Health Status of Older Adults (Mental Disorders) Lecture 6 – Chapter 6.
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Transcript of Health Status of Older Adults (Mental Disorders) Lecture 6 – Chapter 6.
![Page 1: Health Status of Older Adults (Mental Disorders) Lecture 6 – Chapter 6.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649de75503460f94ae00c0/html5/thumbnails/1.jpg)
Health Status of Older Adults(Mental Disorders)
Lecture 6 – Chapter 6
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Mortality
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Chronic Health Conditions
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Sensory Impairments and Oral Health
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Percent of Medicare Beneficiaries Reporting Difficulty with IADLs or ADLs by Age, 2004
Data Source: Medicare Current Beneficiary Survey
Per
cent
(%
)
0
5
10
15
20
25
30
35
65-74 75-84 85 years and over
IADL Only 1 to 2 ADLs 3 to 6 ADLs
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Dietary Quality
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Cigarette Smoking
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Drinking
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Respondent-Assessed Health Status
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Compression of Morbidity Hypothesis (Fries, 1980):
As life expectancy increases the onset of chronic disease, infirmity or disability are not only postponed but
compressed into a shorter time period nearer the end of life
years2 4 6 8 10 12 14 16 18 20
Onset of illness Death or disability
2006: 2.66% decrease in disability /year
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20-22%
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Mental Disorders in Late Life
1. MD continues or reoccurs
2. Life time of stressors MD
3. Develop disorder in later life
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Problems with Diagnosis
PolypharmacyIs it the drugs or a
real mental disorder???
Medical Condition or real mental
disorder???
Side effects, interactionsIssue re: adipose tissue (lipophillic drugs),
dosage
Alzheimer’s, PD
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Mental Health Among Persons Age 65 and Over by Race/Ethnicity (2004-2005)
0 1 2 3 4 5 6
Visited a mental healthprofessional during the past
12 months
Serious mental illness
Hispanic White non-Hispanic Black non-Hispanic
Percent (%)
Data Source: National Health Interview Survey
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¾!!
¾!!75%!!!
75%!!!
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Poor Quality of Care for Older Adults with Mental Disorders
• Increased risk for inappropriate medication treatment (Bartels, et al., 1997, 2002)
1 in 5 older persons given an inappropriate prescription (Zhan, 2001)
• Less likely to be treated with psychotherapy (Bartels, et al., 1997)
• Lower quality of general health care and associated increased mortality (Druss, 2001)
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Expenditures on NIMH Newly Funded Grants
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000Fiscal Year
Total NIMHGrants
AgingGrants
8% 7% 8% 8% 9% 6%
NIMH, 2001
Mill
ions
of
Dolla
rs
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What is most commonly diagnosedmental disorder among older adults???
More mental illness than other age groups???
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2:1 females to males
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Specific anxiety disorders include the following:
general anxiety disorder (GAD)panic attacks
phobias obsessive compulsive disorder post-traumatic stress disorder
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Anxiety:
-- Necessary part of life! (transitional: adjustment)
-- Warns of danger-- Can stimulate and lead to productivity
Persistent anxiety …not good
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Transitional AnxietyTransitional Anxiety:
-- decreased self-confidence-- fearfulness-- mild concentration decline-- worry related to home, belongings, friends, pets Couple of days to couple of weeks
Transitional Anxiety Disorder
-- interferes with ADL-- intensity is out of proportion to the event-- duration of anxiety episode is out of proportion to the event Couple of days to couple of weeks
Anxiety Disorder
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FACTORS COMPLICATING THE DIAGNOSIS OF ANXIETY IN OLDER ADULTS
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Comorbidity of Mental Illness-- Older Adults
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Panic Attacks (???)sudden, distinct episodes of intense anxiety
• usually a hx of attacks when younger• relatively rare for attacks to begin for the first time after age 55
(usually milder with fewer panic symptoms and less agoraphobia:
fear of open spaces)Phobias (.5%)
specific phobia: fear of a specific person, animal, place, object, event, or situation that results in symptoms of anxiety.
social phobias: fears associated with social situations. The usual fear is of behaving inappropriately in a certain situation and feeling
incompetent or embarrassed.
obsessive compulsive disorder (1.5%)having persistent thoughts (obsessions) that cause anxiety, and then
behaving (compulsions) in ways to decrease the anxiety (< than 1 hr a day).
post-traumatic stress disorder (???)experienced (either as a witness or a victim) a traumatic event and
reacted with feelings of fear and helplessness.
