Mapping the Way to Mental Health and Wellness in May

Mental health is important at every stage of life, from childhood to adulthood. Mental health includes our emotional, psychological, and social well-being. It 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.

Depression in elderlyBut not all of us think about our mental health enough. May is Mental Health Month, a good time to examine our awareness of the risk factors and symptoms of poor mental health so we can do away with the stigma of mental illness, and get educated about the warning signs that can help us prevent suicides. If you or someone you know has thought about suicide at any point in time, you are not alone. Last year the suicide rate was 19% among individuals 45 to 64 years of age, and 18.6% for those 85 years and older.

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 choices and 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. It is natural to feel off balance at times, we all get worried, sad, scared or suspicious. But these kinds of feelings may 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 a person may be experiencing mental illness.

Mental illness is the term used to refer to mental health problems that are diagnosed and treated by mental health professionals. In this article we will discuss depression and anxiety, and the ways in which it affects the elderly. Mental health covers a multitude of topics such as AD/HD, addictions, Alzheimer’s, Autism, Bipolar disorder, dementia, dissociative disorders, eating disorders, learning disabilities, mood disorders, panic, paranoia, personality disorders, phobias, Post-Traumatic Stress Disorder and Schizophrenia, and others too numerous to mention and beyond the scope of this article. You can access information on the aforementioned at the Mental Health America website link:

Scientific studies suggest that many serious mental illnesses involve changes in the chemistry of the brain. We do not know for sure what causes mental illness, but studies suggest that a combination of factors contribute to the onset, recovery, and severity of most mental health problems. These include:

     ~  Family history of mental health problems.

    ~  Biological factors, such as genes or brain chemistry. Aging and gender are believed to affect the rates and prevalence of mental illness when combined with environmental factors.

   ~ Environmental Factors or Life Experiences, such as trauma or abuse. Stress due to finances, relationships, as well as family background, access to health care and social support can all affect mental health. 

    ~  Physical factors and illness.  Symptoms of mental illness are found to occur in people with a chronic physical illness.

anxiety in SeniorsSeniors with mental health problems often exhibit physical symptoms. For example, when someone is very anxious and has an anxiety attack, they experience mental symptoms such as fear, but also 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 might also be affected.

If you or someone you know is experiencing one or more of the feelings or behaviors below, it can be an early warning sign 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

Warning Signs of Depression and Anxiety in Seniors


Has a loved one ever suffered from extended periods of sadness, loss of pleasure in everyday activities, poor sleep, or feelings of worthlessness or guilt? If so, they may be experiencing 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 older adults. Without treatment, depression can impair an older adult’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 daily living activities, and often recover more slowly from physical disorders. Symptoms include:

     ~  Moodiness

     ~  Loss of interest or pleasure in activities

     ~  Disturbed sleep

     ~  Weight loss or gain

     ~  Lack of energy

     ~  Feelings of worthlessness or extreme guilt

     ~  Difficulties with concentration or decision making

     ~  Noticeable restlessness or slow movement

     ~  Frequent thoughts of death or suicide, or an attempt of suicide

Depression in older adults may be linked to several important risk factors including:

     ~  Mental impairment or dementia

     ~  Medical problems, chronic health conditions, disability or age related decline

     ~  Overall feelings of poor health, or chronic pain

     ~  Progressive hearing loss, deteriorating eye sight

    ~  Medication side effects from benzodiazepines, narcotics, beta blockers, corticosteroids, and hormones

     ~  Alcohol or prescription medication misuse or drug abuse

     ~  A history of falling repeatedly

     ~  Sleep disturbances

     ~  Family history of depression

     ~  Extended mourning due to death of a friend, spouse or family member

    ~  Stressful life events like financial difficulties, change in living situation, retirement or job loss, and family conflict


Man SundowningHas 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 causes distress or 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): Occur after experiencing a traumatic event such as violence, abuse, natural disasters, or some other threat to a person’s sense of survival or safety. Symptoms include nightmares, flashbacks, numbing 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, activities and the people they can come in contact to.

Like depression, anxiety disorders are often unrecognized and undertreated in older adults. Anxiety can worsen an older adult’s physical health, decrease their ability to perform daily activities, and decrease feelings of well-being.

Anxiety in older adults may be linked to several important risk factors, many similar to those involved in depression. These include, among others:

     ~  Mental impairment or dementia

   ~ Chronic medical conditions like chronic obstructive pulmonary disease [COPD], cardiovascular disease, arrhythmias, angina, thyroid disease, and a diabetes

    ~  Side effects from medications like steroids, antidepressants, stimulants, bronchodilators or inhalers, etc.

     ~  Alcohol or prescription medication misuse or drug abuse

     ~  Sleep disturbances

   ~ Overall feelings of poor health or preoccupation with physical health symptoms or physical limitations

     ~  Stressful life events, and a negative or difficult childhood


depressed and anxiousIf an individual is screened and diagnosed, there are choices and support to help them recover. These include clinical services, drugs, peer support groups, counseling, family support groups, and other therapies that help to 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. This is what we should be doing when people have serious mental illnesses, too. When they first begin to experience symptoms such as loss of sleep, feeling tired for no reason, feeling low, feeling 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 pain or suffering go away. Older people who attempt suicide are often more isolated, more likely to have a plan, and more determined than younger adults. If you or someone you know is in crisis and would like to talk to a crisis counselor, call the free and confidential National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

Preventing 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

     ~  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

     ~  Access to lethal means like firearms, or other weapons

     ~  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

It 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.

Medicare helps cover mental health services. Worrying about health insurance costs should never be a barrier to treatment for suicide risk. Visit the Medicare QuickCheck® on   to learn more about all of the mental health services available to you through Medicare.

Contact Us: 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” or “different”. Mental health conditions, such as depression or anxiety, are real, common and treatable. And recovery is possible. A Senior family member or elderly loved one might benefit from an in-home care plan that supports their treatment and care management, as well as providing assistance with the activities of daily life. 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 and referral. For a consultation, please contact Ferial Andre, RN, CCM, CDP, at 561-499-8382 or

This article is not intended as medical advice