‘Mental problems in the elderly are still misunderstood’ – Belgium

‘Depressive feelings and suicidal thoughts in the elderly are still too often normalized. As if mental suffering were a normal part of aging,” writes Karolien Favoreel of Vief vzw. She draws attention to the mental health of the elderly who were very affected by the corona crisis.

In his policy statement, Prime Minister De Croo mentions that the corona period was mentally tough. The Prime Minister is emphasizing young people: 1 in 6 young people would suffer from psychological problems. Because of them, the government wants to focus more on mental health. All the extra attention for mental health can only be encouraged, as can the attention for young people’s psychological problems. But as one of the Flemish associations for the elderly, Vief would also have liked to see attention for psychological problems in the elderly: after all, 1 in 5 of 65 to 74-year-olds suffers from psychological problems, and for the over-75s this is even 1 in 3.

The pandemic has been a tough time for everyone, but the elderly have been hit very hard in this crisis. The heavy isolation imposed on some elderly people, the great losses in their environment and the negative reports about the elderly have had a negative impact on their mental well-being. During this difficult period, it is therefore certainly appropriate to pay attention to the mental health of the elderly.

Mental health problems in the elderly are still misunderstood.

The Flemish Elderly Council is committed to making psychological problems in the elderly more open to discussion with their campaign ‘Head worries deserve care’. This is necessary, because psychological problems in the elderly are an underexposed problem and this lack of attention is part of the problem. Depressive feelings and suicidal thoughts in the elderly are too often normalized. As if mental suffering were a normal part of aging. This unjustified normalization means that the elderly do not receive the appropriate help. This is despite the fact that suicide attempts in the elderly are more likely to be fatal than in younger age groups. Suicide and suicidal thoughts are accompanied by severe psychological distress. That’s why it’s important to be aware of the signs of pessimism and verbal signs of suicidal thoughts, at any age.

An additional problem is that training courses pay too little attention to the specific psychological needs of the elderly. Both in care training and training to become a psychologist and psychiatrist. In care training it is important that extra attention is paid to recognizing signals that indicate mental problems. In the training for psychologists and psychiatrists it is important that the necessary knowledge to treat the elderly is taught over the years and for all students. More attention in these courses could lead to more research into the elderly. There is a need for more data on mental problems in the elderly.

The help that the elderly receive for their psychological suffering is too often based on the administration of medication. There is too much of a decline in psychotherapy as a treatment for depression in the elderly. In the age group of 45 to 50 years, 53% of people with depression are still undergoing psychotherapeutic treatment. For the age group of 55 to 75 years, there is a fall to 22%. The numbers take an even more dizzying plunge for the over-75s. In this age group, only 5% of people with depression receive psychotherapy.

The elderly may have an additional vulnerability to developing psychological problems, because this phase of life can be associated more with loss: the loss of a partner and/or friends, loss of autonomy and independence, loss of a home and financial loss. These heavy losses are too little framed as such. As a result, the elderly again do not receive the necessary guidance in processing it.

Diagnosing the elderly can present additional difficulties. This becomes clear when, for example, depression is examined. Depression is often not recognized as such in the elderly. A first cause is that depression is accompanied by a limitation in daily functioning: a characteristic that is also attributed to aging. As a result, symptoms in the elderly are often overlooked. A second reason could be ‘masked depression’. The elderly show less frequently symptoms such as indifference, sadness and a gloomy mood because of neurological changes. This puts the elderly at greater risk of being misdiagnosed. Negative prejudices about the elderly can also lead to the minimization and dismissal of depressive symptoms in the elderly.

Negative stereotypes surrounding aging, prejudice against older people and age discrimination also have a detrimental effect on the mental health of older people. Stereotypes, prejudice and ageism are recognized in themselves as stressors that can contribute to the development of psychological problems or aggravate pre-existing conditions. A negative stereotype about aging is that this stage of life is associated with the end of personal growth. Just think of statements like: ‘You don’t teach an old dog new tricks’. Such ideas about aging make it more difficult for psychologists, psychiatrists, but also for the elderly themselves to consider psychotherapy as a valuable tool in the treatment of mental problems.

A negative consequence of such negative ideas about the elderly is that the elderly can internalize them. Older people who have a negative view of aging and of themselves as older people are more likely to develop psychological problems. When older people do not have a positive image about aging and their future, this can also lead to an increase in depressive symptoms.

In addition, the experience of isolation and loneliness can increase with age. Both social isolation and loneliness can be a factor in developing psychological problems. But elderly people who have had psychological problems all their lives also find it less easy to find the care they need as they get older. Psychological problems in the elderly are therefore certainly a problem that deserves extra attention, care and resources.

