KNPE 335 Wk 4 - Psychological and Mental Healthy Aging

Learning Objectives:

• define they psychological dimensions of aging

• understand the difference between mental health and mental illness

• understand what effects mental health for older adults and aging

• describe the common mental health conditions and their characteristics for older adults

• explore interventions to improve mental health for older adults and healthy aging

Psychological Definitions

Mental Health:

• cognitive function:

  • changes in memory, attention, and processing speed

• mental disorders:

  • depression, anxiety, cognitive impairments, etc

Wellbeing:

• coping mechanisms:

  • strategies used to manage stress and life changes

• resilience:

  • ability to adapt positively to adversity or significant life events

QoL

• life satisfaction:

  • overall contentment and fulfilment with life experiences

• purpose and meaning:

  • a sense of contribution and meaningful engagement in daily activities and relationships

Social Connections:

• social support:

  • relationships with family, friends, communities

• social isolation:

  • the degree to which an individual lacks a sense of engagement with others

Life Transitions:

• retirement:

  • adjusting to a new phase of life with changes to one’s routine, responsibilities, and identity

• bereavement:

  • coping with loss and the associated grief process

Self Identity and Autonomy:

• self esteem:

  • maintaining a positive self image and self worth

• Autonomy:

  • maintaining independence and control over life decisions

What is Mental Illness?

“characterized by alteration in thinking, mood, or behaviour - or any combination thereof - associated with some significant distress and impaired functioning”

• mental illness takes many forms including mood disorders, schizophrenia, anxiety disorders, personality disorders, eating disorders, and addictions such as substance dependance and gambling

Mental Illness vs Mental Health

Mental Health and Aging

• the prevalence of mental health problems in adults over the age of 65 ranges from 20-30%

• depression and anxiety are the most common mental health conditions among older adults

  • sub clinical depression and anxiety raises estimates of mental health issues to 40% for older adults

• globally, ~27.2% of deaths from suicide are among people aged 60 or over

What Affects Mental Health?

• housing

• transportation and mobility

• income

• services

  • health

  • housing

  • dental

  • vision

  • food services

  • hearing

  • recreation

• physical factors

  • exercise

  • nutrition

  • sleep

  • illness/disability

• emotional factors

  • self esteem

  • self knowledge

  • coping skills, etc

• spiritual factors

  • religious beliefs

  • nature and meaning of one’s life

• social factors

  • personal relationships

  • meaningful activity

Neurotransmitters and Healthy Aging

• dopamine

  • reward-motivation system

  • motor control, decision making, teaching, motivation, pleasure

• serotonin

  • boost when you feel significant and important

  • mood, memory, sleep, cognition

• norepinephrine

  • regulates blood pressure

  • memory formation and retrieval

  • stress and sleep regulation

Why are Mental Illnesses Missed?

• in older adults, signs and symptoms often differ than those in younger people

• older adults are less likely to self identify problems

• mental illnesses can accompany or stem from serious physical illnesses and disorders

• environmental social, and cultural factors can affect a person’s signs and symptoms of mental illness and willingness to seek treatment

• caregiver stress about burnout

• ageism

Older Adults, Dignity, and Mental Illness

• causes of compromised dignity in older people with mental illness

  • ageism and elder abuse

  • loneliness

  • lack of policy provisions

  • increased frailty and dependence

  • lesser focus on functional recovery

  • neurocognitive disorders

  • institutionalization

  • healthcare inequalities

  • social stigma and discrimination

Common Mental Health Disorders in Older Adults

• depression

• suicide

• anxiety disorders

• dementia

• loneliness and isolation

• delusional disorders

• delirium

• paraphrenia (mental illness characterized by an organized system of delusions with or without hallucinations)

• concurrent disorders (has both a mental illness and a substance use problem)

Depression and Aging

• not a “normal” part of aging

• there is a distinct type of depression in later life which may be reactive - such as long term care admission

• late onset depression often has a cognitive component, some memory impairment, which may be related to decreased blood flows or TIAs

• depressive symptoms are very similar to dementia, so the person is often labeled as having dementia

Symptoms of Depression in Older Adults

• sleep

  • change in sleep patterns such as daytime napping, being unable to fall asleep. and/or being unable to stay asleep

  • feeling fatigued even with sleep

• interest

  • lack of interest or pleasure in life’s daily activities, anhedonia

  • physical limitations and pain limiting activities that they once enjoyed

• guilt

  • feeling like a burden, worthlessness, grief and loss, compounding life stressors, changes in roles and responsibilities, and feeling sad without a reason

• concentration

  • fears about cognitive decline and memory loss, acute stress

  • medical conditions that may occur independent of depression or alongside depression that can contribute to issues with concentration and memory

• energy

  • changes in energy (lethargy, fatigue)

  • increase in angry, aggressive, agitated, or irritable energy

• appetite

  • changes in appetite, unintended weight gain or loss, increased or decreased sense of hunger and satiety, change in normal eating patterns or preferred foods, changes to perceptions about what foods are digestible or cause digestive issues

