3. Know your mind – normal changes and what can go wrong - Lifelong participation

Hello, and welcome to this introduction to understanding mental health and aging.

My name is Eleanor Curran.

In this session we will explore the psychological aspects of healthy aging,

how this can be disrupted, and the impact of mental health problems in later life.

Clearly, given the time available, each topic will only be touched on briefly.

I hope however, that this class will be of interest, and highlight the importance and

reach of the topic.

If so, you can expand your understandings through the mental health and

aging program at the University of Melbourne.

Retired Marine Colonel Jonathan Mendes is pictured here,

completing the New York Marathon in 2010 at 90 years of age.

I think we would all be comfortable saying that this gentleman has aged well.

However, given that the physical and psychological strength and

endurance required to train for and complete a marathon is something well

beyond most people at any age, let alone 90, what defines a normal,

psychologically healthy experience of aging for most of us?

Sigmund Freud, the father of psychoanalysis,

has long been quoted as defining mental health as the ability to love and to work.

At first glance, this might not seem applicable to older persons.

However, if we take a moment to think of why,

we may find that our initial response was on the basis of negative impressions

of aging that reflect stereotypes rather than reality.

These stereotypes are reinforced in myriad subtle, and not so subtle ways,

every day such as references to doddering grandmothers or grumpy old men.

Such prejudice and the discrimination it often provokes is termed ageism.

And the mental health of older people is a favorite target.

Conversely, most of you will have regular contact with older persons in your day

to day lives, who offer compelling evidence that counters ageist stereotypes.

Most elderly people live healthy, engaged and satisfying lives, where they continue

to love in some form and to work in some way, albeit frequently unpaid.

Equally clear from our personal experiences,

later life does involve multiple changes and often constraints.

A life course perspective of development contends that

this is no different to earlier phases of our lives.

Old age is simply another phase in development in which aspects of our

sense of self in our lives remain the same while others change.

Key challenges faced by people as they age include the obvious physical changes.

These do include changes to the brain and to thinking, termed cognition.

As consequence, older individuals may take longer to learn new things, have

difficulting multi-tasking and experience concentration lapses and forgetfulness.

However these changes do not impair day to day functioning and

are very different to dementia.

Older people may also face changes and challenges in social functioning, but few,

if any, entail complete loss of function and many offer opportunities for

new even potentially better experiences.

Challenges include increased physical dependence, reduced social interaction,

financial changes, and even accommodation changes.

The aging of partners and children, widowhood and

retirement can lead to losses of previous roles, but also, to new roles.

Many of these physical and social changes also result in psychological challenges.

Of particular importance,

the psychological effects of recurrent loss and grief.

Erik Erikson, a renowned developmental psychologist through the middle of

the twentieth century, theorized that the great psychological task of old age

is to be able to look with acceptance at one's self, and one's life, and

to face the reality of that life ending.

Thus we might say that healthy psychological aging is simply

a continuation of healthy living.

Loving, working, experiencing, struggling with, and adapting to changes and

challenges in ourselves and our lives.

Clearly, successful aging is not the reality for all.

Older people can experience the full range of mental health problems afflicting

younger adults.

Some are particularly associated with aging, most notably, dementia.

Not withstanding, it is important to remember that surveys of older persons in

the general population have repeatedly found that rates of mental illness

are actually significantly lower than those in younger age groups.

Here, we only have time to briefly discuss particularly common and

significant syndromes.

Dementia is a syndrome in which people experience a generally progressive

deterioration in cognitive function that results

in significant impairment in their ability to function in their day to day lives.

There are over 100 diseases that cause dementia.

In the Western world, Alzheimer's disease is the most common,

affecting at least 50% of those who have dementia.

Other causes of dementia may be more common in other cultural groups.

Each cause may present with a slightly different pattern

of impairment in thinking, but

common early symptoms include memory loss with difficulty learning new things,

difficulty with finding the right word, changes in personality, a lack of

initiative, poor judgement, or changes in attending to the tasks of daily life.

As dementia progresses, people often develop symptoms other than cognitive

impairment as well, including altered sleep patterns, disorientation in time and

space, anxiety, depression, and psychotic symptoms.

Delirium, in contrast to dementia, is a syndrome of fluctuating confusion and

attention which is due to one or more myriad, underlying medical problems.

Almost any physiatric symptom may also be present.

For example, hallucinations, false fears of being harmed in some way,

disturbed sleep, anxiety, or depression.

