As people age, they become more physically fragile. Many also become more mentally and emotionally fragile.
Researchers and clinicians, such as Jams Stuivenga, are paying more attention to the mental health needs of seniors. Stuivenga is a clinical supervisor at Seattle-based Sound Generations, a non-profit that serves older adults.
Kyrsten Weber: How significant are mental health changes among the 65+ population?
Jams Stuivenga: You know, normal aging does not necessarily indicate that we'll have changes in our mood. Obviously, there's life changes that occur. I think over 60, those might actually be more losses, unfortunately.
Retirements, changes in role and sort of sense of purpose, these things can affect people's mood. It is helpful to do screenings on a regular basis for that reason. The longer we live, the older we are, that itself becomes a greater risk for dementia.
One of the possible symptoms of dementia, at least early on, might be depression. There's also anxiety and distress that comes from someone's cognition declining. They may not be able to understand what's happening or have insight about it, but they are still experiencing distress.
We also want to be mindful that suicide rates have also gone up for everyone over 55, men and women.
KW: What is that attributable to?
JS: I think part of it is certainly that we have more older adults than we've ever had in this country. There's also probably some social factors, sociopolitical factors.
Quality of life might be more difficult with people living longer with chronic illnesses. And yet, you know, you have fixed income or you have fixed resources. Many people are aware that regardless of age, there's a loneliness epidemic.
KW: To what degree do people conflate normal aging and mental health changes?
JS: Ageism is certainly a factor. There are a lot of social beliefs about getting older, the idea that we're just going to decline until we die. That's not very helpful. That's not accurate. Obviously, there are changes in our capacity, our functioning, but it can be varied case by case. It probably depends on how many older adults you know in your life.
You might have a good impression that there's actually a lot of diversity. It doesn't have to look one way. But I do think there are a lot of media portrayals that can be negative or there have been.
I think it's improving. And certainly, there are individuals who are having a hard time and we might see it and we might think that's generalizable to everybody.
KW: So in that case, what would you say to family members and caregivers are the things to look for in their loved one that would indicate, I think this person may need some help?
JS: Yeah, I'm glad you're asking because we don't want people to, on one hand, overgeneralize that things are going to get so bad. But we also don't want people to miss cues for what might actually be concerning.
So I would say as we're all aging, it should be expected that we would hold much of the same personality, our character, our interests, our level of social engagement, our hobbies. We might go through a temporary hardship. I think everyone's familiar with even just having, like, a bad night of sleep or dealing with a new stressor in your life that might change things, but not drastically.
So if you're noticing truly significant changes in somebody's mood, their interests, their hobbies, their pain, or just feeling uncomfortable, indifference, apathy—if these are new to the person in your life, might suggest that something else is going on.
KW: Talk a little bit about the connection between physical pain and mental health changes, because I think that's something that a lot of people assume is just simply part of the aging process.
JS: Yeah, sometimes they can be very similar and it can be hard to know the difference.
What would suggest a need for maybe further evaluation is if there just becomes a truly disruptive level of pain. The person might not admit to it very openly, like they might be sort of stoic. I know a lot of people, not necessarily an age-related thing, but it's just kind of hard to acknowledge to other people that I'm actually not feeling very good.
But if you're having any sense that there's a lot of just intolerance for physical sensations, that might actually suggest something else is going on worth checking out medically.
KW: Can pain kind of be a chicken and egg scenario? Pain can lead to mental health changes, chronic pain, and mental health changes can also trigger chronic pain.
JS: Definitely. That's a very good way of putting it.
Definitely we see anyone with a chronic illness, chronic pain—the symptoms over time, even with treatment that keeps the symptoms at bay or, you know, there's some level of maintenance, there might be an erosion of somebody's ability to feel good on a daily basis, right? Like their quality of life.
On the other side, if someone is dealing with depression, that might start actually to just look like intolerance for a lot of physical sensations. A lot of things just feeling uncomfortable might be a very hard thing to describe, actually.
KW: How does one distinguish between grief and the sort of sadness that is moving into mental health crisis or mental health challenges?
JS: There is actually more of a clinical definition that I'm not sure always works for me. But basically, if someone is having symptoms of grief, after a certain amount of time, I think it's something like six months, that might suggest that something more is going on.
My experience of having gone through grief and knowing other people have gone through grief, I think there's a lot of ways that grief can last over six months. It just sort of takes different shapes.
I think what maybe is more helpful for people to keep in mind, how much is your grief disrupting your everyday life, your ability to do the things that you used to do—whether that's go to work, or your social life, or your hobbies, your interests, even things like just eating, sleeping, hygiene, cleaning up the house. If you feel like those things are hard to do after six months, there's probably something else going on than just grief.
Sure, it could be grief related, but you could probably get even some treatment for it, whether that's just working with a therapist, or even attending a support group, working with a grief counselor, and could really kind of make a difference.
Like I said at the beginning to qualify that, certainly, grief plays out differently for a lot of people, and you probably will still be mourning somebody. It's just more a question of how much you're able to go about your life in the ways that you used to expect.
KW: How do family members and caregivers nudge our loved ones along the path towards screening? There is so much stigma associated with mental health changes, that oftentimes we can run into resistance.
JS: I think it's always important to stay patient, but also persistent without being pushy.
If there's really truly a sense that something is an emergency, I think someone should definitely say that to their loved one, ‘I think we really need to go to the hospital. I think you really need immediate help.’
But up to that point, if it's just trying to schedule a routine appointment to get something checked out, that might be new symptoms, the loved one is sort of waving that off or dismissing concerns, I think it's helpful to just maybe shift to acknowledging ambivalence, and just trying to acknowledge that, trying to offer meeting them where they are, what would it take to make it easier to go to an appointment, or to make this appointment?
Maybe also centering your own concern: I care about you, and this is important to me. I would really like you to do this for me. You don't want to guilt trip somebody [but] as a loved one, you're asking them to do this.
KW: What kind of language can we use to help overcome the stigma that's associated with mental health challenges?
JS: Definitely person-centered language, you know, I don't think it's too common that someone says, ‘oh, that person's just a depressed person.’ I think it's more common you hear that about things like someone is a bipolar, or schizophrenic, or a hoarder, that's pretty stigmatizing language.
So in general, just acknowledging that the conditions that people might be experiencing, the symptoms they might be experiencing, are something that's happening to them, it's not who they are. Certainly it's affecting their personality or mood, their interests, motivation, but that's not who they are at their core, so we shouldn't label them accordingly.
If you or a loved one are considering suicide, please call the Suicide and Crisis lifeline at 9-8-8.