Mental Health Aging 11 24 2014 The majority of persons over 65 DO NOT have some mental illness severe enough to impair their abilities Although Baby Boom generation expected to have higher needs for psychological services The primary mental health problem of older age is depression Most important and most frequent Depression in Later Life NOT a normal part of aging Low rates of diagnosis and treatment in late life Gets more challenging to diagnose Higher prevalence for women than men Major depression is more common at younger ages Older adults may experience more frequent minor depressive symptoms Higher rates among those in health care settings Depressive Symptoms Psychosocial symptoms sadness lack of interest inactivity pessimism low self esteem anxiety crying fear etc Physical Symptoms loss of appetite low energy and sleep disturbance Cause of Late Life Depression Physiological Factors o Neurological issues Ex Alzheimer s other dementias Insufficient supplies of neurotransmitters o Evidence symptoms respond to meds o Antidepressant drugs restore chemical balance Psychosocial Factors o Stressful events loss and cognitive styles Ex loss of loved ones Depression Treatment Psychotherapeutic interventions effective with older adults Cognitive therapy alters maladaptive thoughts Behavior therapy changes activities to modify mood Therapy more effective than medication alone With older patients with depression symptoms for the first time more strength based focus on what they can do now points of leverage overcome adversity focus on what they did in the past that was effective and do that now don t bring in family the less you do the better Later Life Suicide Most common cause Depression Older adults commit suicide at higher rates than any other age group Accurate Gender Differences o Highest rate males over age 85 o Most successful attempts Males Risk Factors o Physical illness chronic pain o Depression and alcoholism o Unmarried recent losses Common causes of delirium Infections fever Medications Fractures Electrolyte imbalance Pain Head trauma Other brain disease Older adults receive fewer mental health services Mental health services Barriers o Expense o Stigma of mental illness o Skepticism of benefits Dementia No single simple test definitively detects dementia Dementia involves impairment in at least 3 of the following o Language memory visual spatial emotion personality and other cognitive abilities Alzheimer s disease First impairment in memory and new learning Early Difficulty with complex tasks Later lose ability to perform basic tasks Personality changes may occur Behavior problems may occur including increased apathy dependency agitation restlessness and inappropriate sexual behavior Genetic markers o Early onset occurs for those 30 60 5 o Apo E 4 o Chromosome 14 Nongenetic factors toxic metals head injury Protective factors higher educations anti inflammatory meds HRT and vitamin E Portion of People 65 and Older with Dementia 7 Types of dementia Alzheimer s Vascular Mixed Alzheimer s Disease characteristic pathology Amyloid Plagues o Degenerated nerve ending with an amyloid core Neurofibrillary Tangles o Tangled protein strands within cell bodies Alzheimer s Diagnosis Medical exam medication nutrition Brain imaging to rule out other possibilities stroke tumor Definitive diagnosis only from autopsy Medical advances in diagnosis Treatment of Alzheimer s Focus on helping people to maintain mental function managing behavioral symptoms and slowing or delaying the symptoms of the disease Drug therapy delay worsening of symptoms Behavioral therapy ex memory training and aides exercise diet Dementia Village Hogeweyk The Netherlands outside of Amsterdam Caregivers and residents live with in the walls of a village Residents unaware they are in LTC Continue with normal routine just with supportive services always available Vascular Dementias Second most common type Accounts for between 8 and 30 of cases Multi infarct caused by small strokes or infarcts in the brain Impairment in memory abstract thinking and language depression anxiety paranoid delusions Sudden onset stepwise decline Diagnosis with brain scans MRI Risk Factors o Hypertension o Atherosclerosis o Diabetes o Inflammatory diseases o Smoking o Obesity Prevention o Lifestyle changes change in risk factors Summary Thoughts Mental illness NOT inevitable consequence of aging Characteristics of aging related to prevalence diagnosis and Involve biological and social factors treatment of disorders Need to acknowledge barriers to seeking services Dementia is NOT a universal feature of aging 11 24 2014 Stress Coping Definitions Stressors Distress o Poverty chronic disease arguments friends illness o Depressive symptoms o Physical symptoms Stressors Objective conditions that tax an individuals emotional physical and cognitive resources Distress Individuals psychological and physical response to those conditions Types of stressors Life events Require significant adjustment Examples in later life Widowhood Retirement Relocation to long term care Chronic Stressors Persistent hardships of problems Examples Poverty Family caregiving Daily Hassles Routine challenges of everyday life Examples Arguments Mistakes Being late Daily events vs daily hassles Experience fewer life events vs daily hassles o 7 10 life events in a lifetime Daily hassles may be more important to health because occur more frequently Contribute to stress accumulation The Stress Process Model Exposure likelihood will experience a stressor Appraisal How evaluate the stressor Reactivity likelihood one will react emotionally or physically to the stressor Studying daily hassles Interpersonal tensions since this time yesterday have you had an argument or disagreement with anyone Overloads Did anything happen at work that most people would consider stressful Network events did anything happen to a close friend or relative that turned out to be stressful for you Age Differences in Exposure Most daily stressors Young adults Most interpersonal tensions Young adults Most overloads Middle aged adults Most network stressors Older adults Most distress Young adults Less distress Middle aged and older adults Why are older adults less reactive to stressors Reflect differences in content of stressors ability to regulate negative emotions Stress and Coping Paradigm Stressor cognitive appraisal distress Different people react to the same stressor differently Takes into account personal