Older people are more susceptible to developing delirium, and

it is a major public health issue across the world.

Concerningly, however, it is very frequently ignored or

misdiagnosed as dementia or another psychiatric problem.

Diagnosis is particularly important because the syndrome may be

completely reversible if the underlying cause is detected and treated.

But without treatment, it is associated with very high morbidity and

mortality rates and is often responsible for older people having prolonged hospital

admissions and even needing to move to residential care.

Depression is a very different experience to merely feeling sad or blue.

Key features of major depressive disorder,

the term used to describe the clinical syndrome and

differentiate it from the normal emotion, include a low or an irritable mood,

a loss of pleasure in life, feeling guilty, hopeless, or even suicidal and

changes in sleep, appetite, concentration, and other aspects of thinking.

Depression can sometimes present differently in older persons with changes

in thinking particularly common.

A little less the half of the older adults presenting with depression

are experiencing it for the first time.

There are multiple hypotheses for

why although no definitive reason has been established.

Briefly it is also important to note that many individuals who experience

significant mental ill health earlier in life can have the continuation or

recurrence of these problems as they age.

Problems more associated with later life like dementia can then be superimposed or

tragically for many, their chronic or

recurrent symptoms may become more resistant to treatment.

Unfortunately, for all but a small minority of conditions,

we do not know exactly what happens to cause most mental health problems.

We do know, however, that certain factors are associated with mental illness, and

some with particular types thereof.

Some, usually rare, forms of dementia are related to known genetic changes.

Beyond this, a family history of several other types of dementia is associated

with an increased risk of an individual developing the disease themselves.

Suggesting some degree of heritability.

In general however, neither the particular genes involved, nor

the effect of inheriting these genes are clearly understood.

Many other variables have also been found to be associated with developing different

mental health programs in later life.

Those noted here in red may be of particular interest as they suggest some

degree of preventability.

Of particular interest are the impact of lifestyle factors, such as obesity,

high blood pressure, and activity level, both in later and

mid-life on the subsequent risk of developing dementia.

As noted above, aging invariably involves significant physical changes and

usually social changes.

Where individuals experience overwhelming change or, have for

various reasons, difficulty adapting to change, they are also vulnerable to

experiencing mental health problems, particularly depression and anxiety.

Examples could include trouble adapting to retirement for

someone who has focused their whole life on work.

Or the overwhelming challenge of experiencing the sudden onset of

debilitating physical illness.

As you are completing this class you likely already have some understanding

of the reasons why problems associated with aging are of concern to us all.

As this graph shows, an aging population means,

simply, the problems associated with aging are increasing at exponential rates.

Currently, the World Health Organization estimates that over 35 million people

have dementia.

By 2050, this is expected to have more than tripled to 115 million individuals

primarily due to increased prevalence in developing countries.

This increase in prevalence is only outstripped by the expected increase is

associated costs, of which only a small amount is attributable to direct

medical expenditure.

Neuropsychiatric symptoms in the overall population are also increasingly common.

Thus, neuropsychiatric illness in aged persons

falls in the overlap between two large and expanding population health concerns.

Again, the associated morbidity and mortality significant and

generally under recognized.

For example, older persons are more likely

have their diagnosis of depression missed than their younger counterparts, but

are well documented to be at the highest risk of any demographic group for suicide.

Surely, the most signficant consequence of illness.

While such statistics convey the magnitude of these problems for policy makers and

tax payers of the future, perhaps the more effecting, even the more real impact

of the problems are best understood through thinking of the effect

of neuropsychiatric illness on people you know who have themselves experienced it or

who have cared for someone with it.

I think it is best left to a carer themselves to convey the impact of that

experience.

And you can view a video of a carer discussing their experience after this

presentation.

I hope you have found this presentation interesting and worth while.

You have learned a little about the types of psychiatric illness that older

individuals can experience and the scope of the problem for individuals, for

those who care for them, and for society in the future.

I'd like you to now consider how you, as an individual who will one day become

an older person, can act now to optimize your mental health in the future.

What changes and challenges do you think might be particularly difficult for

you to cope with?

What might you be able to do now to reduce these challenges, or

improve your capacity to adapt to them?

You may also one day need to care for a loved one who experiences dementia, or

another mental health problem.

I'd like you to also reflect on how you can act now to best prepare yourself for

that role as a carer.

Thank you.

3. Know your mind – normal changes and what can go wrong

Rethinking Ageing: Are we prepared to live longer?

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