SENIORS AND MENTAL HEALTH & DEMENTIAS

Research Highlights

• The prevalence of mental health problems among the elderly is estimated to be between 17% and 30%.
• Dementia is the most common mental problem among seniors. It is age-related, affecting less than 1% of persons under age 65, compared to 35% of individuals over 85.
• Depression co-exists with dementia in 20% to 30% of cases.
• The two main challenges for seniors with mental health problems living in Guelph-Wellington are:
  • Social isolation
  • Housing

How Many Seniors Experience Mental Health Problems?
The occurrence of most mental disorders is considered to be the same among seniors as it is among other age groups, except for age-related psychiatric disorders such as dementia and delirium.¹ Since 2% of the population of Ontario experiences the most severe mental illnesses, then it is likely that a significant segment of this cohort will age and require the same services as those with age-related psychiatric disorders.² If less severe disorders, substance abuse, and age-related disorders such as dementia and delirium are included, then the prevalence of mental health problems among the elderly is estimated to be between 17% and 30%.³

The Most Common Mental Disorders Experienced By Seniors
Dementia
Dementia is a medical condition that interferes with the way the brain works. Symptoms include anxiety, paranoia, personality changes, lack of initiative, and difficulty acquiring new skills.

Alzheimer's Disease is the most common form of dementia, accounting for 64% of all dementias in Canada.⁴ Besides Alzheimer's Disease, some other types or causes of dementia include: alcoholic dementia, depression, delirium, HIV/AIDS-related dementia, Huntington's disease (a disorder of the nervous system), inflammatory disease (for example, syphilis), vascular dementia (blood vessel disease in the brain), tumors, and Parkinson's disease.

In Alzheimer's Disease and other dementias, problems with memory, judgment, and thought processes make it hard for a person to work and take part in day-to-day family and social life. Changes in mood and personality also may occur. These changes can result in loss of self-control and other problems.

According to the Canadian Study of Health and Aging (1994):

• Approximately 250,000 Canadians (8% of the population aged 65 and over) meet the criteria for dementia set by the study.
• Approximately 60% of individuals with dementia were considered to have Alzheimer's disease and almost 20% vascular dementia.
• The number of Canadians with dementia will rise to an estimated 592,000 by 2021.
• Dementia is age-associated. It affects less than 1% of persons under age 65, as compared to 2.5% of persons between the ages of 65 and 74, and 35% of individuals over 85.
• Depression co-exists with dementia in 20% to 30% of cases.

Using data from the Canadian Study of Health and Aging, the Wellington Dufferin Expert Geriatric Services Project estimates that there are 2,452 individuals aged 65 and older living in Guelph-Wellington-Dufferin who have dementia (2001).⁵ This number is expected to rise by 51% by 2016.

Source: Wellington Dufferin Expert Geriatric Services Project – Final Report (March 2005)
with data from the MOHLTC Provincial Health Planning Database, 2002.

Alzheimer's Disease
Alzheimer's Disease is the most common senile dementia in patients greater than 65 years old. It is a devastating disease causing loss of recent memory, followed by old memories and apraxias or inability to carry out a normal procedure such as dressing, eating, etc. It proceeds in stages over months or years and gradually destroys memory, reason, judgement, language and eventually the ability to carry out even simple tasks. The patient is finally bedridden with many neurological signs and usually dies of pneumonia, heart attack, or stroke.

Although there is no cure for Alzheimer's Disease at this time, it may be possible to relieve some of the symptoms, such as wandering and incontinence.

Family History
Some forms of Alzheimer's Disease are inherited. Many studies indicate that people with a relative (parent, brother or sister) with Alzheimer Disease have a greater chance of developing the disease than those with no family history.

Possible Signs

• Learning and remembering new information.
• Handling complex tasks.
• Reasoning ability.
• Spatial ability and orientation.
• Language.
• Behaviour.

How common is Alzheimer's Disease?
About 5% of people above 65 years of age, about 20% of those over 80 years and about 30% of those over 90 suffer from Alzheimer's Disease.

