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Elderly people are healthier today than they were 30 years ago. Still, seniors use the health care system more often than the rest of the population. Physical problems that result from aging are part of the reason. Other reasons are mental illness and substance use problems, especially with tobacco and alcohol. It can be difficult for health care workers, families and seniors themselves to distinguish between problems related to aging and those linked to mental illness. For this reason it is important to be aware of the issues facing older people to ensure they have access to the best social support and care possible.
How common are mental health disorders and substance use problems in seniors?
Seniors are not immune to mental health problems or disorders. Depression, anxiety and suicidal behaviours are not uncommon among older adults.
Depression–About seven per cent of people over the age of 65 show some symptoms of depression. Around two per cent experience moderate or severe depression and around five per cent experience mild depression. The moderate or severe forms are much more common among elderly people living in care homes (eight per cent), or those who have dementia (10 per cent). Depression in people over 65 seems to be less common than it is in younger groups. However, researchers aren’t sure if this is a real difference or an issue with the research questions used.
Suicide–In British Columbia 22 per cent of suicides are committed by people aged 60 and over. About five times as many older men die by suicide than older women. Of all age groups, men over the age of 85 have the highest rate of completed suicides.
Dementia–About eight per cent of people over the age of 65, and 35 per cent of those over 85, have dementia. Dementia involves the loss of brain cells and results in loss of memory, judgment and reasoning. It also shows itself in changes in mood, behaviour and communication abilities (beyond what might be seen in normal aging). Alzheimer’s disease is the most common form of dementia.
Distress–Negative emotions like nervousness, sadness, or hopelessness generally decrease as people age. But as people reach the age of 75 and older signs of distress increase again. Physical problems and loneliness may explain why mental well-being worsens among the elderly.
Substance use and seniors
Tobacco and alcohol are responsible for most illnesses and problems related to substances affecting older people. Seniors who are depressed are more likely to smoke. They are also three-to-four times more likely to have alcohol-related problems than those who are not depressed. Between 15 and 30 per cent of people with major late-life depression have problems with alcohol.
Twelve per cent of seniors in BC are regular smokers. However, in some regions the smoking rate is higher. In northern BC, for example, 15 per cent of older adults smoke.
Eight of the top 14 causes of death among seniors involve smoking.
Thirteen per cent of elderly people (compared to five per cent of the general population) use alcohol every day. This means they have a higher risk of long-term health problems.
Nine per cent of seniors regularly drink amounts that increase their risk of acute harm (like falls or accidents) or chronic harm (like liver disease and several types of cancer).
About half of all alcohol-related deaths in BC involve people over 65.
Some older people also have problems linked to medications they take for mental and physical problems. One problem is the overuse or misuse of medications. Recently, a CBC investigation found that as many as 3,300 Canadian seniors die each year as a result of bad drug reactions. Seniors, who make up 13 per cent of the population in Canada, accounted for 44.4 per cent of all deaths reported to Health Canada’s adverse drug reaction database between 1999 and 2003.
Many seniors—women in particular—are prescribed medications known as benzodiazepines (sleeping pills and tranquillizers such as Ativan and Valium). These medications give temporary relief from insomnia, anxiety and other problems, but prolonged use increases the risk of a long list of negative side effects. However, almost 25 per cent of seniors taking benzodiazepines are long-term users of the medication. More than 10 per cent are dependent on their medications.
Some seniors share medications, re-use old medications or get prescriptions from different doctors. These situations are all problematic. Prescription drugs should only be taken by the person they were prescribed for, and only for as long as the doctor recommends. Old drugs can spoil, lose their effect or become more potent. If several doctors are prescribing for one person, the patient may get too much of one drug, or they may end up taking two or more drugs that are dangerous when combined. Increased awareness of these issues would help elderly people to reduce their risk of unintended misuse of medications.
Why are rates of mental illness and substance-related problems so high among seniors?
An under-treated population
Elderly people are often under-treated for mental health problems. When it comes to discussions about substance use, seniors are almost invisible. One recent study showed that about half the seniors with symptoms of major depression were not diagnosed by their doctors. Sometimes this happens because symptoms are mistaken for a normal part of aging. Also, elderly people often have physical problems which may be confused with mental illness. Symptoms displayed by older people may look different from those in younger people. This can also make them difficult to recognize.
Practically speaking, elderly people may find it hard to access treatment because they cannot get around easily. They may also have less access to treatment because of changes in income and health benefits after retiring.
Stress and trauma
Life as a senior can be very difficult. Elderly people often find themselves faced with many stresses all at the same time. These may include:
a major illness
reduced mobility
retirement
deterioration or death of a spouse
a shrinking circle of friends
Each of these stresses can increase the risk of a person becoming depressed. However, depression in seniors often goes undiagnosed.
Deteriorating physical health can quickly change retirement into a period of confusion, fear and chronic pain. When disabilities occur later in life, people who were involved in working, socializing and travelling may suddenly face decreased income, reduced mobility and dependence on caregivers and assistive devices.
