Month: August 2021 (page 1 of 1)

• Where to get help

About anxiety disorders

Anxiety disorders are a group of mental health problems. They include generalised anxiety disorders, social phobias, specific phobias (for example, agoraphobia and claustrophobia), and panic disorders. Depression is often related to anxiety disorders.

Anxiety disorders are common mental health problems that affect many people. Approximately 25% of the population have an anxiety disorder that warrants treatment at some time in their life and up to another 25% have less severe anxieties such as fears of spider and snakes.

Not all anxiety is a disorder

Everyone experiences anxiety and fear at times – these are normal and helpful human emotions that help us deal with danger. However, some people experience excessive and irrational anxiety and worries that become ongoing and distressing, and that interfere with their daily lives. This may indicate an anxiety disorder. Often there appears to be no obvious or logical reason for the way the person feels. This may make an anxiety disorder even more worrying to the sufferer.

Symptoms of anxiety disorders

The main features of an anxiety disorder are fears or thoughts that are chronic (constant) and distressing and that interfere with daily living. Other symptoms of an anxiety disorder may include:

• Panic or anxiety attacks or a fear of these attacks
• Physical anxiety reactions – for example trembling, sweating, faintness, rapid heartbeat, difficulties breathing or nausea
• Avoidance behaviour – a person may go to extreme lengths to avoid a situation that they think could bring on anxiety or panic.

Panic attacks are a common symptom

A panic attack is a sudden feeling of intense terror that may occur in certain situations or for no apparent reason. A panic attack does not mean a person is necessarily suffering an anxiety disorder. However, a panic attack is a common feature of each type of anxiety disorder. Symptoms of a panic attack may include:

• Shortness of breath
• Dizziness
• Rapid heartbeat
• Choking
• Nausea.

The cause of panic attacks is unknown, but they may be related to a chemical response in the brain, caused by actual threatening or stressful events or by thinking about stressful events. The brain response leads to physiological changes in the body, such as shallow breathing and rapid heartbeat.

Panic attacks can be frightening. Some people say they feel like they are going to die or go crazy. People affected by panic attacks may avoid situations in which they think attacks might occur. In some cases, this may lead to the development of other anxiety disorders including agoraphobia.

Types of anxiety disorders

Anxiety becomes a disorder when it’s irrational, excessive and when it interferes with a person’s ability to function in daily life. Anxiety disorders include:

• Generalised anxiety disorder
• Social phobias – fear of social situations
• Specific phobias – for example a fear of open spaces (agoraphobia) or enclosed spaces (claustrophobia)
• Panic disorders – frequent and debilitating panic attacks.

Generalised anxiety disorder

Generalised anxiety is excessive anxiety and constant worry about many things. The focus of the anxiety might be family or friends, health, work, money or forgetting important appointments. A person may be diagnosed with a generalised anxiety disorder if:

• The anxiety and worry have been present most days over a six-month period
• The person finds it difficult to control their anxiety.

Social phobias

People with social phobia are afraid of being negatively judged or evaluated by others. This leads to fear of doing something that may humiliate them in public – for example public speaking, using public toilets, eating and drinking in public, writing in public, or any social encounters such as parties or workplaces.

Some social phobia sufferers may only fear one type of situation. Others may be concerned about several types of situations. This can lead them to avoid the feared situations, which can then lead to severe isolation and avoiding people and activities they usually enjoy.

Specific phobias

A person with a specific phobia has a persistent and irrational fear of a particular object or situation. They may fear animals, places or people. Fear of the object or situation is so severe that a person may experience physical symptoms and panic attacks. Fears may include dogs, blood, storms, spiders or other objects or situations but, in all cases, the anxiety is both excessive and interfering.

The adult phobia sufferer usually knows that their fear is excessive or unreasonable. However, their need to avoid the object, place or person can significantly restrict their life.

