7 Triggers of Mental Health Decline in Seniors

Introduction

The discussion of the connection between the mind and body has been the topic of many a news’ show, magazine articles and research.Yet, how our mental state impacts the quality of our lives as we age and specifically in our later years is still, from my experience as a Gerontologist, underestimated. There are a broad range of mental health problems in later life, the details of which are outside the scope of this eBook. However, this eBook should serve to inform people about mental health and dispel some fears people may have around mental health as they age. This Article highlights steps that we can take to look after our own mental health, encourages us to look out for the people around us and provides an overview of some common mental health problems in later life. It should also prove to be a useful resource for family members, caregivers and friends. The basic premise is that a good plan, based on solid information, will mitigate many of the fears and insecurities that foster emotional instability as we age. Of course, mental health problems that are chemical in nature or somehow physiologically induced, can affect each of us at any time in our lives. Many older people who have mental health problems may not be diagnosed or get treatment. The detection and treatment of mental health problems early on can lead to significant improvements in the quality of an older adult’s life.

Things Change…

We experience many changes as we grow older and these can be very stressful, especially if we don’t feel prepared or supported. Some of the more obvious changes are retirement, loss of a spouse, the death of friends, loss in physical function and good health, and the loss of independence (which is a multi-faceted concept). Some of the things that change are gender specific. For example, men often lose their ability to have or maintain an erection. Women experience a loss of physical beauty and girlish sexuality. Some people adapt well to change and embrace it with a sense of wonderment. Others fear the unknown. Whatever camp in which one resides, change for older adults who may feel vulnerable, weakened by illness and an ever increasing sense of mortality is usually more difficult.

Trigger 1-Retirement

The modern day notion of retirement has its origins in 19th century politics. Specifically, in 1883, Chancellor Otto Von Bismarck of Germany had a problem. Marxists were threatening to take control of Europe. Fearing that his countrymen would succumb to their ideology, he proclaimed that he would pay a pension to any nonworking German over age 65. This was an empty, yet brilliant gesture since the average lifespan during the late 1800’s was 50 years old. Bismarck not only undermined the Marxists, but set the arbitrary world standard for the exact year at which old age begins and established the precedent that government should pay people for growing old.

Despite the fact that when someone should retire is a capricious line drawn by a paranoid official, the impact of retirement should not be underestimated. For many, work is central to their life and provides structure to their day, a sense of purpose and perhaps a social network. While retirement may be anticipated, it is common for individuals to experience mixed feelings, rejection or sad that they are leaving an environment so integrally interwoven into their daily existence. Anxiety about what the future will hold is common. Feelings range from feeling hurt and angry to worrying about how retirement will affect their relationships and if they will have enough money to live on.

People find that they have a lot more free time when they retire. As a result, relationships with partners and children often change requiring an adjustment for both the retiree and family. Many older people feel more successful when they become more active, and develop a regular structure to their day.

If you are on the precipice of retiring, decide on your goals and plan towards them. Now is a good time to reflect upon the activities that you longed to participate in when you were busy raising your children or working 40-60 hours a week. Did you always want to bike, draw, write, teach, be more civically engaged? Think about what you want the picture of your life to look like and paint it in advance. Talk about it. Dare to dream about your future as filled with fun and joy and then wait for that day with the anticipation of a child at the counter of a candy store.

Many people worry about the financial challenges that retirement may bring. This is why having a plan is so essential. By doing a little advanced planning a person can exert control over this variable. Living in limbo is very difficult for most people, and when you add the vulnerability that many older people experience it can make it all the more difficult.

Don’t be a victim of circumstance because you are not a victim. You may not be as physically powerful as you once were, but you still have power through action. If you are worried whether you have enough money to pay for long term care, if you don’t want to be a burden to your children, if you do not want to go into a nursing home, get long term care insurance.

This product can enable you to save your hard earned money, and get care at home or in a dignified setting. Instead of spending your entire life’s savings on skilled nursing care, you can pass it on to your heirs. You cannot depend on the government to take care of you. For more information about long term care insurance, visit www.mymomnpop.com/lLTCI.

If you are worried about being able to survive on a fixed income and you are over 62 years of age and have a home, look into a reverse mortgage. Why sweat the small stuff? Why worry that you will run out of money to pay for food and medication? Why wonder if you can make home improvements because you have limited resources? You can finance your needs with an asset for which you have worked your entire life. Let that asset work for you now. A reverse mortgage does not just have to be used to avert a financial crisis. As long as your are 62 years of age or older, you can use a reverse mortgage to make home improvements or even buy long term care insurance. You can do anything you wish with the funds from your home. For more information about long term care insurance visit www.mymomnpop.com/RM.

If you are worried that your children won’t be taken care of, have a will or a trust drafted. If you fear that extraordinary measures will be taken should you be rendered comatose, get an advanced directive. An advance directive allows you to name a person, a proxy, to speak on your behalf should you become incapacitated. That person can deal with your finances and be the voice of reason with doctors, insurance companies and medical boards.

