Mental issues affecting senior population is largely overlooked
By Deborah Jeanne Sergeant
More than 15 percent of adults aged 60 and older experience mental health disorders, according to the World Health Organization. Many of those don’t receive proper treatment for conditions such as depression and anxiety.
“Depression is both under-diagnosed and undertreated in primary care settings,” the World Health Organization states on its website. “Symptoms are often overlooked and untreated because they co-occur with other problems encountered by older adults.”
Locally, that rings true as well.
“Anxiety and depression are very overlooked in older adults,” said physician Az Tahir, who practices holistic integrative medicine at Campanella Wellness in Rochester.
He said as an example, depression and dementia can be very overlapping and both misdiagnosed and some older adults don’t express their mental state accurately — and few are asked about it by their health care providers.
“We find many times that patients will look OK, but when we do questionnaires on depression, we find that depression is present,” Tahir said. “Treating the depression and giving medication, their life gets better.”
Mental health issues are different from temporary adjustment to aging. For example, the American Psychiatric Association states that depression’s symptoms last two weeks or longer. An occasional feeling of sadness or grief from loss is different.
“There is a difference between consequences of natural aging and a problem that needs to be addressed,” said physician Daniel Ari Mendelson.
Mendelson is a William and Sheila Konar Family professor of geriatrics, palliative medicine, and person-centered care with the division of geriatrics, department of medicine, University of Rochester, School of Medicine & Dentistry. He also serves as associate chief of medicine at Highland Hospital.
Young people experience depression, anxiety and other mental health issues, yet their age isn’t blamed for their conditions. But older adults may be more prone to mental health issues because of their life stage and the life changes that often come at that stage.
Many older adults possess fewer resources that support good mental health, such as a network of nearby loved ones, the ability to exercise vigorously, overall good physical health, and purposeful, engaging activity. Life changes — such as retirement, loss of peers to death and relocation, encroaching physical limitations, and age-related physical issues — all affect mental health.
Mendelson added that people with lifelong mental health issues may find that the medication that worked well in their 40s and 50s isn’t working as well as it used to, since the body’s ability to metabolize medication decreases with age.
Stephen Ryan, a geriatrician practicing at Elder One with privileges at Rochester Regional Health, encourages older adults and their care providers to review medication.
“The metabolism and brain are different as we age,” Ryan said. “How would we measure that we’ve reached a goal since we’ve started the medication? It can get complex. Having a defined goal can really help with a lot of problems, including mental health issues in older adults.”
He advises older patients to bring along a trusted friend or family member to serve as a “second pair of ears” during visits and to ensure all the right questions are asked and answered regarding the patient’s health concerns.
Christine Peck, licensed master social worker and director at Eldersource Care Coordination and co-director at Community Care Connections at Lifespan of Greater Rochester, said that more general practitioners need to screen for mental health issues, especially in older adults.
“Depression, especially, is sometimes undiagnosed and misdiagnosed in older adults because feeling sad isn’t always the primary symptom they’re reporting to their health care provider,” Peck said.
Less obvious symptoms of depression could include fatigue, sluggishness and lack of interest and motivation.
“If what someone’s feeling starts to interfere with daily life and functioning, we try to send the message to older adults it’s not something you have to accept and attribute it to regular aging,” Peck said.
She recommends working through a primary care provider, since some older adults may resist visiting a mental health professional. A physical could lead to mental health screening if a caregiver comes along and discusses the mental health issues the patient experiences.