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:
Poor adjustment to role changes.
Poor adjustment to lifestyle changes.
Family relationship problems.
Grief.
Low self-esteem.
Anxiety and depression.
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, having frailty,
diabetes, hearing loss, osteoarthritis 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.
Empathy
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.
Elder Abuse
Elder abuse is a single or repeated act, or lack of appropriate action,
occurring within any relationship where there is an expectation of trust,
which causes harm or distress to an older person. This type of violence
amounts to a violation of human rights. Older adults are 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 have serious physical and mental health, financial,
and social consequences, including, for instance, physical injuries,
premature mortality, depression, cognitive decline, financial devastation
and placement in aged care facilities.
Dementia and Depression
The most common mental and neurological disorders in older people are
dementia and depression, which affect approximately 5% and 7% of the
world’s older population, respectively.
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.
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
Grief
As people get older there is an increased likelihood of them experiencing
bereavement. Grief is the natural response to the death of a loved one and
is encountered frequently in clinical practice with the elderly. Acute
grief normally evolves over time into integrated grief. Sometimes grief may
be prolonged, severe and impairing. This failure of adaptation to grief
results in Prolonged Grief Disorder (PGD) which has been recently included
in ICD-11. The hallmark feature of PGD is intense longing for the deceased
or persistent preoccupation with the deceased that lasts longer than 6
months after the death
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.
Consider the psychological factor of adjustment to physiological change
that has left a disability, for example:
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.
Tai Chi, improves well-being
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.
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 have
a role, as our expertise being most beneficial. Simply educating people on
the mental health benefits is a starting point.
Introduction Many people experience a range of emotional responses to
injury or illness. These responses can significantly impact a person's
engagement with treatment, their progress, and outcomes. Understanding
these responses enables healthcare professionals to provide comprehensive,
empathetic care. Being able to recognise psychological barriers and
facilitators to rehabilitation engagement helps healthcare professionals
create effective therapeutic relationships and support patients through
potentially challenging rehabilitation journeys. These positive
relationships can improve rehabilitation outcomes and quality of life.
Ageing and Disabilities - Physiopedia
Introduction The global population aged 60 years or over numbered 962
million in 2017. The number of older persons is expected to double again by
2050, when it is projected to reach nearly 2.1 billion Ageing can be viewed
as a societal accomplishment, but it also poses a challenge in terms of
health care and continuing healthy functioning for this rapidly growing
population. As a result, it's critical to ensure that these extra years are
not only free of chronic disease or disability but also that mental and
physical functionality is maintained. This will lessen the population's
massive economic and social responsibilities. Nearly half of all healthcare
spending occurs after the age of 65, according to estimates. Successful
aging can be defined as "adding life to the years.". There is a growing
recognition among biomedical experts that the quality of life may be just
as significant as the number of years added to life. While a specific
definition of successful ageing has yet to be agreed upon, it is widely
agreed that it comprises the freedom from chronic disease and the ability
to operate well in old age, both physically and cognitively. Ageing is a
multifaceted phenomenon influenced by genetics, constitution, lifestyle,
and environmental factors. There are distinct phases of growth in human
life: there is a progressive increase in functioning (from infancy to
adolescence), there is a type of plateau during adult life, and then there
is a physiological drop in functioning as one becomes older. The pace,
quantity, and quality of this decline are all influenced by genetic factors
(approximately 25%), but they are mostly influenced by lifestyle and
environmental factors (about 75%). A progressive reduction of functioning
(related to genetics, constitutional variables and to lifestyles), together
with negative environmental factors, could lead to diseases, disorders,
functional limitations, and to disability. Disability[edit | edit source]
Disability is viewed in a dynamic way and as a process, according to
International Classification of Functioning, Health and Disability (ICF),
World Health Organization, and other conceptual models of disability and
approved by the United Convention of the Rights of the People with
Disabilities According to this vision, disability is the consequence of the
relationship of the person, with his/her health conditions, and the
environment. There is also an international agreement in the view that
“health and active ageing” is not without disorders or without diseases,
but it refers to well-being from a biopsychosocial point of view: so it
refers to well-being and quality of life, even in the presence of a disease
or a disorder. From the more recent conceptual models of ageing and
disability, the aim of each kind of intervention is to prevent pathological
to reduce the risk of age-related health conditions and their consequences,
to promote active and healthy ageing, and to prevent the change from usual
to pathological ageing[3]. People with disabilities and people who are
ageing with disabilities are on the rise all around the world. According to
a report on disability published by the World Health Organization and the
World Bank, roughly 15.3 per cent of people had disabilities in 2004 and
about 15% of people had disabilities in 2010, with about 2-4 per cent of
these persons with disabilities having severe functional difficulties. Age
has a significant impact: the older you get, the more likely you are to
become disabled. For these reasons, the relationship between ageing and
disability has become extremely important, both in terms of its
implications for ageing people's involvement, inclusion, and quality of
life, as well as its implications for socio-sanitary organizations.
