When we think of growing old, what tends to come to mind are the typical signs of aging—wrinkles, retirement and regression of a few physical functions (and height). What doesn’t usually come to mind are the often invisible mental and neurological conditions that afflict over 20 percent of individuals over 60 years of age. As this segment of the population will nearly double worldwide over the next 35 years, it is important to address these issues with greater attention. Moreover, the deficit in geropsychologists—psychologists who study older adults and their clinical provisions—as well as the lack of opportunities to train in this field only augment this need further.
The most common mental health issues for the elderly population are dementia and depression, while anxiety disorders affect roughly four percent of geriatrics. One percent struggle with substance abuse and nearly 50 percent of nursing home patients have some form of cognitive impairment, many of which involve personality disorders. Many of these disorders tend to go under-identified by both health professionals and the afflicted individuals for various reasons. In fact, less than three percent of mentally ill older adults report seeking professional help, which is less likely than both younger and middle-aged adults.
Because of the various physical ailments that tend to afflict older adults, these individuals are more likely to seek out and receive primary care rather than specialized mental health services despite nearly 70 percent of all primary care visits being driven by psychological factors, such as general anxiety and adjustment disorders. The lack of a well-integrated mental health, primary health and geriatric health system contributes to the tendency for mental health and substance abuse problems to be often overlooked or misdiagnosed in the elderly. Ironically, the onset of physical ailments and their comorbidity with certain mental conditions present a catch-22. Older adults with heart disease, for instance, are more likely to experience depression, while late-life depression tends to negatively affect the health outcome of someone with heart disease. Even mild depression can compromise a person’s immunity against certain infections and their capacity to recover from cancer.
Other social, psychological and physical stressors can impact a person’s mental health later in life—and at any point, for that matter. Events such as bereavement, decreased funds due to retirement, disability, and the common need for long term care because of loss of mobility and, thus, independence, can amplify feelings of loneliness and isolation. Moving out of a family home, for example, can easily coincide with the onset of a depressive mode. Though less common than other factors, elder abuse is a significant contributor to mental health issues among the elderly. It can manifest in many forms, including physical, sexual, emotional and financial, leading to not only physical injuries but also long-term psychological issues like depression and anxiety. Because depression and anxiety tend to coincide with other physical conditions, it is likely that they can be overlooked by a health professional.
Other barriers to treatment could include poor insurance coverage—a problem that much of the mentally ill population faces—as well as the stigma that accompanies mental health issues, a general denial of deteriorating mental health, and logistical access barriers, such as lack of transportation. Even when older adults do pursue or are offered treatments for mental health conditions, the options are rarely psychological interventions, such as psychotherapies, which are preferred over traditional psychiatric medications.
Other psychological interventions include supportive counseling to not only treat the disorders but to also help older adults cope with the stressors that come later in life. Thanks to increased use of sensitive diagnostic tools, behaviorally- and environmentally-based interventions are becoming more effective for helping older adults cope with aging and the mental conditions that can accompany it. Incontinence, for instance, is the second leading impetus for sending the elderly to nursing homes and corresponds to an increased risk of depression. Behavioral training programs that employ biofeedback and bladder training not only reduce incontinence but also prove more effective than drug therapy. Additionally, psychologists have developed cognitive-behavioral techniques and sleep hygiene instruction for treating insomnia, which affects 30-60 percent of older adults.
These interventions have proved effective not only in combination with medications but also on their own. Moreover, because there are many instances when people dealing with late-life depression are not responsive to traditional medications, psychotherapy is a welcomed alternative that has proven effective. The availability of non-pharmacological treatments is especially important because the elderly are often on multiple medications for various chronic conditions, so the risk of adverse effects from psychiatric medications is much higher for them than for younger individuals.
As roughly 85 percent of older adults live with at least one chronic illness, such as arthritis, diabetes or hypertension, it is critical that their comfort and well-being are prioritized not only during life but also in considering end-of-life care. A staggering quarter of the deaths resulting from self-harm occur in people over 60 years of age. Most geriatric suicides could be prevented, as many older adults who committed suicide reached out for help—at least 70 percent within the month that they died.
“End of life” refers to when health care professionals expect their patients to die within about 6 months. Many older adults with chronic illnesses tend to prefer a “good death” that lacks pain, symptoms and excess technology. Much of the anxiety that surrounds end of life care among the elderly involves the fear of pain, emotional concerns and that family concerns will be ignored. Palliative, or comfort, care focuses on helping to make the process of preparation for death as comfortable as possible, although there are still obstacles to a “good death.” Such hindrances include poor or confusing communication from the physicians, lack of understanding of the patient’s culture, and poor knowledge of the patient’s general preferences. Still, it is possible that if more clinical and counseling psychologists are trained in palliative care, issues such as communication of choices and resources can get a more hopeful and supportive spin.
An important step in addressing the mental health needs of the geriatric population would be emphasizing the need for and importance of more trained geropsychologists. Such professionals can not only help to expand upon knowledge of the most effective treatment options, but they can also help to address behavioral health issues, such as dementia and Alzheimer’s, promote quality of life and death among older adults and facilitate the integration of primary, geriatric and mental health care.