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Let's
Talk Facts About...
MENTAL
HEALTH OF THE ELDERLY
Having
good mental health throughout life does not ensure immunity
from severe depression, Alzheimer's disease, anxiety
disorders and other disorders in the senior years of
life. In fact, some studies show elderly people are
at greater risk of mental disorders and their complications
than are younger people. However, many of these illnesses
can be accurately diagnosed and treated.
From
15 to 25 percent of elderly people in the United States
suffer from significant symptoms of mental illness.
The
highest suicide rate in America is among those aged
65 and older. In 1985, this age group represented 12
percent of the total U.S. population, but accounted
for 20 percent of suicides nationwide. That means close
to 6,000 older Americans kill themselves each year.
Worldwide,
elderly people lead the World Health Organization's
list of new cases of mental illness: 236 elderly people
per 100,000 suffer from mental illness, compared to
93 per 100,000 for those aged 45 to 64, the next younger
group.
Severe
organic mental disorders afflict one million elderly
people in this country and another two million suffer
from moderate organic disorders.
Sadly,
many of the nation's elderly are reluctant to seek psychiatric
treatment which could cure or alleviate their symptoms
and return them to their previous level of functioning.
Why? Many older people don't understand mental illnesses
or acknowledge that they even exist. They feel ashamed
of their symptoms or else feel that they are an inevitable
part of aging. Medicare, which sets the standard for
health care insurance coverage, has traditionally discriminated
against psychiatric care by offering a low level of
benefits. Elderly people, their loved ones and friends
and often their own doctors fail to recognize the symptoms
of treatable mental illness in older people. They blame
them on "old age" or think nothing can be
done to alleviate the problem. As a result:
- Though
nearly 25 percent of elderly persons suffer from symptoms
of mental illness, they do not seek care; only 4 percent
of the patients in community mental health centers
are elderly.
- Only
two percent of the patients seen in private practitioners'
offices or hospitals are elderly.
- Less
than 1.5 percent of the direct costs for treating
mental illness is spent on behalf of older people
living in the community.
- Don't
ignore noticeable changes in an older person's behavior
or moods. These changes could be symptoms of depression,
dementia, Alzheimer's disease, or other conditions
for which you can get help. Seek medical and psychiatric
evaluations which can lead to treatments that can
return an older person to a productive and happy life.
Depression
Depression, considered the most common mental disorder,
afflicts up to five percent of people aged 65 and older.
Many researchers think this is a low estimate, because
depression can mimic dementia. Some experts thus estimate
that as many as ten percent of those diagnosed with
dementia actually suffer from depression that, if treated,
is reversible.
If
you or a loved one experience any of these symptoms
of depression for more than two weeks, you should seek
help.
Feelings
of worthlessness, hopelessness, helplessness, inappropriate
guilt; prolonged sadness or unexplained crying spells;
jumpiness or irritability; loss of interest in and withdrawal
from formerly enjoyable activities, family, friends,
work or sex.
Intellectual
problems such as unexplainable loss of memory or the
ability to concentrate; confusion and disorientation.
Thoughts
of death or suicide; suicide attempts (seek help immediately).
Physical
problems such as loss of appetite or a noticeable increase
in appetite; persistent fatigue and lethargy; insomnia
or a noticeable increase in the amount of sleep needed;
aches and pains, constipation, or other physical ailments
that cannot be otherwise explained.
Dementias
Dementia,
which is characterized by confusion, memory loss, and
disorientation, is not an inevitable part of growing
old. In fact, only 15 percent of older Americans suffer
from this condition. Of that number, an estimated 60
percent suffer from Alzheimer's disease, a progressive
mental deterioration for which no cause or cure has
been found.
The
other 40 percent of all dementias can be caused by:
- Complications
of chronic high blood pressure, blood vessel disease
or a previous stroke. Deterioration is in steps rather
than in a steady progression.
- Parkinson's
disease, which generally begins with involuntary and
small tremors or problems with voluntary movements.
Dementia may occur when the disease is severe or very
advanced.
- Huntington's
disease, a genetic disorder that begins in middle
age and has symptoms of changed personality, mental
decline, psychosis and movement disturbance.
- Creutzfeldt-Jakob
disease, thought to be caused by a viral infection
leading to rapid and progressive dementia.
Pseudodementias
Elderly people may become forgetful, disoriented, or
confused because they have developed a quickly reversible
condition that is totally unrelated to dementia. For
example, drug interactions or overdoses, poor diet and
other physical or mental problems cause symptoms that
mimic dementia. Depression often resembles dementia
in that its victims withdraw, cannot concentrate and
appear confused.
These
pseudodementias can be reversed when their causes are
diagnosed and treated. It is therefore important that
a psychiatrist first complete a thorough medical evaluation.
