Older Adult Mental Health

What Are Mental Illness Warning Signs for Elders?

Observation of an older person's appearance or behavior – and changes in a person's routine pattern – may alert family and caregivers that the person is in trouble or potentially at-risk for a mental health problem. Below are some situations and symptoms (warning signs), which may indicate a need to help an older person arrange for further assessment and mental health care.

Physical Losses

Physical changes (weakness, shaking) or losses (hearing, vision, walking), and chronic or acute illness can sometimes affect the older person's emotional or mental status and impair their ability to cope and function. Persons experiencing severe incapacity and lack of social supports are at higher risk.

Social Problems

Isolation can profoundly affect an older person's well-being. Areas of concern include:
Being home-bound.
Lacking social relationships.
Not mentioning family or friends.

Suicide

People over age 60 have a significantly high rate of dying from suicide – especially single men. Subtle statements or direct threats to harm oneself should be taken seriously and mental health care should be sought (see page 8). Indicators of risk include:
  • Multiple and/or recent losses.
  • Saying, "There's no use in going on
  • everyone would be better off without me."
  • Alcohol or drug abuse.
  • Increased isolation.
  • Talk of giving personal possessions away.
  • Putting personal and business affairs in order.
  • Unceasing depression, hopelessness.

Personal Appearance

Neglect in the area of self-care is often a sign that the older person is experiencing difficulties:
  • Untidy appearance
  • Dirty or uncombed hair
  • Unshaven
  • Dirty clothes
  • Inappropriate clothing for weather/season/situation
  • Body odors

Conditions of the Home

The appearance of an older person's residence may reflect an inability to care for self or a loss of interest:
  • Exterior and/or interior of home in poor repair
  • Old newspapers lying around
  • Unopened mail visible
  • Calendar on wrong month or year
  • Little or no food
  • Strong odors
  • Many pets – animals appear neglected
  • Garbage or litter

Personality Changes

Personality changes may indicate the onset of physical, mental, or emotional problems:
  • Marked change, gradual or sudden, in the person's overall ability to function
  • Increased withdrawal or isolation
  • Disheveled appearance
  • Suspiciousness or anger
  • Unusual or bizarre behavior

Mental or Emotional State

Many people who experience mental or emotional problems suffer the first onset after the age of 60. Problems in these areas can seriously undermine an older person's ability to cope and function.

Mental State

  • Confusion
  • Disorientation
  • Inappropriate responses
  • Forgetfulness
  • Repetitiveness while talking
  • Seeing, hearing, smelling, tasting,
  • feeling things that are not there
  • Persistent false or irrational beliefs
  • Suspiciousness or lack of trust
  • Suspicion or unwarranted belief that one is being harmed or mistreated

Emotional State

  • Complains of not eating or not wanting to eat
  • Complains of difficulty sleeping or early morning awakenings
  • Exhibits anger, irritability, hostility towards self and/or others
  • Appears nervous or fidgety and has a decreased ability to concentrate
  • Appears to have been abused, neglected, or exploited
  • Cannot get back to normal after suffering a loss through separation or death from friends or family member
  • Appears sad or blue
  • Is tired or has a loss of energy

Distinguishing Normal Grief from Depression

Persons of all age groups respond to significant losses – of loved ones, health, status, employment – with grief and sadness. Others may experience a more severe depression. Several distinctions bet-ween normal grief and depression are:

What about the Caregiver?

There is often a natural resistance on the part of the caregiver to accept help for a spouse or relative suffering from mental or emotional problems or severe cognitive impairment. Trying to handle the burden and responsibility alone can be overwhelming and lead to depression or physical problems. Indications of caregiver stress may include:
  • Caregiver increases use of alcohol or abuses alcohol.
  • Caregiver conveys the message that a loved one's condition is getting worse in spite of their best efforts.
  • Caregiver becomes impatient, irritable, and frustrated with the person they are caring for.
  • Caregiver has no support system providing assistance or relief from giving care.
  • Caregiver complains of feeling exhausted or overwhelmed by the burden of care, but is unwilling to reach out for help.
  • Caregiver may state: “I should be able to handle this alone – it's selfish to think of my own needs.”
  • The following are some options if you or someone you know needs relief from taking care of an elderly person:
  • Place patient temporarily in an Adult Day Care center, for several hours a day. Go to www.elderlyaffairs.com, select “Senior Information and Assistance Handbook” for list of Adult Day Care providers.
  • Utilize a volunteer to provide relief by doing chores, running errands, taking care of patient so caregiver can leave for a few hours, and helping in whatever way is needed. Project Dana, 945-3736, maintains a list of such volunteers.
  • Hire a respite caregiver. Honolulu Gerontology Program, 543-8405, or Catholic Charities Hawai`i, 595-0077, maintains lists of respite caregivers.
  • Attend caregiver support groups through the Alzheimer's Association, Project Dana, or Honolulu Gerontology Program.

Topics Include

  • What Are Mental Illness Warning Signs for Elders?
  • Physical Losses
  • Social Problems
  • Suicide
  • Personal Appearance
  • Conditions of the Home
  • Personality Changes
  • Mental or Emotional State
  • Mental State
  • Emotional State
  • Distinguishing Normal Grief from Depression
  • What about the Caregiver?
© Mental Health America of Hawaii
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