Mental Health Issues and Frailty
As the population continues to age, it becomes pertinent to consider the experience and quality of life of older adults. With the advancement of age, older adults experience many physical challenges (e.g., mental health issues and aspects of frailty)and changes in their everyday lives. Frailty can be an outcome of decreased movement, stimulation, and confidence. Mental health issues like anxiety and depression can occur from changes in self-perception, abilities, and relationships. Socialization is affected by changes seen with aging, even though a social support system is an integral part of successful aging. For health care professionals working with older adults, it is important to provide education about mental and physical health changes to assist older adults maintaining their well-being and thrive as they age. Encouraging older adults to seek timely and necessary help to handle challenges and changes as needed is also a productive way to foster successful aging. This paper aims to discussexisting knowledge mental health and frailty with the hope that health care professionals may find it useful to stabilize and diversify the care older adults receive, thereby improving quality of life and reducing mental health and frailty issues.
Introduction
Many older adults may experience frailty that has adverse effect on their daily life and mental, emotional, and physical well-being [1, 2, 3, 4]. Frailty refers to the increase in vulnerability due to age-related declines in abilities and mobility that affect the capacity to perform and cope with everyday functions and challenges [2, 3, 4]. Frailty can increase the risk for physical and mental health issues, which can compound already existing issues like loneliness, chronic health problems, and diminishing social network [1, 3, 5, 6]. Changes in movement ability, memory, and independence can also affect many aspects of life for an older adult, like frailty and quality of life [1, 3]. By understanding the physical, mental, and social causes of frailty and working to improve the aging experience, a reduction of frailty in older adults can be achieved, which could improve quality of life and support successful aging [1, 2, 3, 4]. Physical Decline Frailty in older adults stems from a vast number of changes that accumulate and cause vulnerabilities [1, 2, 3, 5]. Many physiological changes occur with age as the organ systems experience a general decline in function and capability [3, 4, 5]. The endocrine, immune, urinary, cardiovascular, respiratory, gastrointestinal, muscular, skeletal, nervous, integumentary, and sensory systems all experience changes with age [3, 7]. The structural and functional changes that occur in the body with normal aging rarely directly cause death but can compound with existing health issues and age-related diseases, creating frailty and potentially increased susceptibility to other issues [3, 5]. Sensory changes in vision, hearing, smell, taste, touch, and temperature can affect the older adult’s ambulation, communication, and socialization by affecting their ability to interact effectively with the world around them, increasing the prevalence of inactivity [3, 4, 5]. Nutrition and mood can be affected by changes in smell and taste that may reduce the desire and satisfaction of eating, resulting in potential nutrient deficiency [3, 7]. Hearing issues may cause the older adult to forgo socializing, which can result in loneliness and depression [1, 3]. Changing sleep patterns can affect mood, intelligence, and memory and can be caused by changes in the brain and central nervous systems [3, 7]. Memory trouble may affect daily activities and socialization in older adults and can result in feelings of inadequacy, anxiety, and embarrassment [3]. The various age-related changes can compound to cause a decreased ability to accomplish instrumental activities of daily living like managing a budget, doing housework, meal preparation, shopping, and extracurricular activities, as well as activities of daily living such as bathing, eating, dressing, getting in and out of bed, and toileting [3]. Not being able to carry on throughout the day as expected due to physical instability and social changes can affect an older adult’s mental health [3, 8].
Some exterior age-related changes like wrinkles, age spots, easy bruising, and greying of the hair can affect an older adult’s perception of themselves and how they feel others perceive them [3]. Being worried about self-perception may result from the aging stigmas and stereotypes that are pervasive in our society, often causing a negative view of aging [3, 9]. Feelings of inadequacy, anxiety, and frustration can occur when the older adult can no longer accomplish tasks easily and is faced with asking for help, which can counter the desire to not be a burden and remain independent [3]. Feelings of anxiety, loneliness, and depression can result from a loss of independence and can cause the older adult to reduce certain activities or social interactions, increasing the likelihood of experiencing frailty [1, 3].
Anxiety
Many older adults are active, enjoying life, and managing age-related changes despite the stereotype of older adults being unhappy, inactive, and frail [10]. Even so, about 20% of older adults experience some type of mental health issues like depression, anxiety, or cognitive impairment [10]. These mental health issues can develop in older adults who may be dealing with medical issues, living in an institutional setting, or have experienced unexpected changes [10]. Age-related changes can bring on a decline in memory, low physical activity, unhealthy diet, poor behaviors, and a decrease in social support, all of which can affect mental health and cause frailty in older adults, which often increases the risk of anxiety [3, 4, 11, 12]. An anxiety disorder is more than just short-lived feelings of anxiousness, it is a mental health issue that can affect daily life and make normal tasks daunting or challenging, with anxiety not going away or getting worse with time [10, 12, 13].
