Common Mental Health Problems in the Elderly (part I)

Introduction
The health of the elderly:

In most countries, as physical health improves, people are living longer

The average number of years that person may expects to live is now well over 60.
It means a longer life to share, learn, experience and contribute

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As people grow older their bodies and minds more vulnerable to certain health problems Social life changes. People retire from regular work & earn less than they used to. Their daily routine changes. Their children become adults and may leave the home and start their own family.

Common Mental Health Problems in the Elderly (part I) mahar

For most elderly people old age is a positive and rewarding period:

It is a period in which to enjoy grandchildren.

It is a time to read a book or do things that could not be done during working years.
It is a period to spend time with friends.

Common Mental Health Problems in the Elderly (part I) mahar

The mental health problems faced by elderly that may cause them suffer from mental illnesses

Loneliness
Physical health Brain disease Financial difficulties

Common Mental Health Problems in the Elderly (part I) mahar

Loneliness

In many places, joint family systems are giving way to smaller families.
More and more elderly people are living alone with little support from their children. Loneliness is an especial difficulty when an elderly person loses a spouse

Common Mental Health Problems in the Elderly (part I) mahar

Physical health

Some elderly people develop physical health problems that cause disability (examples: arthritis, heart or lung disease) These problems limit what the person can do and make him increasingly dependent on the others

Common Mental Health Problems in the Elderly (part I) mahar

Brain disease

Some type of brain disease especially dementia & stroke are commoner in elderly people By affecting the brain they can lead to mental illness

Common Mental Health Problems in the Elderly (part I) mahar

Financial difficulties

Elderly people generally do not work

They are therefore reliant on pensions and savings, which, in a world of rising cost, may be inadequate

Common Mental Health Problems in the Elderly (part I) mahar

Condition that often cause elderly may behave unusually

There are four type of main mental disorders in the elderly:

Depression Delirium or confusion Psychosis Dementia

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Case:

Elder was a 70-year-old retired engineer who was living with his wife who was 55-year-old. The only son was working abroad and only see him once a year. Over the past few years Elder had become increasingly withdraw from social activity, poor sleep, being suspicious, sometimes agitated, confusion, looking sad and forgetfulness. His condition made his wife become boring therefore she often joint many activities that worsen Elder condition moreover after he has low back pain The only thing that made Elder looking better was when he meet his friends in senior gathering program or if his friends visited him
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Depression

Depression is the commonest mental illness in older people The common feature of depression in elderly people are:

withdraw from everyday life activities, loss of appetite, poor sleep, & physical complaint

Some can become agitated & suicidal

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Delirium or Confusion

Usually occurs as a result of medical problems or medicines The typical feature of delirium:

it is acute, the disturbed behavior will have begun in the past few days.

The person may be:

hallucinating & agitated

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Psychosis

Psychosis is a condition when someone has no insight & it is showed by an un-ability to differentiate between real and fantasy or has very disorganized thought or behavior Severe mental disorders in the elderly can rise to suspicious thoughts & hallucinations Psychosis can also occur in elderly people who suffer from dementia
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Dementia

Mainly affect older people especially > 65 y The earliest symptoms is memory problem Usually the illness comes to the notice of the family or health worker because of the disturbed behavior

Is a disease where the brain gradually degenerates

No cure Will gradually get worse & die within as few years. The commonest cause: Alzheimers disease & strokes

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Deciding whats wrong

There are two important diagnostic decisions you must take:

First you need to tell the difference between the four conditions that can cause disturbed behavior

Sometimes, two of these conditions can occur together:

Dementia and delirium or confusion; and dementia & psychosis.

The first priority is to ensure that the person is not confused, because delirium can be life-threatening and often treatable

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Deciding (cont)

There are two. (cont) :

Once this is excluded, and if you are in doubt, treat the person as if depressed. If the person was depressed they would recover; if not you would not have harm them. Only if the person is neither depressed nor confused should you consider the possibility of dementia. Sometimes it is necessary for the elderly person to be seen by a mental health specialist to make the correct diagnosis. Brain scan may also help in detecting dementia

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Deciding (cont)

There are two . (cont) :

Second, if it is dementia, make sure that there is no treatable medical condition that is causing it The main ones to think of are:

Thyroid disease Head injuries that cause slow bleeding inside the head AIDS (in younger people) Vit. B 12 Deficiency Chronic liver or kidney disease Brain cancer

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Treatment
The principal of the treatment:
1. based on the main problems of the elderly
Loneliness Physical health Brain disease Financial difficulties

2. holistic approached and 3. appropriate to health systems

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Based on the main problems of the elderly

Loneliness Improve interpersonal relationship some issues:

Lives in the family with home care or lives in home for the elderly Alliance for the elderly with activities such as:
Routine gathering Sports etc

Social worker

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Financial difficulties some issues:

insurance special budget for conducting program for the elderly fulfilling basic needs with programs such as: Empowering skill for increasing income subsidize

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Physical health

recognize the common physical health problems of the elderly some issues:
promotion, prevention, cure & rehabilitation

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Brain disease

recognize the common brain disease of the elderly some issues:

promotion, prevention, cure & rehabilitation

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Holistic approached

Mental health problems of the elderly influenced by some factors such as:

Economic Housing Social, etc

should involve interdisciplinary need prompt coordination

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Refer to mental health systems

Primary health system:

Establish in every village Close to the community Has successful experience in dealing with other health programs (mother & child program): Capacity building for primary health personnel & key person volunteer (cadres)
Involve community actively who understand their problems & potency: Programs should be planned, managed evaluate by the elderly
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Community based program for the elderly:

Note: Caring for the elderly

Most elderly people live healthy lives and are mentally able. If elderly person appears withdrawn or has memory problems, always make sure that it is not depressed or suffering from dementia. Keeping regular contact with elderly people provides an excellent opportunity to support them and to detect mental problem early on.
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Elderly person need about half the dose that prescribe to younger adult
Too much medicine may cause confusion

Elderly person need sufficient supervision

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