“While families tend to notice when children and younger adults experience mental health problems – in the elderly these are often mistakenly attributed to a decline associated with ageing and there is an unfounded belief that nothing can be done to improve their situation. As a result, mental health problems in older individuals often go undiagnosed and untreated,” he said.
“This is most unfortunate, as mental health problems in elderly people can in many instances be successfully managed. While dementia and Alzheimer’s disease are much more commonly associated with older age, it can be a mistake to assume that a loved one is experiencing memory loss and psychological distress as a normal part of their ageing process,” added Dr Fuller, who has established multi-disciplinary psycho-geriatric MemoryCare units at both Akeso Parktown and Akeso Alberton in Johannesburg in association with fellow psychiatrist, Dr Lolita Mostert.
According to the World Health Organization (WHO), approximately 15% of adults aged 60 and over globally suffer from a mental disorder of some kind. Given the steadily increasing elderly population both internationally and in SA, Dr Fuller believes there is a need for much greater awareness of this field of mental healthcare.
“Approximately half of the patients that we see at our psycho-geriatric MemoryCare units do not actually have dementia but rather are affected by other mental health challenges such as bereavement, depression, anxiety, and/or severe stress. These can all impact memory and even appear to present in a similar way to dementia. In many individuals these conditions can be managed and successfully treated to enable elderly individuals to enjoy an enhanced quality of life.
“For these reasons we strongly advise families to have their loved one properly assessed and diagnosed by a team of healthcare practitioners who are experienced and specialised in supporting mental health in the elderly,” noted Dr Fuller.
MENTAL HEALTH PROBLEMS IN THE ELDERLY
Asked what kinds of mental health problems affect the elderly, Dr Fuller said that they tend to be similar to those experienced by any other part of the population, and can include anxiety disorders, post-traumatic stress disorder (PTSD), depression, bipolar depression, personality disorders, sleep disorders, and others.
Dementia, however, which is characterised by memory loss, and a deteriorating ability to perform daily activities due to conditions such as Alzheimer’s disease, occur much more commonly in the elderly, and is considered a particularly important mental health challenge within this population.
“Among the many challenges that form part of old age psychiatry in particular, is that existing psychiatric disorders can be exacerbated by advancing dementia, making it difficult for doctors who are not experienced in geriatric care to reach an accurate diagnosis, and therefore to treat the conditions involved appropriately,” said Dr Fuller.
Dr Mostert explained that in addition, elderly people often have to deal with so many changes in the later stages of their lives that a considerable number consequently suffer from severe anxiety or even PTSD.
“Anxiety disorders and PTSD – which may be caused by severe shock, for example, the loss of a loved one – are likely among the foremost undiagnosed mental health conditions in the elderly in SA.
“An additional challenge with PTSD is that symptoms can look a lot like other conditions such as personality disorders, making diagnosis exceptionally challenging for those not familiar with it. Anxiety disorders, on the other hand, can express themselves in obsessive-compulsive and hoarding behaviours, as well as phobias,” said Dr Mostert.
A decline in kidney functioning in elderly people may also affect their reaction to medicine. In addition, those with memory problems may not be taking their medication as prescribed, which can result in them suffering drug interactions, overdoses and even delirium, which may seem like dementia.
WHEN TO SEEK HELP
When should caregivers become concerned about the mental health of an elderly individual? Dr Fuller said that the following warning signs could indicate a mental health concern:
- Confusion and disorientation.
- Memory loss, and difficulty in decision-making and in performing daily tasks.
- Depressed mood that lasts more than two weeks, loss of interest in activities that were previously enjoyed.
- Lack of self-care and changes in appearance and in appetite.
- Expressions of feelings of guilt, helplessness, and worthlessness.
- Increasing withdrawal from family and friends.
- Overwhelming feelings of anxiety and fear.
- Problems in coping with a deeply shocking event such as the loss of a loved one.
- Increased fatigue and loss of energy.
- Changes in sleep patterns and problems sleeping.
- Increasing obsessive-compulsive and hoarding behaviours.
- Physical problems such as aches and pains that cannot be medically accounted for.
SUPPORTING MENTAL HEALTH IN SENIORS
Dr Fuller, who underwent specialised training in geriatric psychiatry in London, observed that geriatric mental healthcare can be highly complex. A trusted family doctor is nevertheless a good place to start should you or your patient have concerns about an elderly loved one, and they may refer the individual on to a geriatrician, or psychiatrist specialising in elder care.
“In our experience a multi-disciplinary ‘needs-led’ team approach to each case is ideal, as treatment and management mostly depends on the individual, but also the structure and function of the family system involved. The dedicated team can offer a range of interventions to support their individual condition and needs.”
These can include individual or group therapies, improving family support, and where necessary using appropriate psychiatric drugs, such as for example anti-depressants, to assist with depression and anxiety.