Depression
Next to dementia, the most common mental health problem among seniors is depression.⁶ Poor physical health, financial insecurity, loss of a partner, living alone, and social isolation are some of the factors that can lead to depression.

However, depression among the elderly is often under-diagnosed and under-treated since other health problems can mask its symptoms. The observed symptoms may also be considered as part of the normal aging process. Unlike depression in younger people, depression in seniors is often exhibited as anxiety, agitation, and complaints of physical and memory disorders.⁷

The prevalence of clinical depression among seniors living in the community in Canada ranges from 1.2% to 11.2%.

There are significant differences in prevalence rates between women and men, with women experiencing almost twice the rate (14.1%) than reported for men (7.3%).⁸

It is estimated that between 30% and 40% of seniors living in an institution suffer from some degree of depression.⁹

Studies suggest that unrecognized and untreated depression among seniors may result in excessive use of health care services, increased length of stay during hospitalization, decreased treatment compliance, and increased risk of medical illness and suicide.¹⁰

Delirium
Delirium is generally a reversible mental health disorder but can have serious implications if not diagnosed and treated. It is usually precipitated by a physical illness or drug use. Behavioural changes associated with delirium include extreme agitation or withdrawal and drowsiness to the point of stupor. Disorientation, incoherent speech and hallucinations are also common indicators.¹¹

It is estimated that 13% of all hospitalized older adults develop delirium.¹² Prevalence rates in the community are difficult to determine since most estimates are based on patients admitted to hospitals.

Suicide
In 1993, 14 out of every 100,000 seniors in Canada committed suicide. This rate is comparable to people in the 15 to 24 age group.¹³ The suicide rate among male seniors (24 per 100,000) is much higher than among female seniors (6 per 100,000).¹⁴

Substance Abuse
Alcohol is the most common substance misused by older adults. Alcoholism is often hidden, denied, or unrecognized. Substance abuse among seniors may also involve prescription or non-prescription (over the counter) drugs. Since aging tends to slow the body's metabolic rate, seniors may experience new reactions to substances they have been using for years. Generally, they require less of a substance than when they were younger to feel the same effects.¹⁵

Alcohol abuse is estimated to affect between 5% and 11% of seniors.¹⁶ As in other age groups, men over 65 years of age tend to drink alcohol more frequently than women over 65 years of age.¹⁷ One third of older adults with drinking problems begin misusing alcohol after they reach old age.¹⁸

Community Supports & Services (non-medical)
Alzheimer’s Society is dedicated to improving lives of those with Alzheimer’s Disease and related dementias, their caregivers and those who provide care, through support, education and the promotion of research. They provide a Safely Home Program (a national registry for those who wander) and offer support groups for individuals with Alzheimer’s disease.

The Canadian Mental Health Association (CMHA) focuses on combating mental health problems and emotional disorders through research and information services. In addition, CMHA acts as a social advocate to encourage public action and commitment to strengthening community mental health services and legislation and policies affecting services.

The Community Mental Health Clinic (CMHC) offers specialized psychiatric and mental health assessments and treatments for seniors experiencing mental health difficulties.

Homewood Health Centre is a privately owned and publicly funded mental health and addiction treatment centre, providing specialized psychiatric services to Canadians. The Centre runs a Program for Older Adults which provides assessment and treatment for adults 55 and older who have an identified mental health problem, which requires hospitalization, such as depression, anxiety, general psychiatric illness, dementia or addiction.

The Mood Disorders Support Group of Guelph is a self-help and support group for people dealing with depression, bi-polar, and anxiety disorders working towards reducing stigma both within the group as well as in the community.

Of the above programs, United Way Community of Guelph & Wellington funds CMHA’s Community Development & Education service and the Mood Disorders Support Group.

What are the Social Service Issues in Guelph-Wellington?

