Elderly Mental Health

Mental health problems can affect anyone of any age; however, as we age, mental health issues can often become exacerbated.

People often fail to recognise they are suffering from a mental health issue, so it could be a friend or family member that notices the change first. Suppose you see your loved one’s mental or emotional state deteriorating quickly or believe that they are in danger of harming themselves or others. In that case, you can request an emergency assessment by contacting their GP.

How Do I Spot an Issue?

Spotting poor mental health can be really difficult; this is especially true if you don’t usually engage with it. Just looking for behavioural changes is not enough, as a change in habits does not mean that someone’s health is getting worse.

What Is Good Mental Health?

Good mental health is defined as a state of well-being in which an individual realises their own abilities, can cope with everyday stresses of life, can work productively and is able to make a contribution to society. It is a positive sense of well-being and an underlying belief in our own dignity and worth. 

What does good mental health look like?

• Healthy cognition – our ability to think clearly, solve problems and make good and safe decisions
• Positive emotional health – our ability to experience, understand and express emotions and feelings
• Healthy perception – our ability to make sense of events around us
• Being able to function – to be able to form relationships and participate in society
• Being able to cope- being resilient and being able to deal with experiencing disappointments, sadness, stress and setbacks

Knowing the above may help you to spot when something is wrong.

What Is Bad Mental Health?

Bad mental health is defined as when a person is finding it difficult to think clearly and rationally, or struggles to interact with others and cope with the everyday demands of life.

This begins to effect all aspects of their work relationships and quality of life.

What Should I Do if I Spot Signs of Mental Health?

Contact the GP of your family member or friend. It seems like an obvious answer; however, it is the best one. The GP will complete their assessment; if they think it is necessary, they will refer them to a mental health professional.

Below is a list of common mental health issues that all people can face, not only in old age but throughout their lives. As well as some of the associated symptoms and possible treatments.

Stress:

This can be a build-up of pressure over time, and it can be emotional, physical or psychological. 

Stress can be caused by many things: work problems, relationship issues, financial worries, health issues, housing issues, abuse or just about anything else.

The Impact of Stress:

The symptoms of stress are also varied from:

• Psychological – They may be easily distracted, have memory lapses, engage in negative thinking or lack of concentration.
• Emotional – They get angry, have mood swings, are tearful, and lack motivation or self-esteem.
• Physical – They might get unexplained skin rashes, experience weight loss or gain, have high blood pressure, panic attacks, sickness, constipation, grind their teeth or frequently get headaches.
• Behavioural – They become socially withdrawn, begin working too hard, increase their smoking or drinking, have insomnia, or start neglecting themselves.

This may seem like a lot of information to take in and is fairly scary to deal with! However, stress can be managed and supported.

How to Manage Stress

• Identify the source of the stress
• Identify the signs of stress
• Look at how they cope when they are stressed

Once these questions have been answered, you can start applying methods to help ease their stress. Such as:

• Setting aside time for relaxation – try some meditation, yoga, painting or going for a walk
• Adopt a healthy lifestyle – eat a balanced diet cut down on alcohol and, caffeine and sugars
• Routine – adopt a regular routine, especially before bed. When it comes to sleep, turn off the TV and leave phones out of the bedroom  
• Talk to others – get yourself or your loved ones out and about, meeting friends or even going to support groups

You can find more guidance and advice here:

• British Autogenic society   www.autogenic-therapy.org.uk
• British Wheel of yoga  www.bwy.org.uk
• Citizens Advice  www.citizensadvice.org.uk
• Trade union congress  www.tuc.org.uk

Anxiety

Everyone will have experienced some anxiety before, but it can take over your life and be debilitating for some.

As with stress, anyone can suffer from anxiety, but some people will be more prone to it than others, especially if they have been exposed to prolonged periods of stress or have had negative experiences.

There are a few categories that anxiety falls into panic attack disorder, social phobia, obsessive-compulsive disorder, specific phobias, post-traumatic stress disorder and generalised anxiety disorder.

