Presentation. What is Mental Health. The Mental Health Detective

Transcription

1 The Mental Health Detective Maureen Osis RN, MN Marriage & Family Therapist 1 Presentation Mental Health and Aging Qualities of mental health Sifting through the signs/symptoms Depression, anxiety, bipolar, & PD Assessment Treatment/Intervention October 1, 2008 Telemental Health Education 2 What is Mental Health Mental health: The capacity of individuals to interact with each other and their environment in ways that enhance or promote: their sense of well-being their sense of control and choice with their life optimal use of their mental abilities achievement of their own goals (both personal and collective) and their quality of life. 3 1

2 I believe the most critical issue to optimum mental health for seniors is the sense of belonging and having a place in society which is valued. This involves receiving respect from those around them and society generally, being cared for by family and formal caregivers, having a social network or at least one person they can talk to about their past experiences (someone who knows them) and a strong sense of self or in what way they fit into their community. (Seniors Organization) 4 Mental Health & Aging Sense of belonging Respect Being cared for Having a social network One person they can talk to Strong sense of self How they fit into their community 5 Mental Health and Aging Myths, stereotypes Older people are miserable Dementia is inevitable Old age causes depression Anxiety decreases with aging 6 2

3 Challenges with Aging Older Adults are often dealing with Retirement Bereavement Physical health changes Loneliness 7 Challenges for Professionals Diagnosis is confounded by Aging Medical health problems and Medications Reporting of S/S 8 Mental Health Detective Medical S/S Aging Mental health 9 3

4 Case Study Mrs. M. is an 85-year old woman, living in an apartment. She is currently treated for CHF, osteoporosis, constipation, and insomnia. She is widowed: has several adult children and grandchildren: some live in same town Hospitalized twice past year: pneumonia and a fall, without fractures 10 Mrs. M. Mrs. M. recently lost her driver s license. One of her long-time friends died last month. She used to go to church regularly, but now goes occasionally. Her family visited recently and called the home care nurse, - worried about mom. 11 Mrs. M. Family reported: Mom is so irritable. She never used to be like this. She does not want to come and visit us: she used to really enjoy the visits. Her clothes don t fit her: she has lost weight. 12 4

5 Mrs. M. Mrs. M. says My family worries too much. You would feel cranky too if you were my age. I don t know what to do anymore. Sometimes I wonder Why bother? Sometimes I feel like I am having a heart attack my heart pounds. I prefer to stay at home by myself. 13 Mrs. M. You observe Loses track of the conversation Repeats herself Acknowledges that she has little interest Admits that she feels like her life is worthless MMSE is Mrs. M. Your best guess right now R/O Depression? Anxiety? Bereavement? Adjustment disorder? Loneliness? Physical health problems? Early dementia? 15 5

6 Some Thoughts on Depression Not the same as the Blues Depression is a disorder, not an emotion Equal opportunity disorder Treatable Not that easily diagnosed! 16 Depression Constellation of affective, cognitive, somatic and physiological manifestations Older adults at risk for several types of depression: accurate diagnosis essential Treatment: pharmacological, supportive and therapeutic 17 Incidence Surveys indicate about 10-15% of healthy elderly people living independently suffer from depression Long-term care settings: 3 4 X greater 18 6

7 Contributing Factors Aging Development Previous depression Illness Medications 19 Aging Decreased neurotransmitters Changes in hormones Reduced reserve and resiliency Chronic illness Effects of treatment 20 Developmental Stage Losses Changes in social roles 21 7

8 Previous Depression Previous episode of depression Recurring depression throughout life 22 Illness Metabolic electrolytes Endocrine thyroid Infections Chronic Illnesses CHF Arthritis 23 Depression: Signs May (not)look sad Withdraw Changes in hygiene or personal appearance Sudden aging Increased use of alcohol Changes in behavior (very slow or more agitated) Changes in eating (under-eating and weight loss more common than overeating) 24 8

9 Depression: Symptoms Physical (sleep problems, pain, increased concerns with physical problems) Emotional (increased or exaggerated worries, feeling tearful, emptiness, irritability) Cognitive (changes in memory, poor concentration, paranoia, self-blame) Suicidal thoughts or plans 25 Depression: Suicide Highest rate: single, white men over 80 Any expression of suicidal ideation must be investigated 26 What is Not Depression? Grief Dementia (Alzheimer Disease) Sadness (lingering sadness) Thinking about death 27 9

10 Depression & Chronic Illness 30-45% with recent MI, cancer, stroke, Parkinson s and diabetes 28 Anxiety Anxiety in the older adult is not well understood Underestimated One study: 10% anxiety disorder May accompany depression 29 Anxiety in Later Life GAD most common Post-traumatic stress disorder not well understood (e.g. veterans) Older adults may have a third reaction to stress/anxiety Fight flight freeze 30 10

