Mental health is comprised of our emotional, psychological, and behavioral well-being and affects how we think, feel, and act. There are many common risk factors that impact mental health which can present themselves at any time or any age. While most older adults have good mental health, many are at risk for developing mental health disorders caused by physiological, social, neurological, or other environmental factors detrimental to good mental health.
Mental and neurological disorders comprise 6.6% of total disability in seniors over the age of 60 worldwide, with about 15% experiencing some form of mental disorder. The CDC finds that 20% of older adults experience mental health issues in some form. Depression is one of the most common mental health disorders among the elderly. More than 5% of Americans aged 65 or older experience depression, with symptoms generally being caused by lack of social support, lack of access to health or mental health support systems, illnesses common in older age like Parkinson’s, Alzheimer’s, and often comorbid chronic conditions. Losing one’s spouse is also a common pathway to depression, with many seniors remaining depressed one year after the death of their spouse.
Depression in older adults can lead to an array of adverse health effects, such as longer hospital stays, increases in hospital readmission, less adherence to clinical treatments, low motivation for recovery, self-neglect, increased risk of suicide, and decreased physical, cognitive, and social functioning capacity. Hospitalization itself can lead to higher rates of depression amongst seniors, with depression being prevalent in as much as 50% of older adults who are hospitalized. Patients with depression experience higher rates of mortality, even after being discharged from the hospital. They also tend to have longer lengths of stay, in addition to emotional distress, reduced mental health, and diminished quality of life. Post-discharge depression can be attributed to low social support and limitations on the ability to execute ADLs (activities of daily living).
Despite being very common and widespread, depression is not a normal part of aging. Seniors with depression typically function less effectively than those of the same age group with chronic physical conditions and can present different symptoms than younger people such as sleep disorders, irritability, and behavioral changes. Insomnia is an oft-overlooked cause for depression in seniors, typically caused by prescription medications, declining physical health, and reduced engagement in daily activities, which themselves are common risk factors.
Depression in older adults “is commonly expressed by changes in energy levels, sleep patterns, and appetite; difficulties with concentration or decision making; lack of pleasure in activities that were previously enjoyed; and feelings of hopelessness”. Confusion or attentiveness issues, however, may be mistaken for dementia and leave depression undiagnosed or untreated. The Harvard Health newsletter outlines some helpful distinctions between depression and dementia:
- Decline in mental functioning is more rapid with depression than with dementia.
- People who are depressed are less often disoriented.
- People with depression have difficulty concentrating, while those with Alzheimer’s have short-term memory problems.
- Writing, speaking, and motor skills are usually not impaired in depression.
The WHO states that “Mental health-specific health promotion for older adults involves creating living conditions and environments that support wellbeing and allow people to lead a healthy life.” Improving mental health conditions depends on providing resources for seniors that meet their basic needs, such as:
- providing security and freedom;
- adequate housing through supportive housing policy;
- social support for older people and their caregivers;
- health and social programmes targeted at vulnerable groups such as those who live alone and rural populations or who suffer from a chronic or relapsing mental or physical illness;
- programmes to prevent and deal with elder abuse; and
- community development programmes.
At its core, home care provides a basic support system for seniors as well as their families. Unpaid family caregivers account for 19% of the total population in America. In some cases, family members move closer to their loved ones when challenges in their care arise. Many family caregivers, however, are often confronted with care that becomes too complex, overwhelming, or beyond their scope of knowledge. This additional physical and emotional strain can be isolating and leads many family caregivers to experience physical pain, depression, anxiety, and other declines in mental health. Family caregivers who lack professional caregiving support report significantly higher levels of emotional distress and decreased mental health.
The WHO states in their global action response to dementia that the key mechanisms to improve support services for family caregivers and their loved ones with dementia relies greatly on “ensuring access to respite services, peer support, reducing social isolation, and access to information”. The US is not the only country whose family caregivers become overwhelmed, overburdened, and faced with negative health effects. It is a global issue affecting families and patients worldwide.
How home care helps:
- Monitoring and keeping seniors on a consistent schedule, including sleep, meals, and ensuring medications are taken at the proper intervals, can affect and improve the ability to and quality of sleep, as well as other crucial physical functions that, when interrupted, can decrease mental health.
- ADL limitations are modifiable variables that can be addressed during post-hospitalization after care – through transition treatment, in-home assistance, personal care, and companion care – in order to diminish symptoms of depression, prevent hospital readmission, and decrease risk of mortality following acute stays.
- With professional home care, seniors who lack social resources can directly benefit from companion care. The support and stimulation that come with having another person with which to talk, eat, spend time, play games, exercise, etc. can greatly outweigh the effects of depression caused by isolation and loneliness.
- Respite care for family caregivers helps improve mental health outcomes for family members, as well as the seniors themselves, by giving family caregivers the time and space they may need to rest, recoup, focus on their personal lives, and improve relations with the senior for which they’re caring.
- Professional caregivers help counteract depressive symptoms like decreased self-care by encouraging activities such as getting out of bed, grooming, hygiene, adhering to clinical treatments, and other activities that involve goal setting and achievement.
- Losing the ability to care for oneself, and the subsequent loss of independence and perceived dignity, is a pathway to depression that can be impeded by the objectives of home care which are to ensure that seniors can still live comfortably and independently at home with dignity and support.
- Both transitional care and medication assistance help reduce the risk of hospital readmission by providing a bridge between care settings and reducing adverse drug-related events resulting from confusion or difficulty with prescription medications. Having a home care professional monitor the vitals and condition of a client after a hospital or rehab/nursing home stay can improve their chances of recovery and comfort in the home.