Getting Serious about Seniors’ Mental Health


Depression in elderly Parkinson'sMental Health Month is a good time to look at the risk factors and symptoms of poor mental health, and get educated about the warning signs that can help us prevent suicides among Seniors. If you or someone you know has had thoughts about suicide at any point in time, you are not alone! Last year the suicide rate was 19% among individuals 45 years old to 85 years and older.

Our mental health affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. We all experience depression and anxiety at some point in our lives, but how we deal with it determines whether or not we are at risk for something more serious.

Being mentally healthy means there is balance in all aspects of your life whether physical, mental, emotional, and spiritual. Mental wellness means you can enjoy life and deal with the challenges you face each day like making decisions, adapting in difficult situations, or talking about your needs and dealing with your desires. There will be times in life when people experience problems and stresses and these often change a person’s ability to cope and function. Everybody gets worried, sad, scared or suspicious from time to time, but these feelings can create mental health issues if they get in the way of daily life. When changes in thinking, mood, and behavior are associated with significant distress and impaired functioning, you need to recognize that either you or a loved one may be experiencing mental illness.

In this article we will take a look at depression and anxiety, and the ways in which it affects older adults. Scientific studies suggest that many serious mental illnesses involve changes in the chemistry of the brain. Seniors dealing with depression have a chemical imbalance in their brain. And that chemical imbalance is treatable. We do not know for sure what causes mental illness, but studies suggest that a combination of factors contribute to the onset and severity of most mental health problems. These include:

 ~     Family history of mental health problemsanxiety in Seniors

 ~     Biological factors, such as genes or brain chemistry

 ~    Aging and gender affect the rates and prevalence of mental illness when combined with trauma or abuse

 ~   Environmental factors or stress due to finances, relationships, poor access to health care and lack of social support

 ~    Symptoms of mental illness occur in people with chronic physical illness and pain

Seniors with mental health problems often exhibit telltale physical symptoms. For example, when someone is very anxious and has an anxiety attack, they experience mental symptoms such as fear, but also physical symptoms like a racing heart, sweaty palms, and difficulty breathing. When someone is experiencing depression, they may feel despair, be sad and cry, but their sleep patterns, eating habits, appetite, and energy level might also be affected. Look for these physical symptoms which can be early warning signs of mental health problems:

  • ~       Eating or sleeping too much or too little
  • ~       Pulling away from people and usual activities, inability to perform daily tasks
  • ~       Feeling helpless or hopeless or like nothing matters
  • ~       Smoking, drinking, or using drugs more than usual
  • ~       Having low energy levels or no energy at all
  • ~       Having unexplained aches and pains
  • ~       Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared
  • ~       Experiencing severe mood swings, yelling or fighting with family and friends
  • ~       Hearing voices or believing things that are not true
  • ~       Thinking of harming themselves or others

Depression in Seniors

depressed and anxiousHas a loved one ever suffered from extended periods of sadness, loss of pleasure in everyday activities, or feelings of worthlessness or guilt? If so, they may be experiencing symptoms of depression. A physical exam from a medical doctor can determine if there is a physical basis for the depression. Be aware that some physical conditions and the use of some medications and drug interactions may cause symptoms of depression.

Depression is not a “normal” part of aging. It is a medical problem that affects many older adults and can often be successfully treated. Depression is often under-recognized and under-treated in Seniors. Without treatment, depression can impair a Senior’s ability to function and enjoy life, and can contribute to poorer overall health. Compared to older adults without depression, those with depression often need greater assistance with self-care and activities of daily living, and often recover more slowly from physical disorders.

Some diseases and certain medical problems can cause symptoms of depression (and anxiety) along with:

  • ~  Thyroid disorders
  • ~  Diabetes
  • ~  Cognitive impairment or dementia
  • ~  Parkinson’s disease
  • ~  Multiple sclerosis
  • ~  Strokes
  • ~  Tumors
  • ~  Chronic illness, disability or chronic pain, some viral infections
  • ~  Progressive hearing loss, deteriorating eye sight
  • ~  Alcohol or prescription medication misuse or drug abuse
  • ~  A history of falling repeatedly
  • ~  Extended mourning due to death of a friend, spouse or family member
  • ~  Stressful situations like financial difficulties, change in living situation, retirement or job loss, and family conflict

Depression can manifest itself through one or any combination of the symptoms below:

  • ~  Moodiness
  • ~  Loss of interest or pleasure in activities, lack of energy
  • ~  Disturbed sleep and noticeable restlessness
  • ~  Weight loss or gain
  • ~  Feelings of worthlessness or extreme guilt
  • ~  Difficulties with concentration or decision making

Anxiety in Seniors

Has someone you know ever suffered from excessive nervousness, fear or worrying? Do they sometimes experience chest pains, headaches, sweating, or gastrointestinal problems? If so, they may be experiencing symptoms of anxiety.

