by Lindsay Felsing M.S.W., Director of Economic Security
In 2014, President Obama declared the month of May as National Mental Health Awareness Month. Sometimes, mental health problems in older adults are overlooked or minimized as being merely a part of the aging process. The truth is, however, that mental health disorders are not a “normal” part of the aging process. Let’s look at four areas of mental health issues that older adults face: depression, co-occurring conditions, substance abuse, and dementia.
Depression What do you think of first when you think of older adults or seniors? One stereotype I hear often is that older adults are “grumpy.” Irritability and grumpiness are not “normal” parts of the aging process. Irritability is one of the most common symptoms of depression along with anxiety, hopelessness, sadness, somatic complaints, and difficulty concentrating. Depression is not a “normal” part of the aging process either. Older adults are less likely to display obvious symptoms or talk about their depression. So that “grumpy” older adult may actually be displaying the subtler symptoms of depression, but his/her actions may be simplified and disregarded because of a problematic and unfortunate stereotype. It is not surprising then, that two-thirds of older adults with mental health disorders do not receive treatment or access needed services. This is a worrying statistic considering that men over 85 have the highest suicide rate of any group, and 20% of adults over 55 experience disturbances in mental health.
Comorbidity Depression and other mental health disorders in older adults are often comorbid with chronic health problems. Comorbidity is especially important to understand when working with the aging population. Comorbidity is the simultaneous presence of two or more chronic health problems in an individual. Co-occurring issues generally exacerbate one another. For example, an older adult may experience depression and also have a chronic illness like diabetes or heart disease. A depressed person may experience more severe symptomatology than someone who is not depressed, which in turn exacerbates the depression. Similarly, someone with dementia may forget how to regulate their diabetes. This is a reciprocal relationship where the co-occurring problems reinforce one another.
The way a person perceives or conceptualizes their experiences has a real and profound impact on both their physical and mental health and the reverse is also true. These problems can also affect an older adults’ economic security. Someone experiencing mental health issues may avoid dealing with bills or other financial difficulties as a coping mechanism. Similarly, they may have trouble taking steps to access benefits that provide financial assistance, and the resulting prolonged financial problems may increase depressive symptoms. Economic insecurity and maladaptive behavior patterns, like avoidance, can ultimately negatively affect both physical and mental health as well.
Substance Abuse Mental and physical health problems sometimes co-occur with substance abuse. Older adults might have struggled with alcohol abuse their whole life or onset may have occurred later in life as a means of coping with difficult issues such as loneliness and chronic illness. Denial of substance abuse in older adults is a common problem, and is often worse than in younger individuals. The negative health effects of even light to moderate drinking are markedly more profound in older adults as well. Chronic alcohol abuse in older adults can lead to cognitive impairment including Korsakoff’s Syndrome, a type of alcohol dementia. This causes atrophy of the frontal lobe and has negative, long-term implications for brain functioning. Prescription drug abuse can be a problem among older adults as well. Abusers are more likely to be men than women, while abuse of illicit drugs is less likely in the aging population than in younger adults.
Dementia Like depression, dementia is not a “normal” part of the aging process. Dementia is an acquired cognitive disorder marked by persistent decline of memory, language, math, problem solving, and recognition. Nearly 11% of adults over age 65 and 36% of adults over age 85 suffer from some form of dementia. Dementia can also cause behavior changes including increased irritability, aggression or passiveness, and inability to manage emotions. There are several types of dementias, and they are classified depending on the region of the brain impaired by the disease. It often results in marked personality changes that are upsetting and confusing for the individual and their family members and friends.
Dementia is diagnosed by taking a medical history and conducting a physical and mental status examination. Depression and anxiety are generally comorbid with dementia and are also prevalent among caregivers. Alzheimer’s is the most common type of dementia. It is estimated that the number of older adults affected by dementia of the Alzheimer’s type will rise to 14 million by 2040. Alzheimer’s has a gradual onset and is often well-established before the disease is apparent. It also can be devastating for families.
Depression Depression is treatable in 80% of cases. Unfortunately, many older adults do not receive treatment. Social and emotional supports are important protective factors that work against depression and are associated with reduced risk of mental illness. According to the Centers for Disease Control and Prevention (2008), the percentage of older adults reporting that they rarely or never received the social and emotional support they needed increased with age. Here are some resources for finding support:
- Depression Tool Kit for Older Adults, University of Michigan
- Depression Treatment Centers in Michigan
- Community Mental Health Services Programs
- Michigan State University Counseling & Mental Health Resources
- The State of Mental Health and Aging in America
- Mental Health America
Substance Abuse Alcohol and drug abuse and misuse can affect older adults differently than young people. Many older adults also take medications that have contraindications for mixing with alcohol. Drinking can also mask physical and mental problems that people may write off as just a part of aging. Here are some resources for finding substance abuse support:
- Alcoholic’s Anonymous
- Narcotic’s Anonymous
- Al-Anon for friends and families of problem drinkers
- Sparrow Hospital
- Michigan Department of Community Health, Office of Recovery Oriented Systems of Care
Dementia Dementia can be devastating for those it affects as well as their family members and caregivers. While there is no cure and no preventive treatment, there is support available. Here are some resources for finding support:
- Alzheimer’s Association
- Alzheimer’s Support Groups
- Alzheimer’s and Dementia Caregiver Support Groups
- Area Agencies on Aging Association of Michigan
- Michigan Department of Community Health, Dementia in Michigan
- National Public Radio, For Elders with Dementia, Musical Awakenings
- Detroit Institute of Art, Meet me at the DIA: People with early stage dementia (including Alzheimer’s) and their caregivers are invited to participate in gallery discussions about art led by DIA staff and volunteers with expertise in this area
- Alzheimer’s Foundation of America
Lindsay Felsing, M.S.W. is the Director of Economic Security at Elder Law of Michigan. She joined Elder Law in 2011 as the Regional Project Manager for MiCAFE, was promoted to Assistant Director in 2012, and then assumed the position of Director in 2013. Through her work at Elder Law, Lindsay has managed over 100 community partners and 200 volunteers across the state of Michigan – including recruitment, training, and education related to the State of Michigan Food Assistance Program.