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There are a wide variety of mental health problems which affect older people. Some people develop these in later years, while others grow old with these.
Depression affects the largest number of older people.
Other problems, such as schizophrenia, affect a relatively small number of older people but their effects can be extremely damaging for the sufferer and their families.
Therefore, a greater awareness is necessary to allow for prompt diagnosis and effective treatment.
Below are the main types of mental health issues affecting older people but in no way are they a substitute for diagnosis by a medical professional. Please consult your GP if you are concerned for your health or the health of loved one.
You are more at risk from alcohol in old age as even modest alcohol use can have a significant impact on your health and wellbeing. Reasons for the higher risks of alcohol as you age include:
- Tolerance for alcohol tends to decrease with age
- The capacity for the nervous system to tolerate alcohol reduces with age
- Older people often take prescription medication which can be dangerous with alcohol
- Risk of falls is higher in older age and this is increased further by intoxication
You may drink alcohol for a variety of reasons such as socializing, but it can also be used as a coping mechanism for pain relief, bereavement or loneliness. Drinking alcohol regularly or over sensible limits can cause a wide range of serious health problems including mental and physical problems such as:
- Depression (or making existing depression worse)
- Vascular dementia
- Heart disease
- Bowel cancer
- Stomach ulcers
It can be difficult for professionals to spot alcoholism as you get older as it may be mistaken for physical or mental health problems. In fact, you may not even realize that you have a problem.
Consider the 4 L’s when thinking about whether you have an alcohol problem:
- Liver: is drinking affecting your health?
- Lover: is drinking affecting your relationships with partner, family and friends?
- Livelihood: is drinking affecting your work/study or causing financial problems?
- Law: is drinking causing you to get into trouble with the police or law?
If you think you may have a problem, discuss it with those close to you, your GP or support services such as Alcoholics Anonymous.
Anxiety in this context is an overwhelming state of worry and nervousness beyond our natural anticipation of threat. It is a symptom that is prevalent in many other mental disorders and is suffered by one in five people aged 65+ (source: Age Concern 2007).
- Feeling worried
- Unable to concentrate
- Difficulty sleeping
- Irregular heartbeats
- Difficulty relaxing
Anxiety can also trigger other disorders such as panic attacks, phobias or obsessive compulsive behaviour. It is closely linked to depression in later life. In fact, most older people who have anxiety developed it when they were younger and have grown older with it.
Dealing with anxiety
Anxiety can be dealt with in a variety of ways including, talking about the problem, learning to relax and control situations, psychotherapy, self-help groups and medication.
Also known as manic depression, bipolar disorder involves extreme mood swings with severe highs and lows
- Mood swings – highs & lows
- Elation to depression
- Difficulty sleeping
- Overactive & racing mind
- Excessive spending
During high (manic) periods when you feel elated, you may display symptoms of confusion and disorientation.
Lows (depression) bring on symptoms experienced in other kinds of depression. You may feel sad, lose your appetite or become agitated. Periods of deep depression can even cause you to harm yourself or make you think about taking your own life.
Lows tend to be a more consistent symptom of bipolar disorder with highs (mania) flaring up now and again. However, it is possible to have mixed episodes, such as feeling manic (wired) but with negative feelings.
You do not simply experience either highs or lows as you often have long periods of stability in between. You may be unaware of the changes in your mood and may even be shocked about your behaviour.
Dealing with bipolar disorder
Severe and untreated bipolar disorder can be damaging to you, your relationships and the quality of your life. It is difficult to live with so it is important that you and your family as well seek help and advice.
Correct diagnosis and treatment of bipolar disorder is essential for recovery. Treatment can include developing self-awareness of symptoms – keeping a mood diary, for example – or medication. Different approaches will suit different people.
The term dementia is used to describe brain conditions that have in common a loss of brain function.
- Anxiety or depression
- Personality changes
- Speech problems
- Problems with coordination
Alzheimer’s disease is the most common cause of dementia and vascular dementia the second most common form. If you have parents or siblings who have developed Alzheimer’s disease, you are more likely to develop the disease than people with no family history.
Dementia can affect your mental ability, memory and concentration. It may even affect your perception and behaviour. Indeed, in the worst cases, communicating and simple hand-to-eye coordination may prove so problematic that you may not be able to carry out everyday tasks or look after yourself properly.
Dementia is usually progressive so symptoms gradually worsen. Its rate of development or severity varies from person to person. Early stages may simply involve being a bit forgetful, puzzled or confused.
In the middle stages you may become more forgetful or confused and have difficulty understanding what people are saying to you.
In the final stages, you may not remember what you have just said nor done, you may not recognize those close to you or you may not be able to express or look after yourself.
