Health is a state of complete physical, mental and social well-being,
and not merely the absence of disease or infirmity.
~World Health Organization, 1948
In the United States more than 33 million people are older than 65 years, and they comprise 13 percent of the whole US population. The quantity of elderly women correlates with the quantity of men as three to two. When getting older people come across numerous physiological, psychological, social and cultural changes. They become more exposed to illness and traumas, and often experience stress as a result of personal loss (spouse, friends, grown-up children, necessity to give up various activities and former roles). Many individuals after retirement loss the sense of goals in life. Even beloved pets and things have to be left behind. (Gallagher-Thompson & Thompson, 1995).
The stress that the elderly people undergo does not always cause psychological problems. In truth some adults who are older than 65 years use such life situations to learn more about themselves and grow spiritually, intellectually and professionally. However, others under such stress become more vulnerable to psychological disorders. Researches show that 50 percent of the elderly population requires psychological help (MacDonald & Schnur, 1987), and less than 20 percent actually receive it. Nowadays less than 4 percent of all clinical medical workers are concentrated on helping elderly patients.
Presence of good mental health throughout the life does not provide an immune for psychical disorders at an elderly age. Elderly people suffer from mental illnesses much more often than middle aged individuals. According to the statistics of the World Health Organization among the elderly 236 individuals from 100 thousand people suffer from psychical illnesses, whereas in the age group from 45 to 64 years this indicator is represented by only 93 individuals. However, one should not think that aging is necessarily connected with health problems of various types. Many diseases occurring at the old age can be cured. It is important to be attentive to the elderly relatives and timely consult with a medical specialist.
Meanwhile, elderly people appeal to psychiatrists and psycho-therapeutist for medical aid twice less frequently than the whole population in general. Individuals older than 60 often do not notice their psychical disorders and consider them as inevitable results of aging. Unfortunately, this completely erroneous attitude also occurs among the relatives as they often believe that nothing can be changed. (Segal, D. L., Smyer, M. A., 2009)
One of the peculiar features of psychopathological disorders among the elderly population is the somatization, which is "a tendency to experience and communicate somatic distress in response to psychosocial stress and to seek medical help for it". (Lipowski, Z. J., 1988) Patients usually appeal for medial assistance to general practitioners, who are not always capable of diagnosing a mental disorder, especially when it comes to depressive disorders, light memory and thinking disorders.
It is important to notice behavioral changes and mood swings among elderly individuals. These changes can be symptoms of depression, dementia, psychogenic and neurotic disorders. Many somatic diseases at the last stages of life are accompanied with psychical disorders, and this is the time when assistance of a professional psychiatrist is most highly required. With proper treatment patient’s health conditions are most likely to improve bringing joy of a full life to the former patients.
Elderly patients often suffer from various manifestations of the neurosis syndrome, the foundation of which lies in the cerebral atherosclerosis. Patients complain about the feeling of heaviness in the head, noise and ringing in the ears, dizziness, vacillation when walking or getting out of bed, increasing and rapid fatigability even under light physical pressure. In addition, resting during the day becomes a critical necessity. The patients become irritable, impatient, unreceptive towards noise, sensitive; they suffer from memory loss and sleep disturbance. Aid in such cases is provided in the outpatient setting. (MacDonald, M. L, & Schnur, R. E., 1987)
One of the most widely spread psychical disorders among the elderly individuals is depression. The patient is in low spirits, constantly experiencing the feeling of melancholy or anxiety, often feeling unwanted, hopeless, helpless, and groundlessly guilty without interest towards any activities, family, friends or work. Decreased mental efficiency, which grounds upon the incapability of concentrating, memory loss and general disorganization of psychological processes, can also be symptoms of depression. Depression can also have somatic manifestations – loss or excessive appetite, insomnia or sleepiness, constant tiredness, constipation, sensation of pain, which cannot be explained by any somatic diseases. If any of the mentioned above symptoms last longer than two weeks, it becomes vitally important to consult a specialist. (Segal, D. L., Smyer, M. A., 2009) According to the statistics elderly men are exposed to suicide more than any other age group. The suicide rate among men of over 85 years of age is 45.23 per 100,000, in comparison to the general rate of 11.01 per 100,000 for all ages (Web-based Injury Statistics and Query Reporting System, 2010) Widowhood, incurable and chronic physical diseases, low level of education (less than high school), inferior social status, and heavy alcohol addiction are among the main reasons of depression among the elderly. (U.S. Department of Health and Human Services, 1999) Contemporary psychiatry possesses a wide range of methods and medications capable of treating depression. Suitable treatment conducted in time will most probably bring back human’s health.
