Managing mental health for older adults
For older adults, managing mental health can be tough.
At this stage of life, the family have long since left the nest. Travel becomes less enjoyable, making it harder to keep in touch like before. And, let’s face it; with age a lot of older family and friends fall off the perch, often leaving the elderly isolated and alone.
These unique factors affect older people, and can lead to mental health problems like anxiety and depression. Unfortunately, the stigma surrounding mental health and lack of mental health awareness held by many older Australians only makes these challenges worse.
This begs question; how should older people manage their mental health to maximise their quality of life? And what do you do if you, or someone you know, are struggling with their mental health?
Read on to find out.
Mental Health Risk Factors for Older Adults
The stats are in. Over 20% of the world’s population aged over 60 experiences some form of mental or neurological disorder.
Depression is particularly common, with 15% of older adults presenting symptoms.
Considering, by 2050 22% of the world's population will exceed 60 years of age, these mental health challenges are a ‘hot topic’ and impact a large portion of the population.
For older adults in particular, there are several factors that increase the risk of developing anxiety and depression.
This list displays the specific depression and anxiety risk factors and the population that is most ‘at risk’ of these problems.
Depression and Anxiety Risk Factors
· The rise in physical health problems and chronic health conditions (e.g., stroke, dementia, chronic pain cancer or heart disease).
· Experiencing Loss: These can include the loss of relationships (spouse, family member or friends), mobility, independence, work/income and/or self-worth
· Specific anniversaries may evoke painful memories of past loss
· Social isolation
· Significant changes to one’s living arrangements (e.g., moving in with relatives or into an aged care home)
· Admission to hospital or inpatient clinics
· Medication induced side-effects
· Ongoing stressful life events
· Personality Factors (e.g., low self-esteem, excessive need to be in control or being easily agitated)
· Genetic predisposition/family history of a condition
· Substance use/abuse
Due to the in-twined nature of the risk factors it’s vital to know the signs and symptoms of depression when it comes on.
Since we know that the older population are at a higher risk of depression, it’s important that the signs and symptoms are identified as early as possible so something can be done.
So how do you know if you, or someone else is experiencing depression?
Identifying symptoms Depression in older adults
Despite being common, depression should not be considered a normal part of ageing.
Life events that disproportionately impact older adults, such as physical illness, losing loved ones, moving home and retiring can contribute to depression development.
While there are a number of symptoms of depression, not every symptom is needed for a diagnosis.
Below are signs and symptoms to help you identify signs and symptoms of depression:
Physical Symptoms
· Slowed movement
· Memory issues
· Loss of or change of appetite
· Significant weight loss or weight gain
· Sleeping more or less than usual
· Feeling tired/fatigued all the time
· Agitation, hand wringing and/or pacing
· Nausea and digestive upsets
· Changes in bowel habits
· Headaches, backache, pain or similar complaints with no other explanation Feelings
· Feelings of becoming overwhelmed
· Feelings of worthless or guilt
· Feelings of sadness, hopelessness or emptiness
· Moodiness/irritability, which may manifest as anger or aggression
Thoughts
· Excessive concerns about financial situation
· Persistent suicidal ideation/thoughts
· Excessive concerns about financial situation
· Persistent suicidal ideation/thoughts
· Becoming increasingly indecisive
· Loss of self-esteem
Behaviours
· Neglect of responsibilities and self-care
· Difficulty getting motivated, especially in the morning
· General restlessness or ‘slowing down’
· Decline in day-to-day ability, confusion, worry and agitated
· Withdrawing from their family and friends
· Denial of depressive feelings as a defence mechanism
· Inability to find pleasure in any activity
· Generally behaving out of character
Someone may be experiencing depression if they have either felt sad/miserable most of the time. Or if they have lost interest/pleasure in their usual activities. This includes experiencing several signs/symptoms from at least three of the categories above, for over two weeks.
Older adults with depression commonly show more symptoms from the physical category listed above. The people are more likely visit their doctor for various physical ailments and sleeping problems rather than complaints of sadness/low mood.
Not every symptom is needed for a diagnosis. Someone may have depression if they have either felt sad/miserable most of the time. Or if they have lost interest/pleasure in their usual activities in addition to experiencing several signs/symptoms from at least three of the categories below, for over two weeks.
Remember that everyone experiences some symptoms occasionally, but this doesn’t mean they ‘have depression’.
Another common disease for elderly people is dementia. Depression affects around 1 in 5 people with dementia. Dementia and depression are very different conditions that require different treatments, but they can be hard to distinguish due to their similar symptoms. For further information, read our dementia article.