Helen Dennis, PhD., and founder of Aging, Employment, and Retirement Specialists, Redondo Beach, California suggests the following for successful retirement-planning couples:

1. Both spouses or partners should be encouraged to attend retirement planning and education programs together.
2. Spouses and partners should have equal access to information and discussions. Facilitators and instructors can design nonthreatening exercises to determine the extent to which spouses and partners are financially literate and have similar or divergent thoughts about use of time, relocation, and other subjects.
3. Principles of communication should be part of the educational program to emphasize the importance of establishing good relationships in retirement and provide tools to accomplish that goal.
4. The value of a nonworking spouse or partner should be emphasized. Her or his job description may be more demanding and diverse than that of any paid employee.
5. All couples should have equal access to useful retirement information and enlightening discussions that lead to a secure, meaningful, healthy, and joyous future. As boomer women begin to retire, they are likely to be equal participants in retirement education and decision making. The bottom line is that most things we fear, we can control by having a plan. For those things that we cannot control, let them go and see where that takes you. Maybe that blank canvas will turn out to be a masterpiece.

Trigger 2- Bereavement

With a long life comes the loss of friends, family, maybe even a partner. The loss of a spouse, however, can be one of the most harrowing and stressful events in a person’s life. This loss is painful at any time of our lives, but when you grow older you are less able to cope and move on than if you were younger. The intensity of emotion over this loss is typically magnified by a confluence of events that happen at this stage in life.

This can be a time of dramatic upheaval that tests physical, psychological and spiritual boundaries. For example, children may have moved away, and in many cases, the couple was retired, which as discussed above, can result in a significant change in routine. Being on a fixed income may cause uncertainty about one’s ability to be cared for. Contacts with friends and acquaintances may have been curtailed and the widow or widower’s own health may be declining.

Mutual dependence for love and support is a cornerstone of a long marriage. For many couples who have weathered the storms of a long relationship, a person’s spouse is more than someone they married long ago—there is great friendship and everlasting respect for the other. To the person they left behind, they were their best friend, their guide, and their companion. Their will to survive is often shattered.

In short, when your spouse dies your universe changes. You are in mourning— feeling grief and sorrow at the loss. Feelings of numbness, shock, and fear are natural. You may feel guilty for being the one who is still alive. If your spouse died in a nursing home, you may wish that you had been able to care for him or her at home. At some point, you may even feel angry at your spouse for leaving 5 you. All these feelings are normal. There are no rules about how you should feel. There is no right or wrong way to mourn.

When you grieve, you can feel both physical and emotional pain. People who are grieving: • Can have trouble sleeping

• Often cry easily.
• Show little interest in food.
• Experience problems with concentration.
• Have a hard time making decisions.

What can you do?

• Take a walk with a friend or meet with old friends.
• Go to the library to check out books; volunteer at a local school as a tutor or playground aide; join a community exercise class or a senior swim group; be part of a chorus; sign-up for bingo or bridge at a nearby recreation center; join a bowling league or a sewing group; offer to watch your grandchildren or a neighbor’s child; consider adopting a pet.
• Think about a part-time job.
• Let family provide nurturance and support. Additionally, professionals such as mental health specialists, clergy and doctors can be of assistance. • Grief and loss support groups are also extremely helpful. The opportunity to process and share feelings with others experiencing similar difficulties can be invaluable in the healing process. Check with hospitals, religious groups, and local government agencies to find out about support groups.
• Don’t rely on your children to pave the way for you during this transition. Most children will be supportive, but will be proud and be grateful if you allow them to lead their lives while you begin to reconstruct yours. They are grieving too. It will take time for the whole family to adjust to life without your spouse.
• Try not to make any major changes right away. It’s a good idea to wait for a while before making big decisions like moving or changing jobs.
• Don’t think you have to handle your grief alone. Sometimes short-term talk therapy with a counselor can help.
• Take care of yourself. Grief can be hard on your health. Try to eat right, exercise, and get enough sleep. Avoid bad habits such as drinking too much alcohol or smoking that can put your health at risk. Be sure to take 6 your medicines as your doctor ordered. Remember to see the doctor for your usual visits.

The grieving process, given its length is not too extreme, is one of the most vital components of the healing process. For some people however, mourning can go on so long that it becomes unhealthy. If you’re having trouble taking care of your everyday activities, like getting dressed or fixing meals, this can be a sign of serious depression and anxiety. If your sadness stays with you and keeps you from carrying on with your day-to-day life, talk to your doctor. Although a grieving person may experience a number of depressive symptoms such as frequent crying and profound sadness, grief is a natural and healthy response to bereavement and other major losses. There is a difference, however, between a normal grief reaction and one that is disabling or unrelenting. While there’s no set timetable for grieving, if it doesn’t let up over time or extinguishes all signs of joy—laughing at a good joke, brightening in response to a hug, appreciating a beautiful sunset—it may be depression which is discussed at length below.

