Don't ignore emotional health as you age

Very few psychological problems found in the elderly are actually caused by the aging brain. Most are caused by other physical and emotional issues.

Only dementia in its various forms increases dramatically during people's older years. It increases dramatically in people 65 and older, said Dr. Christopher Watson, a clinical psychologist with Northwest Behavioral Health Services in Arlington Heights. In fact, of the estimated 5.2 million adults with dementia living in the United States, only about 200,000 of them are younger than 65.

Rates of generalized anxiety are also higher in the elderly but, interestingly, rates of true clinical depression decrease in the senior population, Watson said.

"Most seniors go into their doctors complaining of physical problems that are eventually traced to anxiety and depression. And often, these symptoms are caused by drug interactions because seniors are on so much more medicine than when they were younger, and (because of) problems with their thyroid. Low thyroid function can mimic depression and high thyroid function can mimic anxiety," he said.

"In fact, psychologists are usually called in by a family member or by the hospital once the senior has fallen or had another problem. The seniors themselves seldom seek out psychological treatment. Instead, adult children will report that mom is anxious, for instance. She can't shut her mind down at night to sleep and lack of sleep causes other problems," Watson said.

Symptoms of depression and anxiety can also be caused by a senior's lack of purpose in life when they no longer have work to do and something to accomplish each day. They also tend to worry about their finances, their health and the loss of their friends, and this can spiral into depression.

"Some seniors open up just fine to psychological therapy, but most of us in my practice handle this kind of situation on more of a case-management basis, acting like a social worker to hook the senior up with volunteering possibilities and other connections," he said. "We have found that the best therapy for 'the blues' is for seniors to get connected to community groups, their churches and other agencies."

He also recommends that seniors only schedule doctor appointments on two specific days per week so that going to doctor visits doesn't become their life's purpose. They should use the non-doctor days to socialize or donate their time.

Watson believes that a person's move to a senior living community can be wonderful for those with naturally outgoing personalities, because he or she will take advantage of the many opportunities to make friends and new connections. But he cautions that those situations can become like junior high school for those who don't quite fit in, because seniors tend to congregate into cliques. So, for the introverted, life can be worse in a senior community than in their private home.

"Keep in mind that it is also very disconcerting for seniors to be moved to a new situation, so you don't want to move them more than absolutely necessary," he said.

Watson also emphasized that troubling signs of psychological deterioration or distress in senior citizens should never be ignored. Anxiety in many older people actually turns out to be metabolic (detectable through a complete blood work-up) and can be reversed or treated with early detection by the primary care physician and/or a psychologist who asks the important questions like 'how is your diet?' and 'how are you sleeping?' and 'have you experienced any recent physical or emotional traumas?'

In addition, suicide rates are very high in men over the age of 75.

"So it is very important that if you see a loved one who seems lost or very down and out, you get them help. Early detection can change outcomes," Watson said.

Physical work-ups can also reveal if people are experiencing psychological difficulties due to substance abuse, a very underdiagnosed problem in the elderly.

"They may have never changed their drinking habits since they were young and now their livers aren't working as well as they once did. Add to that the issue of drinking while taking many new medications, or not carefully following the directions on the medication labels," he said.

"The medications and the alcohol all get processed by the liver," Watson said, "and if this is the senior's problem, it will show up in a liver enzyme test. If it does, then their doctor needs to discuss alcohol use in relation to their psychological issues."

• Watson, who has had privileges at Northwest Community Hospital in Arlington Heights since 2007, can be reached at (847) 577-0904 or by visiting www.nwbhs.com.