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The mental health of older people

As in any time of life, older people can experience a range of mental health conditions and difficulties, both organic (where there is identifiable brain malfunction) and functional (mental illnesses not due to structural abnormalities of the brain). These include dementia, depression and adjustment reactions, schizophrenia, substance misuse, delirium and anxiety disorders. There are, however, specific aetiologies which predispose older people to particular forms of mental health conditions.

Dementia is the name given to the signs or symptoms associated with a range of primary brain disorders or neurological impairments. These disorders are numerous. Typically dementia can be caused by Alzheimer’s disease, vascular disease, stroke or HIV/AIDS. The signs and symptoms of dementia are likely to include memory loss and confusion, or behavioural and personality change. These symptoms are progressive and can be severe. The prevalence of dementia rises steadily with age, with one-quarter of those aged 85 or over being diagnosed. It is estimated that over one-third of people with dementia continue to live at home with their families.

However, mental health conditions for older people are not confined to the so-called ‘organic’ diseases. Anxiety and, more significantly, depression are also features of daily life for many older people. Although major depression appears to decline with age, studies suggest that between one in ten and one in six older people indicate signs of major depression). One of the major difficulties facing health-care staff working with older people is that many of the signs and symptoms of different mental health conditions are similar. For instance, while older people suffering from anxiety may show signs of fearfulness, distress and panic, these symptoms are also consistent with depression. However, older people who are depressed may also show signs of lack of appetite, poor self-worth, low self-esteem and low motivation. Older people with depressive illness or anxiety may also show signs of memory loss and confusion, which can of course be confused with one of the dementias.

Other disorders, such as delirium and cognitive decline, can also be confused with the above. These prevailing notions of older people’s mental health are, however, problematic. While it can be recognised that organic and functional decline provides us with the primary reason for symptom or behavioural changes which a person may display, the sources of mental health conditions for older people are also firmly rooted in the social and psychological environment. Furthermore, the experience of dementia, depression and anxiety, their trajectory and life impact is shaped by a number of factors diffuse in scope. Within this chapter it is our intention to locate the experience of older people with mental health conditions within a wider social and psycho-social framework. With this in mind, we will now consider experiences of growing older and the range of factors likely to impact on mental well-being during this life phase.

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