Impact of Anxiety

The impact that anxiety can have on a person can be huge; for example, there may be:

• Psychological effects include irrational fears, pessimistic outlook, decreased concentration and memory, restlessness, tiredness, sleep disturbance and impatience
• Physical effects such as heart palpitations, chest pains, butterfly feelings, feeling sick, flushing, dizziness, sweating and aches and pains
• Behavioural effects like avoidance, obsessive behaviour, increased use of alcohol or drugs and phobic behaviour

A person who suffers from anxiety usually is very frustrated about their condition, resentful, mentally exhausted and distressed trying to deal with the situations.

How to Manage Anxiety

Once the problem is identified, a wealth of support and management is available, especially in recent years. The first port of call is the GP. Depending on the severity, they may refer the patient to a counsellor or cognitive behavioural therapist, or a psychologist in more extreme cases.

There are also things you can do at home to help manage and even eradicate anxiety:

• Self-help – take ownership and control over the issue. Read about coping strategies from others.
• Meditation – breathing exercises and muscle training are all commonly used techniques
• Sharing – talk about how you feel to friends and family, learn relaxation techniques, active problem solving, exercise, distracting/refocusing, making time for activities you enjoy

You can find more guidance and advice here:

• Anxiety care www.anxietycare.org.uk
• Anxiety UK  www.anxietyuk.org.uk
• British Association for counselling and psychotherapy www.bacp.co.uk
• No panic  www.nopanic.org.uk

Post Traumatic Stress Disorder (PTSD)

This can develop when someone experiences a highly stressful situation or traumatic event. Not everyone will respond the same way, and others may recover very quickly.

For many, though, PTSD can take a very long time to recover from, if at all. It is especially complex if someone has experienced multiple traumatic experiences such as sexual abuse or domestic violence.

Anyone can suffer from this, and it can also reoccur or resurface many years after the event if something triggers of the memory. The symptoms and signs can vary and are not always noticeable from the outside.

Impact of PTSD

• Reliving the traumatic event – unwanted memories, nightmares, panic attacks and flashbacks
• Avoiding reminders of the event – avoiding revisiting, refusing to discuss the event or feelings
• Feeling wound up – trouble sleeping, concentrating and being unable to relax.
• Negative thoughts and feelings – feeling depressed, suicidal, loss of interest in everyday things
• Emotional – feeling guilty, shame and grief-stricken

If you have a friend or family member who is suffering from PTSD, it’s best to do your research so you can understand more of what they are feeling. Be a patient listener if they start to talk about their feelings or the event.

How to manage PTSD

• Don’t bottle up your feelings or block them out; talk about it 
• Recognise you have experienced a stressful, traumatic event, and give yourself permission to cry
• Recognise this can take time to come to terms with
• Talk to others who have experienced similar feelings and experiences
• Look after yourself
• Make time for relaxation
• Try to live your life as normally as possible
• Spend time with your loved ones and friends
• Get Support

The treatments used to support PTSD are cognitive behavioural therapy, eye movement desensitisation and reprocessing and medication, which can include sleeping tablets and antidepressants.

There are lots of resources online; here are just a few:

• ASSIST (assistance support and self-help in surviving trauma) www.assisttraumacare.org uk
• Combat stress  www.combatstress.org.uk
• UK psychological trauma society www.ukpts.co.uk

Depression

Depression is a prevalent mood disorder where someone has a low mood and is unhappy for an extended period of time. This inevitably interferes with their everyday life.

There are several depressive disorders, such as clinical, psychotic, dysthymia, postnatal and seasonal affective disorder (SAD).

Depression can be caused by:

• Biological factors are sometimes linked to hormonal changes and imbalances.
• Genetic factors such as having a family history of depression.
• Physiological factors include a life-threatening illness, a poor diet or lack of exercise.
• Behavioural factors like alcohol or drug abuse.
• Social factors such as experiencing conflict or poor social networks lead to isolation.
• Situational factors include the break up of a relationship, grief, job loss, accident or illness.
• Historial factors such as difficult childhood experiences, abuse, and family breakups.
• Cognitive factors like negative thinking, emotional sensitivity and stress.

