
• Comfort level with the provider
• Availability
• Timely appointment
• Location

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Finding a Mental Health Provider

• Many people find a health care professional
  through referral a friend, relative, or primary
  physician
• You may want to ask the provider is he or she has
  experience working with older patients
• You can look in your clinics provider directory
  or in the yellow pages of your phone book
• If you are covered by an Employee Assistance
  Program (EAP) or an Indian Health Services you
  might begin your search with either of these to
  agencies

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How can I manage my condition?

• Talk to your doctor about all medications you are
  taking (prescription and non-prescription,
  vitamins, and herbal supplements or teas)
• If your doctor prescribes medication for your
  mental health condition, take your medication(s)
  exactly as your doctor prescribed them
• Dont skip doses, cut down, or stop taking them
  when you feel better
• it can be tempting to discontinue taking your
  medication if you feel its not working or if it
  is working and you feel better- but it is
  problematic to do so.

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How can I manage my condition? (continued)

• You may want to keep a daily journal to track
  your mood and feelings so that you can share
  these with your doctor and/or counselor
• Keep all of your appointments with your doctor or
  counselor so that they may treat your illness
  effectively
• Educate yourself about your condition and learn
  how to take an active role in your own recovery

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Taking good care of yourself

• Work on reducing or managing your stress
• Take care of your physical body
• Get plenty of rest (most people need 7-8 hours of
  sleep per night)
• Eat healthfully (for more information visit
  www.mypyramid.gov)
• Stay or get connected to your community you may
  want to
• Volunteer
• Join an organization or club
• Take a class
• Try to incorporate some physical activity into
  your life
• Make a list of activities you enjoy such as
  gardening, walking, swimming, tennis, riding
  bicycle, and so forth and try to do one of these
  enjoyable activities each day

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Impact on Others

• Family may be the informal support of older
  adult.
• Must serve as historian for an older adult who
  has limited memory.
• Family provide care

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