When you feel stronger, you may need to think about:

• Writing a new will.
• Looking into a durable power of attorney for legal matters and a power of attorney for health care in case you are unable to make your own medical decisions.
• Putting any joint assets (such as a house or car) in your name.
• Checking on your health insurance as well as your current life, car, and homeowner’s insurance.
• Signing up for Medicare by your 65th birthday.
• Paying state and federal taxes.

When the time is right, and only when the time is right, go through your spouse’s clothes and other personal items. It may be hard to give away these belongings. If it is too hard to part with everything at once, do it in incremental steps. For example, instead of parting with everything at once, you might make three piles: one to keep, one to give away, and one “not sure.” Ask your children to help. Think about setting aside items to give to your children or grandchildren as personal reminders of your spouse.

Trigger 3-Loss of Independence/Moving From One’s Home

Seniors often are very attached to their home because it symbolizes stability and comfort. Even in the face of compelling reasons to find better living arrangements, most seniors would probably go to extra lengths just to remain there.

Whether an older adult is involuntarily forced to change their residence or chooses to do so, it can be very stressful. In fact, according to research, the elderly population is extremely susceptible to what is known as Relocation Stress Syndrome (RSS). This condition, which is also known as transfer trauma, was recognized as an official nursing diagnosis in 1992.

RSS is characterized by a combination of physiologic and psychological disturbances such as symptoms such as anxiety, confusion, hopelessness, and loneliness, which can significantly affect behavior, mood, morbidity and even mortality. Studies show that 31% of seniors decrease their social network, along with 30% possibility of hospitalization within a month of moving.

Based on these statistics, it would be best to understand the effects of transferring a person from one environment to another can bring about. This is especially important in light of the fact that RSS can last for several months, often persisting a year or longer. In fact, in one study, more than half of the older adults who were interviewed did not feel at home in long-term care after residing there between two to seven years.

Symptoms of RSS can include exhaustion, sleep disturbance, anxiety, financial strain, grief and loss, depression, and disorientation. In older people, these symptoms can quickly become exacerbated by dementia, mild cognitive impairment, poor physical health, frailty, lack of support system, and sensory impairment.

The most reliable study done on RSS found that the problem is better handled and accepted when a psychological and sociological approach to treatment is taken, rather than a medical approach, which invariably means the use of medication.

So what can you do if you are dealing with a parent who must move from their home?

• Discuss the move in detail, use pictures, or if possible take them on a tour of the facility they are going to. Reassure them continually and keep them in the loop.
• Whenever possible, allow them to make decisions. Let them feel some control, even if they are small ones, like choosing which pictures or blankets to take with them.
• Be patient and recognize that they may require extra attention and reassurance after the move.
• Stress the positive aspects of moving such as socialization, freedom from the demands of maintaining a home, and increased opportunities for both mental and physical activity.

If you are faced with the need to move from your home yourself, there are many options available. Seek advice and choose the best option for you. Fear of the unknown can make moving from home into care more difficult. There are many things that can be done to make the process easier:

• Be involved in the decision-making as much as possible. – Visit the place in which you will be living before you move. – Meet the other residents and become familiar with the staff and environment.
• Make a plan for your move. – Find a moving company that specially caters to seniors. These companies usually have senior relocation specialists to help coordinate all aspects of moving.
• Make a list of who you should contact to tell them about your move, including the post office, utility services, your friends and neighbors. Don’t forget to give them your new address and phone number.

It is normal to feel anxious, stressed or angry at the time of the move and even if you are prepared, you may panic. It takes time to settle into any environment and after you have had time to catch your breath, it should get easier. Surround yourself with your belongings, photos of family or favorite books. Maintain contact with your family and friends. Remember to tell people how you are feeling at this time.

What can you do for yourself if your parent must move into your home? In some instances there could be real benefits to having a parent move in.

If your parent is healthy and able-bodied, is personally close to you and gets along with everyone in your family, the benefits could be enormous. They could be very helpful around the house as well as be helpful with your children. It could be a great time for them to bond more with your kids and be another positive adult role model for them to learn from.

However, there are other circumstances where it might not work out as well. The following are some things to consider before deciding on making the big move.

Physical Care

How much physical care will the person need? Are they physically able to take care of themselves or do they need round the clock attention? Do they have any physical conditions that you might not be able to handle in an emergency? Are they able to be left alone if you have to run out for a few hours?

These are important things to consider because chances are your life is pretty full and stressed as it is now. Having to worry about being responsible for another person’s’ safety and well-being is not only a full time job, but a very stressful one as well. It can become very difficult if you will have to make arrangements every time you need to leave the house.

Relationships

What is your current relationship to the parent and how do they get along with the rest of the family?

If you, your spouse or children has had personality clashes with this parent in the past, do not believe those issues will suddenly disappear when a parent moves in. In fact, it will be just the opposite, because you will all be spending that much more time together.

Even if you personally get along with them, be sure to take your spouse and children into consideration. If you have a parent that drives your kids or spouse crazy you can end up alienating your own family. The new stress level in your house will make everyone unhappy.

