Mental Health in Older Adults

Mental Health in Older Adults

• Mental health problems are often under-identified in older adults, partly due to stigma associated with these problems.
• Mental health disorders are independent causes of decreased function and disability, and are associated with increased psychological and physical morbidity, and decreased satisfaction with life.

Depression in Older Adults

• Depression is common in older adults, especially in those who are chronically ill, isolated, or have experienced loss.
• Depression affects intrinsic capacity and functional ability, and it is essential to screen for and manage depression in care plans.
• Depression is linked to cardiac, cerebrovascular, and peripheral arterial diseases, and increases the risk of obesity, frailty, diabetes, cognitive impairment, and mortality.

Non-Cognitive Symptoms of Dementia (NCSD)

• NCSD include symptoms such as delusions, anxiety, depression, hallucinations, and apathy.
• These symptoms can lead to behaviors perceived as challenging, such as wandering, resisting care, shouting, hoarding, and lack of sexual inhibition.

Late-Onset Psychosis

• Late-onset psychosis is characterized by delusions, hallucinations, or both, and includes schizophrenia and depression with psychotic symptoms.
• It is essential to rule out underlying medical conditions, such as dementia, delirium, adverse effects of medication, or drug withdrawal, when an older person presents with depressive or psychotic symptoms.

Anxiety in Older Adults

• Anxiety disorders are highly prevalent in older adults, affecting almost one in five.
• Anxiety is disabling and is associated with poor overall quality of life, and may present with physical health complaints such as pain.
• Four types of anxiety disorders that affect older adults are Generalized Anxiety Disorder (GAD), phobias, Obsessive-Compulsive Disorder (OCD), and panic disorder.

Barriers to Seeking Help

• There are many reasons why older adults might be unable or unwilling to access mental health services and supports, including stigma, lack of awareness, and lack of access.
• Healthcare professionals working with older adults should aim to overcome these barriers and provide support to patients and caregivers.

Treatment of Mental Health Disorders

• Psychosocial interventions, such as cognitive-behavioral therapy, acceptance and commitment therapy, and brief psychological interventions, can be effective in managing depressive symptoms.
• Exercise, particularly social exercise, and mindfulness can also be beneficial in managing depressive symptoms.
• Pharmacological treatment, including selective serotonin reuptake inhibitors (SSRIs), can be effective in treating depression, but it is essential to consider the potential side effects and interactions with other medications.

Diagnosing Depression

• Depression can be diagnosed using assessment tools such as the Geriatric Depression Scale (GDS) and the Patient Health Questionnaire for Depression (PHQ-9).
• It is essential to assess for both depression and dementia using the appropriate tools, particularly in individuals with mild cognitive impairment.
• Karl's symptoms, including low mood, loss of interest or pleasure, decreased appetite and weight loss, insomnia, psychomotor retardation, low energy, and diminished ability to think or concentrate, indicate depression.### Psychosis Treatment Approaches
• Cognitive behavioral therapy (CBT) for psychosis aims to reduce distress and regain a sense of control, effective in improving positive and negative symptoms and treatment compliance.
• Family intervention includes meetings with the person with psychosis, family, and caregivers to discuss treatment, progress, and future management, and provides ongoing support and education.
• Assertive community treatment (ACT) is a type of community-based mental health care, providing team-based support for people with serious mental illnesses to become independent and integrate back into the community.

Antipsychotic Medications

• Antipsychotic medicines are recommended for treating psychosis, but should be prescribed cautiously, using a low dosage and over a short period, due to increased risk of adverse drug interactions.
• Commonly used antipsychotic medications include:
  • Haloperidol: treats schizophrenia, rebalances dopamine to improve thinking, mood, and behavior.
  • Olanzapine: treats schizophrenia and bipolar disorder (manic depression) in adults.
  • Quetiapine: used to treat bipolar disorder (depressive and manic episodes) and schizophrenia, alone or with other medicines.

Care Settings

• Community: multi-disciplinary team (MDT) care for patients at home or in a nursing home setting.
• Day hospital: provides community-based treatment, including psychiatric review and assessment, for individuals who might otherwise require inpatient admission.
• Acute inpatient: for patients with more severe illness, who may present a risk to themselves or others, and may require inpatient care.
• Long stay care: for patients who require admission under the Mental Health Act, often termed involuntary admission.

Non-Cognitive Symptoms of Dementia (NCSDs)

• NCSDs are associated with worsening cognition and progression to more severe stages of dementia, and increase the risk of secondary complications.
• Examples of NCSDs:
  • Hyperactive behaviors (agitation, disinhibition, irritability, etc.)
  • Affective symptoms (depression, anxiety, apathy)
  • Psychotic symptoms (hallucinations, delusions)
• Triggers of NCSDs may include unmet universal human needs (e.g., meaningful activity, belonging, acceptance, and social interaction) and environmental triggers.

Managing NCSDs

• Thorough assessment involving medical and social history, physical examination, and understanding of unmet needs and environmental triggers.
• Differential diagnoses should consider medical and environmental triggers, drug-related side effects, and pain that people with NCSDs are unable to express.
• Managing NCSDs requires understanding the implications of caregiver responses and addressing unmet needs.