Mental Health in Older Adults – Your Organization’s Role

The healthcare industry is shifting toward whole-person, integrated care, and the post-acute care industry is no exception to this shift. In order to provide whole-person care, it is crucial to consider not just the physical health of an individual, but also mental health and social well-being. May marks the beginning of Mental Health Awareness Month – now is the time to understand the prevalence of mental illness and risk factors for populations that you serve, and take action to ensure that you are well equipped to address these health challenges.

The Centers for Disease Control and Prevention report that 20% of people age 55 years or older experience some type of mental health concern – that’s 1 in 5 of the individuals at your assisted living or skilled nursing facility, or home healthcare agency.

20% of people age 55 years or older experience some type of mental health concern.

Mental illness factors into the public health issue of suicide in the United States, from which older adults are not exempt. In fact, older men over the age of 75 have the highest suicide rate of any age group. Although depression affects only about 5% of older adults, this number jumps to about 13.5% of those who receive home healthcare.

Older individuals may exhibit a number of factors that put them particularly at risk for some of the most common mental illnesses, such as depression and anxiety.

Factors That Contribute to Mental Illness for Older Adults

• Chronic pain/chronic diseases: Chronic pain and illnesses that continuously flare up or return can lead to depression and anxiety as the individual may experience hopelessness and frustration with their situation. It can be increasingly difficult to enjoy day-to-day experiences with the presence of chronic illness.
• Physical impairments/physical disabilities: Physical impairments that may occur as people age can reduce functionality and make it difficult to independently complete activities of daily living. This shift in independence can cause many to lose interest in activities they used to enjoy and feel helpless.
• Major life changes and grief: Older adults who experience widowhood, grief with the loss of friends and family, and other major life changes are particularly at risk for depression.
• Social isolation and loneliness: Older adults who may be confined to the home or a facility and lack easy access to social connection can become depressed and isolated in their life.

These are not the only factors that can contribute to mental health concerns in older adults – many people are predisposed to mental illness due to genetic factors, and environmental factors such as those above can trigger the onset of mental illness.

For these reasons, it is important that your organization and your staff are dedicated to caring for the whole-person, keeping in mind physical, mental, and social factors that contribute to the overall well-being of an individual.

Common Types of Mental Illness Experienced by Older Adults

Depression

Depression is NOT a normal part of aging, although you may have encountered people who believe that it is. Older adults are at high risk for depression because of their tendency to have at least 1 chronic health condition. Older adults’ symptoms of depression are often overlooked and undertreated, often attributed to sadness surrounding the aging process with an associated sense of loss.

Dementia

Sometimes people with depression have dementia, too. This makes it more difficult to identify what is causing problems. The inability to concentrate, which can be part of both depression and dementia, can eventually lead to physical problems that result from such things as poor nutrition, illness, and medication misuse. This group of symptoms makes it challenging for the person with dementia to perform usual daily tasks.

Alzheimer’s Disease

The risk of Alzheimer’s disease increases with age and it represents 60-80% of all cases of dementia. As the disease progresses, you will see a significant loss of function related to the affected areas of the brain. For more information on Alzheimer’s disease and dementia, read about our collaboration with industry leader Teepa Snow.

Suicide

Never assume an older adult is incapable of suicide. Regular assessment for suicide risk is imperative. Check with your organizational policy and protocol to determine the guidelines for you in your practice regarding assessing for suicide risk.

If an individual ever answers “yes” to your questions exploring whether they have had any thoughts about hurting or killing themselves in the past 2 weeks, stay with them until emergency services are in place and according to your organizational protocol. That admission should be taken seriously and requires immediate attention by a mental health professional.

Anxiety

Anxiety in older adults can lead to many health problems and interfere with daily life, even when symptoms do not warrant a diagnosable disorder. The most common anxiety disorders include generalized anxiety disorder and specific phobias, followed by less common panic disorder and social phobia. Additional common disorders that involve anxiety symptoms but that are not technically considered anxiety disorders are post-traumatic stress disorder and obsessive-compulsive disorder.

Substance Use Disorder

In 2014, over 1 million older adults had a substance use disorder (SUD) and that number is expected to rise to 5.7 million by 2020. Substance use in older adults is often not recognized by providers, so routine screening is critical.

Bipolar Disorder

Bipolar and related disorders (BRD), are a group of mood conditions involving manic symptoms and often, depressive symptoms. Generally, in BRD the individual experiences at least 1 manic episode or hypomanic episode, which is less severe symptoms of mania, with depressive symptoms. It is important to note that an individual can have a BRD without ever experiencing a depressive episode, as in a condition known as bipolar I disorder. Individuals commonly have dramatic mood swings, moving from depression to manic excitement within several days or weeks.

Eating Disorders

Eating disorders such as anorexia and bulimia are probably not something that you immediately think of as having a role in the lives of older adults, but researchers and healthcare professionals are discovering these disorders more often in both sexes, especially in older adult females. Many older adults lose their desire to eat and become clinically anorexic, which can be particularly detrimental to an older body with less resilience than in previous years.

Steps to Address Mental Health in Older Adults

• Train your staff: Providing training on mental and behavioral health concerns will better equip your employees to recognize and address these concerns and ensure that you are dedicated to promoting the overall well-being of those you care for.
• Be aware of signs and symptoms: The symptoms of common illnesses such as depression or anxiety can be easily overlooked and ignored – it is your responsibility to recognize and be able to use appropriate tools for behavioral health screening, and take next steps in their care when necessary.
• Promote a culture of caring: Show your residents, clients, or patients that you care by speaking openly about mental health and reducing stigma. This can be particularly helpful for older adults who may be suffering but are otherwise unlikely to ask for help.

By providing training and promoting awareness of mental health in older adults, you can ensure that your entire staff is caring for the whole person, and your organization will continue to be well-equipped to address these challenges.