It stands to reason that the ideal scenario is to avoid a move. Again, this is when having a plan comes in to play. If your parent had purchased long term care insurance then they might have been able to age in place. Long term care insurance pays for in home care and provides assistance to those who are finding it difficult to manage simple tasks such as bathing, eating, walking, grocery shopping, to name a few.

If your parent needs to move because he or she can no longer afford to live in their home, they may be able to do so by getting a reverse mortgage.

Like all stages of life, older age brings its own challenges, but with the support of family, friends and the many organizations ready to listen and help, these challenges can be overcome.

Trigger 4- Loss of Intimacy

It is frequently assumed that elderly persons lose their sexual desires or that they are physically unable to perform. The media often portrays the elderly as sexually undesirable. The whole notion of older adults having sexual relations is somehow perverse. This is especially true for women who tend to outlive their male counterparts by seven or more years and who are left without sexual partners in the later years. Society has condoned the relationships of older men and younger women, but tends to ostracize older women who establish relationships with younger men. Elderly women are the neuters of our culture.

Society has not left older men unscathed by its portrayal of their sexual capacity. With so much attention paid Viagra, it is assumed that older men are unable to become aroused or maintain a state of arousal, a notion that is at odds with 10 human sexuality and degrading to men. Impotence is not exclusively a biological phenomenon. There can be a number of factors involved, such as: boredom, fatigue, overeating, excessive drinking or medications, medical or psychiatric disabilities. Nevertheless, they are often seen as impotent buffoons which unnecessarily fuels fear in men about the loss of sexual prowess. Societal jokes about elderly men and sex such as the bumper sticker: “I’m not a dirty old man, I’m a sexy senior citizen.” ridicule them.

While both men and women can continue to have a satisfying sex life as they grow older, and while many seniors continue to enjoy their sexuality into their 80s and beyond, it would be irresponsible to refrain from mentioning some challenges that older adults could face.

In both sexes, hormone levels decline and changes in desire and sexual function are common. Health can also impact one’s sex life and sexual performance. If you or your partner is in poor health or has a chronic health condition, such as heart disease or arthritis, sex and intimacy become more challenging. Moreover, certain surgeries and many medications, such as blood pressure medications, antihistamines, antidepressants and acid-blocking drugs, can affect sexual function.

As an older adult you are entitled to your sexuality. In fact, it is good for your mental health and self esteem. It is perfectly acceptable for you to have sexual feelings and for couples to have sexual feelings about each other and act on them. Even if desire and ability to have intercourse has declined, the need for touch and intimacy continues throughout our lives. Without intimacy, any adult, regardless of age can get despondent and depressed.

Adapt to your changing body and know your limitations. Focus on ways of being sexual and intimate that work for you and your partner. Here are some ways to facilitate this adaptation:

• Communicate with your partner. Open discussion of sex has become more common in recent years, but many older adults come from a generation where sex remains a taboo subject. But openly talking about your needs, desires and concerns with your partner can make you closer and help you both enjoy sex and intimacy more.
• Talk to your doctor. Talking about sexual issues with your doctor can help you maintain a healthy sex life as you age. Your doctor can help you manage chronic conditions and medications that affect your sex life. Some older men have trouble maintaining an erection or reaching orgasm. Your doctor may be able to prescribe medications or other treatments for these problems.
• Expand your definition of sex. Intercourse is only one way to have fulfilling sex. Touching, kissing and other intimate sexual contact can be just as rewarding for both you and your partner. Realize that as you age, it’s normal for you and your partner to have different sexual abilities and needs. Be open to finding new ways to enjoy sexual contact and intimacy.
• Change your routine. Simple changes can improve your sex life. Change the time of day when you have sex to a time when you have the most energy. Try the morning — when you’re refreshed from a good night’s sleep — rather than at the end of a long day. Because it might take longer for you or your partner to become aroused, take more time to set the stage for romance, such as a romantic dinner or an evening of dancing. Try a new sexual position or explore other new ways of connecting romantically and sexually.
• Seek a partner if you’re single. It’s never too late for romance. It can be difficult starting a relationship after the loss of a partner or being single for a long time — but socializing is well worth the effort for many single seniors. No one ever outgrows the need for emotional closeness and intimate love. If you start an intimate relationship with a new partner, be sure to practice safe sex. Many older adults are unaware that they are still at risk of sexually transmitted diseases, such as AIDS.
• Stay healthy. Staying healthy can help your sexual performance. Keeping up your health by eating regular nutritious meals, staying active, not drinking too much alcohol, and not smoking or using illicit drugs are important for your overall health. Follow your doctor’s instructions for taking medications and managing any chronic health conditions.
• Stay positive. The changes that come with aging — from health problems to changes in appearance and sexual performance — leave many men feeling less attractive or feeling they’re less capable of enjoying or giving sexual pleasure. Discussing your feelings with your partner can help. Feeling angry, unhappy or depressed has a strong negative impact on your sex life. Professional counseling or other treatment can improve your sex life — and your well-being. For more information on sex and aging click on the links below:
• Sex in America

