Main image courtesy of SmithLife Homecare.
When we think about caring for the elderly, we often only think of ways to best meet their physical and emotional needs. Whether this involves helping them with their daily living activities and personal care, or ensuring they’re engaged in meaningful projects that match their interests. However, there is another aspect to consider when speaking about the care of senior residents in long term nursing facilities and that is their mental health.
Mental illnesses may be more common than you think in the elderly, which is why it’s so important to have staff up to date and trained to spot early warning signs and symptoms of these kinds of conditions. Mariposa Training offers training courses in mental health, as well as suicide prevention, which can unfortunately sometimes be the result of an undiagnosed mental illness.
Keep reading to learn about:
- Mental illness and the elderly
- How mental illness and suicide relate
- What some of the early signs and symptoms of mental illnesses are
- Ways to support residents with mental illness
Mental Illness and the Elderly
How mental illness affects the elderly
Seniors may be at an increased risk of developing a mental illness. Image courtesy of AgingCare.
Although it can be difficult to think about, it’s important to know that people of all ages can be affected by mental illness, and this includes senior residents in nursing facilities. Not only are they dealing with physical illnesses or conditions relating to aging, some seniors may also develop a mental illness as well. In fact around 20% of people 55 and older may be living with one (or more) mental health conditions. This means that in most facilities, you will encounter residents who have a mental illness, whether it has been diagnosed or not.
While the discussion surrounding mental illnesses has expanded recently, it’s still important to point out that these conditions are a serious medical concern, and that they are not the result of a senior who is “making it up” nor are they choosing to be “non-compliant.” One of the positive things that have surfaced by decreasing the stigma associated with mental illness is that more people are getting the help they need, as mental illnesses are treatable.
Common mental illnesses in the elderly can be broken up into three major groups.
Mood disorders
- Depression. One of the most common mental illnesses in the elderly is depression, whether it is major depressive disorder or persistent depressive order. Depression can materialize for a variety of reasons in the elderly, and can seriously impair their ability to function physically and socially. Depression can interfere with and complicate the treatment of other chronic conditions and increases the chance of hospitalization.
Depression can cause seniors to feel hopeless, helpless, and cause them to withdraw socially. They may even start to lose interest in those activities and hobbies that they once enjoyed. Depression in elderly adults many times goes untreated if staff are not able to spot the warning signs.
- Bi-polar disorder. Another mental illness that can be found in older adults is bi-polar disorder. This condition causes residents to swing between periods of mania and depression (highs and lows). Residents with this condition can appear to be doing very well when they’re in the mania stage, but you might find their actions excessive when it comes to their excitement and restlessness.
The other side of this coin involves depressive symptoms such as feelings of worthlessness, uncontrollable crying, loss of interest, and even suicidal ideation.
Anxiety disorders
- Generalized anxiety disorder. Statistically, anxiety disorders are some of the most common mental illnesses affecting the elderly. Among those who are 60 and older, 15.3% of seniors are living with this condition. Generalized anxiety refers to a vague but sometimes overwhelming sense of fear that is not attached to any specific situation or occurrence. Seniors with this condition may be found to exhibit signs such as irritability, restlessness, or feeling on edge at all times.
- Panic disorder. Panic attacks can sometimes be brought on by anxiety, and can be very unsettling and intense for those with this specific condition. Panic attacks can have physical effects on the body, including palpitations, shortness of breath, chest pain, and feeling dizzy.
- Phobias. Phobias of particular circumstances or situations can also present themselves in the elderly in care facilities. Phobias such as fear of confined spaces, fear of heights, or fear of open spaces are common possibilities with senior residents.
- PTSD. Trauma and stress-related disorders such as PTSD (post-traumatic stress disorder), adjustment disorder, and transfer trauma. These conditions typically have symptoms that can present themselves as either reliving (such as nightmares), avoiding (removing themselves from situations or people), and increased arousal (such as excessive emotions or outbursts).
- OCD. Obsessive compulsive disorder deals with the persistent and unwanted thoughts or actions that causes a resident a significant amount of stress. These can appear to be rituals related to the need for order, cleanliness, or to keep away a perceived harm.
Psychotic disorders
- Schizophrenia. Another class of mental health conditions that can affect seniors are psychotic disorders like schizophrenia. This typically causes the resident to experience paranoia and even hallucinations. A senior resident may appear confused or appear disorganized as well as have frequent mood swings.
How Mental Illness Relates to Rates of Suicide in the Elderly
The relationship between mental illness and suicide
History of depression may increase the chances a senior engages in suicidal ideation. Image courtesy of Forbes.
In 2019, suicide was the 10th leading cause of death of Americans, and although the elderly only make up about 12% of the U.S. population, they account for about 18% of suicides. When a senior resident has a mental illness such as depression—or has a history of mental illness—this can also greatly increase their chances of suicidal ideation or attempted suicide.
