pa behavioral health & aging coalition | rebecca may-cole, executive director pa behavioral...

PA Behavioral Health & Aging Coalition | www.OlderPA.org

REBECCA MAY-COLE, EXECUTIVE DIRECTORPA BEHAVIORAL HEALTH & AGING

COALITIONWWW.OLDERPA.ORG

Recognizing Mental Health Concerns in Older Adults


PBHAC

Formed in 1999 as a statewide coalition of individuals and organizations concerned about the mental health and substance use needs of older adults across the Commonwealth

Primary Role: Advocate for changes that will improve services for older adults with mental health or substance use disorders


PBHAC

What we do: Outreach/education Medicare counseling specific to behavioral health

prescription medications Serve on statewide advisory committees Advocate at state and national level on issues that will

help improve behavioral health services for older adults


PBHAC

Contact information: www.OlderPA.org [email protected] 717-541-4219

Do you receive our emails? Go to www.OlderPA.org and click on “Join Now!” You will receive our monthly newsletter and

notification about upcoming training opportunities.

http://www.olderpa.org/

mailto:[email protected]

http://www.olderpa.org/


Aging and Life Cycle

1970 – Life expectancy was 70.8 years2000 – Life expectancy was 76.9 years2008 – Life expectancy was 78.0 years2020 – Life expectancy expected to be 79.5

yearsRate of disability from physical decline has

dramatically decreased over past 20 years

National Institutes on Aging


Normal Aging

Physical ChangesPsychological ChangesSocial ChangesAs changes begin to happen in one area of a

person’s life, most likely the other two will be affected as well.

LeadingAge Wisconsin http://wahsa.org/agingprocess.pdf

http://wahsa.org/agingprocess.pdf


Normal Aging: Physical Changes

Decrease in physical strength, endurance and flexibility

Decline in efficiency of body organsLoss of bone massSlower reflexesTaking longer to return to equilibriumDecline in the senses


Normal Aging vs. Illness

Normal age related changes exacerbated by the presence of chronic disease

80% of older adults have at least one chronic health condition

50% have at least 2 chronic diseasesChronic illness can contribute to a loss of

control and can cause depression and/or social isolation


Normal Aging: Psychological Changes

Intelligence gained throughout the years remains intact, and can even improve!

Learning may not be as easy as in early years and may take longer

Remembering may take longer Be patient

It may become difficult to process information from many sources at one time One on one communication is helpful


Psychological Changes

Mild Cognitive Impairment Problems with memory, language or another mental

function sever enough to be noticeable to other people but not serious enough to interfere with daily life

Individuals with MCI have an increased risk of Alzheimer’s, but not everyone with MCI will develop Alzheimer’s

Alzheimer’s Association (2009 www.alz.org)


Someone with DementiaSomeone with normal age-related changes

Forgets whole experiences

Rarely remembers later

Is gradually unable to follow written/spoken directions

Is gradually unable to use notes

Is gradually unable to care for self

Forgets part of an experience

Often remembers later

Is Usually able to follow written/spoken directions

Is usually able to use notes

Is usually able to care for self

What’s the Difference?

Alzheimer’s Association, Delaware Valley Chapter (2008)


Social Changes

Loss, grief, bereavementRetirementChange in living arrangements


Emotional Needs Later in Life

Two most important emotional needs of older adults: Sense of control Being involved in decisions

Elders who feel no sense of control Tend to be more discouraged and less satisfied Have higher rates of depression Have lower functioning levels

Even the most frail elderly are healthier and happier when they feel they have some control over their own environment and some responsibility for their own lives


Mental Health Concerns in Older Adults

Older adults often do not seek help with mental health problems because They believe it is a normal part of aging (It is not!) Stigma Difficulty accessing mental health care Don’t know where to turn


Depression Affects as many as 15 - 30% of older adults Often underdiagnosed Frequently occurs with anxiety

Half of older adults with major depression have anxiety diagnoses

25% of those with anxiety suffer from major depression Treatment for depression works!


