Emotional and Intellectual
Each human being is a combination of
body, mind, and spirit; we should be aware of how these parts
interact. For example, people may have powerful emotional responses
while facing the many challenges which life presents. Thus, some may
often appear cheerful and optimistic while others are anxious and
unhappy. In later years, we usually continue our basic moods, but
the ways we express our feelings often become more obvious.
Depression: Signs and Causes:
In the midst of losses, such as
physical changes, death of friends or loved ones and reduction of
income, older people may begin showing signs of depression. Some
things to look for are:
If older people brood about their
unhappiness, much of their energy is focused on worry. Part of that
worry may relate to the fear that they will become forgetful and
unable to manage their affairs. This worry can lead down the path to
more depression, which may cause physical problems.
- inability to concentrate or make
- lack of feelings of enjoyment,
or enthusiasm even for doing those things that were favorites,
- little interest in eating
(causing weight loss) or changes in eating habits (overeating
causing weight gain),
- lack of interest in being with
other people, or loss of sex drive (libido),
- feeling unwanted and worthless,
sometimes leading to the thought that life is not worth living,
- sadness or crying spells for no
- problems with sleeping
(sleeplessness during the night or excessive sleep during most
of the day),
- feeling tired most of the time,
regardless of adequate rest.
In exploring the cause of
depression, the following questions should be asked:
Once these questions have been
answered, steps can be taken to relieve the depression. It will take
some work from both the caregiver and the care-receiver to change
habits and routines. Prolonged depression causes biochemical changes
in the brain, usually requiring treatment with medication. The
doctor is a good person the contact to find help for treatment of
depression. Other resources are County Mental Health Centers,
psychologists, counselors or clergy.
- Is there a physical or medical
problem causing the depression?
- Have there been changes in
hearing, seeing, moving, or other body functions?
- What social contact does the
- What are the opportunities for
- What kind of personal losses
(death of friends, relatives, or pets) have there been?
- Is the older person getting
- What kind of mental stimulation
is the person getting?
- Has there been a difficult
adjustment following retirement?
- Is the focus entirely on the
past or is there some enthusiasm about coming events?
- Is there a possibility of
reaction to medications?
- Is there a dependency on alcohol
Suicide among the elderly is a
significant and ever increasing problem. Statistics show that 27
percent of all suicides in San Diego county (1985-87) were committed
by people 60 years of age and older. Nationally, elderly (65+ years)
made up 12.3 percent of 1987 population and committed 21.0 percent
of suicides. Elderly complete one suicide every 1 hour and 21
minutes, or each day 17.7 seniors committed suicide.
Unlike other segments of the
population, the elderly do not often make threats or mention
suicidal thoughts to others. Therefore, it is important that
caregivers also know other warning signs:
Suicide can be prevented. If the
person you care for shows any of the warning signs, you can:
- Depression - feelings of
sadness, hopelessness, a sense of loss and statements as
"Life isn't worth living" are common before a suicide.
- Chronic or terminal illness.
- Withdrawal and isolation -
suicidal people may pull away from family, friends and others
close to them.
- Behavior changes - sudden
changes such as irritability, aggressiveness or changes in
eating and sleeping habits can signal problems.
- Making final arrangements - a
suicidal person may give away valued possessions, making out a
will, make a plan for suicide, or write a suicidal note in
preparation. They may purchase weapons or stockpile medications.
Death and Dying Interventions Elderly
terminally ill encounter anxiety and fear regarding death:
- Ask - don't be afraid to ask
directly if the person is thinking about suicide. It is not a
taboo subject. You will not be putting ideas into the person's
head. It can be a relief to the suicidal person to talk openly
about their feelings.
- Listen - let the person express
his/her feelings and concerns. Don't worry about saying the
right things - just listen.
- Show you care - tell the person
you care and want to help. Take active steps to make sure the
person is safe; remove weapons, pills, etc., and stay with
- Get help - make sure the
suicidal person gets in contact with a professional counselor or
other helpful person who will know what to do. Or have the
suicidal person call (suicide prevention/crisis intervention
Hotline in your community. Telephone numbers for such local
resources should be at the front of your telephone directory.) A
crisis counselor can help figure out the best way to handle the
situation and give referrals to other resources.
You may wish to ease these fears
through an open discussion of these fears and intervening:
- fear of the process of dying;
will there be pain?
- fear of losing control; will I
be at another's mercy?
- fear of letting go; I can not
leave family and friends to an uncertain future.
- fear of seeing how others will
- fear of losing my caregiver;
will he/she be turned off emotionally to me?
- fear of the unknown after death.
- fear that my "life's
script" has been meaningless, unfulfilled, a waste.
Promoting Emotional Well-being
- Regarding the death process, a
"faith system" may be of great help; if you can get
the person involved in his/her religious faith, the subject of
death is well covered.
- Regarding fear of letting go and
isolation, assist then person to get his/her "house in
order." This entails a will, funeral arrangements, burial
plot, etc. Also attempt to have the person and family involved
discuss the situation.
- Regarding meaninglessness of
one's life, have the person do a "Life Script,"
whereby he/she writes all the good things done for others, all
accomplishments, etc. Then discuss with the person that had
he/she not been there to do what he/she did at that time, no one
else would have, and society would have been the worse for it.