Others
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unrealistic or excessive worry not related to a particular problem or event
Related to vague fears about losing control, fear of failure, fear of death
• fatigue • muscle tension • trouble sleeping through the night panic attacks• difficulty concentrating on a task • feeling irritable or on edge
1) Chronic anxiety that persists for more than 6 months2) be accompanied by decreases in activities or some sort of
impairment3) be caused by more than one worry (ex: intense worry over
financial matters or a medical illness alone, even with all the associated symptoms, does not mean someone has GAD)
General anxiety disorder (GAD)
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• Hughes’ OCD was not treated• Became a recluse• Died– largely of starvation - 71 yrs old,
1905 - 1976)
Howard Hughes
“The Aviator” Draws Attention to Anxiety Disorders in Older AdultsUntil recently, anxiety disorders were believed to decline with age
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Depression
Reactive-Exogenous triggered by an obvious event
Endogenous No trigger No obvious event
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•Anhedonia (experience pleasure)•Weight gain or loss•Hypersomnia, insomnia• Fatigue, loss of energy• feelings of worthlessness guilty• difficulty concentrating
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Indicator 18 - Depressive Symptoms
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Clinical Depression ~ 5%:
• Depressed mood most of the day, nearly everyday • Loss of pleasure in daily activities • Significant weight loss or gain • Change in mobility (slowing down or nervous gestures)• Feelings of worthlessness, self reproach, excessive guilt • Diminished ability to concentrate • Suicidal thoughts
Steffens et al. (2000) : depression in older adults was 4.4% in women and 2.7% in men
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When depression occurs in late life:
1. relapse of an earlier depression
2. If first time occurrence may be triggered by another illness, hospitalization, or placement in a nursing home
3. Unlike the onset of depression in younger adults depression is thought to be a psychological disorder triggered by specific life stressors (loss of loved one)
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Attitudes Of Older Adults Towards DepressionAmericans aged 65:
• 68% know little or almost nothing about depression
• 38% believe that depression is a "health" problem
• more likely than any other group to "handle it themselves“
• 42% would seek help from a health professional
National Mental Health Association, 1996
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Peak suicide rates: goes up continuously for men / at midlife for women, then declines
1/3 of older men saw their primary care physician in the week before completing suicide; 70% within the prior month
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Leading Causes of Suicide Among females,
2001
0
10
20
30
40
50
60
70
80
90
100
10-14 15-19 20-64 65+
Pe
rce
nt
of
all
su
icid
es
by
ag
e
Firearm Suffocation Poisoning Fall-jump Drowning Cut/pierce
Source: National Vital Statistics System - Mortality, NCHS, CDC.
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Leading Causes of Suicide Among Males, 2001
0
10
20
30
40
50
60
70
80
90
100
10-14 15-19 20-64 65+
Pe
rce
nt
of
all s
uic
ide
s b
y a
ge
Firearm Suffocation Poisoning Other
Source: National Vital Statistics System - Mortality, NCHS, CDC.
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Nursing Homes: The Primary Provider of Institution-Based Care for Older Persons with Mental Disorders
• 65-80% of Nursing Home Residents-A Diagnosable Mental Disorder(vs 20% in older adults at home)
• Among the Most Common Disorders– Dementia – ***Depression (as high as 50%!!!)– Anxiety Disorders and Psychotic Disorders
(Burns & Taube, 1990, 1991, Rovner et al., 1990)
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Unmet Need for Mental Health Services
in Nursing Homes
• Over one month: 4.5% of mentally ill nursing home residents received mental health services (Burns et al., 1993)
• Over one year: 19% in need of mental health services receive them. – Least likely: Oldest and most physically impaired
(Shea et al., Smyer et al., 1994)
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Decrease by 50%
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