The Impact of the Depression

Living with depression can affect a person’s everyday life and involve friends and family.

A person suffering from depression can neglect themselves. This may manifest in a dirty or untidy environment/home. They may also try to avoid going out and meeting people.

This is why friends and family can often feel helpless as they want to help but are often rejected by the sufferer, refusing to admit that they need help.

How to Manage Depression

The national institute for health care excellence (NICE) recommend a stepped approach before medication is prescribed:

1. Recognition of the issue: The patient must first come to a realisation that they have a problem and decide that they want to get it treated
2. The GP prescribes Cognitive Behavioural Therapy to attempt to tackle the issues without using drugs. Alongside this, the patient is advised to engage in self-help to avoid negative thinking and other self- help strategies, which may include exercise and avoiding alcohol and drugs.
3. Finally, medication, such as antidepressants, mood stabilisers and antipsychotics, are typically prescribed.

More information can be found on these websites.

• Depression Alliance www.depressionalliance.org
• Action on depression www.actionondepression.org
• Depression UK  www.depressionuk.org
• Mind www.mind.org.uk
• Seasonal affective disorder association www.sada.org.uk
• National childbirth trust www.nct.org.uk
• Association for postnatal illness  www.apni.org
  

Bipolar Disorder

There are two different types of bipolar disorder:

• Bipolar 1 – The most severe form of mental illness with severe forms of depression and mania. This can last for weeks or months at a time and could lead to hospitalisation.
• Bipolar 2 – The person suffers from shorter episodes and a milder form of depression and mood swings.

Stress and stressful life events are believed to change the balance of chemicals in the brain. There may be genetic factors, such as a family history of illness. Or environmental factors like pressures within everyday life at home or work.

How to Manage Bipolar:

The most important part of treatment is recognising and understanding the illness. This is because self-monitoring, where the person feels and recognises the early warning signs of episodes, is central to delivering direct treatments.

Support from others is very important; groups online and in the local community meet to support one another, as they have had similar experiences and feelings.

Developing a good routine encourages the person to have set times for daily tasks like resting, eating, exercising and relaxing. Avoiding stress is so important, and recognise them so you can walk away and get some space.

Having a healthy diet/lifestyle is also very important, as you should try to avoid foods with high sugar levels, caffeine and limit alcohol consumption. Plenty of sunlight, calming activities like yoga and hobbies like painting can also be helpful coping techniques.

Medication and treatment include mood stabilising drugs, antidepressants, electroconvulsive therapies and talking therapies. The doctor may also prescribe other medicines, such as lithium and antipsychotics.

You can find out more information from the sources below:

• Bipolar UK www.bipolaruk.org.uk
• Mind www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/
• NHS www.nhs.uk/conditions/bipolar-disorder/living-with
• Rethink  www.rethink.org/advice-and-information/about-mental-illness/
• Mental health foundation www.mentalhealth.org.uk/a-to-z/b/bipolar-disorder
• Young minds https://youngminds.org.uk/find-help/conditions/bipolar-disorder/
  

Schizophrenia

This is a severe psychotic disorder which is often described as a person being split or losing reality with their surroundings or family.

It can be caused by genetic inheritance, drug abuse or stressful events in a person’s life. It is often diagnosed when a person develops bizarre or paranoid delusions. These episodes may re-occur regularly over the years.

This can disrupt a person’s everyday life and upset relationships, employment and general social activities. A person suffering should always get expert advice and support from the mental health team or doctor. The delusions/hallucinations vary but can include the following:

• Delusion of control is when a person thinks others are controlling their thoughts and actions.
• A delusion of reference, believing they are receiving particular messages that they can only understand.
• Having a delusion of grandeur when they think they are a famous historical person and have special powers.
• Delusions of persecution are when they think people are deliberately plotting against them, spying, cheating, harassing them, or even trying to poison them.
• They may also experience hallucinations where they hear voices, smell, see, taste, or feel things that no one else can.

