The Intricate Relationships Between Mental Health and Aging

The Intricate Relationships Between Mental Health and Aging

Episode 19

Helen Sneed: Welcome to Mental Health Hope and Recovery. I'm Helen Sneed.

Valerie Milburn: And I'm Valerie Milburn.

Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational true stories of recovery. Our knowledge is up close and personal.

Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals. But we are experts. We are experts in our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.

Helen Sneed: We live in recovery. So can you this podcast does not provide medical advice. The information presented is not intended to be a substitute or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers and with any health related questions you may have.

Valerie Milburn: Welcome to episode 19, the intricate relationships Between Aging and Mental Health Research has shown that our mental health affects the aging process and the aging process affects our mental health. We are going to explore the intricate relationships between aging and mental health in this episode. Adults aged 65 and older currently make up more than 12% of the American population, but this will grow to 1/5 of the American population by 2030. This rapid growth in the older adult population requires attention. The demand for mental health services is likely to increase. Baby boomers, that's the population that is currently aged 62, 76, tend to use more mental health services more frequently than previous groups of older adults. These baby boomers also tend to be less stigmatized by seeking mental health care. Of additional concern, by 2030, the United States will have less than 1 geriatric psychiatrist per 6,000 older adults with mental health or substance use disorders. These facts are some of the reasons Helen and I chose this topic of aging and mental health.

Helen Sneed: Well, I'm very interested in the topic, Valerie. As you know, see, I never expected to live for very long. I was too sick, too suicidal, too hopeless. And that was before, though I began living in recovery. But here I find my older self facing the issues of aging complicated by battling the mental illnesses that have shaped much of my life. As I grow older, I find the subject of aging and mental capacity is a subject not only for the elderly, but friends and colleagues in their 40s, 50s, and 60s. As Valerie and I explore the impact of aging on mental health and vice versa, the most important truth is this one Cognitive aging is not a disease. It doesn't involve neurodegeneration or significant damage to the brain's neurons. It's the same as your body parts working somewhat less efficiently due to age. The brain is no different. As we journey through the subject today, try to bear

00:05:00

Helen Sneed: in mind that it's a natural process that can be dealt with in a number of very effective ways. Here's what we'd like to do today. These are our objectives. To determine what is normal in the cognitive aging process, and that's both the challenges and the positives. To define the causes of mental illness in the elderly, to examine the impact of aging on the middle aged, to explain the impact of mental health on the aging process, and to encourage treatment methods and coping through skills, strategies, relationships.

Valerie Milburn: Let's take a look at some information about mental health later in life. This research is from the center for Disease Control and the center for Disease control estimates that 20% of people aged 55 years or older experience some type of mental health concern. The most common conditions include anxiety, severe cognitive impairment, mood disorders such as depression or bipolar disorder, and substance abuse. Mental health issues are often implicated as a factor in cases of suicide, and older men have the highest suicide rate of any age group. In fact, men aged 85 years or older have a suicide rate of 45 per 100,000, compared to an overall rate of 11 per 100,000 for all ages. Depression, which is a type of mood disorder, is the most prevalent mental health problem among older adults. Depression is associated with distress and suffering, and it can also lead to impairments in physical, mental, and social functioning. Anxiety, like depression, is among the most prevalent mental health problems among older adults. The two conditions, anxiety and depression, often go hand in hand with almost half of older adults who are diagnosed with the major depression also meeting the criteria for anxiety. Now we have a bit of mental health Information to keep in mind as we discuss the aging process. One of the reasons I'm interested in the aging process, particularly the normal aging process, is because of my dad's Alzheimer's. My dad had Alzheimer's for eight years and this kept him from speaking for the last three or four years of his life. And my mom was unhappy her entire life. So I got no clear picture from either of my parents of how someone could age happily, healthily and with acceptance, because that is possible. My mother in law, a role model for me and a loving presence in my life, did exactly that. She lived to 93, strong and healthy until her death. And that's my goal.

Helen Sneed: Well, it's easy for me to identify my greatest fear about aging. I don't want to lose my mind. What I mean is I'm not interested in outliving my functioning brain. We thought it would be valuable to look at what is normal in the aging brain and its functioning. People won't think they're going crazy or developing dementia when it's a natural process occurring. I must admit to bouts of anxiety and depression with these same concerns. The thing that helps me most is acceptance, when I can reach it. These are the key areas where aging affects thinking. This comes from the betterhealthwhileaging.net the first.