Dementia is a state of serious emotional and mental deterioration. Dementia is a noticeable decline of the intellectual and mnestic level closely connected with various diseases of the human brain. Under these conditions specialist observe memory loss causing disorientation, confusion, incapability of carrying out the easiest intellectual operations. Such patients do not remember where they live, and can easily be lost on a street. In the most severe cases patients are unable to serve themselves – patients cannot wash and dress, they lose skills of food intake and personal hygiene. (Gallagher-Thompson, D., Thompson, L. W., 1995)
The main reason of dementia among the elderly population are vascular diseases (hypertensia, cerebral atherosclerosis, heart problems etc.) and atrophic brain diseases, usually it is the Alzheimer’s disease. Up till now scientists have not discovered any effective treatment of dementia; however, in the majority of cases doctors are capable of essentially decelerating this process. Such patients strongly require proper care and attention of their beloved ones. (Segal, D. L., Smyer, M. A., 2009)
Pseudodementia is a reversible psychical disorder, which has the appearance of dementia. If the symptoms of dementia are connected with some other factors, their elimination will improve the patient’s conditions and eventually cause full recovery. For example, patients suffering from depression can sometimes resemble patients with dementia. Absorbed by personal worries and concerns, they seem to be aloof and indifferent, incapable of focusing their attention, they easily get lost in conversations. However, depression can be cured, and the symptoms of dementia will disappear together with it. (Gallagher-Thompson, D., Thompson, L. W., 1995)
Another reason of pseudodementia can be medication overdose. Elderly people usually suffer from more than one somatic disease and are forced to take many drugs. Since the metabolism at that age is rather slow, drugs can remain in the human body for a longer period of time and reach the toxic level causing mood swings, anxiety, appearance of mental disorders and various symptoms of dementia. Therefore, drug withdrawal can cause improvement of the health conditions. Moreover, every year from 3 to 5 percent of the elderly population are diagnosed with problems caused by excessive drinking.
Symptoms of dementia can also appear as a result of improper nutrition (pernicious anemia develops due to the lack of vitamin B), teeth problems (after excluding some types of food as it becomes hard for the elderly to chew), diseases of the gastrointestinal tract (difficulties in digestion and absorption). Heart and lung diseases can cause brain hypoxia and can influence behavior of the patient. Renal insufficiency and hepatic failure causing accumulation of various toxic substances can also imitate symptoms of dementia. Diseases of the endocrine system (thyroid gland, hypophysis, adrenal gland) can also provoke disorders of pseudodementia. (Segal, D. L., Smyer, M. A., 2009)
With the increased attention of the researchers and practitioners towards the problems of the elderly people clinical specialists show growing concern regarding three major issues: ethnical and racial discrimination, insignificant organizational resources for long-tern care and health support for the younger generation.
Gallagher-Thompson, D., Thompson, L. W. (1995). Problems of aging. In R. J. Comer, Abnormal psychology. New York: W. H. Freeman.
Lipowski, Z. J. (1988). Somatization: the concept and its clinical application. Am J Psychiatry 145 (11): 1358–68.
MacDonald, M. L, & Schnur, R. E. (1987). Anxieties and American elders: Proposals for assessment and treatment. In L. Michelson & L. M. Ascher (Eds.), Anxiety and stress disorders: Cognitive behavioral assessment and treatment. New York: Guilford.
Segal, D. L., Smyer, M. A. (2009). Aging and Mental Health. John Wiley and Sons. Retrieve November 22, 2010 from http://books.google.com/books?id=NPmzwlUPZfwC&printsec=frontcover&dq=mental+health+aging&hl=en&ei=453qTKCMEoiX4gall_34Ag&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCcQ6AEwAA#v=onepage&q&f=false
The State of Mental Health and Aging in America. Centers of Disease Control and Prevention. Retrieve November 22, 2010 from http://www.cdc.gov/aging/pdf/mental_health.pdf
U.S. Department of Health and Human Services (1999). Older Adults and Mental Health. In: Mental Health: A Report of the Surgeon General. Retrieve November 22, 2010 from http://www.surgeongeneral.gov/library/mentalhealth/chapter5/sec1.html
Web-based Injury Statistics and Query Reporting System (WISQARS). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieve November 22, 2010 from http://www.cdc.gov/ncipc/wisqars/