ch6 aging

What is Mental Health? - World Health Organization (WHO)

“A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

What is Mental Health? - Public Health Agency of Canada (PHAC)

“The capacity of each of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity.” Many factors affect the mental health of an individual.

Two main diagnostic systems

Diagnostic and Statistical Manual (DSM-5) APA, International Classification of Diseases (ICD-11) WHO

Controversy over DSM vs ICD. Why?

● Initially very little collaboration between the two ● DSM focuses on mental disorders alone ● ICD includes all physical ailments as well as mortality rates; mental disorders is a chapter

ICD

Official world classification system ● more attention given to primary care in low-income countries ● a major focus is ease of use by clinicians and a reduction in the number of diagnoses.

DSM

North American classification system ● focus on secondary psychiatric care in high-income countries ● tends to add more disorders with each revision

Research Domain Criteria

● research framework for investigating mental disorders ● not meant to serve as a diagnostic guide or replace current diagnostic systems

What is Mental Illness?

“A syndrome characterized by clinically significant disturbances in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (APA, 2013, p. 2).

Three criteria typically used to determine a mental illness

● How different is the behaviour? ● How disruptive is the behaviour? ● How distressed is person by behaviour?

Mental Health Facilities in Canada with a Geriatric Specialty Service

● Douglas Mental Health Centre in Montreal, Quebec ● Baycrest Hospital in Toronto, Ontario, ● Centre for Health Care of the Elderly, Halifax, Nova Scotia ● Villa Caritas Hospital, Edmonton, Alberta

● What is assessment?

○ A systematic approach to assessing behaviour, cognition, or emotion ○ Multidimensional ○ Essential first step ○ Clinical interview is the most widely used assessment

Rates of depression in LTC are alarming

● Worldwide

Peer mentoring program found to

reduce symptoms of depression and loneliness.

Why is Depression Lower for Older Adults Living in the Community

● Inaccurate assessment of depression in older adults ● Sub-syndromal depressive symptoms may also be more prevalent ● It could be that older adults generally experience less stress and tend to cope better than younger people

Risk factors

○ Physical illness, low social support and isolation, poor subjective health, and recent bereavement.

There are 800,000 suicide deaths every year, which is one person every 40 seconds (WHO, 2019)

● The suicide rate of 13.0 for men and 7.70 for women per 100,000 population ●Likely an underestimate

In Canada older adults have the highest rate of

suicide ● Many visited their family physician in the days or months prior, but rarely sought services from a mental health professional.

Treatment of Depression

Combination of pharmacotherapy and psychotherapy ● SSRIs are the first medication of choice ● Electroconvulsive therapy (ECT) may be effective in those with severe depression ● Good evidence that older adults can benefit from a variety of psychotherapies

Anxiety Disorders

● Majority of anxiety disorders in older adults start at a younger age ● GAD is most common anxiety disorder ● Variability in prevalence rates ● Difficulty assessing anxiety in older adults ● GAD is associated with a host of poor health outcomes

Treatment of Anxiety Disorders

usually includes medication as well as psychotherapy ● SSRIs ● Cognitive behavioural therapy (CBT), relaxation therapy, worry groups ● Internet-delivered CBT for both anxiety and depression is proving to be effective

Substance Use Disorders - Alcohol

● Females are most likely to be abstainers, but there is considerable variability by region ● The wealthier the country, more alcohol consumed ● 78 percent of Canadians surveyed reported drinking alcohol in the last year ● Canadians like to drink beer followed by wine and spirits

Older adults have similar rates of alcohol use as younger adults but this appears to be increasing ● Why?

○ Baby boomers – alcohol use and drug use became more accepted ○ Media ○ Some diets, such as the Mediterranean diet, promote alcohol use.

Canadian Coalition for Seniors (2019) Canadian Guidelines on Alcohol Use Disorder Among Older Adults

● Recommends less alcohol use ● This is due to physical changes that occur with age ● Recommends even less use if medical comorbidities are present

Prevalence of Substance Use Disorders

● More than 13% of older adults reported a pattern of problem drinking ● This will likely increase due to the number of older adults increasing ● Two patterns of alcohol abuse

Prescription Drug Misuse

● Growing concern for older adults ● Almost 55 percent of hospitalizations due to misuse of medications ● Older adults are at greater risk for hospitalization

Treatment of Substance Use Disorders

● Availability of age-specific services is limited ● Older adults do better when receiving age-specific treatment (e.g., AA, motivational interviewing)

Primary and Secondary Psychotic Disorders

● Psychosis can be caused by ○ a psychiatric illness (primary psychosis) ○ a medical or neurologic condition (secondary psychosis). ● About 60% of psychotic disorders in older adults are due to a medical or neurological condition. ● Depression and dementia account for most psychoses in older adults ● poor health status, cognitive problems, visual impairment, and negative life events are risk factors for psychosis.

Schizophrenia in Older Adults

● Prevalence rates vary by race/ethnicity and across countries and geographic location ● Men are more likely to have the illness before the age of 40 and women are more likely to be diagnosed after the age of 60 ● Growing body of patients and healthcare professionals calling for a name change

Schizophrenia in Older Adults

● Symptoms appear to get worse in those chronically institutionalized ● Studies have found improved symptoms in those not institutionalized, BUT ● Antipsychotic medication is first line ● There is evidence that CBT and psychosocial skills training are effective

Hoarding

used to be considered a form of obsessivecompulsive disorder, but in DSM-5, it was designated as its own disorder

Hoarding Studies on prevalence in older adulthood are mixed

although the severity does seem to increase with age • Very few studies have examined treatment for HD, with those available tend to use CBT with very modest success

Positive Psychology

● The scientific study of strengths, wellbeing and functioning ● Interventions have been shown to decrease depressive symptoms and pessimism ● Limited research in older adults but results look very promising

Underutilization of Mental Health Services

● Evidence to suggest that worldwide, older adults underutilize mental health services ● Most likely to seek out their family physician for help ● What could be the barriers to seek treatment?

Working with Mentally Ill Older Adults

● There is a lack of even the basic skills required to work with older adults. ● However, we seem to be moving in the right direction ● The Pikes Peak Model Competencies underscore the core elements needed in geropsychology training. ○ Attitudes ○ Knowledge Base ○ Skill Competencies