Mental Illnesses in the Elderly

Four Common Mental Illnesses in the Elderly: Learn the Risk Factors and Symptoms to Watch for

Do you have an elderly loved one in your live who you suspect is showing signs of mental illness? This is all too common. In fact, according to a recent CDC report, over 20% of adults ages 55 or older have had a mental health concern, but only about two out of three received treatment. [i]

While mental illness in the elderly is often overlooked and challenging to diagnose, its effects can greatly diminish a senior’s health and well-being, complicate the treatment of other chronic diseases, and even lead to death.

Read on to learn about common mental health issues in the elderly population and what you as a caregiver or family member can do to help a loved one get the treatment they need.

In this article we will discuss:

Elderly Mental Health Statistics

 According to the World Health Organization, mental disorders affect approximately 15% of the population over the age of sixty, a number that is expected to increase substantially as the population ages. [ii]

 Anxiety disorders affect 3.8% of the older population. [ii]

 The CDC states that people fifty-five and older, an estimated 20% have some type of mental health concern. [iii]

 Depression affects up to 5% of older adults, but that number jumps to around 13.5% for those requiring home healthcare. [iv]
 Men ages seventy-five and older have a higher suicide rate than any other age group (38 per 100,000). [v]

Why Mental Health Issues Are Not Addressed with the Elderly

Despite what the statistics reveal, it can be difficult to pick up on mental health issues among seniors because of the unique age-related health and life challenges they face. Sometimes symptoms can be very subtle or attributable to a variety of other health conditions or life changes.

Additionally, older adults are less likely to notify a health care provider of symptoms related to mental health problems than for physical symptoms they are experiencing. This can be due to the stigma attached to mental health problems, or because the individual may not be able to explain what he or she is experiencing.

As caregivers, the best thing we can is to understand the symptoms and risks associated with common mental health problems and be diligent in observing and communicating changes or symptoms to the appropriate health care professionals.

Risk Factors and Causes of Health Issues in the Elderly Population

One major problem in diagnosing and treating seniors with mental illness is that elderly individuals are more likely to report physical issues than they are psychological issues (CDC). [i]

But even the typical emotional and physical stresses associated with aging can lead to depression or anxiety.

Here are some possible triggers for mental illness in senior citizens: [vi]

• Chronic pain
• Chronic disease
• Physical impairments like thyroid or adrenal disease that affect emotion, thought, or memory
• Physical disabilities
Loneliness
• Major life changes
• Grief
• Widowhood
• Certain medications
Heavy alcohol consumption or drug abuse
Malnutrition/poor diet
• Dementia-causing illness

Elderly Mental Disorders or Effects of Old Age? Symptoms of Mental Illness in the Elderly

As we grow older, it isn’t uncommon to see changes. General forgetfulness is normal, but persistent depression, anxiety, memory loss, or other cognitive issues can be signs of something more serious.

If you are a caregiver or have an elderly loved one in your life, you can help spot indicators of a mental health issue. Here are some common warning signs to look for: [vii]

• A marked change in appetite, energy level, and/or mood
• Feeling emotionally “flat” or finding it difficult to experience positive emotions
• Trouble sleeping too much, or difficulty falling and staying asleep
• Persistent thoughts of hopelessness, sadness, or suicidal thoughts
A desire or need for drugs or alcohol
• Feeling on edge, restless, or having trouble concentrating
• Increased feelings of stress or worry
• Short-term/recent memory loss
• Anger, agitation, or increased aggressiveness
• Obsessive-compulsive behavioral tendencies or thoughts
• Unusual behaviors or thoughts directed towards others
• Behaviors or thoughts that affect social opportunities, work, or family
• Persistent digestive issues, pain, or headaches not explained by other health problems
• Difficulty managing finances or tasks involving numbers
• Problems with grooming or household maintenance

If a family member or someone under your care exhibits any of these symptoms, get in touch with the senior’s care team, including the primary care physician, to determine the best way to diagnose and treat possible mental health concerns before they become more serious.

