Health Promotion Sunday: Aging and Mental Illness

Our population is aging. It is estimated that by 2050, persons 65 and older will comprise 20.7 percent of the U.S. population, compared to 12.4 percent in 2000. Currently, there are more than 4 million Americans 85 and older, and this number is expected to increase to almost 20 million by mid-century. Further, it is suggested that over 1 million of these people could be 100 years and older!1,2

According to a recent report approximately 20 percent of all older Americans experience a mental illness, and most of them (90 percent) will receive inadequate or no treatment. “Only 3 percent receive treatment for mental disorders from a mental health specialist,” the report stated. With a growing older adult population, among whom mental health issues are common, it will be imperative that our society address mental health issues in the older population.

This report will focus primarily on two of the most common mental health concerns in seniors — depression and dementia. It is estimated that approximately one third of elderly medical outpatients have a diagnosable psychiatric disorder, particularly depression, with the rate in the nursing home population even higher.3 Research would suggest that depression appears to affect quality of life in older individuals to a greater extent than chronic physical illness.4

Currently, there are approximately 4.5 million persons with Alzheimer’s Disease in the United States, and it is estimated that by 2050 13.2 Americans will have Alzheimer’s Disease if current trends continue and no treatments to prevent the disease are found.10 The annual direct and indirect costs of caring for Alzheimer’s Disease patients in the United States is estimated to be as much as $100 billion.10

Depression
John is 78, and a retired farmer. Lately his wife has been concerned about his mood. He has had less interest in helping his son do odd jobs on the family farm, which he has thoroughly enjoyed in the past. He has had increased difficulty in falling asleep, and in getting up in the morning. He also has had less of an appetite, and has had a variety of vague physical complaints, which have been completely evaluated by his physician, with no medical cause found. John’s wife feels he is also worrying more about their finances than what their situation warrants.

c) cognitive symptoms, such as thinking more slowly, difficulty making decisions, or suicidal thoughts.

Other symptoms of depression in older adults may include confusion, increased anxiety, or increased physical complaints.

A diagnosis of depression can be made by a professional if a person has several of the above symptoms that persist for more than two weeks. In determining the presence of depression in an older adult, a thorough medical evaluation is necessary to rule out other factors that may be contributing to the depressive symptoms, such as an endocrine problem, electrolyte imbalance, or side effects of medication the person may be taking for some other physical condition. Depression is a highly treatable condition; a mental health professional can help determine what treatment is most appropriate on an individual basis. This may include medications or psychotherapy, or often a combination of both.

The importance of recognizing and effectively treating depression in older adults cannot be overemphasized. Depression leads to an increase in mortality from a variety of factors, including greater immune system changes3 and an increase in death from cardiac events.6 Generalized anxiety disorder is also associated with an increased risk of coronary heart disease.7 The use of some antidepressants is associated with a decreased risk of hospitalization for a heart attack among persons with a history of cardiovascular disease.8 In a study of over 1,000 persons aged 60 and over, severity of depression had a greater (negative) impact on a variety of general health indicators than did chronic medical conditions.4

Depression is a medical illness, not a personal or spiritual “failure.” As shown above in the case of John, depression may feel like distance from God. This is a symptom of the depression, not a “spiritual fact.” Congregations can help by offering unconditional support to depressed persons and their families, and supporting educational events on depression and anxiety.

Dementia
The term dementia refers to changes in the brain that may impact a variety of domains such as memory, judgment, personality and social functioning. The most common type of dementia is Alzheimer’s Disease, which is a progressive dementia that develops over a number of years, affecting approximately 10 percent of persons 65 years old, and close to 50 percent of persons 85 and older.9 Other causes of dementia include vascular dementia due to disruption of blood flow in the brain, dementia due to multiple causes, and Lewy Body dementia, among others. The symptoms of Alzheimer’s Dementia may include11:

a) difficulty recalling recent events, appointments, or conversations
b) repeating conversations or activities
c) losing important objects frequently
d) gradually losing ability to perform multi-step tasks like balancing a checkbook or preparing a meal
e) getting lost in familiar surroundings
f) paying less attention to grooming
g) losing interest in hobbies or family activities
h) more easily agitated or unpredictably angry

If you or a loved one are experiencing any of these symptoms, a thorough medical evaluation is important to clarify the nature of the problem and rule out any reversible causes. Alzheimer’s Disease has no cure at this time, although medications are available that can slow the progression of the disease.