So he/she did make a difference. Truly, no person is an island!
It is important to help the elderly
remain involved in decision-making as long as possible. You must
stress that needing help with everyday activities does not mean that
they cannot make decisions for themselves. Also, granting others the
right to decide does not mean you are ignoring or abandoning them.
Caregivers need to be sensitive to the right combination of giving
just the right amount of assistance and no more.
Ways to promote good mental health
in the elderly:
The Importance of Lifetime Learning
- encourage socializing with
friends and relatives through visits, phone calls or letters.
- arrange fun times such as
parties or outings.
- help start new hobbies or revive
- listen, talk, and share
- assure privacy.
- treat with respect, not as
little children unable to think for themselves.
- encourage movement and exercise.
- help find ways to be as useful
- strive to keep the lines of
Research shows that reaction time
may be slower in older people but they can still learn. Families and
friends may need to be patient in waiting for responses. It is also
important to remember that short-term memory may not be as good as
The brain helps link people to the
world. If we are able to process and understand what we see, hear
and absorb from our senses, our experiences will become more
Sometimes older people are
incorrectly labeled as "senile"; the misconception is that
they are no longer able to think for themselves. However, for the
most part, older people continue to make good use of their creative
powers, and as is true for all parts of the body, the brain usually
will function better if it is used regularly.
Lifetime learning means exploring
new ideas, whether this is from reading, listening to radio or
television, trying a new hobby, or trying a new recipe. It can
include lively conversation with friends and family. What it boils
down to is a willingness to keep exploring the many adventures that
life has to offer.
The benefits of lifetime learning include more
enthusiasm for life, less boredom and depression, increased feeling
of self-esteem and self-respect, more interest in the surrounding
world, and new ideas to share with family and friends.
Memory loss can be one of the
hardest problems for both the care-receiver and the caregiver. Some
memory problems are treatable, some are not. Therefore, it is
important for the doctor to determine the causes of memory loss in
Forgetfulness, even inability to recognize familiar
faces and places, might result from such treatable causes such as
malnutrition related to improper eating habits, alcohol, side
effects of medications, loneliness, isolation, few chances to
socialize with others, sensory impairment (decreased vision,
decreased hearing), surgery or accident resulting in injury to body,
viral infections or other illness, or depression or other mental
People who have losses in hearing
and vision may have trouble understanding things consequently
negatively affecting their emotional well-being. Basic aids to hear
and see are vital. At times an older person may be cut off from the
world because of wax in the ears or worn out hearing-aid batteries.
Glasses may need to be adjusted or perhaps just cleaned. Good
lighting, without glare, is important. Magnifying glasses or large
print can make reading easier.
For people who are confused, the
following tips can be useful:
- Make changes in routines
- Be clear about reminders for
appointments or meetings,
- Write simple directions in
large, clear print,
- Use large labels (words or
pictures) on drawers and shelves to identify contents,
- have clocks and calendars
clearly visible and mark off passing days,
- Make certain that medicine is
being taken regularly,
- Confused or forgetful patients
must have assistance with their medications,
- Encourage consumption of
- Encourage movement and/or
exercise as this will increase circulation of the blood and help
improve bodily functions, including the ability to think.
For people who are acting out,
being disruptive, or have other undesirable behaviors, it is best to
not antagonize or confront but to temporarily remove your presence
from the person, giving the message that "I love/care for you
but not this behavior." Below are some suggestions to minimize
- Avoid confrontation. If the
behavior deals with disrobing, offer brightly clothes which make
the person feel good.
- Don't argue. If the person
becomes too agitated, change the subject/object to something
- Reduce stimulation. Lower
lighting, reduce noise (radio, TV) to soothing music, minimize
items in the area to a few possessions known to the person, and
- Promote familiar objects,
- Walk slowly with the person to
reduce anxiety and stress the muscle tension.
Because many older people enjoy
recalling events from past years, families and friends should
encourage the sharing of stories. Activities which stimulate the
brain (visiting with others) can contribute to the goal of continued
Often, older people can become
happier, more productive individuals when they are encouraged to
perform fun, brain-stimulating activities. The following activities
are especially good for homebound elderly:
In addition, older people who are
physically able should be encouraged to participate in swimming,
bowling, gardening, dancing, miniature golf, nature walks,
mall-walking, jogging, shuffleboard and other activities outside the
- sew or knit,
- be a friendly telephone caller,
- be a foster grandparent,
- be a pen pal,
- be a reader to children at an
- save stamps for collectors,
- write favorite recipes on cards
and share them with others,
- read books, magazines,
- do puzzles (jigsaw, crossword),
- try artwork (calligraphy,
- write or record memoirs, poetry,
- keep a joke book,
- care for pets or plants,
- listen to soothing music,
- take correspondence courses,
- play musical instruments,
- start or re-arrange a family
- volunteer, at libraries,
hospitals, museums, schools, Retired Senior Volunteer Program
- bake for self and others,
- plan a potluck or brown-bag
lunch at home,
- tutor or visit with children and
- type for self and others,
- participate in radio call-in
- learn to use a computer.
Drawing, writing, reading, crafts,
taking classes, and other hobbies encourage creativity. Indoor games
including chess, checkers, monopoly, cards, billiards and Parcheesi
provide interesting relief from boredom as well.