• psychomotor

  • reduced activity, low energy, feeling that they have slowed down, sense of restlessness

• suicide

  • feelings of hopelessness, helplessness, and sadness can lead individuals to consider suicide as a possible option

Late Life Depression

• a depressive disorder developed at the beginning of old age

• a serious and life threatening disorder which affects every 1 in 5 individuals in a lifetime

• typically characterized by an atypical cluster of symptoms (ie. somatic symptoms, anxiety, and psychotic symptoms)

  • somatic (physical) symptoms are most common in late life depression compared to early

• less likely to be characterized by sadness

• under diagnosed and inadequately treated

• becomes challenging to distinguish it from dementia (due to overlapping symptom profiles) especially when depression affects the cognition and is presented as ‘pseudodementia’ 

Delirium

• delirium is an acute change in mental status causing shift in cognitive functioning, reduced environmental awareness, altered attention, and behaviour changes

Types of Delirium

• hypoactive

  • withdrawn, reduced speech and activity, apathy, unawareness

• hyperactivity

  • increased activity, irritability, restlessness, combativeness

• mixed

  • fluctuations in psychomotor activity

Short Term Outcomes of Delirium

• falls

• pressure injuries

• aspiration pneumonia

• distress

• prolonged hospital stay

• long term care admission

• increased risk of mortality

Long Term Outcomes of Delirium

• functional and cognitive impairment

• dementia

• post traumatic stress syndrome

• sleep disturbances

• increased risk of mortality

Factors Reducing Risk of Delirium

• cognitive reserve

  • the capacity of the mature adult brain can butter the effects of neurological disease or injury

• social support and interactions

  • regular visits from care partners help to reduce the burden of cognitive impairment and provide comfort with frequent reorientation

• environmental influences

  • exposure to natural daylight can support the promotion of regular circadian rhythms and healthy sleep cycles

• pain management

  • appropriate and consistent pain assessments should be conducted to ensure pain is adequately controlled and severity is monitored, especially if communication becomes difficult with delirium

The Intersection of Delirium and Mental Health Conditions

• unfortunately, some of the populations most vulnerable to delirium are older adults who have dementia, depression, and acute psychiatric syndrome

• each of these syndromes can co-occur with delirium

• when an individual develops delirium, it is called delirium superimposed on dementia

Loneliness 

• ‘a state of solitude or being alone’

• ‘the perception of being alone and isolated that matters most’ and is a state of mind

• typically thought to be a subjective, negative feeling related to the deficient social relations

• reported to be more dangerous to health than smoking

High Degree of Loneliness Precipitates:

• suicidal ideation

• para-suicide

• alzheimer’s disease

• dementia

• negative effects of immune system

• negative effects of cardiovascular system

• increased risk of hospitalization

• increased risk of LTC facility placement

Types of Loneliness

• developmental loneliness

  • lack of balance between individualism and innate desire to relate to others

• internal loneliness

  • the perception of being alone. associated with low self esteem and self worth

• situational loneliness

  • socio-economic and cultural milieu. effected by the environment

Interventions for Loneliness

• activity involvement

• volunteer roles

• developing and keeping quality relationships

• pharmacological management of physical ailments

• staying in contact with family and friends

Social Isolation

• “a state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts and they are deficient in fulfilling and quality relationships”

• social isolation is a major and prevalent health problem among community-dwelling older adults, leading to detrimental health conditions

• prevalence of social isolation in community-dwelling older adults indicate that it is as high as 43%

Impacts of Social Isolation

• health behavioural

  • behaviour habits

  • encouragement to adhere to medical treatment

  • refrain from negative or risky behaviours

• psychological

  • less participation in social activities

  • increased risk of cognitive decline

  • increased risk of suicide or depression

• physiological

  • predictor of mortality from heart disease or stroke

  • decreased infection resistance

• other outcomes

  • all cause mortality

  • risk of falls

  • rehospitalization and institutionalization 

Interventions for Social Isolation

• Fakoya et al., (2020)

  • no one size fits all approach

  • tailor programs to individual needs, specific population, degree of loneliness

• Paquet et al., (2023)

  • social prescribing programs can enable primary care providers to refer patients to a range of local nonmedical services

  • group based social activities, support groups, recreational activities, training or use of technology are most effective

• Manjunath et al., (2021)

  • patient centred approach is essential for any effective intervention ie. social facilitation, exercise, psychological therapies, health and social services, animal therapy, befriending, and leisure and skill development

Mental Health Interventions

• mental health promotion and prevention strategies for older adults focus on supporting healthy aging including:

  • measures to reduce financial insecurity and income inequality

  • programs to ensure safe and accessible housing, public buildings, and transport

  • social support for older adults in their carers

  • support for healthy behaviours, especially to eat a balanced diet, be physically active, refrain from tobacco and reduce alcohol use

  • health and social programs targeted at vulnerable groups such as those who live alone or in remote areas and those living with a chronic health condition