Karolien Favoreel is staff member of Imaging and Participation at Vief vzw.

In his policy statement, Prime Minister De Croo mentions that the corona period was mentally tough. The Prime Minister is emphasizing young people: 1 in 6 young people would suffer from psychological problems. Because of them, the government wants to focus more on mental health. All the extra attention for mental health can only be encouraged, as can the attention for young people’s psychological problems. But as one of the Flemish associations for the elderly, Vief would also have liked to see attention for psychological problems in the elderly: after all, 1 in 5 of 65 to 74-year-olds suffers from psychological problems, for the over-75s this is even 1 in 3. The pandemic has been a difficult period for everyone, but the elderly have been hit very hard in this crisis. The heavy isolation imposed on some elderly people, the great losses in their environment and the negative reports about the elderly have had a negative impact on their mental well-being. During this difficult period, it is therefore certainly appropriate to pay attention to the mental health of the elderly. The Flemish Elderly Council is committed to making psychological problems in the elderly more open to discussion with their campaign ‘Head worries deserve care’. This is necessary, because psychological problems in the elderly are an underexposed problem and this lack of attention is part of the problem. Depressive feelings and suicidal thoughts in the elderly are too often normalized. As if mental suffering were a normal part of aging. This unjustified normalization means that the elderly do not receive the appropriate help. This is despite the fact that suicide attempts in the elderly are more likely to be fatal than in younger age groups. Suicide and suicidal thoughts are accompanied by severe psychological distress. That’s why it’s important to be aware of the signs of pessimism and verbal signs of suicidal thoughts, at any age. An additional problem is that training courses pay too little attention to the specific psychological needs of the elderly. Both in care training and training to become a psychologist and psychiatrist. In care training it is important that extra attention is paid to recognizing signals that indicate mental problems. In the training for psychologists and psychiatrists it is important that the necessary knowledge to treat the elderly is taught over the years and for all students. More attention in these courses could lead to more research into the elderly. There is a need for more data on mental problems in the elderly. The help that the elderly receive for their psychological suffering is too often based on the administration of medication. There is too much of a decline in psychotherapy as a treatment for depression in the elderly. In the age group of 45 to 50 years, 53% of people with depression are still undergoing psychotherapeutic treatment. For the age group of 55 to 75 years, there is a fall to 22%. The numbers take an even more dizzying plunge for the over-75s. In this age group, only 5% of people with depression receive psychotherapy. The elderly may have an additional vulnerability to developing psychological problems, because this phase of life can be associated more with loss: the loss of a partner and/or friends, loss of autonomy and independence, loss of a home and financial loss. These heavy losses are too little framed as such. As a result, the elderly again do not receive the necessary guidance in processing it. Diagnosing the elderly can present additional difficulties. This becomes clear when, for example, depression is examined. Depression is often not recognized as such in the elderly. A first cause is that depression is accompanied by a limitation in daily functioning: a characteristic that is also attributed to aging. As a result, symptoms in the elderly are often overlooked. A second reason could be ‘masked depression’. The elderly show less frequently symptoms such as indifference, sadness and a gloomy mood because of neurological changes. This puts the elderly at greater risk of being misdiagnosed. Negative prejudices about the elderly can also lead to the minimization and dismissal of depressive symptoms in the elderly. Negative stereotypes surrounding aging, prejudice against older people and age discrimination also have a detrimental effect on the mental health of older people. Stereotypes, prejudice and ageism are recognized in themselves as stressors that can contribute to the development of psychological problems or aggravate pre-existing conditions. A negative stereotype about aging is that this stage of life is associated with the end of personal growth. Just think of statements like: ‘You don’t teach an old dog new tricks’. Such ideas about aging make it more difficult for psychologists, psychiatrists, but also for the elderly themselves to consider psychotherapy as a valuable tool in the treatment of mental problems. A negative consequence of such negative ideas about the elderly is that the elderly can internalize them. Older people who have a negative view of aging and of themselves as older people are more likely to develop psychological problems. When older people do not have a positive image about aging and their future, this can also lead to an increase in depressive symptoms. In addition, the experience of isolation and loneliness can increase with age. Both social isolation and loneliness can be a factor in developing psychological problems. But elderly people who have had psychological problems all their lives also find it less easy to find the care they need as they get older. Psychological problems in the elderly are therefore certainly a problem that deserves extra attention, care and resources. Karolien Favoreel is staff member for Imaging and Participation at Vief vzw.

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