AARP

http://www.aarpmagazine.org/lifestyle/relationships/sex_in_america.html

• Special Report: The 1999 AARP/Modern Maturity Survey AARP http://www.aarpmagazine.org/lifestyle/relationships/great_sex.html

• American Association of Sex Educators, Counselors, and Therapists (AASECT)

http://www.aasect.org

• National Council on the Aging (NCOA) http://www.ncoa.org/attachments/SexualitySurveyExecutiveSummary%2Epdf

Age Page: Sexuality in Later Life

National Institute on Aging

http://www.niapublications.org/agepages/sexuality.asp

Trigger 5-Sleep Deprivation

Sleep deprivation leads to a poorer quality of life, and in the elderly, it can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to experience depression as well as attention and memory problems, excessive daytime sleepiness, more nighttime falls (a leading cause of injury and death among seniors), and use of more over-the-counter or prescription sleep aids.

While it is true that seniors sleep less deeply and wake up more often throughout the night (which may be why they may nap more often during the daytime), it is a myth that older people don’t as much sleep as the average person. In fact, adults require about the same amount of sleep from their 20s into old age. Yet, insomnia is more common for seniors. Older Adults sleep less and wake up more often during the night for a variety of reasons:

• Increased sensitivity to changes in their environment, such as noise.
• Anxiety and the concerns of aging.
• Older adults may produce and secrete less melatonin, the hormone that promotes sleep.
• Frequent urination.
• Pain from arthritis.
• Sleep apnea.
• Restless Leg Syndrome.
• Medications.

Tips for getting more sleep

If you’re having trouble sleeping, try these techniques for getting more shut-eye:

• Get set. Wake up at the same hour every day and exercise and eat meals at set times to help get sleep back on track.
• Get sun. No matter your age, daylight is extremely important because it helps regulate the sleep/wake cycle. Spend as much time as possible outdoors or near sunlight.
• Get checked. Medication can interrupt sleep. A doctor can recommend adjusting the timing or dose, or possibly switching to an alternative prescription.
• Avoid Alcohol. Alcohol can cause restlessness during the night. Caffeine and nicotine have substances in them that will keep you awake.
• Avoid Smoking. Nicotine has substances in it that will keep you awake.
• Avoid Alcohol, Caffeine and spicy or sugary foods 4 to 6 hours before bedtime. These all have substances in it that will keep you awake.
• Exercise Regularly. But do not exercise within 3 hours of your bedtime.
• Avoid Sleep Interruptions. Don’t sleep with the pet, close your door, minimize light and noise.
• Relax Before Bedtime. A warm bath or light snack (bananas, warm milk, chamomile tea and oatmeal are good options).
• Avoid Long Naps During the Day. Naps can disrupt your sleeping pattern.
• Avoid Trying to Sleep. The more you “try” to sleep, the more difficult it becomes.
• Get Up at the Same Time Each Morning. Too much time in bed can lead to restless sleep.
• Use Your Bed for Sleeping. Not for unrelated activities like reading or watching television.
• Check Your Medications. Medications may increase your sleep difficulties.

See your doctor if you’re not getting restful sleep at night and are unable to wake up refreshed. The National Institutes of Health web site includes a sleep and aging section that provides detailed information about the importance of sleep for seniors, some of the sleep difficulties people encounter as they age, and the symptoms and treatment of various sleep disorders, such as insomnia, sleep apnea, and movement disorders

For more information on the relationship of sleep and healthy aging click on the links below: http://health.nih.gov/topic/SleepDisorders

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Trigger 6- Depression and Anxiety

The most common mental health problems experienced by older people are depression and dementia. There is a widespread belief that these problems are a natural part of the ageing process but this is not the case. It is important to remember that most people remain in good mental health throughout their lives.

Depression

There are times when we all feel fed up, miserable or sad. Sometimes there is a reason, but sometimes these feelings just come out of the blue. These feelings generally don’t last for more than a few days and they don’t stop us from getting on with our lives. However, you may be experiencing depression if you have any of the following symptoms and they last for more than two weeks and interfere with your everyday life:

• Feelings of sadness or hopelessness.
• Difficulties with daily activities.
• Difficulties concentrating.
• Changes in your sleep pattern.
• Changes in your eating pattern.

Depression is not a normal or necessary part of aging. These symptoms, regardless of your life stage or circumstances, should always be taken seriously and never be dismissed. Both psychological and medical treatments are available to treat depression.

As discussed above, many elderly adults face significant life changes and stressors that put them at risk for depression. Those at the highest risk include older adults with a personal or family history of depression, failing health, substance abuse problems, or inadequate social support. Prescription medications can also trigger or exacerbate depression as can chronic or severe pain, cognitive decline, as well as one’s body image due to surgery or disease.

Some older adults may experience what some doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. Such hardening of vessels prevents normal blood flow to the body’s organs, including the brain.

