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, Evan Thomas, Amrita Patro, Amanda Ager and Lauren Lopez

Introduction

The increase in the number of older people worldwide, alongside an increase in life expectancy, has led to a more attention to the psychological factors of ageing. While the majority of attention in the life extension and successful ageing field has concentrated on physical factors, eg. 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.

Remember that prompt recognition and treatment of mental health issues in older adults is essential. Both psychosocial interventions and medicines are recommended.

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. Acute grief normally evolves over time into integrated grief. Sometimes grief may be prolonged, severe and impairing. This form of grief can linked with higher rates of depression and suicidal thoughts.

• Unfortunately, older people may be reluctant to discuss their mental health and grief with their family, GP or other care staff. Grief in older people may, consequently, go undetected and untreated.
• Older people who have experienced the death of a partner are up to four times more likely to experience depression than older people who have not lost there partner.

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.

Physiotherapy

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. 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.

Being active is good for mental health. Exercise releases chemicals in the brain increasing a sense of well being eg boosting self-esteem, helping with concentration, improving sleep. This is an area a physiotherapist can have a role, our expertise being most beneficial. Simply educating people of the mental health benefits is a starting point.

See 

1. Physical Activity and Older People
2. Mental Health, Physical Activity and Physical Therapy

Further ReadingThe 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