If you’re concerned, an assessment by a health professional is strongly recommended. For older adults with any personal or professional carers, it can be beneficial to include them in healthcare discussions.
Anxiety in older adults
We all experience some anxiety from time-to-time, but it can be difficult to identify when it becomes clinically significant. In older adults' symptoms of anxiety are often subtle and develop gradually.
Listed below are the four categories of anxiety symptoms that you can monitor if you are concerned for yourself or a loved one:
Physical Symptoms
· Feeling lightheaded, dizzy or faint
· Increased heart rate
· Vomiting, nausea or stomach pain
· Muscle tension and/or pain
· Numbness, tingling or pins-and-needles
· Hot or cold flushes
· Sweating and/or shaking
· Sleeping issues
· Feeling detached from your physical body or surroundings
Feelings
· Feeling constantly tense or nervous
· Feelings of being overwhelmed
· Feelings of dread or impending doom
· Overwhelming or uncontrollable sense of panic
· Worried about experiencing physical symptoms
· Fear, especially in relation to certain events, situations or objects
Thoughts
· Thoughts such as “I’m going insane”, “I’m dying”, “it’s all uncontrollable”, or “ why is everyone watching”
· Unwanted/intrusive thoughts and worry
· Experiencing flashbacks of a past traumatic event(s)
· Experiencing nightmares
Behavioural
· Struggling to make decisions
· Becoming easily startled
· Avoiding physical and/or eye contact
· Not being assertive
· Actively avoiding particular objects or situations that trigger anxiety
· Develop urges to perform specific rituals to give a sense of relieve from anxiety
Psychological Treatment and Counselling
Sometimes professional help is needed to help you manage your mental health, and you shouldn’t be ashamed.
Professional psychological assistance is necessary when symptoms begin to significantly negatively impact your quality of life. Where suicidal thoughts are prevalent, depression becomes life threatening.
You don’t need to have a severe mental condition to warrant seeking help. The sooner you seek treatment, the better. If you feel like your mental health is deteriorating, it is a good idea to see your GP. Your GP will assess whether preparing a GP Mental Health Treatment Plan is necessary and refer you on.
Counselling can greatly benefit older adults as they’re more prone to experiencing cognitive decline, physical illnesses and grief. Even for someone to talk to during tough times, trained counsellors and psychologists can help you. If you’re in an aged care facility, counsellors or psychologists are sometimes provided but usually an external therapy should be arranged.
You can talk to a psychologist about the different interventions available and what’s right for you.
These include:
· Cognitive behavioural therapy (CBT)
· Interpersonal Psychotherapy (IPT)
· Behaviour Therapy
· Marital Therapy
· Problem-solving Therapy
· Psychodynamic Psychotherapy
Medications
Medications are an effective treatment for several mental health issues, but they are strictly controlled and prescribed by medical health professionals. In most cases, of clinically diagnosed depression and anxiety the use of medication can be a safe and effective part of a treatment plan. It’s always important to be aware of potential drug interactions and consult your doctor if you have any concerns.
Support groups:
Support groups are another way of discussing problems. Such groups are useful if you don’t want to discuss things with your family or friends. They can provide a place to discuss your concerns and develop supportive new friendships.
There are a number of groups for specific areas of concern. Groups exist for people experiencing: chronic illnesses, dementia, large lifestyle shifts, addiction and grief. Finding the right group can offer opportunities to develop strong social bonds with peers to help you cope.
The Do’s and Don’ts of Helping someone with Mental Health Issues
If you are concerned about yourself or someone you know experiencing anxiety, depression, or not coping, it’s important to have a conversation with them about it. How you do it is another thing.
With stigma around mental health, broaching that subject can be very difficult and uncomfortable. This short guide provides useful tips for “do’s” and “don’ts” to help you or a loved one help converse with someone who is struggling.
Do’s
· Show empathy and compassion. Putting yourself in their shoes will help you understand them better.
· Communicate your thought and feelings. Mental health issues shouldn’t be treated like a taboo subject. Openly communicating and non-judgementally listening to one another is helps let your loved one know you’re there to support them.
· Take care of yourself. Attempting to help someone struggling with a mental health issue places a lot of pressure on you too. If you feel yourself getting overwhelmed, it’s vital to communicate this with them. Not in a manner that blames them, but in a way that acknowledges your limits.
