Other Late Life Mental Illness

In addition to dementia a number of mental health problems can occur in old age and people suffering from them may need support and treatment from specialist Mental Health Services for Older People.

These include:

PARAPHRENIA (or LATE ONSET PSYCHOSIS) –an illness occurring in old age which is characterised by fixed paranoid delusions, anxiety as a result of these beliefs and irrational or disruptive behaviour arising from the individual’s response to them. For example a person may believe that their neighbours are listening to them through the walls and plotting against them. They may try to prevent this by putting tape round doors and windows and be extremely suspicious of visitors. It affects approximately 1% of older people and is more likely to affect women and those who live alone. It can be difficult to convince the person that they have an illness but it is possible to successfully treat this condition with medication and support e.g. from a community psychiatric nurse.

DEPRESSION

Undoubtedly the kinds of things which we might expect to make us feel depressed do become more common as we grow older – having to stop work, probably less income, perhaps the start of arthritis or other physical problems. There are also the emotional losses – the death of a partner, or friends, or even of a dearly loved pet.

Feeling low or sad is not the only sign of depression other common symptoms include:

• a feeling of sadness, depression or being ‘down’ which is worse than normal sadness
• a loss of interest in life – not being able to enjoy the things that usually give pleasure
• a sense of fatigue or tiredness which is there even when the person is not doing much – making even the simplest task a major effort
• a loss of appetite and weight or weight gain
• an inner feeling of restlessness, making it hard to rest or relax properly
• a feeling of wanting to avoid other people. If people are around they may become snappy or irritable
• poor sleep. This may include waking early in the morning (at least an hour or two earlier than usual) and then being unable to get back to sleep again.
• Loss of self confidence – feeling useless or a burden to others
• feelings of being bad or guilty – dwelling on things from the past and possibly getting things out of proportion, perhaps even wondering whether God is punishing them
• thoughts of suicide – most people with severe depression feel at some point like ending it all. These feelings should be taken seriously. They mean that help is definitely needed. Sometimes they become so strong that a person will work out ways of harming themselves, and even make preparations. This is a sign that help is urgently required.

Depression can make a person feel terribly worried and anxious. Some people have always worried more than others but, if this is unusual in the person you live with or support, then it may be a sign of depression.

In fact, worry and agitation may be so great that a person can feel and appear quite confused because they don’t seem to be able to remember things. This itself can cause further anxiety because many older people worry about becoming ‘senile’. Just occasionally, severe depression can be mistaken for dementia. Very depressed people are only too aware of not being able to remember things, whereas people with dementia usually are not. Dementia and depression are completely separate conditions, so don’t put off seeking help. Having said this, people who do have dementia are quite likely to get depressed and treating this can be very helpful.

ACUTE CONFUSIONAL STATES

The reason that these conditions are included in the is that in their most severe forms the symptoms of memory loss and confusion may mimic dementia and it can be very difficult to identify which illness the person is actually suffering from. Acute confusional states are characterised by severe confusion, disorientation and a fluctuating level of awareness. This is usually caused by a medical condition, such as a chest infection, which has a sudden onset and an acute clinical presentation.

A significant number, perhaps one third of those admitted to hospital wards, suffer from an Acute Confusional State to some degree. This stresses the need for a comprehensive assessment of the individual’s medical, psychological, emotional and social problems, which needs to take place in order to arrive at an accurate diagnosis.

People suffering from these conditions can be restored to independent functioning with an improved quality of life, and their confusion and memory loss can be reversed. If a person with dementia suddenly becomes much more confused it should not be assumed that this is merely a worsening of the dementia. It may be that they are suffering from a underlying condition such as a urine or chest infection. Once this is discovered and treated appropriately they can become much better.