Mental health of older adults

 Our body goes through different changes as we age. During this process many physical and mental health issues can develop or worsen. In this interview, Dr Tanveer Ahmed, a psychiatrist at Hills Clinic, Australia talks about mental health of older adults, challenges they face in transition stage and ways to deal with them

SN: Which psychological issues develop or worsen with age?sni

Short-term memory becomes less efficient with age. Individuals are prone to illnesses like dementia which occur due to changes in the brain. Declining physical health and activity leads to loneliness, depression and anxiety. Hormonal changes in menopause cause melancholic depression; a more biological form linked to low motivation, social withdrawal and depressed mood. Alternatively, some issues like those related to personality disorder may improve with old age as people become less self-conscious.sni

SN: How are physical and mental health related?sni

Good physical health helps us remain active and relate to others more easily. It is critical for mental health too. Whereas vision, mobility, hearing and other health changes can impact our ability to sustain relationships and activities. Hence cause low confidence and isolation.sni

SN: Why do elders become aggressive or stubborn with age?sni

It is difficult for the elderly to make sudden changes in old routine. Aggression is likely in case of brain-related changes. This can lead to frustration, low tolerance, increased sensitivity and inability to deal with unexpected situations. Families should be aware and acknowledge that elderly too can get upset over something. Therefore, it is important to be consistent in understanding them and always have your voice toned down.sni

SN: Losing a spouse is hard. However, some believe that men suffer more than women. Is it true?sni

Women express their pain, cry or grieve openly. Whereas men withdraw, become silent or grieve secretly. Thus are prone to isolation or at least in western countries, more prone to substance use. They are more likely to engage in risk-taking behaviors and have higher risks of suicide. Moreover, they are also inclined to action-oriented forms of grief like occupying themselves in work or new activity. Many south Asian men have the tendency to express psychological distress through physical pain.sni

SN: Recommend ways for elders to cope with loneliness and loss of partner.sni

Coping with loss of partner is difficult for elderly as they have been in certain routines for decades. To reduce the feeling of loneliness they can learn new skills, engage in volunteer work and stay in touch with relatives. Families can support by finding them new routines, making them feel useful by giving them new social roles within the extended family and helping them learn about technology. Also avoid considering them less functional because of old age. Treating physical health problems can improve overall confidence of an elder too. sni

SN: Are insomnia and other sleep issues a part of normal aging? Also how do they affect mental and physical health? sni

Sleep patterns change with age. Many find it slightly hard to sleep and other wake up more often. Physical and mental illnesses like frequent urination, heightened anxiety or depression can interfere too. Thus total average sleep time is reduced to six and a half hours a night and less time is spent in deep sleep. This can affect physical recovery and broader health markers. Also lethargy makes it difficult to participate with family or keep up with other interests. sni

SN: How can elders affected with insomnia spend quality time? sni

One of the rules when having difficulty sleeping is not to lie in bed for too long. It is best to get out of bed and indulge in some activity, like have a glass of milk or read and then try going to sleep once you feel tired. sni

SN: Suggest ways for families to ensure adults get sound sleep. sni

Reassuring if they are anxious, helping them get light exercise and keeping an eye on their diet can help. This includes going for walks and limiting intake of alcohol and spicy foods and smoking etcetera. sni

SN: Are there any healthy activities that if started in a younger age can be continued in the older age too. sni

Best activities are those which can be continued in old age too. For example walking or swimming is one of the best forms of exercise. But swimming is relatively rare and harder for women in Pakistan. However, reading and other intellectual activities can sharpen the mind even in old age. Engaging with children allows to learn and understand trends like technology. Other healthy activities include knitting and gardening which offer light exercise too. sni

SN: Older adults often experience difficulty adjusting in new places. What can be done in this case? sni

To accept dramatic change is difficult for anyone especially for elderly. So keeping things similar to the previous residence, old family pictures and other familiar possessions can help them move. Ensuring the availability of appropriate physical aids can be useful too. sni

SN: Death is inevitable. But many tend to develop a fear of it. How can they overcome this fear? sni

Fear of death with age and on seeing friends die is unavoidable. In the late stage of life, healthy aging depends on acceptance of death but a feeling that one can still be useful to others until that time. With age, one experiences physical as well as emotional loss. Death of close relatives changes our identity like we are no longer the son or spouse of someone. Healthy mourning depends on coming to terms and accepting these identity changes. sni

SN: What role does financial stability play in sustaining confidence? sni

Financial worries are a very common part of anxiety in old age. Feeling secure in one’s finances and being able to hand on some assets to next generation is an important aspect of healthy aging. The actual amounts will vary according to the person and the country they live in. It also depends on healthy saving throughout their life and prudent spending. Relatives can advise them to spend wisely as some neglect themselves fearing their care would be costly. sni

SN: How can those looking after elderly protect their own mental health? sni

Caregivers can suffer stress; feel overwhelmed and burnout. This can include resentment towards the person being taken care of. They must rest and maintain a semblance of their own life, with their interests and other relationships. Relatives often remain highly engaged in elder’s care in Pakistan. Hence, private care is considered a stigma but sometimes it is required and should be given. sni

SN: How can seniors benefit from technology? sni

Better use of technology can help them stay connected, especially with their grandchildren and those living overseas. Being able to access social media and see the photos of their children and relatives can reduce the feeling of isolation. Mobile applications like puzzles and games can make them stay mentally active. sni

SN: What is schizophrenia? sni

Schizophrenia is associated with brain-related degenerative changes, which make people paranoid and experience sensory disturbance like auditory hallucinations . It also leads to disorganized speech and behavioral disturbance. Symptoms combined can cause dramatic decline in one’s ability to maintain work or relationships. Individuals affected with it can no longer interpret reality in a healthy way. sni

SN: What lifestyle changes can improve schizophrenia? sni

Individuals with schizophrenia lose motivation and become isolated. They may be using medicines that cause excessive weight gain. Also are more likely to die of a heart attack or diabetes than their mental illness directly. So maintaining good physical health, especially losing weight is important. Moreover, family support and involvement can help them remain functional and retain dignity in the long-term. sni

SN: What is dementia? sni

It is the loss of memory and brain function with age. Commonest cause is Alzheimer’s disease in which a certain type of plaque clogs brain and affects memory. Other causes are alcohol use, viruses and blood-related changes. Mostly it is not reversible but the condition can be improved with medication or lifestyle modifications. There are no natural remedies for it. sni

SN: Do psychological problems run in families? sni

Mental illness is rarely entirely hereditary. Some like bipolar disorder and anorexia have a stronger genetic component. But there is always an environmental dimension too. Those from conflicted families or ones who have suffered trauma or major losses are more prone to these issues. sni

SN: Recommend ways for elders to maintain good mental health in transition stage. sni

Transition phases can be an important part of maintaining good mental health. With age our roles change so it gets difficult to feel useful and connected. Volunteering and learning new things can help brain stay active. One must continue hobbies and interests, retain relationships and include those of similar age.  Also avoid underestimating your capabilities because of growing age. Many in their 80s are running marathons, getting married or running businesses. sni