Category: Mental Health

Guest post by Dr. Tamir Aldad, CEO of Mindful Care

I’m an addiction psychiatrist by training. In my work, I found that access to care was a major issue for seniors experiencing mental illness. In fact, my grandmother was dealing with really bad depression and we had nowhere to take her. That is part of why, in 2018, I founded Mindful Care, the first-ever chain of psychiatric urgent care clinics. We provide care to seniors in independent living, assisted living and skilled nursing communities.

One Definition of Mental Illness

Let’s start our discussion about older adults by talking about mental illness in general. Mental illness is a huge category ranging from depression to bipolar disorder to eating disorders and more. The common denominator is the fluctuation that affects people’s daily living. If someone has changes in their thinking and cognition, their ability to relate to others, and their functioning each day, those all are high criteria for mental illness.

Mental Illness in Older Adults: Underappreciated and Underrecognized

Older adults are more likely than any other age group to have mental illness, due to risk factors such as changes in their physical health; losses of their support system, spouse and friends; lack of a sense of purpose; substance disorders; and decline in functioning ability. Seeing as older adults are a very vulnerable population, but with fewer resources than others, and less likely to seek help, they need lots of attention. Unfortunately, healthcare providers and older adults often mistake depression, in particular, for a natural response to aging. This can lead to providers not screening for or treating it.

The Four Ds of Mental Illness in Older Adults

Here are the “four Ds” we should keep in mind when it comes to recognizing and treating mental illness in older adults:

Dementia: Life-altering loss of cognitive functioning
Dementia affects approximately 10% of people 65+ in the United States, according to a 2022 Columbia University study.

Delirium: An acute, fluctuating syndrome of altered attention, cognition and awareness
Delirium affects an estimated 14% to 56% of all hospitalized elderly patients, 20% of which experience complications while hospitalized directly because of delirium.

Depression: The persistent feeling of sadness or loss of interest that may include changes in sleep, appetite, energy level, concentration, daily behavior or self-esteem, and thoughts of suicide
Depression is increasing in the 65-plus population with suicide rates being a very serious problem, and it needs more awareness and attention.

Demoralization: A psychiatric experience of existential despair, hopelessness, helplessness, and loss of meaning and purpose 
Demoralization requires a certain level of empathy because it stems from despair and hopelessness at not being able to function at the same level anymore.

Many people don’t realize how widespread these symptoms of mental illness are. The two conditions that get neglected the most in the senior population are depression and demoralization. 

Causes and Risk Factors for Senior Mental Illness

Physical disability and changes in physical and cognitive health are a big risk factor for mental illness, as is a change in environment, like a sudden hospitalization or a move to assisted living. Grief is also a very common risk factor.

Other risk factors to watch for are long-term illness, substance abuse, medication interactions, the illness or loss of a loved one, and poor diet or malnutrition.

10 Symptoms of Mental Illness to Watch for in Your Residents

1. Sad or depressed mood lasting longer than two weeks
2. Social withdrawal, loss of interest in things that used to be very enjoyable
3. Unexplained fatigue, energy loss or sleep changes
4. Confusion, disorientation, problems with concentration or decision-making
5. Increase or decrease in appetite; changes in weight
6. Memory loss, especially recent or short-term memory problems
7. Feelings of worthlessness, inappropriate guilt, helplessness, thoughts of suicide
8. Physical symptoms that can’t otherwise be explained: aches, constipation, etc.
9. Changes in appearance or dress, or problems maintaining the home or yard
10. Trouble handling finances or working with numbers

Helpful Mental Health Goals and Interventions

Here are some goals and interventions that can help older adults experiencing mental illness:

 Validate the individual’s feelings

• Nurture a healthy adjustment to their stage of life
• Help promote acceptance of loss — letting go
• Explore and treat “survivor guilt,” which is often present when an elderly person has survived one of their children
• Explore for and treat a deep sense of guilt for wishing a loved one would die
• Foster involvement in life activities as fully as possible — especially exercise, which is not only healthy for the body, but for emotional well-being
• Use reminiscence therapy — discussion of past activities and experiences with another person or group
• Practice an integrated care model, where one person acts in the role of case manager, and the entire team shares information about the older person’s health

Overcoming Obstacles to Care and Stigma

One major obstacle to care is that people think symptoms of mental illness are a normal part of aging. Our culture teaches us to think these feelings are normal, when they’re not. What I’ve found effective with older adults is to not use formal terms like “‘mental illness” or “depression,” as they are loaded words and can have inherent bias. My approach is to treat feelings and validate them. It’s helpful to meet people where they’re at and recognize that these feelings can be embarrassing and hard to talk about. Encourage your team to do so as well.