Panic disorders

Panic or anxiety attacks are common. Panic disorders are less common, affecting about 2% of the population. For a person to be diagnosed with a panic disorder, they would usually have had at least four panic attacks each month over an extended period of time. Often panic attacks may not be related to a situation but come on spontaneously.

Panic disorder may be diagnosed if panic attacks are frequent and if there’s a strong and persistent fear of another attack occurring.

Anxiety disorders can have serious effects

An anxiety disorder may lead to social isolation and clinical depression, and can impair a person’s ability to work, study and do routine activities. It may also hurt relationships with friends, family and colleagues. It’s common for depression and anxiety to happen at the same time. Depression can be a serious illness with a high risk of self-harm and suicide.

Recovery is possible with treatment

Recovery from an anxiety disorder is possible with the right treatment and support. Effective treatments for anxiety disorders may include:

• Cognitive behavioural therapy – aims to change patterns of thinking, beliefs and behaviours that may trigger anxiety.
• Exposure therapy – involves gradually exposing a person to situations that trigger anxiety using a fear hierarchy: this is called systematic desensitisation.
• Anxiety management and relaxation techniques – for example deep muscle relaxation, meditation, breathing exercises and counselling.
• Medication – this may include antidepressants and benzodiazepines.

Where to get help

You can contact us for more information.

Over the years, it is easy to forget about exercise when it’s not routine. Remaining sedentary over life can lead to metabolic disorders and other diseases associated with physical inactivity. A recent study suggested that about 67 percent of the older population is sedentary for at least 8.5 hours each day, suggesting a need to improve activity levels for senior health.

Exercise for elderly people should be something performed regularly, and making it fun and a routine can help in the long term. Moreover, there are numerous health benefits the older adult can receive from long-term exercise. Following are 10 reasons seniors should continue to exercise.

1. Arthritis: Exercise is one of the most crucial options for arthritis management. Regular activity helps lubricate the joints and can help reduce overall pain and stiffness that is often present among individuals with arthritis. Moreover, obesity is a risk factor for the disease, and increasing physical activity levels can help better manage the debilitating symptoms of arthritis. (Here’s another NIFS blog post about exercise and arthritis.)
2. Heart disease: Heart disease is one of the biggest causes of death in the United States. The Centers for Disease Control and Prevention state that about one in every four deaths is attributed to heart disease. More people exercising later in life can help reduce the number of individuals with heart disease through the management of blood pressure and blood glucose, and decreasing LDL cholesterol.
3. Metabolic Dysfunction (type II diabetes and obesity): Type II diabetes and obesity are two closely related diseases in which the body is in metabolic dysfunction. Exercise can help maintain proper body weight and help regulate blood glucose and insulin levels to make the body more efficient.
4. Cancer: Exercise has been shown to help improve overall cancer risk among a variety of different forms of cancer. Studies have shown a 30 to 40 percent reduction in breast cancer risk among women who perform moderate to regular exercise.
5. Hypertension: Exercise can help lower systolic blood pressure significantly through moderate-intensity physical activity. Try breaking up exercise into three bouts throughout the day lasting for at least 10 minutes each to receive blood pressure–lowering effects.
6. Depression: Exercise can have a beneficial effect on personal mood. Studies suggest that group exercise classes among older adults can help reduce symptoms of depression by 30 percent or more in exercising older adults. The modest improvement in depressive symptoms can help maintain an overall greater vitality later in life and help prevent negative feelings or thoughts that are common with aging.
7. Dementia: Dementia is a disabling condition affecting many older adults. With a wide range of mental disorders categorized as dementia, there is a great need to understand how to prevent the condition. Exercise is one prevention strategy that can help slow the mental decline. A recent study showed a 37 percent reduced risk and a 66 percent reduction in risk of dementia when older adults performed moderate-intensity exercise, suggesting every adult ought to exercise to help lower the risk of mental decline and to help prevent mental disability later in life.
8. Quality of life: Maintaining functional independence is something many older adults want. A regular exercise inclusive of strength and balance training can help accomplish this. Aim to be physically active for 30 minutes every day and to strength train at least two non-consecutive days per week.
9. Insomnia: Certain medications and life events can prevent the body from proper sleep. Higher levels of physical activity can help exhaust the body enough to place it in a position for restful and lasting sleep. Avoid strenuous exercise two hours before bed to obtain these benefits, and aim to meet the daily activity recommendations.
10. All-cause mortality: Exercise is known to reduce death from all causes. In fact, a recent study showed a 30 to 80 percent reduction in all-cause mortality when individuals exercised at an intensity level greater than 4 METS, suggesting that exercise can help delay premature death from various causes.

