Mental Health Problems in Older Adults: Signs & Symptoms Addressing Illness, Injury, & Loss

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1 Mental Health Problems in Older Adults: Signs & Symptoms Addressing Illness, Injury, & Loss Tobi A. Abramson, PhD September 22, 2013

2 Myths, Misperceptions, & Stereotypes Questions to consider Who has misperceptions of older adults? Professionals? Older Adults? Lay public? How do I know if I hold misperceptions and stereotypes about older adults? What are some of these misperceptions? How do they impact the older adult or the care and interaction professionals have with older adults?

3 Professionals Expectations What do you expect of someone who is 72, 82, or 92? Myths, misperceptions, & stereotypes are in all aspects of society

4 Myths, Misperceptions, Stereotypes = Ageism Ageism: Process of systematic stereotyping & discrimination against individuals based on their age Dr. Robert Butler (1968) Deep and profound prejudice against the elderly which is found to some degree in all of us ageism allows the younger generations to see older people as different from themselves, thus they subtly cease to identify with their elders as human beings

5 Elderly are expected to be Asexual Intellectually rigid Unproductive Forgetful Happy Enjoying retirement Invisible Passive Uncomplaining

6 Ageism Can be seen in one s. Perceptions Language Media

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8 Perceptions: Myths vs. Facts MYTH FACT Most older people are pretty much alike. They are generally alone and lonely. They are sick, frail and dependent on others. They are often cognitively impaired. They are a very diverse age group. Most older adults maintain close contact with family. Most older people live independently. For most older adults, if there is decline in some intellectual abilities, it is not severe enough to cause problems in daily living. APA Working Group: What Practitioners Should Know About Working with Older Adults

9 MYTHS They are depressed. FACTS Community dwelling older adults - lower rates of diagnosable depression than younger adults. They become more difficult and rigid with advancing years. They barely cope with the inevitable declines associated with aging. Personality remains relatively consistent throughout lifespan. Most older people successfully adjust to the challenges of aging.

10 Language Disaster Waiting To Happen Old Biddy Nightmare On A Stretcher Dotty Old Guy In Bed Three Dirty Old Man Old Biddy Gramps Down The Hall Sweet Old Lady Rickety Dirty Old Man Still Sharp As A Tack Old Crone Hag Fuddy-duddy Miser Young Blood Needed

11 Grumpy Old Men Media Grumpier Old Men Multidimensional Presentations of Older Adults On Golden Pond Fried Green Tomatoes Driving Miss Daisy

12 Positive Stereotypes Golden Years Nice Friendly More free time Knowledge Wisdom Warm Freedom Financially well off

13 Ageism in Healthcare Lack of preventive care Lack of effective treatment provision Lack of adequate health research Lack of training Ageism in America : The Status Report (2006)

14 Impact/Effects of Ageism Hurtful to older adults Shortens lives of older adults Premature loss of independence Increased mortality and disability Depression Less quality/preventive healthcare Positive beliefs/attitudes toward older adults boosts mental health better memory, better balance

15 Depression IS NOT A NORMAL PART OF AGING!! IS AN ILLNESS

16 Depression Most..COMMON Mental Illness Most..TREATABLE Most..MISDIAGNOSED/..Underdiagnosed

17 Because Masked by Physical Illness Everyday Problems of Aged Ageism/Stereotypes Viewed as Normal

18 CLASSIFICATION of MOOD DISORDERS Two Categories: Depressive Disorders Major Depressive Disorder Persistent Depressive Disorder Adjustment Disorder w/ Depressed Mood Bipolar Disorders (manic-depression)

19 Major Depressive Disorder SIGNS & SYMPTOMS Persistent Depressed Mood Interest & Pleasure in Most Activities (Anhedonia) Significant Disruption in Important Areas of Functioning Continuous - at least 2 Weeks S.I.G. E. C.A.P.S.

20 Persistent Depressive Disorder Chronic Moderate Persistent Depressed Mood + other symptoms Most days for at least 2 years

21 Older Adult Symptoms Also Include: Irritability Anger Agitation Gastric Complaints Multiple Medical Complaints w/o Physical Causes Unexplained Decline in Motor Functioning Dress Gait Hygiene

22 Older Adults vs Younger Adults Older Adults Less Intense Mood Symptoms Prominent Sadness Suicidal Ideation Guilt More Difficult to Recognize Sadness Negative Moods Denial of Depression Weight Loss Disturbances in Sleep, Sexual Activity, Appetite, Lethargy, Fatigue Memory Complaints Self-reproach

23 Prevalence of Depression in Older Adults Older Adults Generally Satisfied w/ Their Lives Less Likely To Suffer From Depression Some - Vulnerable Both Symptoms & Disorders

24 Prevalence Estimates Vary Depressive Disorders w/age Highest in Young Adults Until Age 75 Then in Oldest-Old

25 Prevalence 10-25% Clinically Significant Depressive Symptoms Symptoms Severe Enough Interfere w/ Functioning & Warrant Tx Comorbidity of Depression w/other Psychiatric Disorders

26 Physical Illness & Depression DEPRESSION - BOTH CAUSE & CONSEQUENCE Aggravates Illness Illness Depression + Illness Risk Factor/Imitates Depression Depression Medications to Treat Illness

27 Prevalence of Depression among Medically ill Older Adults Depressive Symptoms Among Older Adults w/ Serious Medical Problems Living in Nursing Home/Institutional Settings Older Hospital Patients 6-44% MDD Rates higher severe illnesses (Cancer, functional disabilities) 18-26% Other Depressive Disorders

28 Medical Outpatients 12-20% in Primary Care Additional 10% w/ Clinically Significant Depressive Symptoms Rates high = recent immigrants & under social stress Nursing Home Patients 16% w/ MDD 16% Clinically Significant Depressive Symptoms UNDERDIAGNOSED GROUPS

29 Late Life Depression Risk Factors Female Life Stressors Alcoholism/Substance Abuse Previous Hx Of Depression Familial Pattern / Hx Medications Medical Conditions

30 Symptoms May Arise because Organic/Biological Factors Social/Psychological Factors Situational Factors

31 BIOLOGICAL TRIGGERS Chemical Imbalance Neurotransmitters Serotonin & Norepinephrine Medical Conditions Medications

32 Medical Problems Associated with Depressive Symptoms Alcohol & Drug Abuse Alzheimer s Disease Cancer Cardiac Illness Cerebrovascular Disease Chronic Pain Central Nervous System Infections (i.e. Lyme Disease)

33 Endocrine Disorders Inflammatory Diseases (i.e., Lupus) Multiple Sclerosis Nutritional Deficits (i.e., Vitamin B 12) Parkinson s Disease Stroke Vascular Dementia Viral & Bacterial Infections Vision Loss Blazer (2002);Cummings & Mega (2003)

34 Social /Psychological Triggers Bereavement Stressors Despondency due to Recent Onset Disability Perception of Failing Health Multiple Losses Loss of Hope Caregiving

35 Situational Triggers Retirement Relocation Poverty Living in Nursing Home / Institutional Living SES

36 Keep in mind Etiology is Multifaceted Need Multidimensional Approach Interventions

37 PROGNOSIS Outcomes Generally Positive Long-term 60-80% Do Well Poorer Prognosis Evidence of Cognitive Impairment or Chronic Physical Illness AGE NOT RELATED TO POORER LONG-TERM PROGNOSIS

38 Depressive Disorders Most Common Mental Health Problems In Older Adults Can Present Numerous, Serious Problems If Not Diagnosed Or Treated DO NOT DISMISS DEPRESSION AS A NORMAL PART OF AGING!!!