Mental health: staying mentally fit in later life

Over the years, people lose more and more close friends and family members, which can lead to phases of loneliness and sadness. In later life, our physical and mental capabilities also undergo changes that sometimes cause concern and worry. 

But there is not always an illness behind every forgotten name or unhappy mood: sometimes forgetting something or getting slower is normal, and no cause for concern. Nonetheless, depression and dementia are amongst the most common mental illnesses in later life. But one can help prevent these illnesses through one’s own behavior.

A dignified life affects the quality of life in old age. This is conditional on retaining one’s mental faculties and the ability to perform activities in everyday life. 

Dependence on others tends to increase with age. So being able to make decisions oneself, having responsibility for one’s own life, private life and personal space play a big part in maintaining one’s quality of life. 

Numerous studies show that mental health problems negatively affect the quality of life of older people. Doctors, psychiatrists and clinical psychologists can then provide help.

Anxiety and depression, as well as dementia, are the most common mental health problems in older people. In particular social isolation, but disabilities such as poor eyesight and hearing too, are associated with depression.

It is estimated that 17% of the population over the age of 75 experience clinical depression and 7% severe depression. Depression occurs no more frequently in old age than in other life phases, but there is a need to remain alert. In old age, however, there are more depressed moods that do not have the character of being an illness (“subclinical”), and which one can influence oneself.

There are some things that the person themselves can do if they are feeling depressed: 

• As many people who are depressed restrict their social contacts, a vicious circle can set in whereby the social isolation increases. Phone calls or meet-ups can break through this.
• Even minor activities like cooking and listening to music can improve one’s mood. 
• Studies show that regular exercise with achievable goals reduces symptoms of depression, including in older people and generates social contact when done in a group.
• Accepting support from loved ones and acquaintances: shared activities, such as looking at photos and chatting, also help. Loved ones should not take any rejection personally, however, and should respect it.

In old age depression is less frequently expressed through a sad mood, and it is linked to symptoms that are less clear than is the case with younger people. It can easily be mistaken for dementia, particularly when it is linked to mainly mental impairments. 

Depression can be improved through medication or psychotherapeutic treatments. So if the indications prove to be longer term it is a good idea to consult a doctor or psychotherapist, including because, if left untreated, depression can become chronic. Moreover, depression can be made worse by some drugs, such as products for reducing blood pressure, tranquilizers, and drugs for Parkinson’s and cancer. In such cases the doctor can check whether there is a more suitable alternative.

Dementia involves both a deterioration in (short-term) memory and in the person’s orientation in time and space, and their speech. Behavioral changes often occur, for example the person becomes listless, anxious, has outbursts of anger, is hyperactive, restless, or withdraws. Depressive episodes also occur with dementia. 

Most types of dementia – including Alzheimer’s disease and vascular dementia – remain incurable. Certain drugs can delay their progression, however. Whether they are suitable depends on the nature and severity of the dementia.

The first step if dementia is suspected is to consult a doctor. An initial diagnosis of, and therapy for, dementia can be carried out in the familiar environment of the doctor’s office. It is also a good idea to find a memory clinic that can offer a memory consultation. The doctors and psychologists there specialize in dementia issues.

However, those affected can also do something themselves to aid their memory and help themselves cope better with everyday life. For example:

• Techniques that revive memories or stimulate mental abilities (so-called cognitive stimulation), such as solving puzzles, mental arithmetic, and consciously exercising the memory
• plenty of physical activity, for example Nordic walking
• singing, and playing or learning instruments
• not smoking if possible, and avoiding excess weight
• maintaining close relations with other people
• taking as many positives as possible from one’s aging process, and not being negative about growing old
• getting involved, for example as a volunteer
• avoiding stress where possible

Even though old age is the strongest known risk factor for deteriorating mental capacity, dementia is not a natural or inevitable consequence of old age: many circumstances and illnesses can contribute to the occurrence of dementia. Some of them can be influenced or treated, for example high blood pressure, cardiac arrhythmia, diabetes, obesity, and smoking. The illness can be prevented by being active while in middle age. This particularly involves regular exercise, a balanced diet and an active mental and social life.

