Psychological Factors in Ageing

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Original Editor - Bhanu Ramaswamy as part of the AGILE Project.

Top Contributors - Admin, Lucinda hampton, Kim Jackson, Mande Jooste, Amanda Ager, Lauren Lopez, Evan Thomas and Amrita Patro

Introduction

The increase in the number of older people worldwide, alongside an increase in life expectancy, has led to a deeper look into the psychological factors in ageing. While the majority of attention in the life extension and successful aging field has concentrated on physical factors, for example exercise, diet, sleep, genetics, we need to increase our knowledge on the interaction between psychology, physical activity and health. In particular on the benefits of physical activity practice on psychological health in the aged.

There is a growing body of evidence suggesting that successful ageing is multidimensional, incorporating a level of physical, social, and psychological well-being. The field of geropsychology is becoming increasingly important as populations age. Currently many seniors with mental health issues may not be receiving the right treatment.

On the whole, exercise increases general well-being, renewing mental energy and drive, which is where the expertise of physiotherapist is most beneficial. 

Mental Health and Psychological Changes

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.

Psychosocial problems include:

1. Poor adjustment to role changes.
2. Poor adjustment to lifestyle changes.
3. Family relationship problems.
4. Grief.
5. Low self-esteem.
6. Anxiety and depression.
7. Aggressive behavior.

Risk Factors

Older people may experience the same life stressors common to all people, however they have additional stress in the form of eg a significant ongoing loss in capacities and a decline in functional ability. Older adults may experience reduced mobility, chronic pain, frailty or other health problems, all requiring 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. Sadly these stressors can result in isolation, loneliness or psychological distress in older people.

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.

Elder Abuse

Older adults are also at risk of elder abuse, in its many form eg

• Physical, verbal, psychological, financial or sexual abuse
• Abandonment;
• Neglect
• Serious losses of dignity and respect.

Current evidence suggests that 1 in 6 older people experience elder abuse. Elder abuse can lead to physical injuries, or serious, sometimes long-lasting psychological consequences, including depression and anxiety.

Dementia and Depression

1. Depression: may cause great distress and leads to impaired functioning in daily life. Depression is underdiagnosed and undertreated in primary care settings. Symptoms are often missed and untreated because they co-occur with other problems meet by older adults. Older people with depressive symptoms have function worse in comparison 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.
2. Dementia is an umbrella term used for signs and symptoms characterised by a generalised and irredeemable impairment of intellect, memory and personality. The decline is permanent and progressive. It mainly affects the elderly, although it is not a normal part of ageing. It is estimated that 50 million people globally live 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.

Bereavement

As people get older there is an increased likelihood of them experiencing bereavement. Most come through the experience without the need for professional help, but for some there are longer lasting detrimental effects on physical and mental health. This may leave someone in a pattern of grief and mourning, experience some or all of the following:

1. An initial experience of numbness (sense of isolation, withdrawal, loss of appetite) and denial (constant reminiscing, expects the return).
2. In the first 3 months it could be anxiety (sense of insecurity, often irrational fears), anger (‘why me’), pain, guilt (self-recrimination)
3. From 3 months onwards, depression is more likely, exacerbating existing personality problems, apathy (neglects own best interests, lack of will) and possible a loss of identity
4. For the first year or more we should expect acceptance (can settle into new circumstances, loss no longer felt as an appalling tragedy) and healing when equilibrium is regained. The depression may continue in older people, and if severe is a suicide risk that needs recognition and treatment. Liaison with clinical psychologist, community psychiatric nurse, GP or other mental health professionals is appropriate.

Disability

Consider the psychological factor of adjustment to physiological change that has left a disability, for example:

1. A stroke. It may mean lifestyle changes such as having a bed downstairs, leading to loss of privacy, or having to give up driving, leading to isolation.
2. A major disability may also alter the person's position or status within the family, for example, a change from being a carer to being cared for may lead to low esteem.

Healthcare professionals may sometimes overlook the acceptance of these changes as the priority is normally to deal with the physical disability. If the physiotherapist has knowledge of the possible psychological consequences they can refer on to colleagues and ensure a holistic approach to person-centred care is maintained.

Discussion

For most of us who are in a general setting, dealing with complex emotions in rehabilitation is vital, as many factors will affect involvement and participation with treatment. The range of patients you will see encompasses people with anxieties born of their pathologies of a non-organic nature; e.g. someone with osteoporosis with a great fear of moving in case they fall and fracture a bone.
How would your response differ to a patient who has anxiety centred on falling, compared to a person with dementia and anxiety about walking outside?

Good Practice

Many treatments for those with mental health problems are no different from those used to solve physical problems with client groups elsewhere; however, the approach taken may need to reflect the person’s individual health needs. Overall, patience and empathy are a must (with good listening/counselling skills with both client and carers), as are re-orientation to the individual’s environment, and an understanding of their behaviour. Good practice point for people with mental health problems.

Further reading

The Social Care Institute for Excellence site (SCIE) is still running a page about ageing, discrimination and mental health in older people. Access this and information sheets at: http://www.scie.org.uk/publications/elearning/mentalhealth/mh08/index.asp

Mind publishes information on many topics relating to mental health. They are grouped into seven broad categories: diagnoses and conditions, treatments, mental health statistics, support and social care, communities and social groups, and society and environment. http://www.mind.org.uk/help/information_and_advice

You can also read the Northern Ireland Association for Mental Health's response to The Commission of the European Communities Green Paper “Improving the mental health of the population. Towards a strategy on mental health for the European Union” (April 2006) http://ec.europa.eu/health/ph_determinants/life_style/mental/green_paper/mental_gp_co062.pdf

Resources

Also see - Medication and Older People