Lecture 3: Psychological Distress in Old Age Part 1

What is psychological distress?

A state of emotional suffering associated with stressors and demands that are difficult to cope with in daily life

How is psychological distress characterized?

It is an emotional disturbance that undermines the social and physical functioning of individuals

Also defined by conditions such as depression, anxiety and PTSD

What are sources of psychological distress?

Loneliness

Physical illness

What is loneliness?

Refers to deficiency in the quality and quantity of social relationships (with friends, family, colleagues and community)

How does loneliness arise?

Discrepancy between actual and desired levels of social interaction

How might social relationships have an effect on loneliness?

Social relationships = source of mental stimulation

Insufficient or poor social relationships can be psychologically distressing to older adults

What are the three types of loneliness?

Social loneliness

Emotional loneliness

Existential loneliness

What is social loneliness?

Arises from no or limited social contacts/networks

What is emotional loneliness?

Arises from the absence of intimate figures (spouse, children, trusted friends)

What is Existential loneliness?

Withdrawal from others and outside world due to fear of disappearing, fear of death, or solidarity confine for creative purposes (musical composition, philosophical understanding of the world)

What are the most common forms of loneliness?

Social and emotional

What factors are associated with loneliness of older adults?

1. Post-World II changes in family structure

2. Loss of family/friends due to death (widowhood)

3. Gray divorced

4. Retirement (from paid employment)

5. Low-self esteem (causing people to withdraw from others)

6. Change of residence

7. Poor health

How does WWII impact loneliness?

Family caregivers (mostly women) joined the labour market and no longer available for care duties

How does loss of family/friends impact loneliness?

Size of social networks reduces from age 60 years old due to death of age cohorts (reduced opportunities for social interaction)

How does gray divorce impact loneliness?

Increases risk of emotional loneliness due to loss of companionship

How does retirement impact loneliness?

Leads to a reduction in social interaction with colleagues at work

How does low self-esteem impact loneliness?

Individuals with low esteem are shy, feel unaccepted and tend to avoid interaction with others

How does change of residence impact loneliness?

Moving from community residence to long-term care facilities or nursing home

How does poor health impact loneliness?

Depression, chronic pain and disability

Health status generally declines with age; poor health limits interaction with others, leading to loneliness

What is the prevalence of loneliness in North America?

Approx. 19.2% of Canadian seniors experienced loneliness in 2019

35-40% of American seniors are socially isolated/lonely

Estimates of loneliness (prevalence) may be underestimated due to stigma associated with admitting loneliness (people do not want to admit they are lonely)

What are the sociodemographic differences in prevalence of loneliness among older adults?

1. Sex differences

2. Age differences

3. Sociodemographic status

4. Living arrangements

How do sex differences impact loneliness?

More older women than men experiences loneliness (due to sex differences in mortality)

How do age differences impact loneliness?

Loneliness increases with age; more prevalent among 75+ year olds than those 60yrs younger (due to severe illness and mobility challenges)

How does SES impact loneliness?

low SES (low education, income) is associated with higher prevalence of loneliness

How does living arrangements impact loneliness?

Living alone is associated with higher prevalence of loneliness. In 2023:

• 32% of divorced Canadian seniors were lonely

• 31% of widowed Canadian seniors were lone

• 29% of never-married Canadian seniors were lonely

What are psychological impacts of loneliness?

1. Depression

2. Anxiety

3. Cognitive decline

However, these relationships can also be bi-directional (when depression and anxiety, and cognitive decline can predict loneliness)

How does depression impact loneliness?

Lonely older adults are generally unhappy, less satisfied with life and more pessimistic (symptoms of depression

How does anxiety impact loneliness?

Lonely older adults may experience insomnia, restlessness and fear (symptoms of anxiety)

How does cognitive decline impact loneliness?

Lack of mental stimulation due to limited social interactions can lead to cognitive decline in older adults

How can one mitigate loneliness in older adults?

• Create opportunities for social interactions (reading clubs, day centres)

• Social enrichment programs, especially in long-term care settings (music programs, games)

• Age-friendly communities like sidewalks, sign boards, age friendly buildings (including elevators)

• Community participation: participation in decision-making (community boards), volunteer opportunities

What is a comorbidity?

2 ways:

• 2 or more physical problems

• 2 or more physical and psychological/cognitive problems

Health problems affect mood, especially when experiencing chronic pain

• people with Alzheimer’s disease are easily irritated or agitated and may physically attack others

Is comorbidity common in advanced age?

Yes, these include:

• Alzheimer’s disease

• cancer

• cardiovascular diseases

• diabetes

• respiratory diseases

• hypertension

• arthritis

• back pain

Risk of these diseases increase substantially from age 65 yrs

This understanding challenges the body-mind dualism, and instead emphasizes their interconnections

What is the relationship between physical comorbidity and psychological distress?

Chronic comorbidities may inflict physical pain and emotional distress

Can interfere with social life and lead to loneliness

Physical appearance may change (leading to low self-esteem

How does physical disability impact psychological distress?

Leading to loss of independence and reduce quality of life

• dependence on others for activities of daily living

Sufferers of physical illnesses may feel demoralized, hopeless, purposeless, incompetent, burdensome

What is an example of physical comorbidity?

The combination of vision and hearing impairments can lead to social isolation/loneliness and eventually depression

How else might physical comorbidities impact loneliness?

Grief associated with terminal illness can increase depressive symptoms

Request for euthanasia (assisted suicide) is common among older adults experiencing chronic pain and depression

Suicide and suicide ideation are common in older adults with comorbidities

How does invasive treatments impact loneliness?

Can alter body appearance and cause depression

Some drugs may cause delirium (anti-hypertensives and opiates)

What is the relationship between physical and mental health problems?

Bidirectional (physical health problems can cause depression and vice versa)

• depressive mood can lead to unhealthy behaviours (smoking, alcoholism) that affect physical health

• Positive mood can lead to healthier lifestyles and longevity

Stigmatization (embarrassment) due to loss of body parts can cause depressive mood

What are interventions that can help with loneliness?

Medical and mental services are currently separated. Mental services are not readily accessible in Canada (per current wait times)

Depressed older adults use more medical services, increasing costs to healthcare systems

Integration of medical and mental services are critical to the wellbeing of older adults

Integrated care models ensure older adults presenting medical problems are also screened for mental health (vice versa)