Enhancing Mental Wellness in Older Adults by Dr Vani Rao, MBBS, MD**

                                            Photo by Marcus Aurelius from pexels 

Why Mental Health is Important for Seniors -Mental or Emotional wellness is an important aspect of overall well-being. Problems such as anxiety, depression insomnia are not signs of aging. The persistence of these symptoms are signs of mental illness for which professional treatment should be sought.

Is Mental Illness in Older Adults Treatable?

The good news is treatment is available and mental illness is a treatable condition.

Age is not a bar for the treatment of mental illness.

Early recognition and management are important as mental illness is treatable and can help the person have a better quality of life.

 Are seniors more susceptible to Mental Health Issues? As we age, we are more susceptible to experiencing losses – e.g. death of a loved one, loss of work, loss of a constant source of income, etc. Many can adapt to these changes but others may not be able to cope and are at risk of developing mental illness

  In addition to losses, chronic physical health problems such as stroke, cardiovascular issues, arthritis/degenerative disc disease with chronic pain problems are risk factors for developing mental illness.

 Personality traits such as neuroticism, physical /mental frailty, and chronic stress are other risk factors.

 The 5 common signs of mental illness:

1.   Feeling that life is not worth living or having suicidal thoughts. This is a major red flag for which you need to contact the doctor immediately.

2.   Persistent (i.e. lasting for several days) feelings of sadness, dullness, lack of enjoyment in usually pleasurable activities, lack of interest or motivation to initiate or complete tasks, unexplainable fatigue, change in appetite and/or  weight – either reduction or increase, feelings of being a burden to the spouse or family, feelings of inappropriate or excessive guilt, and/or not keeping up with hygiene and grooming

3.   Chronic anxiety about everyday things or constant ruminations and worries about things that have happened in the past or are likely to happen in the future.

4.   Frequent outbursts of irritability or anger

5.   Sleeplessness or sleeping too much. Sleeplessness may be difficulty in falling asleep, maintaining sleep, or waking up very early in the morning and finding it difficult to go back to sleep.

 Cognitive problems are also common in the elderly. However, the presence of cognitive problems does not always mean the person has dementia or a neurodegenerative disease. It only means the person needs a comprehensive assessment from a physician with expertise in memory problems. 

5 common signs that should alert you to seek professional help:

1.   Constantly repeating conversations,  difficulty learning and remembering new information, asking the same questions repeatedly

2.   Frequently misplacing or losing things. Getting lost in familiar places.

3.   Language problems such as word finding difficulties, and difficulty expressing or comprehending information.

4.   Decline in organizing, planning, and executing tasks. Examples include difficulty keeping up with finances, not paying bills on time, checks bouncing back, making errors with dates and numbers, and difficulty doing daily chores such as cooking, shopping, and laundry.

5.   Change in personality. Examples include apathy, disinhibition, increased impulsivity, showing poor judgment, change in dietary/eating practices

 How can Seniors Improve Mental Health -10 Tips and Tools

 1.   Be alert to changes in your or your loved one's mood or behavior. Learn to recognize signs. If you notice any of the above signs, please contact your doctor or your loved one’s doctor about these changes.

2.   Always keep medical records in a folder (paper or electronic), organized in some chronological order. Carry these records with you to doctors’ appointments. It may also be good to have an extra copy stored in a safe cabinet.

3.   Keep a list of diagnoses made with updates as changes happen.

4.   Keep a list of current medications including dosages and frequency of when taken. In addition, to ensure compliance, maintain a pill box. It would be probably best to have a 7-day AM/PM pill organizer.

5.   Maintain notes on Medications - When medicines were started, dosage changes, medicines discontinued, and medication side effects.

6. If possible maintain a shared calendar between you/your spouse or loved one of everyday activities. Sharing can not only give a feeling of caring but also accountability and  ownership
7. Engage in meetings and group activities. Social isolation and loneliness are major triggers for the development of depressive and anxiety disorders. Socialization helps sharpen your cognitive skills, improve your overall well-being, and may even help with longevity.
8. Exercise regularly. Even simple exercises such as taking walks 3-4 x/week for 20-30 minutes can help. If you are not sure about what type of exercise is most appropriate for you or your loved one, check with a doctor as it may be different for different people based on their physical health/medical problems. Exercise is a great stress buster and mood enhancer. Working out together provides extra oomph.

