Module 16 : Aging & Mental Health: Depression, Alcohol and Prescription Drugs

• Neurological disorder that causes general and progressive problems affecting:
• Memory.
• Learning new information.
• Communicating.
• Making good judgments.
• Coordination.
• Usually accompanied by personality and behavior changes.
• Onset is gradual.
• Condition gets progressively worse.
• Other medical conditions such as hypothyroidism and B12 deficiency are ruled out.

Signs and Symptoms Suggesting Dementia

• Becomes lost or disoriented.
• Has difficulty performing familiar tasks.
• Cannot make decisions.
• Repeats things.
• Displays poor grooming.
• Wears inappropriate clothing.
• Problems with language.
• Disoriented to time and place.
• Has poor or decreased decision-making abilities.
• Has problems with abstract thinking.
• Misplaces things.
• Experiences changes in mood or behavior.
• Experiences changes in personality.
• Losses of initiative.
• Becomes accusatory and aggressive.

Incidence of Dementia 

• 4 million Americans have dementia.
• 5% of people over age 65 and 20% of those over 85 have some degree of dementia.
• Alzheimer’s disease accounts for 60% of all cases of dementia.
• 15-20% caused by strokes (vascular dementia).
• 15-20% results from other neuro-psychological disorders, i.e. Parkinson’s disease and Huntington’s disease.

• Neurological disorder that causes general and progressive problems affecting:
• Memory.
• Learning new information.
• Communicating.
• Making good judgments.
• Coordination.
• Usually accompanied by personality and behavior changes.
• Onset is gradual.
• Condition gets progressively worse.
• Other medical conditions such as hypothyroidism and B12 deficiency are ruled out.

Signs and Symptoms Suggesting Dementia

• Becomes lost or disoriented.
• Has difficulty performing familiar tasks.
• Cannot make decisions.
• Repeats things.
• Displays poor grooming.
• Wears inappropriate clothing.
• Problems with language.
• Disoriented to time and place.
• Has poor or decreased decision-making abilities.
• Has problems with abstract thinking.
• Misplaces things.
• Experiences changes in mood or behavior.
• Experiences changes in personality.
• Losses of initiative.
• Becomes accusatory and aggressive.

Incidence of Dementia 

• 4 million Americans have dementia.
• 5% of people over age 65 and 20% of those over 85 have some degree of dementia.
• Alzheimer’s disease accounts for 60% of all cases of dementia.
• 15-20% caused by strokes (vascular dementia).
• 15-20% results from other neuro-psychological disorders, i.e. Parkinson’s disease and Huntington’s disease.

• Everyone who has Alzheimer`s disease has dementia.
• Not everyone who has dementia has Alzheimer`s disease.
• Not the same progression for everyone but predictable stages.
• Diagnosis:
• Complete medical history.
• Medical tests – such as tests of blood, urine, or spinal fluid.
• Neuropsychological tests to measure memory, problem solving, attention, counting, and language.Brain scans

Normal Aging or Dementia and Alzheimers (Microsoft Word Document)
Alzheimer`s Disease 

Ruling out other disorders – the only true diagnosis for Alzheimer`s Disease is finding ‘plaques and tangles` in the brain during autopsy after death.

• Disease of the brain.
• Causes injury to nerve cells in the brain.
• Results in disrupted memory, thinking and functioning.
• Somewhat greater risk for people with family history of Alzheimer`s disease.
• Race or ethnicity does not seem to be a factor.

• Symptoms of Depression
•  Loss of joy.
• General sadness.
• Fatigue.
• Changes of appetite.
• Changes of sleep patterns.
•  Loss of self-worth, self destructive thoughts.
• Decreased performance.
• “Slowness” of physical and mental functions.

Depression in the Older Adult

• Treatment complicated by other illnesses and aging body functions.
• Physicians may overlook, assuming symptoms are a normal  part of aging.
• Loss and grief are part of everyday life.
• Physical limitations.
• Loss of purpose (retirement).
• Loss through death.
• Depression is a treatable medical illness.

Suicide Risk

• Suicide is the major consequence of undetected and untreated depression.
• Greatest risk factors of suicide in older adults:
• Living alone.
• Being male.
• Experiencing the loss of spouse.
• Failing health.
• Use of alcohol.

Warning Signs of Potential Suicide

• Extreme mood or personality changes not related to dementia or other diagnosed illness.
• Talking about death and suicide.
• Preoccupation with the continuing the struggle of daily life.
• Feeling helpless and hopeless.
• Giving away cherished objects.
• Disturbance in sleeping or eating.
• Severe threat to self or self-worth.
• Extended grief following death of loved ones.

• Older adults use 1.5 billion or 30% percent of all prescription drugs and 40% percent of all over-the-counter drugs (US Food and Drug Administration, 2004).
• Estimates vary of average number of medications older adults take each day – up to 20 or more.

Over the Counter Drug Usage of Older Adults – OTC

• 87% of older individuals (mean age 745 years) reported regular use of at least one OTC medication.
• 57% reported taking five or more OTC medications daily.
• Given the recent rise in use of “nutriceuticals” such as herbal remedies, these figures are likely to be underestimates.
  Aging & Drug Effectiveness (Microsoft Word Document)
  Prescription Drugs & Aging (Microsoft Word Document)
  Click here to download a free Word viewer if you don`t already have Microsoft Word on your computer.