Diagnosing depression in the elderly:

The highest suicide rates of any age group occur among persons aged 65 years and older. One contributing factor is depression in the elderly that is undiagnosed and untreated.

Before being diagnosed with depression, elderly adults should be screened for common health issues that can affect mood. These include:

• Hormonal imbalances.
• Thyroid problems.
• Vitamin B12 deficiency.
• Other nutritional deficiencies.
• Electrolyte imbalances or dehydration. Illness and depression When undergoing evaluation for depression, long-term or severe health issues should also be taken into account. Chronic medical conditions, particularly those that are painful, disabling, or life-threatening, can understandably lead to depression. Illnesses that affect the brain can also cause depression through the disease process itself. Medical conditions that commonly trigger depression include:
• Heart attack or disease
• Parkinson’s disease
• Stroke
• Alzheimer’s
• Multiple sclerosis
• Cancer
• Diabetes

Medication-induced depression

Some medications can actually cause symptoms of depression or make a pre- existing depression worse. All medications have side effects, but harmful drug interactions or a failure to take a medication as prescribed can also contribute to depression. The risk of medication-induced depression is particularly high for elderly individuals with multiple prescriptions. Some medications that can induce depression include:

• Steroids
• Painkillers
• Hormones
• High blood pressure drugs
• Heart disease medication
• Tranquilizers
• Arthritis medication
• Cancer drugs

Bring a list of all medications to the doctor so that he or she can help you determine if any of the prescriptions are the cause of depression symptoms.

Older adults don’t always fit the typical picture of depression. Many depressed seniors don’t claim to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or headaches that have gotten worse, are often the predominant symptom of depression in the elderly.

Older adults with depression are also more likely to show symptoms of anxiety or irritability. They may constantly wring their hands, pace around the room, or fret obsessively about money, their health, or the state of the world.

Older adults who deny feeling sad or depressed may still have major depression.

Here are the clues to look for:

• Unexplained or aggravated aches and pains
• Hopelessness
• Helplessness
• Anxiety and worries
• Memory problems
• Loss of feeling of pleasure
• Slowed movement
• Irritability
• Lack of interest in personal care (skipping meals, forgetting medications, neglecting personal hygiene)

The very nature of depression interferes with a person’s ability to seek help, draining energy and self-esteem. For depressed seniors, raised in a time when mental illness was highly stigmatized and misunderstood, it can be even more difficult—especially if they don’t believe depression is a real illness, are too proud or ashamed to ask for assistance, or fear becoming a burden to their families. With such roadblocks, assistance from others can mean the difference between suffering and recovery.

If a senior citizen you care about is depressed, you can make a difference by offering emotional support. Listen to your loved one with patience and compassion. Don’t criticize feelings expressed, but point out realities and offer hope. You can also help by seeing that your friend or family member gets an accurate diagnosis and appropriate treatment. Help your loved one find a good doctor, accompany him or her to appointments, and offer moral support.

Other tips for helping a depressed elderly friend or relative:

• Invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved 17 one used to enjoy: walks, an art class; a trip to the museum or the movies—anything that provides mental or physical stimulation.
• Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused. Depressed people often feel better when they’re around others.
• Plan and prepare healthy meals. A poor diet can make depression worse, so make sure your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some protein at every meal.
• Encourage the person to follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help your loved one keep up with his or her treatment plan. If it isn’t helping, look into other medications and therapies.
• Make sure all medications are taken as instructed. Remind the person to obey doctor’s orders about the use of alcohol while on medication. Help them remember when to take their dose.
• Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.

If you’re depressed, you may not want to do anything or see anybody. But isolation and inactivity only make depression worse. The more active you are—physically, mentally, and socially—the better you’ll feel.

Some ways to combat and prevent depression include:

Keeping Active. Exercise has many great benefits for both physical and mental health. It improves mood and maintains physical function. As we grow older we generally loose flexibility. This can mainly be explained by our lack of activity rather than the aging process itself. As we grow older it is important to maintain good flexibility and range of movement. Maintaining regular physical activity will help prevent the development of health problems as we age, and it can also reduce the impact of health problems on our bodies.

Include physical activity as part of your regular routine. Many of us do this without even realizing it. For example, We walk to the shops or the post office, do gardening or housework. Exercising can also be a good way to meet people and maintain contacts in your community.

Most exercise is safe for older people, as long as it is tailored to your fitness level and takes into account any health or mobility problems you may have. It is never too late to start! If you are concerned about your level of activity, or would like to take up a new activity, visit your family doctor for a routine check-up and see what would work best for you.

Healthy Eating. If you eat well, you are likely to feel healthier and happier, stay active for longer and protect yourself against illness. However, you may face challenges to regular healthy eating, such as a decreased appetite, difficulty getting to shops and services, or perhaps after the loss of a partner you are finding it difficult to prepare or eat meals on your own.