How to Manage Schizophrenia

Reducing stress is a great place to start; this can be aided by joining a self-help group. Make sure they are getting enough sleep, maybe reduce caffeine before bed and turn off phones and televisions an hour before you go to bed.

Avoid alcohol or drugs, as substance abuse worsens the symptoms and makes the illness even more complicated. Getting regular exercise is good for the mind and body and distracts from the disease. Hobbies are suitable for the mind and body, distract from the illness and give a sense of achievement.

It is extremely important to take medication as directed. The stated dose should always be taken and never stopped unless under a doctor’s guidance and recommendation.

Also, consider complementary therapies; these can often help, like acupuncture, aromatherapy, massage therapy or reflexology. Much like a placebo, it the person taking them believes in them, they can work.

Find out more from the links below:

• NHS www.nhs.uk/conditions/schizophrenia
• Mind www.mind.org.uk/information-support/types-of-mental-health-problems/schizophrenia
• Rethink www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/schizophrenia/
• Time to change www.time-to-change.org.uk/about-mental-health/types-problems/schizophrenia
• Help guide www.helpguide.org/articles/mental-disorders/schizophrenia-signs-and-symptoms.htm
  

Eating Disorders

Eating disorders have the highest death rate, and 1 in 5 will die out of those suffering. Anyone can suffer from this, male or female, but mainly it is young women between the ages of 15 and 25.

An eating disorder is when someone has an unhealthy eating pattern, either overeating to the extreme or under-eating. The impact can be devastating on mental and physical health.

Causes of Eating Disorders

Psychological and emotional issues such as low self-esteem, lack of control, depression, anxiety, anger and difficulty in expressing emotions and feelings.

Social media and cultural factors pressure people to conform regarding body image, physical appearance, inner qualities and strengths.

Types and impact of Eating Disorders

• Anorexia nervosa:
  • Anorexia means loss of appetite, but it is when a person denies themselves food. They often have low self-esteem, fear of rejection and a distorted view of their bodies or they may see themselves as overweight when not. They often become obsessed with food, weight and body image.
  • The signs of someone suffering from this are osteopenia, brittle hair /nails, dry yellowish skin, muscle weakness, constipation, low blood pressure, tiredness and feeling cold all the time.
• Bulimia Nervosa:
  • This is when a person eats unusually large amounts regularly, followed by the wish to then get the food out of their body by being sick or using laxatives. They feel they have a lack of control over their eating. This behaviour is generally done secretly as the person will feel guilty or ashamed of their actions.
  • The signs of a sufferer may be an inflamed and sore throat, swollen glands around the neck, bad teeth, intestinal distress, kidney problems and dehydration.
• Compulsive overeating, otherwise known as binge eating:
  • When a person has no control over their eating and will continue to overeat, becoming overweight or obese. They will also feel shame and distress, making them eat even more.
  • A person who suffers from anxiety, depression or a personality disorder may be more prone to this illness. This can affect both males and females but the most usually those around the age of 30 to 40.
  • The signs can be becoming obese or overweight, regularly eating large amounts of food, disappearing certain foods, eating until they feel really uncomfortable, being emotionally distressed after eating, constantly hungry and never feeling full.

Managing Eating Disorders

Treat Eating Disorders with talking therapies, close monitoring, weight management strategies, medication and having the support of family and others who have recovered from similar illnesses.

Find out more information using the sources below:

• Beat www.b-eat.co.uk
• Overeaters anonymous www.oagb.org.uk
• National centre for eating disorders  www.eating-disorder.org.uk
• Nutritionist resources  www.Nutritionist-resource.org.uk
• Young minds www.youngminds.org.uk