Social Isolation
Research shows that seniors with strong social networks, who feel useful to society and participate actively in it, have lower mortality and better physical and mental health.¹⁹

Social support tends to decline with age. Many seniors lose their support networks, when spouses and friends die or are moved to residential care facilities. According to the Ontario Health Survey (1996/97), 43% of seniors over the age of 75 reported high social support, compared to 89% of the population above 12 years of age.²⁰

Isolation directly impacts on an individual’s quality of life. Socially isolated individuals can easily fall into the spiral of doing fewer activities, including activities of daily living such as self care (e.g. bathing, grooming, mouth care), exercise and meal preparation. Seniors risk losing their sense of purpose and self-worth, and are prone to depression. Local providers report a need for more for social programs that allow seniors, especially those experiencing similar issues such as dementia, to interact.

Housing
There is currently a long waiting list for residential care facilities. This is especially true for individuals diagnosed with dementia or other mental health problems.

1. Conn, D. K. (2002). An overview of common mental disorders among seniors. Writings in Gerontology, No .18, 19-32, National Advisory Council on Aging.
2. Offord, D. et al. (1994). Ontario Health Survey 1990 – Mental Health Supplement. Ottawa, Ontario: Ontario Ministry of Health.
3. Elderly Mental Health Care Working Group (2002). Guidelines for elderly mental health care planning for best practices for health authorities. Vancouver, British Colombia: British Columbia Ministry of Health Services.
4. Toronto Dementia Network(n.d). Altzheimer’s and Heredity. Retrieved from http://www.dementiatoronto.org/FAQ/faq_heredity.htm.
5. LeBlanc, Jocelyn (ed.) (2005). Wellington Dufferin Expert Geriatric Services Project – Final Report (with data from the Canadian Study of Health and Aging Working Group). Waterloo Region-Wellington-Dufferin District Health Counco; Guelph, Ontario, pp. 56.
6. Elderly Mental Health Care Working Group (2002). Guidelines for elderly mental health care planning for best practices for health authorities. Vancouver, British Colombia: British Columbia Ministry of Health Services.
7. National Advisory Council on Aging (1999). 1999 and beyond: Challenges of an aging Canadian society. Ottawa, Ontario: Health Canada - Division of Aging and Seniors.
8. Newman, S.C.; Bland, R.C.; Orn, H.T. (1998). The prevalence of mental disorders in the elderly in Edmonton: A community survey using GMS-AGECAT. Canadian Journal of Psychiatry, 43(9).
9. National Advisory Council on Aging (1999). 1999 and beyond: Challenges of an aging Canadian society. Ottawa, Ontario: Health Canada - Division of Aging and Seniors.
10. Conn, D. K. (2002). An overview of common mental disorders among seniors. Writings in Gerontology, No .18, 19-32, National Advisory Council on Aging.
11. Ibid.
12. McEwan, K.L. et al. (1991). Mental health problems among Canada’s seniors: Demographic and epidemiologic considerations. Ottawa, Ontario: Health and Welfare Canada.
13. National Advisory Council on Aging (1999). 1999 and beyond: Challenges of an aging Canadian society. Ottawa, Ontario: Health Canada - Division of Aging and Seniors.
14. Ibid.
15. Eliany, M. & Clarke, J. (1992). The use of alcohol and other drugs by older Canadians and its consequences. Ottawa, Ontario: Health and Welfare Canada.
16. McEwan, K.L. et al. (1991). Mental health problems among Canada’s seniors: Demographic and epidemiologic considerations. Ottawa, Ontario: Health and Welfare Canada.
17. National Advisory Council on Aging (1999). 1999 and beyond: Challenges of an aging Canadian society. Ottawa, Ontario: Health Canada - Division of Aging and Seniors.
18. Elderly Mental Health Care Working Group (2002). Guidelines for elderly mental health care planning for best practices for health authorities. Vancouver, British Colombia: British Columbia Ministry of Health Services.
19. National Advisory Council on Aging (1999). 1999 and beyond: Challenges of an aging Canadian society. Ottawa, Ontario: Health Canada - Division of Aging and Seniors.
20. Public Health Research, Education & Development Program (2000). Report on the Health Status of the Residents of Ontario. Chapter 11, 141-154.