Most older people do not develop mental health problems, but a significant minority have dementia or experience problems such as depression.
It is estimated that 18% of the general population in the UK are of pensionable age and that this figure will grow to 20% by 2025. As a society, we tend to assume that older people will develop mental health problems as a ‘normal’ aspect of ageing. Most older people do not develop mental health problems, although a significant minority does. For example:
about 25% of people over 85 have dementia.
between 10-15% of people over 65 have depression
between 4-23% of older adults seen by medical staff have an alcohol problem.
In addition to those older people who have an identifiable mental illness such as dementia, there are many who experience psychological or emotional distress associated with isolation, loneliness or loss. These problems are not recorded by the health or medical care system.
What problems affect people in later life?
Dementia is a decline in mental ability which affects memory, thinking, problem solving, concentration, perception and behaviour. Some forms of dementia, such as Alzheimer’s disease, are degenerative. That is, they get worse over time. Other forms of dementia, such as vascular dementia, may be non-degenerative. That is, they may not get worse over time.
People with dementia can become confused. Some people also become restless or display repetitive behaviour. They may also seem irritable, tearful or agitated. This can be very distressing for both the person with dementia and their family and friends. Some people with dementia also develop other problems such as depression, disturbed sleep, aggression, inappropriate sexual behaviour and incontinence, although the latter issues tend to be associated with more advanced dementia.
About one in 20 people over the age of 65 are affected by dementia and this figure rises to one in four people over the age of 85 (Audit Commission, 2000). People under the age of 65 can develop dementia but this is rare and is known as early onset or pre-senile dementia.
What causes dementia?
Dementia occurs as a result of the death of brain cells or damage in parts of the brain that deal with our thought processes and functioning. The most common form of dementia is Alzheimer’s disease. We do not know what causes Alzheimer’s disease but we do know that ageing is the biggest risk factor. The second most common type of dementia is vascular or multi-infarct dementia. This occurs as a result of a series of mini-strokes which constrict blood flow and oxygen to the brain.
Can dementia be prevented and is there a cure?
Most types of dementia cannot be cured but a number of psychological treatments and anti-dementia drugs can be very effective for those in the early stages of dementia. It is therefore very important to get a proper assessment of cognitive function from a medical practitioner as early as possible.
There are no guaranteed ways of preventing dementia, but you may find it helpful to follow a sensible diet and pursue a healthy lifestyle. Regular physical exercise and supplements like Gingko Biloba can help to ensure that there is always a good supply of blood to the brain. Please consult your GP before taking such medication. You can also help yourself by keeping your mind active, for example by doing crosswords or puzzles.
Depression describes a range of moods, from feeling a bit low to a severe problem, which interferes with everyday life and normal functioning. People with severe depression may experience a range of symptoms including low mood, loss of interest and pleasure as well as feelings of worthlessness or guilt.
Depression can affect anyone, of any culture, age or background but it affects proportionally more older people than any other age group. It is estimated that around 10-15% of elderly people in the community exhibit depressive symptoms, with this proportion rising to about 40% of care home residents. That said, you will not necessarily become depressed just because you are getting older.
What causes depression?
There are a number of risk factors that play a role in increasing older people’s vulnerability to depression including:
being widowed, divorced or retired
neurobiological changes associated with ageing
use of medication for other conditions
greater physical impairment and disease
loneliness and isolation
genetic susceptibility, which increases with age.
Can depression be prevented and is there a cure?
Depression in later life is a widely under recognised and under treated medical condition. Up until recently many health professionals – including GP’s – failed to offer the treatments and supports available to other age groups. Most forms of depression can be treated, using medication, talking treatments or other strategies.
It is can be difficult to diagnose depression in older people because it often occurs alongside other mental and physical illnesses, such as dementia, stroke, diabetes and cancer. In addition many older people do not seek help from their GP until they have a number of symptoms. As with dementia, it is important to seek help as early as possible.
Self-help strategies that can help reduce the risk of depression include:
taking regular exercise
planning for critical transitions such as retirement
seeking support from family and friends following the loss of a long-term partner
ensuring that you pursue a range of interests in later life.
Dementia and depression
The relationship between dementia and depression is complex. The symptoms of dementia and depression – including withdrawal from social activities and general apathy – are very similar. An elderly person with severe depression may occasionally be misdiagnosed as having dementia. A person with dementia may also become depressed.
It is estimated that between 4%-23% of older adults seen by medical staff experience problems with alcohol. Figures also show that older men are currently between two and six times more likely than older women to be at risk of abusing alcohol.
Although alcohol abuse is a problem for people of all ages, it is more likely to go unrecognised among older people. Many older people use alcohol to deal with loss or loneliness. Approximately 10-30% of older people who abuse alcohol become depressed. They are also at greater risk of suicide.
Prescribed medications can cause mental health difficulties among older people. A 2001 Department of Health survey found that 79% of older people take prescribed medicines. Many older people take four or more medications at the same time. There are risks associated with taking multiple medications, including confusion.
More detailed information about medication and mental health problems can be found at the following sites:
Other mental health problems
There are a number of rarer mental health problems that affect older people, including delirium, anxiety and late-onset schizophrenia. The prevalence, nature, and course of these disorders are different in older people, as are the treatments that may be offered.
Capacity and older people with mental illness
People with dementia or severe mental illness may have difficulty in making and communicating decisions. Very few people are unable to be involved in making choices at all but some may have partial or fluctuating mental capacity and may need help with communication. Different approaches are also required to engage a person with dementia. They often need longer to make decisions, may need an advocate to speak on their behalf and their mental functioning may also vary by day, and time of day. Family members or carers are often useful sources of information but it is important to take account of the views of the person with dementia alongside those of their carer.
Help for carers
Caring for an older person with mental health problems can be very stressful, time consuming and emotionally and physically challenging. Caring for an older person with dementia is associated with higher levels of stress, with a third of carers suffering from depression.
For free advice on depression or a free consultation visit http://www.clairehegarty.co.uk or ring 0151 678 3358 or 07714853524
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