Mental health impacts overall health in older adults

Mental health issues affect overall health, especially in older adults. Experiencing mental health conditions is not a normal part of aging despite many people often believing that feelings of depression or anxiety come with age. If an older adult deals with mental health concerns that affect their day-to-day abilities, those symptoms warrant a better understanding.

“The decline is physical and mental health in older adults can reciprocally worsen social stressors, including social isolation, increasing health expenditures leading to further stress, and difficulty in accessing care, which can lead to further decline in health,” said Dr. Ali Abbas Asghar-Ali, associate professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine and staff psychiatrist at the Michael E. DeBakey VA Medical Center. “While they seem distinct, physical and mental health are extremely interrelated and affect one another.”

Overall effects

Mental health issues have a significant impact on older adults’ quality of life and level of functioning.

• Reduced independence: Lack of independence stemming from mental health issues makes it difficult to perform daily tasks, such as filling a prescription or attending doctor’s appointments, which can reduce one’s autonomy.
• Increased disability: Older adults with mental health conditions generally have more physical disability, meaning they are more likely to need assistive devices.
• Cognitive decline: While the chemical effects of mental health and cognitive decline are still unknown, untreated mental health issues can contribute to overall cognitive decline.
• Substance use: Older adults might start using substances such as drugs, alcohol or other medications.
• Suicide: The risk of suicide increases among older adults.
• Slower healing: Mental illness slows healing from physical illness.
• Physical conditions: Diabetes and heart conditions are more likely to occur in people with depressive illness or anxiety disorders.

“Many of the illnesses listed in psychiatric textbooks either present differently or may affect older adults differently. Depressive symptoms that don’t meet the definition of major depressive disorder can nonetheless impact older adults more than a younger person,” he said.

Symptoms

Mental health symptoms can include physical symptoms, including:

• Loss of appetite
• Fatigue
• Muscle pain
• Changes in sleep

Some conditions along with aging-related changes can lead to similar physical changes, so it is important to consider the emotional state of a person before assuming they are experiencing mental health issues. If a loved one is getting depressed, feeling hopeless or helpless or feeling on edge, they could be dealing with a mental health condition.

“If we only rely on the physical symptoms, we may not be able to ascertain if it’s related to a medical condition, medicine or the emotional state,” Asghar-Ali said.

Other symptoms include outward expressions of distress, such as crying more frequently, being more irritable, not participating in activities they used to find enjoyable and thoughts of suicide. While they may not share these thoughts with others, behaviors might reflect wanting to die or end one’s life, such as saying goodbyes, giving away prized possessions suddenly or talking about or imagining themselves dying. Suicidal thoughts are not normal in aging, and older adults are at a greater risk of death by suicide. If you or a loved one experiences this, call or text 988, a crisis line open 24 hours. If there is imminent concern, call 911 or 988 and for immediate local help. If there are firearms in the home, store them securely, unloaded and locked in a safe.

Treatment

A host of treatments exist for older adults experiencing mental health issues, and the type of treatment depends on the condition. The options usually include psychotherapy, talking to a trained therapist or counselor, taking medication and neuromodulation, such as electroconvulsive therapy and transcranial magnetic stimulation. Older adults generally opt for psychotherapy over medication.

“Some treatments have not been tested on older adults as robustly, or at all, so sometimes we rely on what is known for treatment of those who are not over the age of 65,” he said. “Nonetheless from what we know from years of practice and study is that these medications, therapies and neuromodulation interventions can work well for younger people and older adults. There is no reason for older adults to not seek treatment.”

The 4 Ms approach

Asghar-Ali recommends the concept of the 4 Ms in older adult care for mental or nonmental health conditions: “When a person is having an interaction with a clinician, we want the clinician to be thinking of at least these four elements when developing a treatment plan with the older adult.”

Medication: Are the medications necessary and helpful? Are the side effects of the medications causing more problems or worsening the person’s life in some way?

Mobility: How can one’s mobility affect the other aspects of their life?

Mentation: Includes all aspects of mental health, including depression, anxiety and cognitive disorders

What matters most: The individual should have a conversation with their clinician about their values, as those values drive the discussion about treatment and how specific aspects of medication, mobility and mentation might be addressed. If someone’s value is to be connected to family and it requires having their grandchildren over after school once a week, tell the clinician that you cannot make a recurring medical appointment that coincides with that day of the week so they work around your schedule.

As adults age, mental health issues can exacerbate overall health issues. If you or a loved one experiences mental health concerns, speak with a primary care physician and seek mental healthcare. Regardless of age, seeking help is crucial.

By Homa Warren