If you’ve gotten to know a resident and they’re not acting like themselves, alert your team. Most importantly, create an environment where people are welcome however they are and however they feel.

If you have any other questions about mental health in seniors or want to learn more about Mindful Care, please feel free to engage with me at .

 

 

Last Monday, we organized a virtual forum where communities exchanged ideas about engaging residents during the coronavirus shutdown. Check out their creative solutions below.

We’re holding another Resident Life roundtable soon, and all are welcome to attend.

Join the next Resident Life roundtable on April 20!

We thank everyone for participating, and we invite you to join the next session, Monday, April 20, at noon ET: Resident Life discussion

You don’t have to be a client to join the session — all are welcome. For call-in information, email .

 

We know that every community and business in the aging services space is trying to stay ahead of safety and communications for the COVID-19 virus while juggling the needs of residents and staying connected with prospects. This led us to think about some free and easy tips that can keep current and future residents engaged and upbeat as much as possible while their movement is restricted.

Here are some ideas we’ve collected that we wanted to share with you. We realize that there are many more out there, but we thought this would be a good place to start.

Keeping Residents Engaged

Educational opportunities/lifelong learning/cultural stimulation

• Online museum tours
• Free live opera audio streams
• Resources for online courses, books, etc.
• Giant panda cam (National Zoo)
• San Diego Zoo live cams
• Fast Company article featuring different options
• 450 Ivy League courses you can take online right now for free 
• Wildlife cams
• The 50 best museum tours around the world

Spiritual grounding

• Free mediation
• Church services (many options online)
• Shabbat services (many options online)

Exercise

• Planet Fitness Free home “work-ins” every day
• Silver Sneakers  Free access to exclusive classes for yoga, cardio, balance and more

Connections

• Use in-house channels to share “coffee chats” with residents.
• Ask residents to send pics of what they enjoy doing in their homes to share with others in the community.
• Encourage residents to FaceTime with each other and with their families. (Send an email to all family members encouraging them to FaceTime with their loved ones regularly.)
• Caution against reading social media or listening to “hype” on TV or the radio, and encourage residents to reach out to the appropriate person if they’re at a low point.

Maintaining relationships with prospects

It’s important to always look for opportunities to follow up with prospects in meaningful ways, and the coronavirus pandemic is one of those (unfortunate) opportunities. Call your prospects to check on them during this health crisis, and ask if they are doing okay. Do they have food in the house? Is there anything they need? If they are local, drop off soup, muffins, toilet paper or other necessities on their doorstep. Recommend Netflix movies, documentaries, comedy shows or online live theater performances that might appeal to them. Give them ideas on how to stay safe, entertained, occupied and healthy. They will be grateful that you thought of them during this extremely stressful time.

In addition, we recommend virtual marketing events, where you can share details, floor plan walk-throughs, advice and just somebody new to talk with.

Social distancing doesn’t have to mean social detachment. During these troubling times, we all have to find new ways to stay connected.

 

The facts are clear: More Baby Boomers are working past what has been traditionally thought of as retirement age. In fact, a recent Pew Research Center study found that Baby Boomers are staying in the labor force at the highest annual rate for people their age in more than half a century.

Why Residents Still Work

We’re also hearing from communities that more residents are still working. That could mean full-time, part-time, freelance, consulting or owning a business. Financial reasons for continuing to stay in the workforce include not wanting to draw on social security and needing to help grown children financially. Some other reasons I’ve heard are nonfinancial. Residents are saying that working does some important things for them, like:

• Keeps me connected socially to a group of people I have come to appreciate being with
• Allows me an opportunity to keep my mind focused on something other than “retirement” and “getting old”
• Stimulates my mind, helps me remain relevant and gives me a sense of purpose
• Has always been such a significant part of my life — I can’t give it up yet

How Senior Communities Can Attract Them

So, how can senior living communities appeal to residents who are still working? Here are a few ideas:

1. Evening fitness classes — Whether residents are working from home or going to an office, they may be busy during the day. Traditional classes at 10 or 11 in the morning just won’t work for them. The same goes for gym hours. This innovative wellness program  features a 24-hour gym and flexible class times.
2. Smart home office design — When a couple I know moved into a retirement community, their apartment came with a small third bedroom. They redid it into an office, adding built-ins to make room for desks and storage, and made much smarter use of the space. Well-designed, highly functional office space that doesn’t need any remodeling to be effective could be a major draw.
3. High–speed internet — Wireless internet is the #1 desired amenity in senior living. It is even more important if a resident is working from home.
4. Co-working spaces — Residents who work at home would appreciate a dedicated co-working space where they could interact with other working residents. Click here to see one example of an amazing co-working space for seniors.
5. Work-related seminars and groups — Workshops and lectures on topics such as how to start a business or develop an online presence would be attractive to working residents and would help them build a network with their peers.

According to the U.S. Bureau of Labor Statistics, the labor force participation rate for the older segment of the population will continue to climb. Why not prepare your community by designing features that appeal to this rapidly growing demographic?

 

 

Your elderly widower neighbor, Mr. Johnson, has always been a jovial and social member of the community. About a year ago, he had a stroke that took its toll, but after a couple of months, he seemed to bounce back and was living in his home as usual again.

Last month, you noticed a pink slip taped to his door that was warning of his electric being shut off for nonpayment. Come to think of it, you haven’t seen him in a couple of weeks. That’s when you realize that his mailbox is stuffed to the gills and overflowing. You knock on his door, and he comes to greet you, smiling as always.

When you inquire about the slip and the mail, he tells you that his children are handling all of those items for him now, so he’s just leaving them in place until his daughter comes to visit next week. When you ask him if he needs any help around the house, he politely rejects your offer, saying that he has it under control. He points to his cat and remarks how chubby he is getting from being well-fed. He assures you that everything is fine and seems to genuinely appreciate your visit. You walk away from the house, feeling confident that Mr. Johnson is okay. Little do you know, he’s in an abusive situation because of self-neglect.

Elder abuse is a serious topic that aging services organizations have invested millions of dollars in preventing. They’ve trained their staff and volunteers to look for signs of abuse and actively report any issues that may arise. The culture around abuse has changed for the better, and older adults are living longer, happier lives because of it. Yet, there is still one area of elder abuse that we can’t seem to get our hands around: self-neglect.

A 2014 survey conducted by the National Association of Professional Geriatric Care Managers found that self-neglect among seniors was the most common form of non-financial elder abuse/neglect. Everyone knows to look out for signs of physical, sexual and even financial abuse among those they care for, but self-neglect can be a bit harder to spot and is easily written off as a personal or lifestyle choice rather than a form of abuse.

So, when does self-neglect rise to the level of truly being abuse that should be reported by a caregiver? Here are six signs to watch out for, as reported in the study:

1. A decline in personal hygiene, such as unkempt hair, failure to bathe regularly and inability to keep up with basic grooming habits
2. Failure to take medication on time and on schedule
3. Malnutrition or dehydration
4. Unsanitary living conditions
5. Inability to meet financial deadlines, such as unpaid bills, shut-off utilities, etc.
6. Weight loss, especially in light of food insecurity in the home

These signs all seem like they’d be very obvious to an outsider providing care, yet in practice, the signs can be much harder to spot, as the opening story illustrates.

We encourage everyone who is working in the aging services space to always remember to be on the lookout for signs of self-neglect, as they can occur both in the home and in retirement communities.

Sources:

http://www.asaging.org/blog/elder-self-neglect-growing-and-largely-hidden-problem

In an era where the average person feels more connected than ever, the issue of loneliness among seniors is becoming disconcerting. Boomers, Xers and Millennials have adapted to a social world that revolves around mobile technology, yet seniors are becoming increasingly disassociated from their families. So, what’s the root cause of this problem, and how can we address it as aging services professionals?

According to the latest U.S. Census Bureau data, about 28 percent of people aged 65 and older are living alone. As one ages, the chances of living alone increase. This makes sense, as spouses pass away and children move out. Of course, living alone doesn’t immediately make someone lonely, but we can all agree that it’s a step in the direction of loneliness.