Valerie Milburn: Key area where aging affects thinking is in the area of processing speed. Processing speed is how quickly you can manage a menial task. A decrease in processing speed starts in early adulthood. The implications of this is that as we age, we need more time to take in info and to respond. Complex tasks that require quick information processing become a struggle, such as driving.

Helen Sneed: Okay, here's a big one. Memory. Memory is the ability to remember and retrieve information. Now, some aspects, as we well know, decline with aging, but not all implications. You're good at retaining information and memories that were previously acquired. You have the ability to perform well learned procedures that remains stable, such things like typing. It can help to give older adults more time and support to actually encode new information into their memories. They just need processing time and attention.

Valerie Milburn: Another area is attention. Attention is the ability to concentrate

00:10:00

Valerie Milburn: concentrate and focus on something specific so that related information can be processed. And as we age, sustained attention remains stable. We can focus on a task for a period of time. Multitasking, however, is difficult. We are more distracted by noise, clutter, busy situations.

Helen Sneed: Language skills. Vocabulary is stable. Comprehension of written language stays stable. Now this is great news, I think, because I will be able to talk and read, which are two of my favorite things. Yes, both of us right now, language production does decline. Retrieving words takes longer and spelling becomes more difficult. And you also have to struggle with comprehending rapid or distorted speech.

Valerie Milburn: Executive functioning is affected by aging Executive functioning skills are our mental skills needed for planning, problem solving, abstract thinking. Our executive functioning declines with age after 70 especially. And the implications of this are that we can perform executive tasks, but not as well. We may struggle or take more time for demanding tasks. More demanding tasks, especially when we're tired. Another area is emotional processing. Emotional processing is how we physically and emotionally react to interpersonal stressors. Emotional processing, however, is affected positively by aging, especially the ways we process and regulate negative emotions. Here's what changes with aging. We become generally more positive and optimistic. We pay less attention to negative situations, paying more attention and better remembering positive things. We develop a positivity bias. We tend to be happier and recover from negative emotions more quickly as we age. We may avoid or deny issues that we find unpleasant.

Helen Sneed: Well, that is very encouraging. And now I've got something that I feel is very exciting. It's called crystallized versus fluid intelligence in aging. Crystallized intelligence is everything one has learned over time skills, abilities, knowledge. And it increases as people get older. It's a function of experience, practice, and familiarity. It's called wisdom. Here's some of the implications. It gets better or stays stable as one ages. It enables older adults to compensate for a decline in processing speed and other abilities. Older adults may perform better at those mental tasks that require depth of experience or knowledge. Then there's fluid intelligence. Now this peaks in young adults and declines over time. Its abilities are related to processing power, taking in new information, problem solving with new or less familiar information, and reacting quickly. Now, the proven strengths of crystallized intelligence are where the older person has superior knowledge to the younger gives me great hope for the aging process. It's not all about loss. My experience and insight can give value to younger generations.

Valerie Milburn: So those are the key areas that are affected by the aging process. Some are positive. The next area we want to look at is what causes mental illnesses in the elderly. The following research is from the National Institute of Health. Again, the most common mental illnesses in the elderly are. The conditions include anxiety, severe cognitive impairment, mood disorders, and substance abuse. The causes of these are increased disability, worsened physical health, and the fact that there's a higher mortality rate among our peers. Other factors are loneliness and a lack of community stigma because stigma deters many from seeking treatment. There's also difficulties in uncoordinated care that contribute to a mental health condition. Also, multiple providers contributes and no oversight in treatment is a contributing factor. Now let's take a look at the common risk factors for depression in older adults. Those common risk factors include changes in physical health or functioning, such as the presence of a new or chronic physical disorder or having a stroke or bypass operation or a hip fracture, and such

00:15:00

Valerie Milburn: things as severe or chronic pain. The next thing is changes in mental health. That includes prior episode or family history of depression, at risk drinking, alcohol abuse or illicit substance abuse, and it can also be side effects of some medications. The last thing is changes in circumstances or social support. And these changes include income changes such as retirement or financial difficulties, social changes, recent loss of a loved one, living alone or social isolation, and a diminished social network.