Common Elderly Mental Health Disorders

While there is a lot of focus on the mental health of younger people, it is equally important for elderly individuals to get treatment, especially for depression, which can complicate the treatment of a number of medical conditions including stroke, diabetes, heart disease, and more.

Here are some of the most common mental health illnesses experienced by older adults:

1. Depression

Depression is a type of mood disorder that ranks as the most pervasive mental health concern among older adults. If untreated, it can lead to physical and mental impairments and impede social functioning. Additionally, depression can interfere with the symptoms and treatment of other chronic health problems. [viii]

Common symptoms of depression include ongoing sadness, problems sleeping, physical pain or discomfort, distancing from activities previously enjoyed, and a general “slowing down.”

Seniors suffering from depression generally visit ERs and doctors more frequently, take more medications, and experience longer hospital stays than their same-age peers. Women are more likely to be affected than men.

Late-Onset Depression Risk Factors to Watch Out For

  • Physical Illness
  • Widowhood
  • Lack of education (below high school level)
  • Diminished functional status
  • Heavy drinking

On the bright side, depression can typically be successfully treated in older adults. If you suspect a loved one or client is showing signs of depression, seek help immediately.

2. Anxiety Disorders

Like depression, anxiety is a very common mood disorder among the elderly. In fact, these two problems often appear in tandem. Statistics from the CDC show that nearly half of older adults with anxiety also experience depression. [i]

Anxiety in seniors is thought to be underdiagnosed because older adults tend to emphasize physical problems and downplay psychiatric symptoms. Women in this age group are more likely to be diagnosed with an anxiety disorder than men.

Risk Factors for Anxiety Disorders in Old Age

Anxiety in the elderly is linked to a number of risk factors, including but not limited to: [ix]

  • General feelings of poor health
  • Sleeping problems
  • COPD, certain cardiovascular diseases, diabetes, thyroid disease, and related chronic conditions
  • Side effects caused by certain medications
  • The abuse/misuse of alcohol, street drugs, or prescription drugs
  • Physical impairments limiting daily functioning
  • Stressful events like the death of a spouse, serious medical condition, or other life-altering event
  • Traumatic or difficult childhood
  • Perseveration on physical symptoms

There are several different types of anxiety disorders, with the most common being generalized anxiety disorder and phobias. Here is a list of anxiety disorders you may observe:

Generalized Anxiety Disorder: The effects of generalized anxiety include persistent worry or fear, which can get progressively worse with time.

These symptoms eventually interfere with socialization, job performance, and day-to-day activities. Seniors with anxiety tend to become more withdrawn and reclusive.

Symptoms and Signs of Generalized Anxiety Disorders in Seniors

Elderly individuals with generalized anxiety may experience the following symptoms: [x]

  • Excessive, uncontrollable worry/anxiety
  • Edginess, nervousness, or restlessness
  • Chronic fatigue or tiring out easily
  • Become irritable or agitated
  • Poor quality of sleep or difficulty falling/staying asleep
  • Tense muscles

In addition to generalized anxiety disorder, seniors can be diagnosed with the following related disorders including:

Phobia: An extreme, paralyzing fear of something that usually poses no threat, phobias can cause individuals to avoid certain things or situations due to irrational fears. Examples can include fear of social situations, flying, germs, driving, etc.

Panic disorder: This disorder is characterized by periods of sudden, intense fear that can be accompanied by heart palpitations or pounding, rapid heartbeat, shaking, sweating, difficulty breathing, or experiencing feelings of doom.

Symptoms of Panic Disorder

  • Sudden, repeated bouts of intense fear
  • Feeling powerless or out of control
  • Persistent worry about the “next” attack
  • Avoiding situations where past panic attacks have occurred

Social Anxiety Disorder: This social phobia causes individuals to fear being in certain social situations where they feel they might be judged, embarrassed, offensive to others, or rejected.