If you get used to missing meals or not eating healthily, you may start to feel tired, depressed or cold. To keep energy levels up and to stay well, it is important to get a good balance of nutrients at mealtimes. We can sometimes start to gain weight as we get older. Remember a little of what you fancy doesn’t do any harm, but try to maintain a healthy eating routine. If you are experiencing problems with your appetite or diet, you may want to speak with a dietician. Your family doctor should be able to point you in the right direction.

Alcohol. Drinking too much alcohol at any age can contribute to memory loss, sleeping difficulties and many other serious health problems. Alcohol is a depressant and overdoing it can increase anxiety and lead to depression. As we grow older, we become more sensitive to the effects of alcohol. It is also important never to mix alcohol with medication, unless your doctor or pharmacist has told you it is safe to do so. Having an occasional drink in company can contribute to a person’s quality of life, but don’t overdo it. Drink in moderation and remember to have some alcohol free days every week. If you are worried about how much you drink, there is lots of help available. Ask your doctor; they can arrange the right help for you.

Smoking. Smoking affects our physical health, but smoking can also affect our mental health. Many people believe that smoking cigarettes can help them to relax and cope with stressful situations. However, research shows that smoking actually increases anxiety and tension. Older people are often more successful at quitting smoking than other people. But quitting is never easy at any age.

Staying Socially Active. People of all ages find that social contact is important for their well-being. Retirement offers new opportunities to spend more time with loved ones, to extend your social networks or to build new ones. Retirement years are a great time to take up voluntary work. Service groups such as Kiwanis and Rotary clubs abound and can provide new social outlets and give a sense of purpose. Research shows that people of all ages benefit from being in contact with older people. Older volunteers can gain pleasure from using their life experience to benefit younger members of the community.

Grandparents play important roles as career, friend, confidante, and sometimes, tutor for their grandchildren. They are a great source of support for their children

If you have no family or friends living nearby or have lost touch over the years, this can be a source of distress and loneliness. It is important to remember how many ways you can keep in touch. Write a letter, pick up the phone or maybe send an e-mail. Retirement years can provide the opportunity to re-establish old relationships or start new ones. Don’t be afraid to get in touch. The good news is that others benefit from your call too!

Staying Mentally Active, Being Creative. Taking up learning opportunities at any age can enhance your life and help you feel healthier and happier. Libraries are a good resource for independent learners, as well as a source of local information. If you would like to return to some type of formal education, there are a range of courses, including short courses, provided by universities, colleges and local authority education centers.

We often think of winding down as we age but research shows that older people can be just as creative as young people. People who tap into their creativeness as they grow older can accomplish amazing things and sometimes develop talents they never knew they had. Whatever activity you choose, being creative and engaged in the process of learning will bring with it enjoyment and fulfillment.

Spirituality. Our spirituality embraces our ideas about who we are and what our purpose is in life. People of all ages have a spiritual dimension in their lives, whether this is within an organized religion, within another type of group or as an individual. Secular spiritual activities are increasingly available and popular too. This spiritual dimension in our lives has an important influence on our mental health. Spirituality is a deeply personal matter. Discover what works best for you. It is possible to find advice about spiritual practices and traditions from your local services, your local church, the internet, or a bookshop. Often time elderly people find a renewed comfort in religion.

Get a Pet to keep you company. If the burden of walking a dog intimidates you, get a cat. They are very self sufficient and can be a great source of company.

Enjoying jokes and stories. Laughter provides a mood boost, so swap humorous stories and jokes with your loved ones, watch a comedy, or read a funny book.

Getting professional help for depression

While support and self-care can help depressed seniors, professional help should also be pursued. If you see the signs and symptoms of depression in yourself or an older relative, schedule an appointment with a doctor for a thorough evaluation, including a complete physical and lab workup. This is particularly important since many medical conditions, medications, and even certain physiological changes of aging can cause depression or compound the problem.

Treatment options for the elderly Depression treatment is just as effective for elderly adults as it is for younger people. Therapy, support groups, and medication can all help relieve symptoms. However, health issues should always be considered in an older adult’s treatment plan.

Any medical issues complicating the depression must be addressed and resolved. For example, many seniors suffer from chronic pain. Pain that interferes with daily activities can prevent depression recovery, so it must be managed as part of the treatment plan.

Antidepressant treatment

Antidepressant medications may help ease the symptoms of depression in the elderly. However, if the depression is due to loneliness, poor health, or other lifestyle issues, medication may not be the best choice.

Antidepressant use in older adults also comes with safety concerns that are important to be aware of. Older adults are more sensitive to drug side effects and vulnerable to interactions with other medicines they’re taking. Depressed seniors may also forget to take the medication. Furthermore, recent studies have found that Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac can cause rapid bone loss and a higher risk for fractures and falls. Because of these risks, elderly adults on antidepressants should be carefully monitored.

Studies have found that therapy works just as well as medication in relieving mild to moderate depression. And unlike antidepressants, therapy also addresses the underlying causes of the depression.

