mental health issues in later life overview. the aging population nationally adults, 65 and older,...
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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 nation’s 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
today’s 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; don’t notice changes
– older persons says he/she is “fine”
• History of difficult relationship– prevents discussion of concerns feelings
• Family doesn’t 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
• Don’t 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 elder’s health conditions– how best to provide supportAdvocating 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 elder’s 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 relationship—
communication, appreciation, time together
• Time and patience• Family therapy
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Important Tasks for Caregivers• Enhance elder’s 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 elder’s 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 clinic’s 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
• Don’t skip doses, cut down, or stop taking them when you feel better; – it can be tempting to discontinue taking your
medication if you feel it’s 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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