Becoming a single-person household can start a chain reaction that leads to larger, wide-ranging problems. Studies have shown that older adults that feel lonely or isolated will begin displaying behaviors that make them increasingly more difficult to interact with in social situations, thus pushing friends and relatives even further away. This, of course, only makes the person feel more lonely, creating a vicious psychological cycle.

The negative implications of a lonely lifestyle are numerous. Isolated and lonely seniors have a 59 percent greater risk of mental and physical decline and show a 45 percent mortality increase. Of those living alone, one in seven is suffering from some kind of dementia, which can go undetected if a person isn’t engaging in regular social interactions.

Family dynamics have also changed. At one time, a child might have gone to visit his or her parents once or twice a month. Now, the number of in-person visits is dwindling, being replaced by less-frequent phone calls or perhaps the use of Skype and FaceTime. These technological visits don’t have the same effect for seniors that in-person interaction does.

One statistic of special note for aging services providers comes from data reported by AARP: Forty-five percent of people aged 45 or older who have lived in their current residence less than one year reported feeling lonely. Let that sink in for a minute!

Even in our vibrant, active communities — filled with intelligent and engaged residents and staff — new residents can feel especially lonely and isolated. It can become difficult for them to make new friends, navigate the social structure of your community and become involved in a meaningful way. Ensuring that each new resident is paired with a neighbor to show them the ropes when he or she moves in is vitally important.

The social workers at aging services communities are on the frontlines of the battle against loneliness, but each associate at your community should be on the lookout for signs of self-seclusion or withdrawal. Protecting residents, both physically and mentally, is an important part of each team member’s job.

Sources:

https://www.aarp.org/research/topics/life/info-2014/loneliness_2010.html

https://www.aplaceformom.com/blog/10-17-14-facts-about-senior-isolation/

“Did you notice that she didn’t come to lunch yesterday?”

“Have you heard who he’s sleeping with?”

“Oh, she’s a mess. She doesn’t comb her hair, and she always smells funny.”

Where do you think these quotes originate? Perhaps in a middle school cafeteria during lunch, or after a high school sports practice? Scarily enough, they could be happening right now, at any aging services community in the world. Bullying like this isn’t just a problem that afflicts young people. Increasingly, Boomers and seniors are becoming the victims of bullying by their peers.

A study released by Dr. Robin Bonifas of Arizona State University cites that 10 to 20 percent of residents of senior living communities have experienced some form of bullying. Take a moment to think about that number. This means that, between one in 10 to one in five residents have been bullied!

We can already hear you saying, “That doesn’t happen at my community! All of our residents are nice, lovely people who would never do that.” While we have every confidence that your community is a wonderful place to live, we also have to recognize that, when large groups of people live together in close surroundings, they are naturally going to come into conflict. For some, the way of handling these conflicts is to engage in negative behaviors that they may not even realize they are displaying.

While physical bullying is more common among younger groups, social and emotional bullying is the forte of older adults. Examples of bullying that fall into these categories are exclusion from social activities, the spreading of rumors and gossip, and negative personal speech. These behaviors can be further amplified by physical conditions, such as dementia and mental health issues. Where once someone was a loving and caring person, he or she might become negative and hurtful with the onset of dementia or after suffering from pain for a long period of time.

So, what can you do as an aging services professional to ensure that bullying doesn’t occur at your community? First, keep an open mind to the fact that it may be happening. Be mindful of residents’ behavior toward one other, and listen to what residents are saying about each other. Be certain to not agree with a resident’s negative actions or statements; rather, remind him or her that his or her behavior could be hurtful, and try to help the resident empathize with how the other person might feel.

A great resource for more information on this trend — and for ways to cope with bullying behavior — can be found at SeniorHomes.com, here: https://www.seniorhomes.com/p/bullying-in-senior-living-communities/

Whether we want to believe it or not, bullying is happening in our communities, and we must be cognizant of the impact that it has on resident life quality. Paying attention to the warning signs now can help to avoid bigger conflicts in the future.

If you’re a grandparent, you can still play a role in you adult grandchildren’s lives, and as a new study shows, they can help improve your life as well. Researchers have concluded that a strong relationship between grandparents and their adult grandchildren has real, measurable effect on one another’s psychological well-being.