Disability with ageing- which refers to ageing people that become people
with a disability only during his/her ageing process, mainly due to
age-related conditions Consequences between being and disability
Three kinds of consequences between ageing and disability.
Disability-related secondary conditions- People with disabilities are more
likely to develop secondary conditions, either directly or indirectly (any
additional physical or mental health conditions that may arise as a result
of a primary disabling condition but are not a specific feature of it),
which are similar to those that ageing people experience in general, but
they occur 20-25 years earlier and are often referred to as premature or
atypical[3]. Age-related conditions—these conditions are related to ageing
and the long-term consequences of exposure to environmental risks, as well
as the effects of poor health behaviours—that may be experienced by ageing
persons and also by ageing people with disabilities. Hypertension, high
cholesterol, diabetes, osteoarthritis, heart disease, gait and mobility
issues, falls, respiratory infections/chronic obstructive pulmonary
disease, urine Urinary Incontinence, osteoporosis, skin disease, hearing
and vision loss, and dementia are examples of these conditions.
Multiple Chronic Conditions- the risk of having two or more chronic
conditions at the same time, either in dyads (hypertension and diabetes) or
in triads (cholesterol, hypertension, and diabetes). Anatomical and
Physiological changes with Ageing[edit | edit source] Muscle Strength[edit
| edit source] Muscle strength and Postural alignment plays an important
role in an effective functioning in older adults. Loss of muscle strength
has been documented in individuals as young as 50 to 59 years old.
Reductions in muscle strength is closely associated with an increase in
age. Normal changes in the ageing musculoskeletal system include reduced
muscle mass, and loss of bone density and can be compounded by physical
inactivity. After discontinuing resistance training for almost 2 weeks,
more than 5% of the benefits gained are greatly diminished. On recommending
the older adults to spend days or weeks exclusively on bed rest due to
illness or injury, muscle strength swiftly declines, it is lost at
approximately twice the rate it takes to regain it. Reduction in muscle
mass leads to an increased rate of disability. For example, quadriceps
strength is necessary to rise from a chair or toilet seat. At worst,
reduced muscle strength leads to loss of function preventing an older adult
from carrying out daily activities independently, assistance either in the
home or a care center is warranted Bones and Joints More peripheral sites,
such as the radius, experience relative stability in density until
menopause, whereas the spine and neck of the femur show bone loss 5 to 10
years earlier. Intake of vitamin supplementation by men and women aged 65
years and older can reduce fracture risk and bone loss. Moreover, focusing
on weight-bearing exercises can reduce bone loss and diminish the decrease
of bone density commonly seen with advancing age. Wear and Tear on the
joint are also associated with aging due to loss of joint fluid. Joint
changes seem almost inevitable with advanced age in fact osteoarthritis is
one of the conditions nearly all aged individuals experience. With ageing,
the intervertebral discs lose water, flatten and undergo other deleterious
changes.
From one of the books AGEING GRACEFULLY
K RAJARAM IRS 4825
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