Thank you to VOYCE’s Mental Wellness Navigator, Heather McDonnell, for providing the content and resources in this article. Learn more about VOYCE’s new Mental Wellness in Skilled Nursing program.
The stigma associated with mental illness is one of the major barriers to accessing care. As we uncover the reasons for stigma, we must consider context, one of which being age. Our seniors grew up in a generation that did not talk about mental health because it was seen as a sign of weakness. If you grew up in a time in America where those with mental illness were treated as sub-human within mental health institutions, you learned very quickly that to protect yourself you would stay silent about mental health challenges. We know that mental health disorders such as anxiety and depression often go unrecognized in older adults, and they often do not seek treatment for a variety of reasons.
Today we know that mental illness is a brain disorder, and although we have a long way to go in breaking the long-held stigma, we have made significant changes to our mental health systems. This CDC document, The State of Mental Health and Aging in America, notes that 20% of people ages 55 years or older experience some type of mental health concern. Among them are a high prevalence of anxiety and mood disorders (such as depression or bipolar disorder).
COVID-19 and Mental Health
When a traumatic event occurs, such as COVID-19, our body kicks into survival mode, making it difficult to focus on anything except protecting ourselves and the ones we love from the threat. When we have spent too long in this survival mode, we can fall into patterns that are unhealthy. When we come out of this brain fog and realize that these patterns are worrisome, it is a good time to reach out for help. There are various screening tools available online, and while they do not replace doctor’s advice, they can be a good place to start as we try to uncover what is going on behind our mood change.
Mental Health Concern: Depression and Older Adults
After experiencing the pandemic, you may be thinking that you do not feel like yourself anymore. New mental health symptoms or worsening pre-existing symptoms may have surfaced as the framework of your life unraveled over this last year. These feelings may have lingered longer than you anticipated, making you question whether these feelings are part of something more serious. Many symptoms of a mental health condition mimic symptoms of a physical ailment, so it is important to seek out the advice of your physician.
There are various forms of depression, but one of the most frequently discussed diagnoses is Major Depressive Disorder (MDD). Depression is one of many mood disorders. The criteria for all types of depression come from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is the most recent edition of the book used by clinicians and physicians to diagnose mental health conditions.
The symptoms of depression in older adults can look different than those in younger populations and as a result often go unrecognized. Feeling withdrawn, apathy, and a lack of interest in activities they once enjoyed, are more common in this population.
Mental Health Concern: Anxiety Disorders
There are several types of anxiety disorders. Some of the most common anxiety disorders include Generalized Anxiety Disorder (GAD) and Posttraumatic Stress Disorder (PTSD). You may be wondering if your symptoms point to one of the various forms of anxiety disorders. Almost half of older adults who are diagnosed with MDD also meet the criteria for anxiety. Those with anxiety can experience both emotional and physical symptoms that point to a diagnosis. The emotional symptoms can include feeling irritable and tense, having racing thoughts, and fear. In addition, physical symptoms like insomnia, racing heartbeat, gastrointestinal issues, and tremors are frequent complaints.
“Normal” vs. “Abnormal” Changes with Aging
We know that there are multiple risk factors for mental health conditions. While depression is not a normal part of aging, there are many reasons why those in long-term care face unique challenges which can create an atmosphere putting them at increased risk for mental illness. These challenges include a loss of independence, changes in mobility, and a lack of social supports. Also, feelings of being a burden to others and changes in their physical health such as vision and hearing changes can all contribute to changes in mental health. Watch this video to understand some of those challenges.
Treatment options are as varied as the type of diagnosis you or your loved one has been given. There are medications and other treatments available to help you manage your symptoms which your doctor can prescribe. Your doctor may be your primary care physician, a psychiatrist, or other prescribers.
It is important to remember that many doctors are not going to screen for mental wellness in you or your loved one’s life, making advocacy crucial. Physical health and mental wellness are intertwined and affect each other. Social, medical, and mental health needs should be addressed together; however, the overarching medical community does not always work together, and best practices are not always utilized. Wrap-around and holistic approaches serve older adults in addressing the needs which are unique to each of us. This video talks about mental wellness in older adults and some best practices that have been used throughout the country.
In addition, there are many non-medical interventions, such as psychotherapy, which are delivered by a professional with a clinical license. There are also non-therapeutic interventions that can be beneficial and may be provided by a layperson, an everyday individual with special training. An example could be support groups given by a peer, which is someone with a mental health condition as well. Most importantly, recovery is possible!