• Prescription medication misuse is the most common form of drug abuse among older adults
• Drug misuse is the under-use, overuse, or erratic use of medications
• 17% abuse alcohol and drugs:
• Alcohol continues to be the leading cause of addiction in older adults
• It is estimated that 25 million older adults have problems related to alcohol
• Rates for hospitalizations due to alcohol-related problems among older adults are similar to those for heart attacks.
• Less than 2% of alcohol or drug treatment admissions in 1997 were for persons 55 and older
• Studies show that half of all tranquilizer prescriptions for older adults were inappropriate

Signs of Possible Alcohol Misuse or Abuse in Older Adults

• Changes in sleeping and eating patterns.
• Confusion or disorientation.
• Malnutrition.
• Poor hygiene.
• Neglecting one`s appearance.
• Slurred speech.
• Incontinence.
• Difficulty urinating.
• Tremors.
• Shakiness.
• Frequent falls and bruising.
• Physical effects of alcohol.
• Drink to “calm my nerves,” forget worries, or reduce depression.
• Lose interest in food.
• Gulp drinks down fast.
• Lie or try to hide drinking habits.
• Drink alone more often.
• Hurts self, or someone else, while drinking.
• Were drunk more than three or four times last year.
• Need more alcohol to get “high.”
• Feel irritable, resentful, or unreasonable when not drinking.
• Have medical, social, or financial problems caused by drinking.

Effects of Alcohol Misuse

• Because alcohol affects alertness, judgment, coordination, and reaction time, drinking increases the risk of falls and accidents.
• Takes less alcohol to affect older people.
• Over time, heavy drinking permanently damages the brain and central nervous system, as well as the liver, heart, kidneys, and stomach.
• Alcohol`s effects can make some medical problems hard to diagnose For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack.
• May cause forgetfulness and confusion, which can seem like Alzheimer`s disease.
• Older persons who abuse alcohol are also more likely to be malnourished.
• These symptoms can also be caused by other medical problems.

Alcohol & Prescription Drugs (Microsoft Word Document)   Click here to download a free Word viewer if you don`t already have Microsoft Word on your computer. When is Alcohol a Problem?

• What time of the day?
• How often?
• What is going on when drinking?
• How much is the person drinking?
• Why?  (Trigger)
• Safety.
• Self care.
• Relationships.
• Physical problems.
• Thinking and reasoning (cognitive impairment).

Prescription Drug Abuse and Older Adults – Common Signs and Symptoms

Prescription Drug Abuse and Older Adults- Issues for older adults

• Adverse Drug Reactions.
• Cost of medications.
• Not taking those prescribed.
• Medication  “swapping.”
• “Polypharmacy“ – Taking   a large number of medications.
• Drug Interactions.
• Drug to drug.
• Drug to disease.
• Food-drug interactions.
• Decline in liver and renal function with age.
• Body composition changes (greater relative fat content, decreased relative free body water).
• Not following medical advice or taking medication as  prescribed
• Sleeping medications (e.g., Ambien, Sonata, Restoril, Halcion, Dalmane)
• Anti-angina medication (e.g., Isordil, nitroglycerin)
• Aspirin
• Flagyl
• Blood thinners (e.g., Coumadin

What to Do?

• Involve the medical doctor.
• Medical examination.
• Report all prescription drugs, over-the-counter medications, and use of  herbal remedies.
• Report observations about alcohol use; encourage the older adult to be candid about use – this is a health issue.
• Use EAP benefits.
• Call 2-1-1.
• Mental Health Association.
• Mental Health Mental Retardation.
• Local council on alcoholism and drug abuse.

• Health care.
• Nutrition.
• Physical activities.
• Mental activities:
• Mental exercises to keep the brain strong and flexible such as reading; crossword puzzles to build vocabulary; jigsaw puzzles; games; mental puzzles/quizzes; crafts; writing journals; discussions with others.
• Hobbies.
• Social and civic clubs.
• Continuing education (through cities, community colleges, etc):
• Computer classes.
• Current event seminars.
• Avoid isolation.

• What not to do?
• What to do?

Care for self

• What not to do?
• What to do?

Also see: Module 9~Caring for the Caregiver
Help Older Adults Balance Stress of Daily Living with Positive Experiences

• Environmental – home/nature
• Social
• Health

• 2-1-1 throughout Texas Provides health and human service information for people of all ages.
• 1-800-252-9240 to get connected with the Texas Area Agency on Aging for your community.
• 1-800-677-1116 Elder Care Locator to find help in another part of the state or another state.

Online: 

• www.benefitscheckup.org  – Helps determine what benefit programs are available.
• Tarrant Council on Alcoholism & Drug Abuse (serving a 12-county region)
• Great Dallas Council on Alcohol and Drug Abuse
•  Star Council (Stephenville)

What Assistance is Available through the Area Agency on Aging (AAA)?

• Information and Referral.
• Caregiver Education and Training.
• Caregiver Respite.
• Caregiver Support Coordination.
• Case Management.
• Transportation.
• Benefits Counseling.
• Ombudsman (advocacy for those who live in a nursing home or assisted living facilities).
• Home Delivered Meals.
• Congregate Meals.
• Light Housekeeping.

• Connie Burdick, LMSW, LCDC
• Zanda Hilger, M.Ed., LPC
• Reviewed by Tarrant Council Alcoholism and Drug Abuse

Sources:

• As sited in the body of the module.
• Caregiver Education, Area Agency on Aging of North Central Texas, Dallas County, and Tarrant County

Permission is granted to duplicate any and all parts of this program to use in education programs supporting family members caring for elders.

• This program is one module of a comprehensive caregiver education program. Go to our site map & links page for more information about family caregiving topics.
  • Internet links
  • Frequently asked caregiver questions
  • Legal forms
  • Phone numbers