0:00
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.
0:32
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.
5:13
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.
7:10
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.
10:23
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.
Rob MoodieCo-Chair Hallmark Ageing Research Initiative
Simon BiggsProfessor of Gerontology & Social Policy
Rebecca KippenSenior Research Fellow
Louisa RemediosDirector of Teaching and Learning
Debra VirtueLecturer
Eleanor CurranConsultant Psychiatrist
Fernando SanchezChair of Health Informatics
Alan PertDirector
Clare NewtonAssociate Professor
Jack BartonUrban Data and eResearch Facilitator
Ian McDonaldEmeritus Professor
Briony Dow
Dominique MartinLecturer
Tara SklarMOOC Project Coordinator; Co-Director of Ageing Programs; Research Fellow in Health Law