In the hustle and bustle of everyday life, it’s easy to take our eyesight for granted. But good vision isn’t a guarantee. Protect your vision by making smart decisions every day with these quick tips:

1. Watching lots of movies? Sit at a distance equivalent to at least five times the width of your TV screen.
2. Include eye healthy foods in your meal Foods containing vitamin C (papayas, red bell peppers, kiwi, strawberries, and oranges) or antioxidants such as lutein and beta-carotene (carrots, sweet potatoes, squash, spinach, kale, and broccoli) can help reduce the risk of developing age-related macular degeneration (AMD).
3. Get regular…with your eye exams! There is no better way to protect your vision than an eye exam, as many eye diseases have no easily detectable symptoms. The Canadian Association of Optometrists recommends children have their first eye exam between ages six and nine months, and annually after that. Adults should have eye exams every two years, or at the direction of their optometrist.
4. Butt out! Smoking contributes to a number of eye related health issues, learn more here.
5. Take 20. Take a 20 second break from your computer screen every 20 minutes and focus your eyes on something at least 20 feet away.
6. Protect your baby blues (or greens or browns). Wear proper protective eyewear when undertaking major indoor or outdoor work, and wear sunglasses outside even when the sun isn’t shining – UV rays are harmful to your eyes year round.
7. Have the conversation. If you have eye irritation from allergies, inflammation, infection or injury, don’t assume it will go away on its own. Unusual visual symptoms can require treatment to resolve, or, in some cases, indicate a more serious vision problem. For eye care emergencies, be sure to ask your optometrist if emergency appointments are available – it’s often faster than going to the ER.

Since 1949, May has been known as Mental Health Awareness Month.  Each year, when May is over, I wonder why we’re not encouraged to be aware of our mental health all year, every year, just as we are for our so-called physical health. Given all we know about the effects of anxiety and depression on our bodies and immune systems, this question is vital.  As Harvard Health pointed out in 2008, “Anxiety has now been implicated in several chronic physical illnesses, including heart disease, chronic respiratory disorders, and gastrointestinal conditions.” These conditions are no joke, so why don’t we take mental health more seriously?

The answer, in part, can be a lack of understanding and sometimes fear.  Both are reflected in the way we routinely belittle mental health, as part of our daily lexicon.  How many times have you heard “I literally had a panic attack”, “She’s so bipolar”, or “He’s a little OCD, ha ha”?  If you’ve never struggled with a mental health issue, you may not give these phrases a second thought.  Those who do struggle, can get the message to battle in silence, given a lack understanding and compassion for their situation.  This is particularly true of the most vulnerable in our midst, teens and tweens, who are often dealing with emerging mental health disorders. 

Two of my adolescent clients with OCD, recently shared frustration about their Health Classes, in separate schools. Both teachers initiated discussions about people who are “a little OCD.”  These conversations lacked any clinical information about Obsessive Compulsive Disorder.  For these clients, OCD meant twice the time to complete homework, up at night cleaning the house, and disturbing, unwanted thoughts of harm coming to their parents.  Their teachers missed a valuable opportunity for kids to learn about the true complexities of a mental health issue.  This type of casual discussion can reinforce the notion that these are not serious concerns, with possible physical ramifications, if left untreated.