Social Phobia Symptoms

  • Extreme anxiousness about being with others
  • Difficulty talking to others in social situations
  • Self-consciousness in social settings
  • Fear of being judged, humiliated, or rejected
  • Fear of offending others
  • Worrying about attending social events long before they take place
  • Avoiding social situations
  • Difficulty with friendships
  • Feeling queasy around other people
  • Sweating, blushing or shaking around others

Post-Traumatic Stress Disorder: PTSD is a disorder that usually manifests following a traumatic event that threatens a person’s safety or survival, greatly impacting his or her quality of life.

Symptoms of PTSD

  • Emotional numbness
  • Flashbacks to the event
  • Nightmares
  • Depression
  • Irritability
  • Easily distracted or startled
  • Anger

Obsessive-Compulsive Disorder: Those who suffer from OCD experience uncontrollable recurring thoughts (obsessions) or rituals (compulsions). Examples of rituals include washing hands, checking if appliances are on or off, counting, or other behaviors typically done to quell obsessive thoughts (e.g. washing hands repeatedly to remove germs and avoid getting sick).

Treatments for Anxiety Disorders

A variety of techniques, supports, and treatments, including medication, psychotherapy, or a combination of both, are available to address various anxiety disorders in seniors. If you suspect someone you care for has symptoms of an anxiety disorder, get in touch with their care team as soon as possible.

3. Bipolar Disorders

Bipolar disorders, or manic-depressive illnesses, are often marked by unusual mood shifts and are frequently misdiagnosed in senior citizens because the symptoms presented are typical with the aging process, especially related to dementia and Alzheimer’s. Bipolar disorder occurs equally among women and men in this age group.

While younger people in the manic phase of bipolar disorder will show classic signs like elation and risky behavior, seniors are likely to become more agitated or irritable. [xi]

Late-Onset Bipolar Disorder Symptoms

  • Confusion</li
  • Agitation
  • Irritability
  • Hyperactivity
  • Psychosis
  • Cognitive issues including memory problems, trouble problem solving, loss of judgment, and loss of perception

It is worth noting that the effects of certain medications and some types of illnesses show similar symptoms. The individual should be seen and diagnosed by a medical professional to determine the root cause of any symptoms as well as the best options for treatment.

4. Eating Disorders

Eating disorders like bulimia and anorexia nervosa are becoming increasingly prevalent among the elderly.

Underlying behavioral or psychological issues that cause and exacerbate eating disorders can go undetected for quite a while before an eating disorder can be identified and treated, making it especially dangerous. [xii]


Underlying Factors for Eating Disorders in the Elderly

  • Changes in taste and smell (often due to medications)
  • Persistent, untreated psychological issues from youth
  • Memory/cognitive impairment
  • Loss of a loved one
  • Attention-seeking behavior
  • Depression
  • Other physical ailments

Eating Disorders – Signs to Watch For

  • Unexplained weight fluctuations (especially weight loss)
  • Anemia and muscle weakness/wasting
  • Increase in falls
  • Memory deficits
  • Cognitive decline
  • Depression
  • Loss of appetite
  • Slow healing
  • Chronic dizziness
  • Unopened or uneaten food in the fridge or cupboards
  • Decrease in food intake or rejection of meals
  • Use of laxatives (for purging)

Because elderly individuals face many unique challenges like loose dentures, digestive issues, medications, or other health problems that affect appetite and eating, it’s important not to make assumptions as to whether he or she has an eating disorder. [xiii]

Instead, alert the senior’s family and care team to make sure they get the care needed for proper diagnosis and treatment.

Elderly Mental Health Assessment Tools

Sometimes it can be difficult to distinguish between mental health disorders and cognitive disorders. Fortunately, there are several assessment tools available to pinpoint mental health disorders in the elderly. Here are some commonly used assessments: [xiv]