Top-level findings indicated that a close emotional relationship between the generations was associated with fewer symptoms of depression for both. Also, giving tangible support to, or receiving it from grandchildren affected the psychological well-being of grandparents but not their grandchildren. That support, also called “functional solidarity” or “instrumental support,” includes good deeds: rides to the doctor, monetary assistance, help around the house, or simple advice.

The study also supports conventional folk wisdom that if a grandparent gets help but can’t give it, he or she feels badly.

“Grandparents expect to be able to help their grandchildren, even when they are grown, and it’s frustrating and depressing for them to instead be dependent on their grandchildren,” said study co-author Sara M. Moorman, Ph.D.

Methodology included data from the Longitudinal Study of Generations, a survey of 3- and 4-generartion U.S. families that had been collected between 1985 and 2004. Subjects included 376 grandparents with an average age of 77, and 340 grandchildren with an average age of 31.

Moorman also believes the research suggests that extended family members serve important functions in each other’s daily lives throughout adulthood, and that efforts to strengthen families shouldn’t simply focus on families with young children. It also indicates that helping older people remain functionally independent may aid their physical and psychological well-being.

“All people benefit from feeling needed, worthwhile, and independent,” she said. “In other words, leg Granddad write you a check on your birthday, even if he’s on Social Security and you’ve had a job for years.”

Source: American Sociological Association

MARKETING INSIGHT: It’s an interesting study, and it supports the important role of grandchildren as being influencers in their grandparents’ lives – from technology to care options. In many cases, this could be due to the rise in multigenerational households, or simply the grandparents’ desire to stay connected and ahead of the proverbial curve. For grandchildren, it’s a primer to stay in contact, whether the grandparent lives in a CCRC or on their own – in person or via Skype. In any case, marketers need to keep the grandkids in the loop when trying to reach the older contingent.

Regards,

The Varsity Team

We’ve seen evidence of how factors such as watching your diet, exercising, and even remaining in the workforce or managing blood sugar appropriately have positive impacts on mental health. Now a recent study has found that a lifetime of reading and writing can also have a huge effect in fighting memory loss.

A research team at Rush University Medical Center in Chicago studied approximately 300 older adults (all over age 55) for a period of six years. Participants were given a survey to determine how frequently they read, wrote or did similar activities as children, adolescents, through middle age, and at their current age. The subjects were then tested for their memory and other mental abilities every year until they died, after which their brain tissue was examined.

The rate of cognitive decline among older adults who reported frequent reading and writing later in life, for example, was 32% lower than those with average or low mental activity (compared with a rate of 48% among people who were less mentally active). Autopsies also revealed that the brains of more mentally active participants showed fewer physical signs of dementia.

“Our study suggests that exercising your brain by taking part in activities such as these across a person’s lifetime, from childhood through old age, is important for brain health in old age,” lead author Robert S. Wilson, senior neuropsychologist of the Rush Alzheimer’s Disease Center, said.

There’s been debate over whether brain activity can resist, prevent – or simply postpone – the effects of dementia or Alzheimer’s. Prashanthi Vemuri, an assistant professor of radiology at the Mayo Clinic, told HealthDay that researchers have long argued whether staying mentally stimulated helps slow cognitive problems, or if those who stop doing mental tasks do so because they are starting to show symptoms of dementia.

“This study gives evidence to the former theory,” he said. “It confirms that whatever is happening in the brain is happening, but the cognitively stimulating activities a person does independently slow down the progression of the disease.”

MARKETING INSIGHT: No one should underestimate the importance of staying mentally or physically active for as long as possible. However, experts recommend a combination of the two – not simply choosing between reading a book or taking a walk.

What this research does provide, however, is something that could be promoted as a benefit of a comprehensive wellness program – something that would appeal to the incoming generations who are increasingly being affected by memory issues, and are seeking unique programs that show tangible results.

Although many retirement communities claim to offer “wellness programs,” we’ve seen through our own research that the concept of “wellness” goes beyond the swimming pool, a craft room, a walking path or standard group activities. There’s a huge demand for an ongoing, full-culture comprehensive and adaptive wellness environment. In many cases, potential residents look directly at these programs in their decision-making process.

Regards,

The Varsity Team