Since 1949, May has been known as Mental Health Awareness Month.  Each year, when May is over, I wonder why we’re not encouraged to be aware of our mental health all year, every year, just as we are for our so-called physical health. Given all we know about the effects of anxiety and depression on our bodies and immune systems, this question is vital.  As Harvard Health pointed out in 2008, “Anxiety has now been implicated in several chronic physical illnesses, including heart disease, chronic respiratory disorders, and gastrointestinal conditions.” These conditions are no joke, so why don’t we take mental health more seriously?

The answer, in part, can be a lack of understanding and sometimes fear.  Both are reflected in the way we routinely belittle mental health, as part of our daily lexicon.  How many times have you heard “I literally had a panic attack”, “She’s so bipolar”, or “He’s a little OCD, ha ha”?  If you’ve never struggled with a mental health issue, you may not give these phrases a second thought.  Those who do struggle, can get the message to battle in silence, given a lack understanding and compassion for their situation.  This is particularly true of the most vulnerable in our midst, teens and tweens, who are often dealing with emerging mental health disorders. 

Two of my adolescent clients with OCD, recently shared frustration about their Health Classes, in separate schools. Both teachers initiated discussions about people who are “a little OCD.”  These conversations lacked any clinical information about Obsessive Compulsive Disorder.  For these clients, OCD meant twice the time to complete homework, up at night cleaning the house, and disturbing, unwanted thoughts of harm coming to their parents.  Their teachers missed a valuable opportunity for kids to learn about the true complexities of a mental health issue.  This type of casual discussion can reinforce the notion that these are not serious concerns, with possible physical ramifications, if left untreated.

Just as we seem immune to comments about OCD, we can be equally detached from commonplace phrases like “worry wart”, “wallflower” and “scaredy cat.”  All of which minimize the effects of living with untreated Generalized Anxiety Disorder, Social Anxiety, Panic Disorder and Specific Phobias. When we trivialize these issues, we throw them in the category of personality traits, to the realm of annoying quirks, without the possibility of change, rather than life altering issues, that are highly treatable with the proper help.As mental health professionals, individuals who fight every day to manage symptoms, and those who love and support them, we can work to slowly turn the tide.  By sharing with people, we trust.  By gently, and thoughtfully educating our doctors, teachers, spiritual leaders, family and friends, we can make those around us more sensitive, and aware, all year round, of the importance of how we all talk about mental health, and how critical it is to our health in general, mind, body and spirit.

Older adults, those aged 60 or above, make important contributions to society as family members, volunteers and as active participants in the workforce. While most have good mental health, many older adults are at risk of developing mental disorders, neurological disorders or substance use problems as well as other health conditions such as diabetes, hearing loss, and osteoarthritis. Furthermore, as people age, they are more likely to experience several conditions at the same time.

The problem

The world’s population is ageing rapidly. Between 2015 and 2050, the proportion of the world’s older adults is estimated to almost double from about 12% to 22%. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60. Older people face special physical and mental health challenges which need to be recognized.

Over 20% of adults aged 60 and over suffer from a mental or neurological disorder (excluding headache disorders) and 6.6% of all disability (disability adjusted life years-DALYs) among people over 60 years is attributed to mental and neurological disorders. These disorders in older people account for 17.4% of Years Lived with Disability (YLDs). The most common mental and neurological disorders in this age group are dementia and depression, which affect approximately 5% and 7% of the world’s older population, respectively. Anxiety disorders affect 3.8% of the older population, substance use problems affect almost 1% and around a quarter of deaths from self-harm are among people aged 60 or above. Substance abuse problems among older people are often overlooked or misdiagnosed.

Mental health problems are under-identified by health-care professionals and older people themselves, and the stigma surrounding these conditions makes people reluctant to seek help.