Recognizing the Mental Health Needs of Older Adults

Depression symptoms Depressed mood Loss of interest or pleasure Appetite disturbances Changes in sleep patterns Fatigue or loss of energy Decreased concentration Thoughts of death or suicide Impaired level of functioning Feelings of worthlessness or guilt



Late onset depression Begins after age 60 Greater apathy (lack of enthusiasm or energy; lack of

interest in anything or absence of desire to do anything)

Cognitive deficits are more pronounced Less lifetime personality dysfunction Can be a precursor to dementia



Anxiety Affects as many as 10 – 20% of older adults Often underdiagnosed Most common behavioral health problem for women,

second most common for men after substance abuse Frequently occurs with depression



Anxiety – Causes Stress or trauma Complicated grief Caffeine Medications Medical or psychiatric illness Family history of anxiety disorders Neurodegenerative disorder



Anxiety symptoms Cognitive – nervousness, worry, apprehension,

fearfulness, irritability Behavioral – hyperkinesis (excessive activity),

pressured speech, exaggerated startle response Physical – muscle tension, chest tightness,

palpitations, hyperventilation, parasthesis (tingling, tickling, burning sensations), sweating, urinary frequency



Treatment options Medications Psychotherapy (counseling) Peer supportCombination of medications and psychotherapy is the most effective treatment

How to access treatment Contact primary care provider Contact county Mental Health Office Contact county Area Agency on Aging


Substance Abuse and Older Adults

Prevalence Majority of problems related to

Misuse of prescription medications Alcohol in combination with prescriptions/over the

counter medications Alcohol only

Alcoholism is four times more common among men age 65 and older

Greatest risk factor for abuse of prescription medication is being female


Signs of Substance Misuse/Disorder in Older Adults

Warning signs: Excessive worrying about whether prescription drugs

are still “working” (evidence of tolerance) Worrying about having enough pills or other activities

revolve around the dosage schedule Continuing to use and to request refills when the

condition for which the drug was originally prescribed has or should have improved

Complaining about doctors who refuse to write prescriptions for preferred drugs, who taper dosages, or who don’t take symptoms seriously



Warning signs (cont.): Self-medicating by increasing doses of prescribed drugs

that aren’t “helping anymore” or supplementing prescribed drugs with similar over the counter medications

Withdrawing from family, friends and neighbors Withdrawing from normal and life-long social practices Eating only at restaurants that serve alcoholic beverages

(and wanting to know whether they do in advance) Involvement in minor traffic accidence (police do not

typically suspect older adults of alcohol abuse and may not subject them to breathalyzer and other sobriety tests)

Sleeping during the day



Warning signs (cont.): Bruises, burns, fractures or other trauma, especially if

the individual does not remember how and when they were acquired

Drinking before going to a social event to “get started”; gulping drinks, guarding the supply of alcoholic beverages, insisting on mixing own drinks

Changes in personal grooming and hygiene Empty liquor, wine or beer bottles or cans in garbage

or concealed under the bed, in the closet or other locations


Suicide and Older Adults

Second highest risk for suicideReluctant to seek helpPeople “expect” older adults to be depressedHigher attempt to completion ratio

If you suspect someone is thinking about suicide Call 911 Call 800-273-TALK (8255)


County Resources

County Aging Office MH Office D&A Office

Allegheny 412-350-4234 888-796-8226 412-350-3467

Beaver 724-847-2262 724-847-6225 724-847-6225

Butler 724-282-3008 724-284-5114 724-284-5114

Westmoreland 724-830-4444 724-830-3617 724-684-9000 ext. 4446

Washington 724-489-8080 724-228-6832 724-223-1181

pa behavioral health & aging coalition | rebecca may-cole, executive director pa behavioral...

Documents

aging slide

behavioral health services

mental health concerns

chronic health condition

helpful slide

life expectancy

early years

physical decline