Helen Sneed: Well, that's just all very sad. And I like to think that there we're going to look at some ways that people can get beyond that. Our objective three was to look at the impact on the middle aged. This is an article from Keep Me Prime. The volume of the Brain declines about 0.2% annually after the age of 35 and reaches 0.5% annual loss after the age of 60. As a patient ages, she may process medication differently and be more susceptible to side effects. This is a very important time to assess and evaluate and keep an eye on medications. Now this is from a publication in the UK called Psychological Medicine. Up to one fifth of adults have mental health problems in midlife. The distress is higher among women than men in middle age. Mental health problems start by age 42, 19% of people have mental problems and by age 46, 20%. Now here's something from Neuroscience News and Research. American adults currently in their 40s, 50s, and 60s have more symptoms of depression and worse memory recall than elderly Americans did when they were the same age. Well, I just find this staggering. The question is why? Well, the researchers have come up with what they think is the problem for Americans is that it's the sandwich generation. You're between juggling working, parenting and caregiving and that this is a big problem for Americans who do it without the social safety nets that are available in other countries. Then we have objective four, the effects of mental illness on the aging process. Now, we've been looking at the effect of aging on mental illness. Now we're going to flip it. This is from the National Institute on Aging. Mental illnesses in early life are linked to faster aging and worse health in later years. Mental disorders in youth lead to accelerated aging in midlife and a higher risk of developing other diseases and dying earlier. Now this is from the journal of the American Medical Association. And this is a result of a huge study. It was 2 million New Zealanders ages 10 60, and it's across 30 years. Here's what they learned. People hospitalized for mental health problems that substance abuse, psychosis, mood disorders, behavioral disorders. People hospitalized for those problems tended to have other diseases such as cancer, diabetes, cardiovascular issues, and they had them at a younger age and they would die earlier. These patterns are seen in both men and women across the lifespan. Now here's what they reported on a smaller study, about 1000 New Zealanders and they were aged 3 45. So they're younger. Here's some results. At middle age, people with a history of mental health problems Were literally aging at a faster pace. Even discounting other factors that could speed the aging process, such as smoking, these findings suggest that treating mental health disorders in young people may forestall the onset of health problems later on. This is just yet another great argument to be made for the benefits of early intervention. It also creates declines in sensory, motor, and cognition function. To make matters worse, you even look older now. Individuals with mental disorders have a reduced life expectancy by approximately 1020 years. Now, the bulk of the mortality gap is attributable to deaths from physical diseases such as the cardiovascular, diabetes, and cancer. Things we mentioned earlier because it seems that the mental illnesses can cause the individual to develop

00:20:00

Helen Sneed: physical illnesses.

Valerie Milburn: Well, on that note, I think it's a good time to look at the strategies and skills that are available for dealing with the challenges of aging.

Helen Sneed: Not a minute too soon.

Valerie Milburn: Not a minute too soon, because there are indeed interventions, treatment methods, and lifestyle challenges that are effective lifestyle changes that are effective for handling these challenges that go along with aging. And first, I want to make a positive comment about the treatment of depression, because depression is one of the most common mental health conditions among older adults. According to the center for Disease Control, depression is one of the most successfully treated illnesses. There are highly effective treatments for depression in later life because most depressed adults can improve dramatically from treatment. So there's that. What can be done to fight or manage the effects of aging on the brain? There are some practical and tangible actions that we can take. We can take sensible steps for cognitive aging changes, and here are two examples. We can get help with business and personal decisions. We can still make business and personal decisions, but as we mentioned earlier, things slow down and get a little more difficult. So we can just get a little help. It can also help to find or create a place that's calm and quiet for concentration and decision making.

Helen Sneed: I find this Very encouraging. Because what you're stating are, yes, there are problems as we get older with the cognitive aging, but there are ways to cope. This is, yes, there are problems, but there is a remedy. I mean, if you have problems concentrating more than you did in the past, find a place that's calm and quiet and do your decision making there. Give yourself, I would imagine, more time to go through a document or a medical report or whatever it is you need to look at. I think that this is again, if I can still do it, I don't mind adjusting the way that I have to get it done.

Valerie Milburn: That's a great way to look at it, being realistic and taking proactive steps. Another thing that has been documented for helping us as we deal with the aging process is that adequate social and emotional support is associated with reduced risk of mental illness as we get older, reduced risk of physical illness and of mortality. So that adequate social and emotional support is really important. Now here are some additional factors for achieving successful aging. This is Helen, exactly what you just said. A positive attitude, realistic perspective, and the ability to adapt to change. Another one is security and stability in our living environment and financial resources and social support, such as spouse, family, friends and security and stability and financial resources are not always in our control, but we can try to develop social support. Another really important thing is health and wellness, including prevention of disease and disease related disability. And this comes with healthy exercise, nutrition and the absence of smoking. Or it also comes with the ability to manage stress. Another thing is active engagement with life, including being socially involved, participating in stimulating activities, continuing to learn, having a feeling or a sense of purpose in life and being useful to others and to society. And that for both of us. Helen is volunteering because we need to keep our brains, our hearts and our souls working.