Risk factors for mental health problems among older adults

There may be multiple risk factors for mental health problems at any point in life. Older people may experience life stressors common to all people, but also stressors that are more common in later life, like a significant ongoing loss in capacities and a decline in functional ability. For example, older adults may experience reduced mobility, chronic pain, frailty or other health problems, for which they require some form of long-term care. In addition, older people are more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement. All of these stressors can result in isolation, loneliness or psychological distress in older people, for which they may require long-term care.

Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome.

Older adults are also vulnerable to elder abuse – including physical, verbal, psychological, financial and sexual abuse; abandonment; neglect; and serious losses of dignity and respect. Current evidence suggests that 1 in 6 older people experience elder abuse. Elder abuse can lead not only to physical injuries, but also to serious, sometimes long-lasting psychological consequences, including depression and anxiety.

Dementia and depression among older people as public health issues

Dementia

Dementia is a syndrome, usually of a chronic or progressive nature, in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing.

It is estimated that 50 million people worldwide are living with dementia with nearly 60% living in low- and middle-income countries. The total number of people with dementia is projected to increase to 82 million in 2030 and 152 million in 2050.

There are significant social and economic issues in terms of the direct costs of medical, social and informal care associated with dementia. Moreover, physical, emotional and economic pressures can cause great stress to families and carers. Support is needed from the health, social, financial and legal systems for both people with dementia and their carers.

Depression

Depression can cause great suffering and leads to impaired functioning in daily life. Unipolar depression occurs in 7% of the general older population and it accounts for 5.7% of YLDs among those over 60 years old. Depression is both underdiagnosed and undertreated in primary care settings. Symptoms are often overlooked and untreated because they co-occur with other problems encountered by older adults.

Older people with depressive symptoms have poorer functioning compared to those with chronic medical conditions such as lung disease, hypertension or diabetes. Depression also increases the perception of poor health, the utilization of health care services and costs.

Treatment and care strategies to address mental health needs of older people

It is important to prepare health providers and societies to meet the specific needs of older populations, including:

• training for health professionals in providing care for older people;
• preventing and managing age-associated chronic diseases including mental, neurological and substance use disorders;
• designing sustainable policies on long-term and palliative care; and
• developing age-friendly services and settings.

Health promotion

The mental health of older adults can be improved through promoting Active and Healthy Ageing. Mental health-specific health promotion for older adults involves creating living conditions and environments that support wellbeing and allow people to lead a healthy life. Promoting mental health depends largely on strategies to ensure that older people have the necessary resources to meet their needs, such as:

• providing security and freedom;
• adequate housing through supportive housing policy;
• social support for older people and their caregivers;
• health and social programmes targeted at vulnerable groups such as those who live alone and rural populations or who suffer from a chronic or relapsing mental or physical illness;
• programmes to prevent and deal with elder abuse; and
• community development programmes.

Interventions

Prompt recognition and treatment of mental, neurological and substance use disorders in older adults is essential. Both psychosocial interventions and medicines are recommended.

There is no medication currently available to cure dementia but much can be done to support and improve the lives of people with dementia and their caregivers and families, such as:

• early diagnosis, in order to promote early and optimal management;
• optimizing physical and mental health, functional ability and well-being;
• identifying and treating accompanying physical illness;
• detecting and managing challenging behaviour; and
• providing information and long-term support to carers.

Mental health care in the community

Good general health and social care is important for promoting older people’s health, preventing disease and managing chronic illnesses. Training all health providers in working with issues and disorders related to ageing is therefore important. Effective, community-level primary mental health care for older people is crucial. It is equally important to focus on the long-term care of older adults suffering from mental disorders, as well as to provide caregivers with education, training and support.

An appropriate and supportive legislative environment based on internationally accepted human rights standards is required to ensure the highest quality of services to people with mental illness and their caregivers.

WHO response

WHO supports governments in the goal of strengthening and promoting mental health in older adults and to integrate effective strategies into policies and plans. The Global strategy and action plan on ageing and health was adopted by the World Health Assembly in 2016. One of the objectives of this global strategy is to align the health systems to the needs of older populations, for mental as well as physical health.…