· Set boundaries. Caring about someone doesn’t mean you aren’t allowed to ask things of them out of feat of impacting them negatively. Requests like “please don’t contact me while I’m at work” or “don’t speak to me like that” (if they’re verbally abusive) are valid boundaries that you shouldn’t feel guilty for setting.
· Seek more information and professional help. Access the resources provided below to help yourself or another deal with the issues presented.
Don’ts
· Don’t get pushed away. It’s common for people to isolate themselves when they are experiencing mental health issues. It’s important to notice when this is happening and continue to support them.
· Don’t push them away. If someone’s behaviour has changed due to a mental health issue, it’s important not to push away from them. They need your support more than ever.
· Don’t ignore any signs of suicidal’ ideation’ where thoughts of ending one’s own life become prevalent. If you notice this in yourself or another contacting professional support is a necessity.
· Don’t think that you can ‘fix’ them. Unless you are medically qualified, you won’t necessarily be able to provide them with proper treatment, but this doesn’t mean your support is not important. Your support may be the thing they need to seek treatment.
· Don’t give up on them. Dealing with mental health issues rarely involves quick fixes, so be patient.
Practical ways to Manage and optimise your Mental Health
It is not all doom and gloom!
One quarter of Australians’ lives are spent post retirement 6 and it’s meant to be rewarding.
For many Australians, later life and retirement can be highly enjoyable because you finally have the time to pursue your interests, enjoy grand-children, and live at a slower-pace. With this freedom also comes an increased opportunity to take care of yourself, physically and mentally.
Quality of life (QOL) is the term used to describe the level of enjoyment or satisfaction people have for their day-to-day lives. Maintaining and optimising your quality of life introduces higher feelings of happiness, satisfaction and joy.
Prioritising quality of life allows for an optimistic outlook and will likely minimise the duration and severity of depression if it arises.
How do you optimise your mental health and improve your quality of life? Here is a number of key areas to focus on to promote mental health in later life.
Keeping Social
Maintaining and developing a strong social network is key to living a happy life. Friends and family are a great source of joy, but seeing them can be difficult especially if you live apart, or your age care facility has restricted visiting hours.
Even if your location or condition prevents you from catching up with people in person, phone calls, social media, and video chats are important ways to stay ‘connected’.
Many aged care facilities and charities offer support group services.
Many social groups are designed to be a place for people to meet and participate in fun activities including table games, quizzes, craft, day outings, cafe lunches, birthdays and celebrations (festivals and religious days), intergenerational programs, cooking, music (singing & dancing) and gentle exercise.
Staying socially active in your community through volunteering or club memberships are a great way to avoid social isolation. Even just going on day trips to the local cinema, theatre, museum or library are all great ways to get out of the house, see people and stay active.
Keep it interesting:
Variety is the spice of life. Often without the routine of work, life can become mundane and empty. Including multiple activities such as learning a new skill, travelling, focusing on a life-long hobby are great ways to improve life satisfaction. Introducing ‘novel stimuli’ into life actually creates new neural connections and improves quality of life.
Exercise improves your mental health
Physical exercise is a great way to improve mental health. It improves mood by triggering our brain to release endorphins like dopamine and serotonin. Physical exercise can contribute to reducing the risk of several physical illnesses including cancer, diabetes and heart disease. It also has the added bonus of helping burn fat.
Not only is exercise good for your health, but it can bolster self-esteem. Exercising is a good social outlet, whether it’s going for a walk with a friend or an organised sport.
The Department of Health recommends older adults be as active as possible by incorporating fitness, strength, balance and flexibility movements wherever possible. They suggest at least 30 minutes of moderate physical activity most days. Or combined shorter sessions throughout the day to total 30 minutes.
To wrap up
Managing mental health can be trying for older adults as they’re at high risk of experiencing physical illness, personal loss and large lifestyle shifts. Such factors often lead to severe social isolation, increasing risk of mental health issues which negatively impact quality of life.
If you want to spend these golden years enjoying life, understanding these risk factors and knowing what to do puts you a giant step ahead.
Positive lifestyle choices like keeping social, focusing on hobbies and improving physical health all boost quality of life and make retirement life enjoyable.
It’s vital to watch out for the signs and symptoms of mental health issues in older people and seek help if you or your loved ones suspect anything could be amiss.
Resources:
Mental health support for you or your loved ones can be accessed from a number of key providers by following the links below.
Want to speak to someone about your mental health:
· Lifeline
To participate in research and find more information about specific conditions, go to:
· Black Dog Institute
To seek mental health advocacy, go to:
To seek government assistance regarding your aged care journey, go to:
