Year: 2021 (page 2 of 2)

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.…

Optometrists provide vision care to individuals, examining their sight, depth perception and ability to focus while also testing for glaucoma and other eye-related conditions. In addition, optometrists can prescribe glasses or contacts and recommend proper eye care.

Demand

Due to a population that is both aging and growing, employment for optometrists is expected to grow a whopping 24 percent between 2008 and 2018, according to the Bureau of Labor Statistics 2010-2011 Occupational Outlook Handbook. Job growth will also occur as more health plans include vision insurance and as more optometrists retire.

Pay

The average optometrist who works in an office makes more than $96,000 as of 2008, and self-employed optometrists averaged about $175,000 in annual income in 2007, according to the American Optometric Association. At first, optometrists who have their own practice make less than salaried optometrists, but eventually they make more.

Hours

Unlike some doctors who work long nights, weekends, and have to be on call every so often, optometrists typically work a fairly standard 8 a.m. to 5 p.m. schedule, Monday through Friday. Likewise, their offices are generally well kept and comfortable, and most optometrists have ample vacation and sick time as well.

Contact us for more information.

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Key facts

• Globally, the population is ageing rapidly. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double, from 12% to 22%.
• Mental health and well-being are as important in older age as at any other time of life.
• Mental and neurological disorders among older adults account for 6.6% of the total disability (DALYs) for this age group.
• Approximately 15% of adults aged 60 and over suffer from a mental disorder.

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.…

Mental illness is a general term for a group of illnesses that may include symptoms that can affect a person’s thinking, perceptions, mood or behaviour. Mental illness can make it difficult for someone to cope with work, relationships and other demands. The relationship between stress and mental illness is complex, but it is known that stress can worsen an episode of mental illness. Most people can manage their mental illness with medication, counselling or both.This page lists some of the more common mental health issues and mental illnesses.

Anxiety disorders

Anxiety disorders is a group of mental health disorders that includes generalised anxiety disorders, social phobias, specific phobias (for example, agoraphobia and claustrophobia), panic disorders, obsessive compulsive disorder (OCD) and post-traumatic stress disorder. Untreated, anxiety disorders can lead to significant impairment on people’s daily lives.

For more information see: Anxiety disorders

Behavioural and emotional disorders in children

Common behaviour disorders in children include oppositional defiant disorder (ODD), conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD). Treatment for these mental health disorders can include therapy, education and medication.

For more information see: Behavioural disorders in children

Bipolar affective disorder

Bipolar affective disorder is a type of mood disorder, previously referred to as ‘manic depression’. A person with bipolar disorder experiences episodes of mania (elation) and depression. The person may or may not experience psychotic symptoms. The exact cause is unknown, but a genetic predisposition has been clearly established. Environmental stressors can also trigger episodes of this mental illness.

For more information see: Bipolar disorder

Depression

Depression is a mood disorder characterised by lowering of mood, loss of interest and enjoyment, and reduced energy. It is not just feeling sad. There are different types and symptoms of depression. There are varying levels of severity and symptoms related to depression. Symptoms of depression can lead to increased risk of suicidal thoughts or behaviours.

For more information see: Depression

Dissociation and dissociative disorders

Dissociation is a mental process where a person disconnects from their thoughts, feelings, memories or sense of identity. Dissociative disorders include dissociative amnesia, dissociative fugue, depersonalisation disorder and dissociative identity disorder.

For more information see: Dissociation and dissociative disorders

Eating disorders

Eating disorders include anorexia, bulimia nervosa and other binge eating disorders. Eating disorders affect females and males and can have serious psychological and physical consequences.

For more information see: Eating disorders

Obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is an anxiety disorder. Obsessions are recurrent thoughts, images or impulses that are intrusive and unwanted. Compulsions are time-consuming and distressing repetitive rituals. Ttreatments include cognitive behaviour therapy (CBT), and medications

For more information see: Obsessive compulsive disorder

Paranoia

Paranoia is the irrational and persistent feeling that people are ‘out to get you’. Paranoia may be a symptom of conditions including paranoid personality disorder, delusional (paranoid) disorder and schizophrenia. Treatment for paranoiainclude medications and psychological support.

For more information see: Paranoia

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop as a response to people who have experienced any traumatic event. This can be a car or other serious accident, physical or sexual assault, war-related events or torture, or natural disasters such as bushfires or floods.

For more information see: Post-traumatic stress disorder

Psychosis

People affected by psychosis can experience delusions, hallucinations and confused thinking.. Psychosis can occur in a number of mental illnesses, including drug-induced psychosis, schizophrenia and mood disorders. Medication and psychological support can relieve, or even eliminate, psychotic symptoms.

For more information see: Psychosis

Schizophrenia

Schizophrenia is a complex psychotic disorder characterised by disruptions to thinking and emotions, and a distorted perception of reality. Symptoms of schizophrenia vary widely but may include hallucinations, delusions, thought disorder, social withdrawal, lack of motivation and impaired thinking and memory. People with schizophrenia have a high risk of suicide. Schizophrenia is not a split personality.

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Being physically active is a major step toward good heart health. It’s one of your most effective tools for strengthening the heart muscle, keeping your weight under control, and warding off the artery damage from high cholesterol, high blood sugar, and high blood pressure that can lead to heart attack or stroke. 

It’s also true that different types of exercise are needed to provide complete fitness. “Aerobic exercise and resistance training are the most important for heart health,” says Johns Hopkins exercise physiologist Kerry J. Stewart, Ed.D. “Although flexibility doesn’t contribute directly to heart health, it’s nevertheless important because it provides a good foundation for performing aerobic and strength exercises more effectively.”

Here’s how different types of exercise benefit you.

Aerobic Exercise

What it does: Aerobic exercise improves circulation, which results in lowered blood pressure and heart rate, Stewart says. In addition, it increases your overall aerobic fitness, as measured by a treadmill test, for example, and it helps your cardiac output (how well your heart pumps). Aerobic exercise also reduces the risk of type 2 diabetes and, if you already live with diabetes, helps you control your blood glucose.

How much: Ideally, at least 30 minutes a day, at least five days a week.

Examples: Brisk walking, running, swimming, cycling, playing tennis and jumping rope. Heart-pumping aerobic exercise is the kind that doctors have in mind when they recommend at least 150 minutes per week of moderate activity.

Resistance Training (Strength Work)

What it does: Resistance training has a more specific effect on body composition, Stewart says. For people who are carrying a lot of body fat (including a big belly, which is a risk factor for heart disease), it can help reduce fat and create leaner muscle mass. Research shows that a combination of aerobic exercise and resistance work may help raise HDL (good) cholesterol and lower LDL (bad) cholesterol.

How much: At least two nonconsecutive days per week of resistance training is a good rule of thumb, according to the American College of Sports Medicine.

Examples: Working out with free weights (such as hand weights, dumbbells or barbells), on weight machines, with resistance bands or through body-resistance exercises, such as push-ups, squats and chin-ups.

Stretching, Flexibility, and Balance

What they do: Flexibility workouts, such as stretching, don’t directly contribute to heart health. What they do is benefit musculoskeletal health, which enables you to stay flexible and free from joint pain, cramping and other muscular issues. That flexibility is a critical part of being able to maintain aerobic exercise and resistance training, says Stewart.

“If you have a good musculoskeletal foundation, that enables you to do the exercises that help your heart,” he says. As a bonus, flexibility and balance exercises help maintain stability and prevent falls, which can cause injuries that limit other kinds of exercise.

How much: Every day and before and after other exercise.

Examples: Your doctor can recommend basic stretches you can do at home, or you can find DVDs or YouTube videos to follow (though check with your doctor if you’re concerned about the intensity of the exercise). Tai chi and yoga also improve these skills, and classes are available in many communities.

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It’s inevitable that as people age, they also become more isolated. A 2016 Merck Manual study found that about 30% of 46 million seniors not living in a nursing home live alone. The consequences of isolation on senior mental health can be tragic, ranging from extreme loneliness to a further decline of health. It’s crucial then, for seniors to seek out companionship.

However, the answer is not necessarily to move to a senior facility. In spite of the prospect of crippling loneliness, many seniors strongly hold on to their independence.  The Merck study also found that about 90% of those seniors who live alone insist on doing so.

How can we then help these fiercely independent but also isolated seniors? There are several possible solutions.

Why are Seniors Alone?

There are many reasons that lead seniors to spend their days alone. Adult children may move away or are simply too busy with their own families to visit often. Even seniors with family caregivers may feel alone if their family caregiver works during the day.

There is also the sad fact that friends and spouses may have passed away. Deteriorating health is another factor, as it can mean losing the ability to drive or go for walks. Embarrassment is another consideration, as seniors with poorly functioning facilities (such as bladder control) may worry about experiencing an incident in public.

Consequences of Isolation

Loneliness is obviously the biggest result of isolation, but this can, in turn, lead to health problems such as high blood pressure, or a risk of depression.

There is also a decline in health and an increased rate of mortality for seniors who live alone. This may be due to unchecked symptoms and a lack of a social network that would advise medical attention. Seniors who live alone may also neglect or forget to take their medication, or have trouble with certain medical treatments.

Social skills also deteriorate among seniors who are frequently alone. Many of us have heard of the “grumpy old man” stereotype. They have trouble interacting with people when given the opportunity, which in turn leads others to back away, causing more loneliness.

In-Home Caregivers as Companions

As mentioned earlier, many seniors value their independence so much that they’re willing to endure isolation. Therefore, relocating them to a nursing facility is not the solution. As long as he or she is able to safely live alone (i.e. no chance of falling or passing out), seniors should ideally live at home where they feel comfortable and secure.

A suitable compromise then would be to hire an in-home caregiver who can provide companionship (and if necessary, some medical assistance) to the senior. This will allow the senior to maintain his or her independence while not feeling lonely and isolated.

In-home caregivers provide physical and mental benefits for seniors. They can help seniors with physical therapy, exercises, or simply taking walks with them. In-home caregivers can even take them on small field trips such to the movies, lunch, or to the mall. They can play mind-stimulating games with seniors such as chess or cards, or assist them with their hobbies.

In-home caregivers can also monitor medication, doctor’s appointments, and the senior’s overall well-being. They can even cook for them, do light housework, and assist in personal care. And of course, in-home caregivers are simply someone to talk to.

Even if your senior has a family caregiver, an in-home caregiver can be a helpful asset. Interacting with a different person is mentally stimulating and can alleviate boredom, for both the senior and family caregiver. An in-home caregiver is also beneficial for the primary caregiver because it allows him or her to take a break and do other things, like work full time, engage in personal outings, or tend to their families.

Additional Remedies for Isolation

There are other ways for seniors to combat isolation. Be sure to take into consideration their physical or mental health, as some of these suggestions may not be ideal for someone with say, dementia or debilitating arthritis.

Volunteer

If the senior is still relatively able-bodied, he or she can take on a volunteer role. Even if it’s only once a week, volunteering for a certain cause gets him or her out of the house and interacting with others.

Adopt a Pet

Animals don’t talk, but they certainly provide companionship and unconditional love. Caring for a pet would also give a senior a sense of purpose and stimulate their minds. Just make sure not to get a pet that would be difficult to care for, such as a large dog.

Schedule Regular Meetings with Friends

It’s crucial for seniors who live alone to maintain contact with nearby friends. Encourage them to meet up for coffee or lunch at least once a week, or even visit each other’s homes.

Meet Other People who Share Your Hobby

Coloring, painting, knitting, playing board games, assembling puzzles—there are countless hobbies that seniors can enjoy with others. Local community centers may have clubs that cater to your senior’s hobby.

Use Video Telephony to Keep in Touch

Your senior can communicate with faraway loved ones via Skype, FaceTime, or some other form of video telephony. Seeing their loved ones on a screen can be more satisfying than simply speaking on the phone with them, and can help alleviate some loneliness. You may first need to teach your elderly loved one how to use the technology, so don’t use an overly complicated program. It may lead to frustration and reluctance to use it.

If you have a special senior in your life that needs companionship, we at Community Home Health Care can help. Our staff of highly trained in-home caregivers includes home health aides, personal care aides, and registered nurses. We are here to provide personal and medical assistance, but most importantly—friendship. Please visit our website, call us at (845) 425-6555, or drop by our facility and we will be happy to answer any of your questions.

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