The evaluation can differentiate true dementia from
the following other factors that could mimic the condition:
Medications.
Elderly people take many more prescription and over-the-counter
medications than other age groups. Because metabolism
is slower in the elderly, these substances can stay
in the body longer and reach toxic levels more quickly.
Moreover, because many older people take more than one
medication and may drink alcoholic beverages, there
is a high risk that the drugs will interact, causing
confusion, mood changes and other symptoms of dementia.
Malnutrition
caused by poor eating habits. Because the brain requires
a steady supply of proper nutrients, poor eating habits
or problems with digestion can upset the way the brain
functions. For example, pernicious anemia, a blood disorder
caused by inability to use B vitamins, causes irritability,
depression or dementia. Too little sugar in the bloodstream
also causes confusion and personality change. Changed
eating habits may result from dental problems. An elderly
person may drop certain important foods from the diet
because they are hard to chew.
Diseases
of the heart or lungs. The brain also requires a great
deal of oxygen to work properly. If diseased lungs cannot
draw enough oxygen into the blood or a diseased heart
fails to pump enough blood to the brain, lack of oxygen
can affect the brain and behavior.
Diseases
of the adrenal, thyroid, pituitary or other glands.
These glands help regulate emotions, perceptions, memory
and thought processes. When they don't function, these
mental processes are affected.
Alzheimer's
Disease
One
form of dementia--Alzheimer's disease--has received
increasing attention in the years since German psychiatrist
Alois Alzheimer first described it in 1907.
Alzheimer's
disease is the fourth leading cause of death in America.
An adult's chances of developing the illness are one
in 100. One million people over 65 are severely afflicted
with Alzheimer's disease and another two million are
moderately affected. The odds of developing Alzheimer's
disease increase fourfold among family members of a
person suffering from the disorder.
Alzheimer's
disease, which causes the brain's cells to die, often
begins in a part of the brain that controls memory.
As it spreads to other parts of the brain, the illness
affects a greater number of intellectual, emotional
and behavioral abilities.
Symptoms
The onset of Alzheimer's disease is usually very slow
and gradual. The first symptom is often a loss of recent,
short-term memory. For example, a person forgets to
turn off the stove or can't remember which medications
he or she took that morning. Mild personality changes,
such as increased apathy or social withdrawal, also
occur.
As
the disease progresses, patients have trouble with abstract
thinking, handling money, working with numbers when
paying bills, understanding what they are reading or
organizing their days. They also may become more irritable,
agitated, quarrelsome and less neat in appearance.
In
late stages of the disease, the patient becomes confused
or disoriented about time and date and unable to describe
where he or she lives or name a recently visited place.
The person ultimately stops conversing, becomes erratic
in mood and uncooperative, incontinent and, in the end,
becomes unable to care for himself or herself.
Scientists
have not yet defined the cause of Alzheimer's disease.
Researchers have learned that the brains of patients
with Alzheimer's have inappropriate levels of the enzyme
choline acetyltransferase, a brain chemical that is
important in memory loss and disorientation. Still other
research has focused on the possibility that a slow-acting
virus causes the progressive brain damage seen in Alzheimer's
disease. Until the cause of Alzheimer's disease is known,
the cure remains elusive.
Because
this disease is so widespread, many associations have
organized support groups and developed educational materials
and insurance information for Alzheimer's sufferers
and their families. Many support groups offer day-care
activities for patients and counseling for family members
who are often faced with years of care for their loved
one.
Bibliography
Butler, Robert N. Aging and Mental Health: Positive
Psychosocial, and Biomedical Approaches. New York, NY:
Merrill, 1991
The
Dementias: Hope Through Research. U.S. Department of
Health and Human Services, National Institutes of Health
Publication No. 81-2252, Washington, D.C.: Superintendent
of Documents, U.S. Government Printing Office, 1981.
Fact
Sheet: Depression in the Elderly. U.S. Department of
Health and Human Services, Public Health Service, Alcohol,
Drug Abuse and Mental Health Administration, 5600 Fishers
Lane, Rockville, MD 20857.
Humphrey,
James H. Stress Among Older Adults: Understanding and
Coping. Illinos: Thomas, 1992
Plain
Talk About Aging. National Institute of Mental Health,
Division of Communications and Education, 5600 Fishers
Lane, Rockville, MD 20857.
Powell,
Lenore, M.D. and Katie Courtice. Alzheimer's Disease:
A Guide For Families. Reading, MA: Addison-Wesley, 1983.
Progress
Report on Senile Dementia of the Alzheimer's Type. National
Institute on Aging, NIH Publication No. 81-2343, September
1981. U.S. Dept. of Health and Human Services, National
Institute on Aging Information Office, 5600 Fishers
Lane, Rockville, MD 20857.
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