It has been proven that if you enjoy an active and healthy lifestyle that benefits your mental well-being, heart and blood vessels, you will lower the risk of dementia or slow its development. Follow these simple steps:
- Eat a varied diet with plenty of fruit and vegetables
- Eat less salty and fatty foods
- Exercise regularly
- Drink alcohol in moderation and stop smoking
- Pursue interests and social activities that exercise both body and mind
- Ask your GP to check your blood and cholesterol level
Depression is the most common mental health problem amongst older people, affecting as many as one in eight people over the age of 65. Worse still, its symptoms tend to increase with age.
- Feeling sad or down
- Loss of appetite
- Difficulty sleeping
- Lacking energy
- Agitation and restlessness
In its mildest form, depression can simply mean feeling a bit low. Mild depression is likely to affect most people at some point during their lives and some people may not realize that they are depressed. Major, or clinical, depression, on the other hand, is less common but more serious and can be potentially life threatening.
Depression can be triggered by a variety of factors including bereavement, trauma, anxieties, hormonal changes, a physical illness and even retirement. Otherwise, you may just develop it as you get older.
Physical illnesses particularly linked to depression include Parkinson’s disease, dementia, stroke, heart disease, and heart or lung disease.
Dealing with depression
Untreated, depression may last for months or even years, or, in severe cases, may drive you to contemplate suicide. Therefore, it is important that symptoms are taken seriously and not dismissed as an inevitable part of life.
Depression can be easily and successfully treated using medical and non-medical treatments such as anti-depressants or counselling.
The NHS provides an on-line mood self-assessment test to help you find out if you may be depressed. Remember, though, that the test is not designed to replace a GP consultation.
Drugs misuse can include the misuse of prescription or illicit drugs. In fact, older people are more likely than younger people to misuse prescription drugs, as they are more likely to be taking these than younger people.
Misuse of prescription drugs can be intentional or unintentional through wrongly prescribed medication or accidental misuse.
Cocktails of drugs can be particularly problematic when you are treated for multiple conditions or by multiple doctors. The mix can cause reactions such as falls, delirium and gastrointestinal bleeds.
As well prescription drugs, growing numbers of older people are taking illegal drugs. This is largely a result of people who use illicit drugs continuing to do so as they age.
Cannabis is the most commonly used illicit drug in later life partly due to its pain relief properties.
Schizophrenia is a severe psychiatric disorder often described as a 'psychosis' during which reality for the sufferer will be distorted.
Schizophrenia may affect relatively few older people but, if you have schizophrenia in later life, you tend to have complex care needs.
- Muddled thinking
- Withdrawn and uncomfortable around others
- Lethargic and apathetic
The most common type of hallucination amongst people with schizophrenia is hearing voices that are not there. These voices sound real and may come from a particular object or place. The voices may talk to the person directly or may talk to each other about the person.
For those diagnosed with schizophrenia the voices are usually critical, unfriendly, rude, abusive or irritating. Some people may have heard voices all their lives but at times of stress the voices may become intrusive and difficult to ignore. The voices may command the sufferer to do certain things such as harming themselves or doing something wrong.
Other hallucinations such as visions, taste, smell or the feeling of being touched can happen but are less common.
A delusion is a belief held that others do not share which seems to be based on misinterpretation or misunderstanding. Others may view it as strange or unrealistic.
For instance, a sufferer may believe that they are being followed or they are being commanded to do things. Therefore, delusions can make people feel paranoid and harassed and can be upsetting for them and their family.
Muddled Thinking (Thought Disorder)
Some sufferers may find it hard to concentrate and may be unable to follow a logical sequence of thought. Their thoughts may wander without any obvious connections and may become hazy. Ideas may seem jumbled and make little sense to others, making it difficult for their family to understand them. This can make communication difficult and lead to loneliness and isolation.
Dealing with schizophrenia
Schizophrenia can be caused by a variety of factors. It may be in your family genes or it could be brought on by addiction, stress, childhood deprivation or brain damage.
Although there is no cure for schizophrenia, there are many treatments available including medication, counselling, behaviour therapy and self-help methods. In certain cases a sufferer of schizophrenia may require compulsory admission to hospital as they may not realise how ill they are or may refuse treatment.
Indeed, suicide is common amongst people with schizophrenia.
So, please contact your GP immediately if you or your loved ones are exhibiting any of these symptoms.
We may contemplate ending our own life when our painful circumstances exceed our resources for coping with that pain.
The leading cause of suicide in older people is depression.
The only way to know if a person is feeling suicidal is to ask. However, a person may display warning signs such as:
- Talking about death
- Expressing feelings of hopelessness
- Disregarding the future or not planning for the future
- Recent loss, trauma or life change
- Change in personality
- Putting things in order such as wills or funeral arrangements
If you are feeling suicidal they should follow the T.A.L.K advice:
- Tell someone what you are thinking and how you are feeling.
- Ask for their help, or seek help.
- Listen to their advice or advice from others.
- Know who to call in a crisis and keep the number with you at all times.
The Samaritans offer a 24 hour listening service on 116 123 (or visit www.samaritans.org) for those needing support or advice.
Positive ageing begins and ends with your health and well-being.