Seniors who are dealing with depression may be having feelings of worthlessness, loneliness, and hopelessness. This is compounded if they are also experiencing physical problems that limit their mobility or do not give them the independence that they once enjoyed. Dealing with chronic medical disorders or daily pain can have a big influence on the quality of life a senior has, and can be a factor in developing (or worsening) depression.
Some factors that can also increase the likelihood of developing depression and therefore possibly suicide include:
- Grief over a loss. Dealing with the death of a loved one is never easy. However for the elderly, the loss of a friend or spouse can be devastating. If they spent many years with them, it can be even harder to make adjustments after they’ve passed. This can lead to a loss of interest in things that once brought joy, and a lack of care for themselves. When seniors are grieving, they may also start to think of their own death, and wonder whether they want to continue feeling all the pain that can come from the loss of a loved one.
- Loss of independence. We all like having the independence that mobility can bring. However, as pain or medical conditions develop, they can prevent seniors from living the way that they once did. No longer able to do basic tasks can make them feel as if they’re useless, and that there’s no hope of them getting better. It can be hard to accept help for activities you once did on your own, which can lead them to think that they’re just a burden to staff or their families.
- Cognitive impairment. Additionally, senior residents who are cognitively impaired or declining may also be at a great risk for suicide. Because they are impaired, they may act impulsively or fail to understand the decisions they’re making.
- Financial instability. Seniors may have difficulty affording the care that they need, or feel that they’re not worth all the expense if their family is helping to pay. They can start to consider themselves a burden, and don’t want to put their family through all the financial strain of long term care.
Seniors with mental illnesses such as depression can be at a greater risk of developing suicidal thoughts. This is why it’s so important to take the mental health of seniors seriously in order to help prevent suicides. Staff should be aware of the risk factors that can influence suicide, and should be trained to recognize the symptoms of a change in mental health.
What are the Early Signs and Symptoms of Common Mental Illnesses?
Learn what some of the early signs and symptoms are of mental illness in seniors
Be aware and observe changes to senior residents’ demeanors. Image courtesy of Brunet.
In order to keep seniors safe and ensure they’re enjoying a high quality of life, it’s important to recognize some of the early signs of a decline in mental health.
- Memory changes
Many people continue to believe that changes in memory or memory loss are just a normal part of aging. However, this is not so. Although everyone forgets where they placed their keys once in a while, significant changes in memory can be an early warning sign. It is key to notice if seniors are continually misplacing things, forgetting important dates, or asking the same questions a lot. Many mental illnesses go unaddressed because we mistakenly think that memory loss is an inevitable part of aging.
- Disruption of personal care
Seniors who no longer take part in their personal care routines as they once did (such as not bathing or no longer brushing their hair) may be at risk for developing a mental illness such as depression. Losing interest in keeping up your appearances can mean they’re beginning to feel worthless, or that it no longer matters anymore.
If a resident once enjoyed picking out their clothing or wearing a certain scent and now they appear to have no interest, this could be a warning sign of a change in mental health.
- Withdrawal
Withdrawal from people and activities is a good indicator that something is not right with a senior. If their hobbies and activities that interest them used to be the highlight of the day, and now they want nothing to do with them, it’s time to check in. This is also true if a senior resident withdraws from social situations and people that once brought them joy.
- Mood changes
Changes to the disposition of a senior resident can also be a sign that something may have changed with their mental health status. If they were previously an upbeat person who now seems very low or expresses feelings of hopelessness, this could be one of the signs of mental illness. This is especially true if the changes in mood last for a couple of weeks or more.
How to Support Residents with Mental Illnesses
What are the best ways to be aware of the mental health of the elderly?
As care workers in a senior living facility, you can be one of the first people to see a shift in the mood and mental health of your senior residents. There are a variety of ways you can support seniors and be vigilant about changes to their demeanor that could indicate the onset of a mental illness.
- Be proactive. Make sure you’re observant and take note of changes in behavior. No change is too small to note and make sure to report these observations to the proper departments.
- Training. Training to recognize the early signs and symptoms of mental illness is key.
When staff know what to look for, the resident can get the help they may need sooner.
- Know the mental health background. It’s helpful to know the mental health background of patients, where they fall on the depression scale, as well as the potential reactions to any medications they may be taking. Speak with the resident and learn what their personalities are like. This can help staff learn to spot changes in demeanor or disposition.
- Ensure engagement. Keeping residents engaged is important, which is why their preferences and interests should always be considered when laying out activities and engagement opportunities.
Mental illness in the elderly is a serious concern. With the right training, staff can learn to recognize the early warning signs, and learn how they can get senior residents the mental health care they need.
