August 4, 2015

August is Mental Health month. Our focus is depression and seniors.

We are in the midst of a mental health crisis that impacts seniors every day. And yet, in the media, the focus tends to be on youth or working adults, not the elderly.

Perhaps it’s because we view some mental health issues as a natural part of aging when in fact it isn’t.

A recent survey performed in Nova Scotia, Ontario, Manitoba, Saskatchewan and the Yukon indicated that 44% of seniors were either diagnosed or had symptoms of depression. Let that number sink in for a moment.

And depression is only one in the list of several mental health issues that can affect seniors. In fact, 1 in 5 seniors have mental health issues.

It’s a rising issue in our country and one that is not talked about nearly enough.

Bonnie Schroeder, Executive Director of the Canadian Coalition for Senior’s Health notes that, “the first step is to understand that mental health issues are not just a natural part of aging and shouldn’t be considered as such.”

We are seeing an increase in dementia and other cognitive impairment issues and already in the long-term care industry in Canada we are struggling to handle this effectively. As this number continues to rise, the long-term care community must be able to step up.

As part of any conversation on mental health an examination of the risk factors for the elderly is important. These factors include a senior moving from their home to another location, the loss of partner/spouse, isolation from their community, and the inability to accomplish tasks that they could easily do before.

Physical illness can also take a toll on a person’s mental health. It’s easy to become discouraged or despondent when illness strikes. Studies are now making links between physical problems such as diabetes and mental health issues like depression.

David Whalen states in his paper, that, “because physical health and mental illness are so often intertwined, the physical changed experienced by the elderly can create stress and uncertainty which can in turn call mental illness.”

He goes on to note that “these changes can range from the reduction of sensitivities (e.g. hearing loss, reduced vision, etc) to conditions affecting mobility and/or cognition (e.g. heart disease, stroke, arthritis, etc).

There are several types of mental health problems seniors face and the list below does not encapsulate all of them.


Depression is often mistaken for being the most natural sign of aging. This is still very much up for debate. For example, bereavement is a natural form of depression when your loved one passes away, however factors such as a disproportional reaction to said loss, guilt that is unrelated to the deceased and mood congruent delusions can signal the deeper issue of depression. The notes that even three to six months after the loss, risk factors can include social isolation, memory difficulties, a recent major physical illness and persistent sleep difficulties.

Past bouts of depression are also something that caregivers need to be aware of, as this can predict potential for future difficulties with it. Depression can manifest itself in many different ways which is why it can be hard to diagnose.

Dementia and Delirium

Dementia is an ever increasing problem however there is a lesser known health problem that could be mistaken for dementia. This is delirium which presents itself as similar to dementia except for an important distinction. Delirium develops over a short period of time and can fluctuate.

The states that “Delirium can occur as a consequence of a medical illness, substance intoxication or withdrawal or other conditions (eg. sensory deprivation). Other risk factors include visual and/or hearing impairment, and depression.”

It’s important to recognize the differences between dementia and delirium and understand that they can also co-exist with each other and other mental health issues.


Suicide is a major concern, especially for older adult males. The 1997 suicide rate for older Canadian men was nearly twice that of the nation as a whole and nearly five times that of older Canadian women. (footnote)

Risk factors include mental illness such as mood disorders, major physical illness, negative life events such as housing changes and financial losses as well as personality factors like non-adaptive coping strategies.


Anxiety is also a common illness among the elderly. Often undiagnosed, anxiety can affect daily tasks, as well as relationships and social interactions.

The umbrella of anxiety includes specific phobias, social anxiety disorder, PTSD and panic disorder. Anxiety is often co-morbid with depression and risk factors include extreme stress, trauma, medical illnesses and neurodegenerative disorders.

Signs can include depression, lack of sleep, self medication, isolation and avoidance of social interactions, hoarding, and physical symptoms like nausea, shaking, and shallow breathing.

These are just a few of the mental health issues to be aware of. It’s also important to recognize other mental illnesses a resident may already be dealing with such as bipolar disorder, substance abuse issues, claustrophobia, generalized anxiety disorder and more.

Mental health issues can be hard to spot and be easily dismissed because it’s something that occurs within us. It can be hard to explain the engulfing darkness that can come with depression or the desperate thoughts that won’t leave you alone when you are suicidal.

Mental health problems and mental illnesses also carry a stigma, one that leaves people unwilling to share what is happening with them. Often when you are in the throes of a mental health problem, you can think you are the only one who is dealing with these problems. This can cause someone not to speak up.

The words mental health and mental illness come with a stigma all their own. It’s important to have open discussions about these issues and to share knowledge on the topic. This is what breaks down stigma and makes it okay for someone to say out loud that they have a mental illness.

In the long-term care industry, there’s often a focus on the physical well-being but it is equally important to focus on the mental well-being of your residents. Schroeder notes that the DSM-IV criteria should be used when assessing residents and their capabilities both on admission to a facility and on an ongoing basis.

There’s a higher rate of mental health problems among the elderly in care facilities. And with the rising rate of dementia and other mental health issues, facilities need to focus on this area of concern.

Training is key

Staff and management must be aware of the risk factors and signs of mental health issues in order to recognize them. Time is also another issue. It can be hard to focus on each resident’s mental health when there are so many physical concerns to deal with as well. There are some tools available.

The Continuing Care Reporting System, launched by the Canadian Institute for Health Information states in its report that the “RAI-MDS 2.0 is a comprehensive assessment that documents the clinical and functional characteristics of residents including measures of cognition, communication, vision, mood and behaviour, psychosocial well-being, physical functioning, continence and more.”

This is an assessment that is completed upon admission to the facility and every three months after.

It’s also important to have procedures and policies in place. Schroeder firmly insists that “facilities should have suicide prevention policies.” There should also be written policies surrounding the administration of medication and the use of restraints. Staff need to be aware of how they can care for their residents who are dealing with mental health issues and this is achieved by education as well as a written protocol.

And most of all, you should listen and understand your residents. Senior men have the highest rate of suicide and perhaps a few small changes, such as providing opportunities for both men and women to participate can make a difference. “[Men] participate differently.” Schroeder states. “And activities tend to be focused on women.” Compounding that problem is a female dominated industry which could make it more difficult to program for traditionally male-centric interests.

Small changes to prevent isolation and indicate that you are there for your residents and are open about their issues can help.

Addressing the mental health needs of residents is a complex issue but one that needs to be focused on as the population of seniors in our country grows.

We are the only country in the G8 without a national dementia strategy. We also do not have a senior’s mental health awareness day, and yet, those who work in long-term care are aware, because you deal with it every day.

We are in the midst of a crisis but there is no doubt the long-term care industry can rise to the challenge.

Article by Lindsey Patten

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