What is the difference between a “senior moment” and a developing dementia? Forgetfulness of incidental items, those things we don’t spend a lot of attention trying to remember, is common as we grow older. Examples of this include forgetting where you placed your reading glasses or purse, or forgetting what you went to get in another room. Another common type of forgetfulness that occurs with aging is having trouble with coming up with the name of a person you run into unexpectedly, and then being able to remember the name later. Where forgetfulness becomes a concern is when you begin forgetting events or information that you’ve spent a great deal of time and attention trying to remember, or you or your loved ones begin seeing a pattern of increased forgetting of more significant information.12

There are several risk factors for Alzheimer’s Disease, including advancing age; some genes that may increase susceptibility; lower educational level; and vascular risk factors, such as high blood pressure, high cholesterol, smoking and diabetes that is not well managed.10 The idea that modifiable lifestyle factors may impact either the development of severity of Alzheimer’s Disease is an emerging and exciting concept. For example, a recent study conducted at the University of Washington with 1,740 persons aged 65 and over would suggest that those who exercised three or more times a week had a 30 to 40 percent lower risk of developing dementia than those who exercised less.13 It has also been suggested that a dietary intake of fish and omega-3 fatty acids has been associated with a lower risk of Alzheimer’s Disease.14 Persons interested in prevention strategies should consult with their physician regarding recommendations of what may be most helpful in their particular situation.

a) treat the person like your “long-lost friend” — stay calm, persons with dementia respond to the mood around them
b) avoid arguing, even about untrue statements
c) don’t expect the person to remember and expect to repeat things frequently
d) use short, simple, “here and now” statements
e) maintain eye contact
f) eliminate distracting noises

Caregivers of those who have Alzheimer’s disease often experience stress, anxiety, depression, and other problems which can lead to negative consequences for their physical health.10 Church families are most helpful when they simply ask caregivers how they can best support them. It can be as simple as offering to watch their loved one while they go shopping or take a nap, preparing meals, providing a listening ear, or other forms of assistance.

a) Exercise both mind and body on a regular basis, such as regular aerobic exercise, stretching, learning to play a musical instrument, or watching Jeopardy
b) Have a good network of social support
c) Practice your faith
d) Have regular medical check-ups
e) Eat a healthy, well balanced diet
f) Have reasonable expectations for yourself
g) Don’t forget to use humor

Charlotte Loewen of Mountain Lake, Minn., consults and provides in-service training sessions for nursing homes. She is a member of the McPherson (Kan.) Church of the Brethren.

4. Hitchcock Noel, Polly, et al. Annals of Family Medicine. “Depression and Comorbid Illness in Elderly Primary Care Patients: Impact on Multiple Domains of Health Status and Well Being.” 2(6):555-562, 2004.

6. Suarez, Edward. Psychosomatic Medicine. “C-Reactive Protein is Associated with Psychological Risk Factor of Cardiovascular Disease in Apparently Healthy Adults.” 66:684-691, 2004.

7. Barger, S. and Sydeman, S. Journal of Affective Disorders. “Does Generalized Anxiety Disorder Predict Coronary Heart Disease Risk Factors Independently of Major Depressive Disorder?” 88 (1), Sept. 2005, pp. 87-91.

8. Monster, T., et al. American Journal of Medicine. “Antidepressants and Risk of First-time Hospitalization for Myocardial Infarction: A Population-based case-control Study.” 2004. 117:732-737.

13. Larson, et al. Annals of Internal Medicine. “Exercise is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older.” Vol 144 (2) January 2006, 73-81.