11 Mrs. M What would you do next? 31 Assessment: Anxiety To identify anxiety: Have you been concerned about or fretting over a number of things? Is there anything going on in your life that is causing you concern? Do you find that you have a hard time putting things out of your mind? Adapted from Ariel J. Lang, Ph.D., and Murray B. Stein, M.D., "Anxiety Disorders: How to Recognize and Treat the Medical Symptoms of Emotional Illness," Geriatrics May; 56 (5): 24-27, Assessment: Anxiety To identify how and when physical symptoms began: What were you doing when you noticed the chest pain? What were you thinking about when you felt your heart start to race? When you can't sleep, what is usually going through your head? 33 11

12 Mrs. M. One diagnosis? Or several? Depression, with anxiety/agitation Bereavement Losses 34 Mrs. M. Sense of belonging Respect Being cared for Social network Fit into community Roles she can still play Family/friends engaging her into their lives Connecting her to the community Volunteer Outreach Neighbours Church 35 Miss. K. The local Care Centre calls you for a consultation. Miss K, age 79, recently admitted. She presents as Agitated, restless Talks very fast: tangential, not easily redirected Emotional outbursts: staff intimidated 36 12

13 Miss K. Your best guess? R/O Bipolar disorder? Personality disorder? Physical health problems? Depression with agitation? Medication side effects? 37 Bipolar Disorder What is it? How common is it? What is the life course of the disorder? Who are more affected (men? women?) 38 Bipolar Disorder Affective mood disorder More common than previously thought 5-19% of adult mood disorders; BPD Life long disorder -- however 10% older adults develop disorder in later life: presentation less dramatic 39 13

14 Bipolar Disorder Complicating factors for diagnosis Prevalence of neurological disorders Complicating factors for treatment Thyroid Medication side effects Alcohol and drug abuse 40 Personality Disorders Long-term pervasive and inflexible patterns of thoughts and behaviours Create difficulty in ability to reason, interact with others, or behave appropriately 41 Personality Disorders Cluster A odd or eccentric Cluster B dramatic, emotional, erratic Cluster C anxious, fearful 42 14

15 Miss K. What would you do next? 43 Case Study Mr. J. is 88 years old: recently admitted to the Care Centre Staff report his bizarre behaviour. They describe him as a dirty old man who sometimes makes sexual comments At team meeting, many staff talk about his dementia. 44 Mr. J. One staff tells his daughter that Mr. J. has dementia: she becomes annoyed. She reports that his behaviour has been odd for the past year. Sometimes he is very talkative and distracted. Other times, he can carry on a lucid conversation

16 Mr. J. Mr. J s daughter, Ellen, demands a thorough assessment of her father. She engages in arguments with staff who indicate that she needs to be reasonable; that she is in denial of her father s age and mental health problems. 46 Difficult Relationships Ideas Beliefs Values Family Professional Ideas Beliefs Values Leahey & Harper-Jaques/96 47 Is the family the - Cause of the problem? Solution? 48 16

17 Relationships Behaviour Beliefs Values Family Knowledge Professional 49 Relationships Family Professional Knowledge Behaviour Beliefs Values 50 Narrative Practice The effective practice of medicine, nursing, social work, requires narrative competence ability to acknowledge, absorb, interpret and act on the stories and plights of others Charon,

18 Mr. J. What would you do next? 52 Resources Please refer to attachment (Word document: References for Telemental Health: Mental Health Detective.) 53 Thank You What are you taking away? 54 18

19 Thank you for your participation For information about Telemental Health education sessions: (403) Initiatives Telemental Health Telelearning Current Telelearning Sessions 55 19

20 Telemental Health Education The Mental Health Detective Sifting through Signs and Symptoms of Mental Illness in Seniors This list of selected references and on-line resources is prepared for participants. Some sites provide information for health care professionals. Others are useful for public education. Maureen Osis Aging and Mental Health - Canadian Mental Health Association Anxiety Disorders in the Elderly from the Calgary Health Region. n.pdf Canadian Coalition for Seniors Mental Health The Canadian Coalition for Seniors Mental Health (CCSMH) is hard at work ensuring that seniors mental health is recognized as a key Canadian health and wellness issue. Working with partners across the country, the CCSMH is busy facilitating initiatives to enhance and promote seniors mental health. Below is a listing of what s new at the CCSMH, but there are always more projects in development. Please bookmark this site and visit us frequently for updates Canadian Network for Mood and Anxiety Treatment this site includes a Geriatric Depression Scale. From Here to Help website s, a fact sheet on addictions in older adults and the link between alcohol use and undiagnosed depression. Geriatric Mental Health Foundation On-line The Geriatric Mental Health Foundation was established by the American Association for Geriatric Psychiatry to raise awareness of psychiatric and mental health problems and issues affecting older adults, eliminate the stigma of mental illness and treatment, promote healthy aging strategies, and increase access to quality mental health care for older adults. Health Canada just for you seniors links. Mental Health Association of Ontario includes information on depression, dementia and links to facts sheets on mental health issues for seniors