The Challenge of Mental Illness in the Elderly

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Vol. 10, No. 5
Corporate Office
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mation and ideas for those
serving seniors.
The Challenge of Mental Illness in the Elderly
Mental illness presents stresses
individual and to his or her family
manager, from grief counseling or
and challenges at any age or stage of
members. While symptoms of
from a support group. Life-
life, but seniors who must deal with
depression may be – unfortunately –
threatening depression in the elderly
issues of aging in addition to a long
very subtle, the delusional and
which does not respond to
standing or newly diagnosed mental
paranoid behaviors are very
medication is sometimes effectively
illness often face overwhelming
distressing to families who
treated with electroshock therapy.
issues. In addition, most elderly
previously enjoyed positive
This is a last resort and must be
people who have long term mental
relationships with the senior. The
approved by the patient’s legal next
illness never sought medical attention
senior may accuse his children of
of kin or guardian.
and treatment for their conditions due
trying to take his money, his wife of
Bipolar disorder, formerly called
to societal attitudes towards mental
having an affair, the government of
Manic Depression, can also be
illness years ago. And those with
beaming messages to him via the TV,
treated with medication. Individuals
acquired mental illness remain
and other such misperceptions. The
who tend to be more depressed than
reluctant to seek psychiatric care,
result of the senior’s delusions is
manic respond well to anti-
again due to old stigmas about
usually increased isolation from those
depressants. Individuals who
mental illness.
trying to provide care and assistance.
experience primarily manic episodes
may benefit by treatment with some
of the newer anti-psychotic
medications. Management of life
Seniors with long standing mental
Effective treatment is available for
style issues can be of help in
illnesses including depression,
mental illness of seniors. The first
reducing the impact of manic
paranoid delusions, bipolar disorder
step to obtaining quality mental
episodes as well.
(manic depression) and other such
health care is to have a thorough
Seniors with long-standing
problems often became estranged
history and physical exam by a
paranoid delusions tend to respond
from their family and friends due to
qualified internal medicine physician
less well to anti- psychotic
objectionable and/or accusatory
or geriatrician. The purpose of this
medication than do those with recent
behaviors, resistance to obtaining
exam is to identify any physical
onset of paranoia or delusions,
medical care, or inability to sustain
problems which need treatment or
although medications may be
reciprocal relationships. Sometimes
which may be causing symptoms of
somewhat effective in moderating
these individuals became quite
mental illness. Help in arranging for
symptoms. The goal of treatment for
isolated from society, functioning
treatment of any physical problems
patients with long-standing paranoid
enough to obtain food, pay taxes and
may be needed if the senior is unable
or delusional thoughts is to minimize
otherwise survive without coming to
or unwilling to make necessary
emotional discomfort and to
the attention of civil authorities.
maximize functional status. This is
As these people age, however,
Next, the senior should be
accomplished by providing a
additional mental and physical health
evaluated by a psychiatrist who
structured environment which limits
issues often arise, such as dementia,
specializes in the diagnosis and
the delusional ideas as much as
heart disease, arthritis and other such
treatment of seniors. Because of age-
possible, avoiding either reinforcing
conditions which further impaired
related psychosocial stressors as well
the delusions or denying them in a
their ability to maintain
as the different physiological
way which forces the person to
independence. Some triggering event
responses to medication and
defend his position, and providing
usually brings these individuals to the
therapeutic techniques which occur
appropriate psychosocial supports.
attention of health professionals or
due to age, the interest and skill of
Paranoid ideation, delusions and
other responsible individuals, and the
the psychiatrist is of paramount
hallucinations which occur as a result
need to intervene becomes apparent.
importance. Because seniors often
of dementia or cerebral vascular
resist seeing a psychiatrist, referring
changes are frequently treated
to the doctor as a geriatric specialist
successfully with the newer
may help overcome objections to the
It is not unusual for people to
generation anti-psychotic medication.
visit. For individuals who refuse to
acquire certain mental illnesses after
These medicines do not cause the
leave their homes, arranging a home
age 65. Depression, for example, is
severe side effects associated with
evaluation is sometimes necessary.
quite common in older persons due
earlier drugs, and are often very
Treatment for depression involves
in part to the inevitable losses which
helpful in decreasing or eliminating
medication and sometimes psycho-
occur with aging. Also, changes in
undesirable ideas and behaviors, such
therapy. There are several newer
brain chemistry can cause profound
as resistance to care, thoughts of
medications which have minimal side
depression in older adults. Several
persecution, visual or auditory
effects and which are usually quite
physical problems, including
misperceptions and aggression.
effective in improving mood and
transient ischemic attacks (TIAs),
However, it is essential that dosage
decreasing symptoms of sadness,
strokes, Alzheimer’s Disease and
regulation occur under the immediate
with- drawl, poor appetite, and
related dementias often cause
supervision of a knowledgeable
impaired sleep. Some seniors are
paranoid thoughts, delusions,
health care provider working with a
amenable to individual
hallucinations and aggressive actions.
skilled geriatric psychiatrist.
psychotherapy with a trained
These acquired mental illnesses
provider. Others can benefit from
are often very frightening to the
informal counseling with a case