Quick fixes
Grief, sadness and anxiety are normal reactions to hard times and major life changes. Older people are often prescribed drugs to help them cope with these feelings. This can be problematic if a person is taking medication for other ailments (which many seniors are) and this is not taken into consideration. A good balance must be found between over-prescribing drugs to help elderly people handle normal feelings, and putting too much down to the natural cycle of things.
Time factor
Some mental illnesses, like dementia and Alzheimer’s, are related to age. While there are some things people can do to help prevent these disorders later in life, they are a fact of life for some older people.
Illnesses from problematic substance use are also connected to time. Many serious negative health effects take years to show themselves. For this reason it is no surprise that the elderly have the highest rates of illnesses related to smoking, drinking and misuse of medications.
Attitudes
A negative attitude can stop an older person from realizing they have a mental illness, not to mention seeking help or treatment for it. In previous generations, mental illness was often seen as a sign of weakness, failure or shame. It was viewed as something to be hidden and not discussed. Another barrier to seniors seeking help for mental health issues is that they themselves may believe that mental health problems are a natural part of aging.
Some older people believe it is too late for them to make positive changes to improve their mental and physical health. For example, seniors who smoke may see no point in quitting or cutting back because they believe their health is already damaged. Some family members and service providers hold similar beliefs. They do not realize that seniors who make positive changes to their substance use patterns do in fact feel happier and healthier.
Why is it important to improve the way mental health and substance use problems issues for seniors are addressed?
By 2031, almost one in every four of BC residents will be 65 and older. If we do not address the mental health and substance use problems of seniors, the future will hold even bigger challenges.
Social responsibility
Seniors deserve more attention than they are getting. As a society, we are capable of doing a much better job of caring for the health and welfare of the elderly. We need to help older people keep a positive outlook and participate fully in life, not simply help them relieve stress or depression.
Part of this involves making sure that people are aware of what to expect as they age. For example, many people don’t realize that their bodies may react differently to substances as they get older. The water content in a person’s blood often lowers as they age, which means they have less liquid to dilute any alcohol that they take in. Therefore they will react differently to alcohol than they did when they were younger.
Economics
Seniors who have problems with substance use require more health care than others. They tend to be ill for longer periods of time and have more complications after surgery. Seniors who maintain better health have significantly lower health care costs, which means they have less impact on the health care system.
What are some ways to help seniors?
1. Offer alternatives and support. Medications can be helpful for mental disorders, but seniors may also welcome information about other treatment options. Older adults need opportunities to express feelings such as anxiety, frustration or grief. In addition, they need to receive recognition that their feelings are normal and valid. Communities can help their older citizens by providing them with information. Some areas of interest may be:
how to work with the medical system
how to describe what they are experiencing
what questions to ask their physicians
It is important to ensure that staff in health care facilities, social services, and community care programs are trained to understand seniors’ needs.
2. Become an advocate.
Governments must give seniors the social and economic resources they need to cope and live happily. For example, access to transportation and social activities are very important for seniors who are often otherwise stuck at home. Contact one of the BC Partners to find ways to get involved in advocating for effective services.
3. Get involved at the community level.
With a comprehensive community health approach, whole communities get involved in the well-being of their members. Visit the Helping Communities section on www.carbc.ca for more ideas and information about this concept.
What to do if you or an older adult you know is experiencing a problem with substance use or mental health issues
If you know a senior with a mental health problem, or if you are an older adult and are concerned about yourself, it’s important to see a doctor to get a proper assessment of your symptoms. In addition to talking to your family doctor, consult the resources below for more information.
BC Crisis Line
If you are in distress, call 310-6789 24 hours a day to connect to a BC crisis line that has received advanced training in mental health referrals, without a wait or busy signal.
If you’d like publications about mental health or substance use, you can contact the BC Partners at 1-800-661-2121.
Alcohol and Drug Information and Referral Service
Call 604-660-9382 (in Greater Vancouver) or 1-800-663-1441 (from anywhere in BC).
Health and Seniors Information Line
Call 250-952-1742 (Victoria) or 1-800-465-4911 (across Canada).
BC NurseLine
Call 1-866-215-4700 for 24-hour confidential health information and advice through a registered nurse, or a pharmacist (after hours).
Your Local Crisis Line
Despite the name, crisis lines are not only for people who are in crisis. Call for information on local services or if you just need someone to talk to. You can find the number for your local crisis line online at http://www.crisiscentre.bc.ca/programs-services/distress-phone-services/ or at the front of your local phonebook under Emergency & Important Numbers> Distress Centres> Crisis Line. Many are available 24 hours a day, 7 days a week.
HealthLink BC
Call 811 or visit www.healthlinkbc.ca to access free, non-emergency health information for anyone in your family, including mental health information. Through 811, you can also speak to a registered nurse about symptoms you’re worried about, or a pharmacist about medication questions.
For more information about substance use, visit www.heretohelp.bc.ca or www.carbc.ca.