• Supportive counseling includes religious and peer counseling. It can help ease loneliness and the hopelessness of depression.
• Psychotherapy helps people work through stressful life changes, heal from losses, and process difficult emotions.
• Cognitive behavioral therapy (CBT) helps people change negative thinking patterns, deal with problems in healthy ways, and develop better coping skills.
• Support groups for depression, illness, or bereavement connect people with others who are going through the same challenges. They are a safe place to share experiences, advice, and encouragement.

Anxiety

Everyone experiences nervousness or worry at different times. This is a normal response to a threat or a stressful situation. However, when these feelings become more intense, ranging from constant worry to fear and panic, it is termed anxiety. The stresses and vulnerabilities associated with getting older can often cause anxiety in later years. The symptoms of anxiety include:

• A racing heart
• Rapid breathing
• Feelings of panic
• Sweating
• Excessive and undue worrying
• Disturbed sleep
• Tense muscles
• Morbid thoughts
• Fear of going mad

Depending on the type and severity of anxiety, it can have a damaging impact on a person’s quality of life. Both psychological and medical treatments are available to treat anxiety.

Trigger 7-Dementia

Dementia is the name given to a group of diseases that affect the normal working of the brain. Dementia can lead to a decline in mental ability; affecting memory, thinking, problem-solving, concentrating and perception. Alzheimer ’s disease is the most common form of dementia. The symptoms of dementia vary according to the stage of the illness. In the early stages, dementia can be difficult to diagnose. The person will experience small changes to their everyday functioning including concentration, decision-making and short-term memory. As the disease progresses, the person will become more confused and forgetful, especially about people’s names and recent events. Medication is available which may help with memory loss. They may also get upset easily or become more angry or aggressive, and advice is available regarding managing such symptoms on the Alzheimer’s Association website. http://www.alz.org/living_with_alzheimers_behaviors.asp

The onset of dementia is irreversible, which makes it very different from other mental health problems. There is no certain way to prevent dementia, but evidence suggests that leading a healthy lifestyle and keeping your mind agile by doing activities such as crosswords or puzzles may be helpful. AARP has brainteasers that are designed to promote better mental acuity. You can find these at http://www.aarpmagazine.org/games/printandplay_brain_teasers.html. There is continuous research into the best treatment options for sufferers from dementia and we are slowly developing a better understanding of the illness.

Caring for someone with dementia can be physically and emotionally exhausting and it is important to look after your own needs as a care giver. As a caregiver, you will need on-going support, as well as regular breaks. Draw on friends and other family members for the practical and emotional help they can give.

Never assume that a loss of mental sharpness is just a normal sign of old age. It could be a sign of depression or dementia, both of which are common in the elderly. But since depression and dementia share many similar symptoms, including memory problems, sluggish speech and movements, and low motivation, it can be difficult to tell the two apart. There are, however, some differences that can help you distinguish between the two.

Is it Depression or Dementia?

Symptoms of Depression

• Mental decline is relatively rapid
• Knows the correct time, date, and where he or she is
• Difficulty concentrating
• Language and motor skills are slow, but normal
• Notices or worries about memory problems

 Symptoms of Dementia

• Mental decline happens slowly
• Confused and disoriented; becomes  lost in familiar locations
• Difficulty with short-term memory
• Writing, speaking, and motor skills are impaired
• Doesn’t notice memory problems or seem to care

Whether the cognitive decline is caused by dementia or depression, prompt diagnosis and treatment are key. If it’s depression, memory, concentration, and energy will bounce back with treatment. Treatment for dementia will also improve you or your loved one’s quality of life.

Other Mental Health Problems

It is beyond the scope of this booklet to give details of the full range of mental health problems that older people may experience. For more detailed information on specific mental health problems, contact your doctor.

If You Are Worried About a Mental Health Problem

 Talk about it and ask for ask for help:

Many of us feel isolated and overwhelmed by problems sometimes. Talking about how you feel will help. Confide in someone you trust. While being diagnosed with a mental illness can be frightening, many people say that being able to put a name to the symptoms you are feeling can be comforting. Knowing what you are experiencing is the first step to recovery. Sorting out whom to talk to and where to get help can be very confusing. The best place to start is often by speaking with your doctor, who can refer you on to the most appropriate service. Bring a family member or friend with you, if it makes you feel more comfortable. Whatever you do, don’t be afraid to talk about how you are feeling and ask for help.

If you have thoughts of suicide, call suicide hotlines and crisis support :

National Suicide Prevention Lifeline – Suicide prevention telephone hotline funded by the U.S. government. Provides free, 24-hour assistance. 1-800-273-TALK (8255).

National Hopeline Network – Toll-free telephone number offering 24-hour suicide crisis support. 1-800-SUICIDE (784-2433)

Conclusion

Many people do not understand the relationship between a healthy mind and body. Without good mental health, the quality of our life is compromised. Because depression is not a normal part of aging, good mental health is a choice. Choose to be prepared for the things that you can control. By reading this book, you have come one step closer to becoming the master of your well being.

Good luck and thank you.