Mental Health and Adult Life Course (Week 6)

Topic: Mental Health
Focus Areas:
- Mental health and the adult life course
- Assessment and therapy
- Conditions covered: Depression, Delirium, and Dementia

Definition:
- Psychological and emotional well-being
- May include cognitive aspects
- Examples of cognitive aspects:
  - Hallucinations
  - Delusions
Cognition Defined:
- Thinking processes including:
- Memory
- Attention
- Spatial orientation

Mental Health Characteristics:
- Positive attitude toward self
- Accurate perception of reality
- Mastery of the environment
- Autonomy
- Personality balance
- Growth and self-actualization

Successful mental functioning results in:
- Productive activities
- Fulfilling relationships
- The ability to change
- The ability to cope with adversity

Context:
- Key is understanding the absence of mental health characteristics
Characteristics of Psychopathology:
- Behaviors that are harmful to self or others
- Behaviors that lower well-being
- Behaviors perceived as distressing, disruptive, abnormal, or maladaptive
Important Note:
- Assessments for older adults must follow distinct guidelines, as some behaviors may be adaptive.

Factors Impacting Development of Mental Illness:
- Biological Forces:
- Neurological changes (structure and function of the brain)
- Chronic diseases
- Functional limitations
- Physical problems can be clues to mental health issues
- Psychological Forces:
- Memory
- Intelligence
- Social cognition
- Personality
- Sociocultural Forces:
- Social norms
- Cultural factors
- Community dynamics
- Definitions of health and illness
- Life-Cycle Factors:
- Past experiences
- Current issues
- Location in the life course (roles, responsibilities, expectations)

Definition:
- A formal process of measuring, understanding, and predicting behavior
Effective Assessment Strategies:
- Multidimensional assessment involving a team of health professionals
- Use of a variety of mental health screening tools, including:
- Clinical interviews
- Mental status exams

Average Age at Diagnosis:
- 32 years
Trends:
- Rates of severe depression decline from young adulthood to older age in the U.S.
- Differences observed among ethnic groups
- Not universally applicable across all cultures
Correlates of Depression in Older Adults:
- Female gender
- Unmarried or widowed status
- Recent bereavement
- Stressful life events
- Lack of an adequate support system

Key Symptoms Include:
- Dysphoria:
- Feeling down or blue
- Symptoms may differ in older adults (e.g., expressionlessness or apathy)
- Physical symptoms:
- Insomnia
- Loss of appetite
- Diffuse pain

Assessment Scales:
- Beck Depression Inventory
- Geriatric Depression Scale

Sample Items Include:
- I'm slightly more irritated now than usual.
- I feel irritated all the time.
Scoring Instructions:
- Various levels of irritation and interest in people assessed with point scale.

Instructions for Patients and Examiners:
- Responses are given based on the previous week.
Sample Questions Include:
- Are you basically satisfied with your life?
- Do you feel that your life is empty?
Scoring Summary:
- Scores range from 0 to 30, indicating levels of depressive severity (0-9 Normal, 10-19 Mild Depressive, 20-30 Severe Depressive).

Statistics:
- 25% of older adults succeed in suicide attempts (NCOA, 2021)
Common Reasons for Suicide:
- Loneliness
- Grief
- Loss of self-sufficiency
- Chronic illness or pain
- Financial troubles

Statistical Overview:
- Average rates by ethnicity and age.
Key Findings:
- Data sourced from the Centers for Disease Control and Prevention.

Characteristics:
- Confused thinking and reduced awareness of the environment
- Symptoms develop rapidly
Causes Include:
- Various medical conditions
- Side effects of medications
- Dehydration
- Sleep deprivation
Risk in Older Adults:
- High likelihood due to multiple medications, with 1/3 of cases preventable.

General Overview:
- A family of diseases affecting mental health without being defined strictly as a mental illness
- Cognitive and behavioral deficits, including:
- Memory loss
- Difficulty communicating
- Result in permanent brain damage and severe decline over time
- Diagnosis requires the absence of delirium
- Approximately 12 types of dementia noted.
- Included: Alzheimer's Disease (AD) and Parkinson's Dementia.

Commonality:
- Most prevalent form of dementia (60-80% of cases)
Neurological Changes Associated with AD:
- Rapid cell death
- Presence of neurofibrillary tangles and amyloid plaques
Progression of Disease:
- Develops slowly with worsening symptoms, ultimately leading to brain destruction and death within the average lifespan of 3 to 11 years post-diagnosis
Symptoms:
- Often vague initially but become pronounced over time
- E.g., sundowning: symptoms exacerbate in the evening

Data Presentation:
- Projections from 2020 to 2060 regarding the number of people affected
Notable Increases Expected in the aging population experiencing Alzheimer's.

Early Stage Symptoms:
- Memory loss
- Disorientation to time and space
- Poor judgement
- Personality changes
Middle Stage Symptoms:
- Increased memory problems
- Difficulties with speech
- Loss of impulse control
- Irritability
Late Stage Symptoms:
- Incontinence
- Loss of motor skills
- Decreased appetite
- Inability to recognize family members
- Decreased ability to fight off infections