Generalized anxiety disorder includes symptoms like feeling restless or on edge, having difficulty concentrating, being irritable, muscle tension, trouble controlling feelings of worry, and sleep issues [10, 12]. Older adults may also experience social anxiety disorder or the feeling of fear or anxiety when faced with social situations, potentially stemming from feeling insecure about their abilities [10, 12]. This fear often leads to avoiding certain situations, which can result in decreased activity, increased loneliness and isolation, and worsening frailty [3, 12]. The risk factors and symptoms for anxiety disorders vary and can be different from person to person, generally including traits of shyness, stress, negative life events, a history of anxiety or mental illness in the family, some health conditions, genetics, environment, and some medications [3, 12]. Analyzing genetics, the environment, physical health, and mental health can be helpful in diagnosing an anxiety disorder [12]. Often, anxiety can be accompanied by depression, with anxiety and depression not being a normal occurrence with age, even though the symptoms seem to have become a stereotypical normal experience with older age [4, 10, 13].
Depression
Depression is a mental disorder that can be serious, often affecting actions, emotions, and thoughts, and is often seen in older adults [13]. Around 5 % of older adults living in the community and about 12 % of older adults receiving assistive healthcare experience depression [13]. Depression can vary in form, with some people experiencing seasonal affective disorder, which is depression that can occur yearly during the winter months and usually lifts in the summer months [10, 14]. Persistent depressive disorder is another form of depression that consists of a depressed mood for at least two years, fluctuating between periods of major depression and less severe symptoms [13, 14]. Symptoms of depression may be persistent sadness, irritability, feeling worthless or helpless, disinterest in activities or hobbies, low energy or tiredness, memory issues, sleep disturbance, weight change, suicidal feelings, or general discomfort that does not respond to treatment [13, 14, 15]. Some of the risk factors for depression are stress, sleeping issues, loneliness, lack of social support, reduced ability to perform activities of daily living, major life changes, trauma, poor health, and medical conditions like cancer or dementia [13]. Depression is not the same for every person and can also be dependent on genetics, health, and environment [16, 17, 18, 19]. Living alone or at a care home, loss of loved ones, chronic illness, hearing loss, or being isolated tends to increase loneliness and social isolation, which are often associated with mental health issues like cognition decline and depression in older adults [3, 15, 20]. Older adults may also experience death anxiety, which, when combined with other issues like medical conditions, genes, stress, loneliness, limited finances, and physical limitations, may further increase the risk of depression [3, 8, 13].
Suicidal risk can be increased by mental health issues like depression and physical issues like frailty [1, 2, 4]. Research has shown that depressive thoughts can often be correlated to increases in physical issues connected to frailty [1, 2, 4]. Older adults can often be misdiagnosed and undertreated for depression due to age stereotypes playing a role in their diagnosis and treatment, as some older adults and providers believe that depressive symptoms are a normal part of aging and not able to be treated [3, 8, 13, 16]. Understanding older adult’s mental health and treating the issues is important because if left untreated, a negative effect on physical health could occur as well as further mental decline [3]. Social Changes All older adults experience aging differently, with some having health issues later in life and some having issues earlier in life with physical, social, emotional, and psychological changes, as well as gender, socioeconomic status, culture, and ethnicity, all influencing the life course and social support systems [3, 8, 17]. Older adults tend to have smaller social networks because of life course changes like retirement, death, declining health, and increases in weakness [6]. The lack of social networks can increase aspects of loneliness, and loneliness can increase anxiety and depression, which can affect the physical aspects of health, especially in older adults [3, 6]. Older adults can decrease the risk of depression and stress and increase psychological well-being by maintaining social relationships [19]. An older adult’s physical and social environment affects their health and, by extension, their decisions, opportunities, and behaviors [3, 17]. Social relationships help older adults feel connected and supported while also assisting in managing mental health issues and stress, helping to decrease mental and physical inactivity, which could lead to increased frailty [18, 19]. Older adults experience social changes when they switch roles within society, which can both benefit and hamper mental health depending on the situation [19]. For example, moving from a working role to a retirement role tends to eliminate a daily schedule and many daily social interactions with coworkers, fellow commuters, or the barista at a morning coffee joint, which is not a negative change but could instead just require supplementation with another daily social activity to maintain socialization and prevent mental, physical, and emotional declines [3, 19]. The older adult may move into the caretaker grandparent role and watch the grandchildren while the parents are at work. Intergenerational interaction tends to be a positive experience for all generations involved as they can learn from each other and keep each other active [3, 19]. Depending on the circumstances, retirement may also motivate more travel or a move to be closer to family [17]. Lack of a social support system or concrete plan for older age can also cause mental health issues like anxiety and depression due to feelings of isolation and uncertainty [3, 19]. Older adults may also feel like a burden to their social support systems, which could prompt feelings of anxiety, worthlessness, guilt, and helplessness, causing or aggravating mental health issues [3]. Older adults can be subject to ageism, which can negatively affect their self- image and mental health, which can further lead to decline and the potential to succumb to aspects of disengagement and subsequent frailty [3, 17]. Luckily, age stereotypes are being challenged as the population as a whole is becoming saturated by diverse aging individuals, changing the cultural perception of aging [3, 19]. Having a social support system provides companionship, emotional closeness, and help as needed, with most relationships adjusting throughout the life course to meet the changing needs of the involved members [3, 20].