Helen Sneed: Yes, and I think also that getting back to this whole business, it also creates a community and also it's being useful to society, you know, which is there are people in need and it feels great to give help.

Valerie Milburn: Here are some effective treatment methods for depression in older adults. Psychotherapy interventions, just also known as talk therapy, counseling, or simply therapy. Another one is cognitive behavioral therapy, and that's how we learn to use problem solving skills to cope with difficult situations. It also helps us learn to develop a greater sense of competence in one's own abilities. That's cognitive behavioral therapy is a very successful treatment method. Another one is antidepressant medications. Then one that's really important is multidisciplinary geriatric mental health outreach services. That's a big term for providing depression treatment in the homes of older adults or in the locations where older adults frequently spend time instead of in a clinic or office.

Helen Sneed: Here, I guess we decided we would save the best for last. One of the most thrilling antidotes to the aging brain is that science has proven now that a person can grow new brain cells throughout a lifetime. Dr. Amar Sahay of Harvard University said, the reality is that everyone has the capacity to develop new cells that can help enhance cognitive function. Well, it sounds too good to be true, right? But no. It's called neurogenesis, which means the creation of new neurons. The National Institute on Aging reports that the new hippocampal neurons continue to form in older adults, including those with mild cognitive impairment and Alzheimer's. This is from a study. One of the studies was from people age 79 to 99, and they were growing new brain cells. Now, Dr. Sahay lists three areas of outcomes from these new brain cells. Number one, growing new neurons can help you stave off Alzheimer's. It will keep your memory sharp, and it can help treat depression as well as anxiety, which means that it actually has a benefit for a healing quality for mental illness. Now, I was Skeptical to the point of disbelief. When a therapist first told me that I could grow new brain cells, I mean, you go, oh, y. I thought she sounded like Pollyanna and I just missed the entire concept. I didn't say so, but of course it kept it inside. Yet this phenomenon must have been part of my recovery because I was literally incapable of positive thoughts and felt that my brain was toxic and damaged beyond repair. Yet over time, through treatment and perseverance and the diligent application of skills and mindfulness, I honestly believe my brain created new cells that support positive thinking.

Valerie Milburn: For the first time in my life, I love that. I totally believe that we can generate new brain cells. How do I feel about my own aging process? Well, I face aging with anticipation because I have to age to live my future. And I so want a long future. There's a common adage, you either get old or you die. Well, I want to get old for a lot of reasons. I want to see my grandchildren grow up. I want to have more wonderful years with my husband. I want to continue to have my mental health recovery offer hope to others. My 38 year old marriage now is full of love, fun, laughter and mutual support. But it wasn't always that way. In fact, it was full of desperation and despair for many, many years when I was in the depths of my mental illness. See, I'd like more years with

00:30:00

Valerie Milburn: this current marriage and my grandchildren. My four grandchildren are ages 4 and under, so if I live to 85 or so, I can see them graduate from college and beyond. Also, contrary to some of the research we discussed, today, I feel like I've been aging backwards since I got sober 22 years ago. I mean, seriously, I look younger now at 62 than when I got sober at 39. That's how beat down I was by 25 years of using drugs and alcohol. Sobriety is just the key. 25 years of drug and alcohol abuse left me haggard, puffy, pale, listless, just unhealthy in general, with my brain cells fried. Now I have that long term sobriety, those 22 years of clean and sober. I eat right, I exercise, I sleep properly. I'm healthy now with a sharp mind and plenty of energy. I want to see what the next 22 years bring.