9.   Healthy nutrition is a must. Home-cooked meals are the best. In general, a healthy meal includes lean protein, fruits and vegetables (the more colorful the better), whole grains (brown rice, whole wheat), and low-fat dairy.

10.              Maintain hydration.  Older adults are at risk for dehydration as they often forget to drink, or take medications that make them frequently urinate, may develop a diminished sense of thirst, or maybe have a fear of drinking secondary to concerns about incontinence or having to use the bathroom frequently. An easy way to tell you are dehydrated is to check your urine. If you are only passing small amounts or if your urine is dark brown in color, you may be dehydrated. If you are well hydrated, your urine is usually clear or pale in color. There is no simple answer for how much fluids a person needs every day as it can vary based on sex, body weight, medications the person is taking, and everyday activities. You might have heard the old saying –‘drink about 8 glasses of water.’ This is reasonable but some may require more and some less. According to the he U.S. National Academies of Sciences, Engineering, and Medicine a healthy male adult requires about 15.5 cups (3.7 liters) of fluid/day and a healthy female adult requires 11.5 cups (2.7 liters)/day. But as  I mentioned above it varies from person to person. So please check with your doctor if you are not sure about the amount needed for you.

 Are Sleep problems a mental health issue?

Sleep changes are not uncommon in the elderly. It may occur as an isolated problem or be associated with other physical and mental health problems.

Sleep Problems -Sleep issues may be insomnia (difficulty in falling asleep, maintaining sleep, or waking up early in the morning and finding it difficult to go back to sleep)  or excessive sleepiness. 

Other problems include circadian rhythm disorders ( a condition where the body’s internal clock is not in sync with the environment) such as advanced sleep phase disorder where the person goes to sleep early (6-9 pm )and wakes up early(2-5 am) or delayed sleep phase disorder where the person goes to sleep late (2-5 am) and wakes up late (1-3pm)  and irregular sleep-wake rhythm.

If sleep problems persist it is important that you seek medical help as most sleep problems are treatable.

Whatever the cause of sleep problems may be, you must maintain/practice good sleep hygiene.

Tackling Sleep Issues with Good Sleep Hygiene:

1.  Maintain a strict sleep schedule and go to bed and wake around the same time every day, 7 days/week, 365 days/year.

2.  Try to avoid daytime naps. But for some daytime nap helps – can be rejuvenating and not interfere with night sleep. If you belong to this group, you can nap for about 30 minutes during the day but make sure that it is around the same time every day.

3.  Use your bed only for sleep or sex. Avoid watching TV, talking on the phone, eating, etc.

4.  Make sure your bedroom is comfortable – e.g. the temperature you prefer and free from noise and light

5.  Avoid caffeine products or any other stimulants late in the day.

6.  Avoid heavy meals just before bedtime.

7.  Avoid moderate-heavy alcohol use lin ate evenings.

8.  Exercise regularly but avoid heavy exercise immediately before bedtime as the increase in body temperature can interfere with falling asleep

9.  Do not clock watch. Frequently checking the time can only increase your anxiety and frustration which can further delay your sleep.

10.             Try to develop a bedtime ritual and unwind before you go to bed. Settle down by calming yourself (e.g. taking a warm bath, listening to music, or anything soothing or comforting). This can reduce anxiety and lead to better sleep.

 Remember the 3-2-1 rule:  Finish eating 3 hours before bed. Stop working 2 hours before bed. Stop watching TV or any other gadget 1 hour before bed.

**Note about the Author - Dr. VANI RAO, MBBS, MD is a part-time  Associate Professor in the Department of Psychiatry & Behavioral Science at the Johns Hopkins University School of Medicine & a Private Practitioner in Washington DC.