Ways to Support Older Adults
Since many mental health issues are treatable medical conditions, the best way to help older adults is to offer support to help them seek treatment from medical professionals [7, 13]. Better or more frequent screening of older adults for markers of anxiety and depression could help catch these mental issues early and prevent other health issues that could lead to frailty [4]. A social support system can help the older adult stay on track with their treatment plan while also providing socialization and stimulation. Educating older adult on aspects of health, falls, and frailty can be helpful to encourage them to avoid harmful choices like excessive alcohol or inactivity and could also help them manage their mental and physical health in a productive manner [3, 7, 13]. Encouraging older adults to partake in activities that they enjoy could help boost mood and encourage activity [7, 13]. Promoting the idea of learning something new or trying new things could also help the older adult’s mental health issues and physical declines as well as their cognition [3, 7, 13]. Most importantly, providing a listening ear can go a long way to help the older adult overcome depression and find comfort and support [3, 13]. Mental and physical issues are less likely to become severe when older adults are engaged, active, and have social interaction and support [3].
Due to increased life expectancy and better general health, older adults are going to make up more than 20% of the population, necessitating society to establish ways to help care for older adults and facilitate a positive aging experience [21, 22]. However, there is a struggle against bias around mental health and aging that often hinders the care provided to older adults and the desire for individuals to specialize in geriatrics [21]. Having programs that supplement knowledge about older adults and their care for current professionals and more gerontology education programs for those coming up in the professional world would help work to cover gaps in the care older adults receive [3, 21]. Care for older adults, especially surrounding their community access and health care, could be much improved by paying close attention to the mental and physical issues older adults are struggling with so that issues like frailty can be addressed and managed more effectively [13, 17, 21]. Conclusion Frailty may manifest in (1) shrinking or unintended weight loss, (2) weakness, fatigue, anxiety, and depression, (3) poor endurance and energy, grip strength, and exhaustion (4) slowness or reduced walking speed, and (5) low or decreased physical ability. Those who exhibit two of these systems are classified as pre-frailty and those with three or more symptoms as frailty [23]. Frailty tends to be more common among older, female and African American, with less education, lower income, poorer health, and higher rates of comorbid chronic diseases and/or disability than their counterparts [23]. The circuitous occurrence of social, physical, and emotional changes with age causing mental health issues that can further cause social, physical, and emotional decline is a reality that needs improvement [3, 11]. By keeping an open mind about aging, helping move society away from age stereotypes, providing opportunities older adults can benefit from in the community, and improving mental and physical health care for the aging, a reduction of issues like anxiety, depression, and frailty can occur, and a more balanced approach towards population aging can occur [3, 11, 20]. Increasing awareness, training, and knowledge of aging, mental health, and older adult’s needs can work to help older adults receive the care they need and hopefully work to help improve the rate of successful aging [3, 11]. Improving and increasing resources for older adults, like senior programs or services that can help older adults stay active, find new individuals to interact with, and provide health and safety tips, could also be beneficial [3, 11, 15, 18, 20]. Connecting older adults, especially those who may be homebound, with these services could be a great way to support older adults as they combat issues of aging, loneliness, and mental health [20]. It is important to remember that aging is an individual experience for each older adult, and not all situations or environments are the same; however, the population as a whole will continue to age, and any solutions implemented to help the current aging population will better enable future older adults to age successfully [3, 11, 13, 15, 18]. In this process, empirical studies emphasized the need for health literacy intervention programs as well as tailored intervention programs by demographic and health-related factors to minimize the risk of frailty among elderly [24].
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