Helen Sneed: Well, I look at it a little differently, although I just so admire your attitude, Valerie, because it's just so. It just sounds. You sound so healthy and optimistic to me. See, I never expected to live very long. As I said, I can still feel shock that I have. And due to the longevity and Severity of my mental illnesses. I feel as if I've gone through old age already and more than once. Now many people know what I'm describing. It's so similar. Mental impairment coupled with depression, anxiety and the inability to function, loneliness and lack of purpose. These are issues that we've applied today to the agent. But I knew them early and for many years. Now that I live in recovery, my life is utterly transformed into one of work, friends and family giving back fulfillment in a sense that even better things lie in the future if I continue fighting, which I plan to do. But this business of aging, it's uphill work, I have to say, regardless of one's mental condition. This time, for me, it's for real. See, in all of our episodes, I've never mentioned the most difficult thing I had to accept in order to recovery to recover. And it can still plague me. I used to say, look, you can have the money and the suffering, fine, but I want my years back. Well, so many of the only years that I will ever get were devoured by illness. And now as the years go by, there are fewer of them ahead of me. How many, I don't know. But now I'm determined to make the most of those years and not lose another moment. Being in recovery has taught me it's never too late to go after your heart's desire. I figure that the terrible, barren years have prepared me for the next great challenge. And it's a big one. To accept my age, its conditions and obstacles. To live one day at a time, to never lose hope, to make the most of my days and dreams and the people I love and serve. I am curious, excited and challenged by what lies ahead. I wouldn't miss it for anything because these are the years I get to keep. So this brings our topic to a close. I think it certainly drives home the saying old age is not for sissies. But it also shows us that there are advantages to aging we may not be aware of. And those may reveal themselves in many aspects of our health, including mental health. Challenges that can become exacerbated or appear for the first time in the elderly. If you take away one concept from our episode today, I hope you've come to see that aging is not a disease. It's a natural human process. With strength and strategy, we can all navigate the aging process and have full, rich lives throughout our years.

Valerie Milburn: Thank you, Helen. And I love what you talked about, about the struggles you had and how you have changed your outlook now and how you're facing the challenges with the different mindset. And like you said, you grew new brain cells through your recovery, and you are optimistic now. And I am looking forward to aging together.

Helen Sneed: Oh, great. I hadn't thought of that.

Valerie Milburn: Well, we are. We're both aging, so let's do it together.

Helen Sneed: Might as well. Might as well. You'd be

00:35:00

Helen Sneed: a good companion.

Valerie Milburn: Yes. And we're going to close this episode in our traditional way with a mindfulness exercise. What is mindfulness? I always give a definition. Mindfulness is a mental state achieved by focusing one's awareness on the present moment while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations without judgment. Today's mindfulness practice is called the purposeful Pause, and it is best done at the beginning of a busy day. Now, however, is a great time to be introduced to it, so let's get mindful. Close your eyes if you can. Settle in and breathe as always. Let's begin with a few diaphragmatic breaths. Whether your eyes are open or closed, let's steady our breathing with two diaphragmatic breaths. When you do this on your own, take as many breaths as you need to become calm and centered. I usually take 10 breaths to start my mindfulness and meditation practices. Let's breathe. Inhale through your nose, expanding that balloon in your stomach as you inhale. Now hold it for a second or two. Exhale through your mouth, pulling in your stomach as you do. Forcefully exhaling again. Inhale through your nose, expanding that balloon in your stomach as you inhale. Hold it for a second or two. Exhale through your mouth, pulling in your stomach, exhaling forcefully. Pull your stomach in all the way. Keep this slow, steady breath going. Now visualize yourself at the beginning of a day, maybe this morning or tomorrow morning. What does the day ahead of you look like? Can you visualize your calendar or your list for the day? What meetings, appointments, or tasks will fill your day? Begin your day with a purposeful pause before you head off to that first appointment or meeting or before you start your first task of the day, take a few moments to look, really look, at your calendar or your list for the day. Is there room in your day to attend to what is important? Have you allotted time for taking care of yourself physically and emotionally? Are you attending some meetings or performing some tasks simply out of habit? Are there other meetings or tasks that serve no real purpose in this purposeful pause? Each morning, check in to determine if you have been making time in your schedule for what's important to you and to your work or your mission. Make a commitment to experiment with making one small change to your calendar or list each day. And remember, it need not be a big change, just a small step. Be disciplined about this practice until it becomes a habit. And never underestimate the ripple effect of those small changes. Thank you for doing this mindfulness exercise with me.

Helen Sneed: Thank you, Valerie. I think that, gosh, if you think about it, we can certainly do mindfulness all our years, which is very encouraging,

00:40:00

Helen Sneed: I think. Our thanks to all of you who are listening. We're honored and delighted to have you with us. Our next episode will be our 20th and one of singular interest to many listeners. The psychiatric condition known as borderline personality disorder has frustrated and baffled professionals for centuries. After untold years of acute stigma, borderline personality disorder is now seen as treatable with a high rising rate of recovery. So what is it like and what's changing the prognosis? Don't miss this riveting subject. And now I leave you with our favorite word. Onward.