Depression Assessment Tools

    • 1. The Geriatric Depression Scale: The GDS is an easy to administer self-reporting scale with thirty yes/no questions. This tool doesn’t require the services of a clinician. There is also a twelve-question version, which is most commonly used. This scale is considered the one against which other assessments should be compared.
    • 2. The Brief Assessment Schedule Depression Cards: The BASDEC system and is based on geriatric patients using cards to choose answers. The assessment can be completed in under ten minutes.
    • 3. The Cornell Scale for Depression in Dementia: This scale was designed specifically for those with dementia to identify signs of depression. Delivered by a clinician, this scale consists of about ten minutes with the elderly person and twenty minutes with a caregiver. The Cornell Scale is considered the best available assessment of mood for those with cognitive impairments.
    • 4. The Geriatric Mental State Schedule: The GMSS is a commonly used tool to measure the mental state of elderly people across settings, most notably in community situations. Administered via laptop computer, a trained administrator spends about forty-five minutes with the person being surveyed. Results are highly reliable.
    • 5. The Centre for Epidemiological Studies—Depression Scale: The CES-D scale is self-administered, includes twenty items, and only takes about five minutes to finish.
    • 6. The Hamilton Rating Scale for Depression: This observer-rated depression scale is considered the industry-standard among those gathering input from observers. Administration is done by a trained interviewer and takes thirty minutes or less to complete.
    • 7. The Montgomery-Asberg Depression Rating Scale: The MADRS is an assessment that is widely utilized in treatment trials of old and young patients. It takes about twenty minutes to finish and should be administered by a trained professional.
    • 8. The Mini-Mental State Examination: The MMSE takes ten minutes for a trained interviewer to administer and measures cognitive function, successfully distinguishing between depression, dementia, or a combination of both.

Other Global Assessment Tools

      • 1. The Brief Psychiatric Rating Scale: The BPRS is done by a trained interviewer and takes about twenty minutes to complete. Following interviews with the patient and a caregiver, scales are derived to measure cognitive impairment, depression, stroke, and behavioral changes.
      • 2. Cambridge Mental Disorders of the Elderly Examination: The CAMDEX is a more comprehensive assessment which includes eight sections for a formal diagnosis in several areas including depression, delirium, dementia, anxiety, paranoia, and other psychiatric disorders.
      • 3. Health of the Nation Outcome Scales 65+: The HoNOS 65+ is adapted from a similar scale used on younger individuals with a focus on one’s mental state and living situation, including self-harm, aggressive behavior, alcohol or drug use, cognitive problems, physical problems, hallucinations, and much more. It is considered a good global assessment of the elderly individual.

To see an exhaustive list and detailed descriptions of available mental health assessments, check out the Assessment Psychology Online website. [xv]

Treatments for Mental Illness in the Elderly

There are a variety of treatment options for those suffering from mental health disorders, including medications, therapies, or a combination of both.

If you suspect that your loved one is struggling with a mental health issue, don’t hesitate to get in touch with the individual’s health care provider. They can direct you to a geriatric psychiatrist, psychologist, or counselor who can help.

Treatment for seniors is a team effort, especially when they are unable to care for themselves. Ensure that the elderly individuals in your care are well supported by seeking help when symptoms are spotted and providing love and emotional support to help ensure the highest quality of life possible.

sources

[i] https://www.cdc.gov/aging/pdf/mental_health.pdf
[ii] http://www.who.int/mediacentre/factsheets/fs381/en/
[iii] http://www.aagponline.org/prof/facts_mh.asp
[iv] https://www.cdc.gov/aging/mentalhealth/depression.htm
[v] https://www.nytimes.com/2016/04/22/health/us-suicide-rate-surges-to-a-30-year-high.html
[vi] https://lifespeak.com/can-aging-affect-mental-health/
[vii] https://www.nimh.nih.gov/health/topics/older-adults-and-mental-health/index.shtml
[viii] http://www.psychiatry.org/seniors%20
[ix] http://www.mentalhealthamerica.net/anxiety-older-adults
[x] https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
[xi] http://www.bipolar-lives.com/bipolar-disorder-and-seniors.html
[xii] https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
[xiii] http://eatingdisorders.com/articles/general/eating-disorders-in-elderly-patients
[xiv] http://www.assessmentpsychology.com/geriatricscales.htm
[xv] http://www.assessmentpsychology.com/geriatricscales.htm