Aging and Mental Illness

 

Since the time of Hippocrates, physicians included conditions what we now consider mental illnesses in their classifications of disease. These conditions were treated in the  same way as physical disorders, using potions, medicine, and other forms of physical intervention. Nevertheless, the belief that insanity is similar to other diseases met with resistance during two periods in Western history. The first followed Thomas Aquinas, a philosopher and theologian who attributed insanity to supernatural possession. The second occurred late in the eighteenth century, when physicians influenced by René Descartes, considered mental illness a disease of the mind rather than body. The psychoanalytic schools emerging at the end of the 19th century promoted this philosophy, treating mental illnesses as psychiatric disorders. Although, medical opinion continues to be uneasy about this issue.  

The study of the frequency of diseases is called epidemiology. Epidemiological studies provided the first comprehensive survey of mental disorders at different ages.

Depression in later life stands opposite to mental well being on a mental health continuum. The symptoms of depression in older people include

- depressed mood

- loss of pleasure

- sleep disturbance

- appetite disturbance

- loss of energy

- difficulty in concentration

- low self-esteem

- psychomotor agitation

- suicidal thoughts

At least five symptoms must be present almost everyday during a two-week period. The worldwide prevalence of depression indicates higher rates among women than in men, and for unmarried  (e.g., divorced, separated) than for married people. Depression in older people increases the risk of mortality from physical illness and suicide. It also contributes to cognitive decline in the non-demented elderly, and may be an early manifestation (rather than predictor) of dementia. 

 Diseases of Memory and Judgement

 The two main conditions associated with impaired cognitive functions in later life are dementia and delirium. Dementia at this stage in life takes the form  of Alzheimer's disease, and to a lesser extent vascular dementia. Both involve a progressive deterioration in cognitive capability because of changes within the brain, but they have different causes. Alxheimer's disease is associated with plaques and tangles in brain matter. Vascular dementia is caused by stroke or artery disease, which staves the brain of oxygen, and includes signs of focal neurological damage. Delirium is a disturbance of the consciousness and cognition associated with a medical condition. Delirium may also be caused by the use or withdrawal  of drugs, or other conditions.

Risk factors for dementia included family history, low education, and head injury, with low risk associated with arthritis and the use of non-steroidal anti-inflammatory drugs.  Recent research on risk factors show that low physical activity in people aged over 65 years may be predictive of the onset of dementia within a six-year period. 

There is a predictable stage-by-stage progression of cognitive decline in Alzheimer's disease. The symptoms include forgetfulness, confusion, failure to recognize familiar people, loss of memory for recent events, disorientation, and the loss of all verbal ability. Other symptoms that accompany cognitive decline include lack of social involvement, behavioural disturbance, and limitations in everyday activity.

Delirium differs from dementia because its (1) onset is abrupt, (2) duration is usually brief, and (3) appearance coincides with that of another ailment.  

Mental health is a continuum  ranging from well-being to distress, and, although older people have rates lower than young people for most diagnosed mental health issues, old people have a higher number for cognitive impairment. Also, the findings on depression may be misleading. Older people often express depression without sadness, but with a loss of pleasure. Depression in elderly people responds well to treatment.