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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Achieving a Balance

Relating Physical and Mental Health in Seniors

Chris Rauscher, MD

Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, p. 14

There is much to be learned from ancient cultures that valued achieving a balance in all things, including a balance in our physical and mental states. With the advent of technology and a more “Western” way of thinking, there has been a shift away from viewing health as a balance achieved for living towards viewing the “parts” of a person that could be analyzed and treated through the technology of Western medicine. However, for people living with the complexities of life, and with complex health conditions, the struggle to maintain the balance in life and health is paramount. Health professionals working to support people whose health is affecting their quality of life can be most effective by helping individuals towards maintaining this balance in their health and lives. This particularly relates to situations where there are complex physical and mental health issues.

It is not uncommon for there to be mental health issues, particularly anxiety and depression, in association with chronic physical disease. For example, chronic pain is a condition where physical and mental health symptoms co-exist, and where a more holistic viewpoint and approach is necessary but, unfortunately, often not brought about. Often, this is because the mental health issues may not be recognized as part of the picture, or the mental state may be thought to be due to personality factors. Or, if the mental health issues are seen as significant, they may be dealt with separately from the management of the physical symptoms of the chronic pain.

There are many more specific and common scenarios that could be highlighted where it is necessary to recognize and work with both physical and mental health, particularly in working with the older adult:

  • the person who is presenting with anxiety (perhaps a nursing home resident on the call bell at night) related to underlying and unrecognized physical symptoms, e.g., heart failure

  • the person who is presenting with “lack of motivation” and possibly depression, related to unrecognized physical symptoms, e.g. heart or respiratory failure, or chronic pain

  • the person who appears to have the recent onset of “confusion” and/or hallucinations, who may have a delirium as a result of an underlying physical health condition

  • the person with a chronic mental health condition whose symptoms get worse in relation to an unrecognized underlying physical health condition, e.g., a person with chronic schizophrenia who develops a thyroid disorder

  • the person with a chronic mental health condition who develops physical symptoms such as falls as a result of a mild physical health condition (mild stroke) with the psychiatric medications possibly now contributing to the falls.

There are many more examples that could be listed, but these are a few common situations illustrating the inter-relationship between physical and mental health that must be recognized and addressed to support the affected person to regain the balance in their health and life. Such complex situations are best addressed by the family physician supported by other health professionals, including medical and psychiatry specialists, through a holistic team approach.

The most successful approaches are those that recognize the need to approach both the physical and mental health aspects of the chronic condition, pain for example, and work to support the persons living with the chronic disease in the self-management of their health for achieving the desired balance in their life. These approaches combine multiple interventions, which involve a partnership between the persons living with chronic disease, their network of support, the family physician and other health professionals, health educators and community organizations.

In some jurisdictions, such “collaboratives” for management of chronic diseases, e.g., diabetes, have been pulled together. In this approach, teams form which can provide support from the primary health care level, on through to interdisciplinary care and support approaches. The family physician is often the central professional who coordinates with the other health professionals to ensure that the necessary care and support is delivered and that the necessary collaboration comes about.

Self-management education strategies and courses and community development strategies can also be included as part of the approach. In British Columbia, these more holistic approaches are in the early stages of development and still require being pulled together in a more cohesive way.

The existing elements include:

  • provincial physician guidelines for support and management of specific chronic diseases (in progress)

  • teams approaches (such as the “Falls Module” and other UBC projects)

  • “shared care” or specialist physician support to primary care physicians dealing with chronic health conditions (in discussion)

  • self-management courses for persons living with chronic diseases (Vancouver).

In conclusion, this article advocates a refocusing of our approach to health. Health should be seen as a balance of physical and mental functioning, which is necessary to achieve the desired balance for life and living. It is incumbent on those working to support people living with health impairments to promote and develop such approaches within their work and community settings.

About the author
Chris is a Clinical Assistant Professor of Medicine at the University of British Columbia and a Community Consultant in Geriatric Medicine for the Vancouver Coastal Health Authority

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