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Psychological problems in seniors are treatable
- May 16, 2002
by Eileen Beal

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Having good mental health throughout life does not ensure immunity from mild to severe psychological problems in the senior years. In fact, according to the latest US Administration on Aging statistics, almost 20% of Americans ages 55 and over experience three specific mental disorders-generalized anxiety, depression, and dementia-in any given year.

The losses-physical, social and emotional-we experience as we age are contributing factors for the two most common psychological disorders, generalized anxiety and mild, moderate, or severe depression says Paula Ogrocki, Ph.D., a neuropsychologist at University Hospitals Foley Elderhealth and Center and Memory and Aging Center.

In order to spot a psychological problem, and in many cases nip it in the bud, you need to "be able to recognize its characteristics and symptoms," added Dr. Ogrocki, who is also an instructor at CWRU's Medical School.

A generalized anxiety disorder is characterized by feelings of dread, apprehension, frustration, and tension which can lead to angry outbreaks, obsessive and/or compulsive behaviors (such as hoarding), or alcohol and/or medication abuse. It can be caused and fueled by anxieties over family matters, financial matters, and/or health concerns, explained Dr. Ogrocki.

Depression is characterized by deep and on-going sadness that can lead to tearful outbursts, feelings of helplessness, social withdrawl and physical decline (due to lack of good nutrition, activity, and exercise). It too, can lead to alcohol and/or medication abuse. "Most seniors who become severely depressed are grieving multiple losses-the loss of a job, the loss of a spouse or close friend, the loss of health or independence due to a debilitating or chronic illness, the loss of their role in the family," explained Karen Vrtunski, L.I.S.W., Director of the Western Reserve Area Agency on Aging's Community-based Long Term Care Program.

Dementia is the third most common psychological disorder, affecting seniors. According to the American Psychological Association, it is characterized by the irreversible deterioration of intellectual ability-loss of memory, inability for form new memories, significant impairment in social functioning, etc.-and accompanied by behavior disorders, such as physical aggression, wandering, verbal outbursts, depression, and emotional disturbances.

"Dementia has multiple causes-everything from Alzheimer's Disease, which causes 56% of all dementia, to multiple infarcts (strokes) to brain tumors. It is the most difficult disorder to characterize and treat," explained Doris Matthey, L.I.S.W, Director of Mental Health Services for Benjamin Rose. "In some cases," she added, "what looks like dementia isn't [dementia] at all. For instance, some medications cause dementia-like symptoms, such as confusion. Once the medication is changed the symptoms go away."

Treatment-either counseling or medications or a combination of counseling and medication-can be an effective remedy for both anxiety disorder and depression. "In 80% of all cases people do better or get better," said Matthey."

Some medications and coping strategies, for both those with dementia and their caregivers, can help slow the symptoms and effects of dementia. "Groups like the Alzheimer's Association and National Association for the Mentally Ill are doing good outreach and education on coping strategies," said Matthey.

Unfortunately, "barriers" keep many seniors-especially men-from seeking help.

"Many people don't recognize they have a problem or, if they do, they don't seek treatment because-for people in their generation, the World War II generation-there is a lot of stigma attached to having a psychological problem," said Dr. Ogrocki.

Treatment costs-both in terms of money and time and energy needed to get appropriate services-are often beyond the means of those needing treatment. Medicare and private co-insurance pick up, at best, 50% of the costs for counseling and treatment, explained Vrtunski, which makes them prohibitive for those on a fixed income. Prescription medications-which usually must be taken for six months to two years-are costly, too.

But the real "barrier" for most people is that they don't know where to seek help. "Primary care physicians, local mental health centers, geriatric assessment departments at the larger area hospitals, and local agencies are gateways, not just for diagnosis and treatment, but also for information, education and support groups," said Matthey.

"Support groups," she added, "are especially important for those caring for loved ones with Alzheimer's or other forms of dementia."

Sources and Resources
For information on where to get help with diagnosis and treatment an/or support groups, contact:

Alzheimer's Association
216-721-8457

Alzheimer Center/University Hospitals
216-844-6400

Benjamin Rose Community/In-Home Services
216-791-8000

Cleveland Clinic Foundation/Department of Geriatrics
216-444-5665

Cuyahoga County Department of Senior and Adult Services
216-420-6750

Cuyahoga County Community Mental Health Board
216-241-3400

Fairhill Geriatric CARE Center
216-844-6370

National Association for Mental Illness (Cleveland area)
216-491-1616

United Way Services of Greater Cleveland's First Call for Help
216-436-2000

University Hospitals Foley Elderhealth Center
216-844-6300

Visiting Nurse Association
216-931-1300

Western Reserve Area Agency on Aging
216-621-0303 or 800-626-7277