Chronic, exaggerated worry about everyday routine and activities, and always anticipating the worst can lead to physical symptoms such as fatigue, trembling, muscle tension, headache, or nausea. Excessive anxiety that interferes with daily activities is not a “normal” part of aging, and can lead to a variety of health problems and decreased functioning in everyday life. Some common types of anxiety disorders and their symptoms are:

~  Panic Disorder: Sudden feelings of terror or fear of dying that strike repeatedly and without warning and bring on physical symptoms like chest and abdominal pain, heart palpitations, and shortness of breath, dizziness, etc.

~  Obsessive-Compulsive Disorder: Recurrent unwanted thoughts or rituals, obsessions and compulsions which cannot be controlled. Behaviors like hand washing, counting, checking or cleaning, are performed in the hope of preventing the thoughts or making the obsessions go away.

~  Post-Traumatic Stress Disorder (PTSD): Occurs after experiencing a traumatic event such as violence, abuse, natural disasters, or some other threat to a person’s sense of safety. Symptoms include nightmares, flashbacks, loss of emotions, depression, being easily startled, and feeling angry, irritable or distracted.

~  Phobia: An extreme, disabling and irrational fear of something that really poses little or no actual danger which leads to avoidance of objects or situations. Usually makes people withdraw, limit their lives and activities as well as people they can come in contact to.woman sundowning syndrome

Anxiety disorders are also often unrecognized and undertreated in older adults and may be linked to the same risk factors listed above for depression. In addition, pulmonary disease [COPD], cardiovascular disease, arrhythmia, and angina have also been known to cause anxiety, as well as the drugs for treating these disorders and depression! Overall feelings of poor health or preoccupation with physical health or physical limitations can be at fault as well as a negative or difficult childhood.

If an individual is screened and diagnosed, there are treatment choices and support available to help them recover. These include clinical services, medications, support groups, counseling, and other therapies that manage thoughts and emotions. The most effective treatment for depression and anxiety is a combination of therapy and medication. When we think about cancer, heart disease, or diabetes, we don’t wait years to treat the patient. We start way before Stage 4 – We begin with prevention. When people start to show symptoms of mental illness such as loss of sleep, feeling tired for no reason, feeling depressed and anxious, or hearing voices, we should act. A person who may be thinking about suicide likely does not want to die, but is in search of some way to make their pain or suffering go away. Older adults who attempt suicide are often more isolated, more likely to have a plan, and more determined than younger adults. If you or a loved one is in CRISIS and need help NOW, CALL  2-1-1 or 1 (800) 273-TALK. Crisis counselors and free and confidential assistance is available at the National Suicide Prevention Lifeline at 1-800-273-TALK  or 1-800-273-8255.

Preventing Senior Suicide

Suicidal thoughts should always be taken seriously. Suicidal thoughts in older adults may be linked to several important risk factors and warning signs. These include, among others:

  • ~  Prior suicide attempts and access to lethal means like firearms, or other weapons
  • ~  Verbal threats like, “You’d be better off without me” or “Maybe I won’t be around”
  • ~  Medical conditions that significantly limit functioning or life expectancy
  • ~  Giving away prized possessions
  • ~  Alcohol or medication misuse or drug abuse
  • ~  Social isolation, family discord or loss of a loved one
  • ~  Sudden personality changes, inflexibility, difficulty adapting to change
  • ~  Feelings of hopelessness, loss of independence, no sense of purpose

thyroid, depression, anxietyIt is critical that the family and friends of older adults identify signs of suicidal thoughts and take appropriate actions to prevent the elderly from acting on these thoughts. Passive suicidal thoughts include thoughts of being “better off dead.” They are a sign of significant distress and should be addressed immediately. Active suicidal thoughts include thoughts of taking action toward hurting or killing oneself. Active suicidal thoughts require immediate clinical assessment and intervention by a mental health professional. If someone you know has a suicide plan with intent to act, you should not leave them alone—make sure to stay with them until emergency services are in place.

Worrying about health insurance costs should never be a barrier to treatment for suicide risk. Medicare helps cover mental health services.  Visit the Medicare QuickCheck® on www.MyMedicareMatters.org  to learn more about all of the mental health services available to you through Medicare. Mental Health America’s website link is: http://www.mentalhealthamerica.net/mental-health-information. Local resources for Palm Beach County include Boca Raton’s Promise, visit http://www.bocaratonspromise.org/.

Contact Us: Seniors’ suicide is a serious problem in South Florida. People often avoid or delay medical care and treatment for their mental health problems because of stigma and the fear others will see them as weak, crazy or “different”.  Mental health conditions, such as depression or anxiety, are real, common and treatable. And recovery is possible. Regal psychiatric nurses and trained caregivers can work with the patient’s mental health professionals so they can be treated comfortably and cost-effectively in the less restrictive environment of the home while receiving appropriate and adequate follow-up. If you have a Senior family member that would benefit from an in-home care plan that supports their treatment and care management while providing assistance with the activities of daily life, please contact Ferial Andre, RN, CCM, CDP, at 561-499-8382 or ferialandre@regalcares.com.

This article is not intended as medical advice