• Exercise: A physically active lifestyle is relatively closely linked to the brain’s capability. People should exercise for at least 150 minutes per week even after the age of 65. This certainly does not need to be extreme, but rather of moderate intensity. In general, the more the better. It is important to start gently and slowly increase the intensity. For people with limited mobility, regular exercise also helps with balance and prevents falls. Specific balance exercises are beneficial. People who are unable to do the recommended amount of physical activity due to health reasons should still be as active as they can.
• Social activities and contact with other people can prevent dementia: interacting with others is mental exercise, to some degree.
• Diet: Studies have shown that switching to a healthy, balanced diet helps prevent many illnesses that increase the risk of dementia, such as diabetes. 
• Smoking is linked to conditions such as deteriorating mental capacity and dementia.
• Alcohol: There are many indications that excessive alcohol consumption is a risk factor for dementia and mental impairment.
• Loss of hearing and sight: Hearing loss often occurs in later life; every third adult over the age of 65, and every second over the age of 80, are thought to be affected. The effects of hearing loss are often underestimated: according to studies, loss of hearing can almost double the risk of dementia. Hearing loss impairs social and emotional wellbeing: it makes communication with others more difficult, which can lead to frustration, isolation and loneliness. Significant vision impairments are suffered by every fourth person over the age of 65 and every third over the age of 80. They threaten the person’s independence and mobility outside the home. So good hearing and vision aids are a “must” in later life.
• Body weight: Obesity in mid-life increases the risk of dementia. It is thought that losing weight indirectly reduces the risk of dementia, because it improves many metabolic factors that are linked to the occurrence of mental impairments and dementia. Lifestyle changes in mid-life that involve diet and physical activity seem to show the best results. 
• High blood pressure: High blood pressure, too, is linked to an increased risk of dementia in old age. High blood pressure can often be reduced by a healthy diet, normal weight and sufficient exercise.
• Diabetes mellitus: Type 2 diabetes and, in particular, poor blood sugar control are linked to deteriorating mental capacity in later life. Complications linked to diabetes, such as kidney and eye damage, hearing loss and cardiovascular diseases seem to further increase the risk of dementia. An active lifestyle can reduce the negative effects that diabetes has on the mental faculties.
• Lipid metabolism disorders: A high cholesterol level is one of the main risk factors for cardiovascular disease that can be changed. It can often be reduced by losing weight and by eating less animal-based foods. As far back as the 1970s, it was suspected that a high cholesterol level in the blood might be linked to an increased risk of dementia. Since then, studies have produced a range of results. They show a strong link between a high level of cholesterol and dementia, in mid-life rather than in old age. Even though the effect on the occurrence of dementia is not certain, it is beneficial to treat the metabolic disorder.
• Depression: According to studies, the risk of dementia is almost doubled if a person has depression. It is important to know that mental impairments may be the main symptom of depression in older people. So treatment of depressive moods and illnesses also helps prevent dementia.

Even in the case of people aged over 75, the desire for medical advice about dementia does not feature in the top 20. Loves ones should respect the fact that there is a right to not know: a dementia diagnosis can be a relief, but for sufferers it can also be a mental burden, and regarded as an attack on their own identity and capacity to act.

People with dementia should be involved as much as possible in decisions being made about them and their care. Aids such as pictures or text in simple language can be used. Preferences, dislikes, the daily routine, personal experiences and the life history ought to be taken into account. 

Physical contact can be used as a means of communication and have a calming effect. However, a need for distance and the patient’s privacy need to be respected.
Loved ones can help capacities to be retained by not taking everything away from the patient, allowing them to carry out simple tasks, and stimulating memories. 

It is helpful to adapt the home to the person’s new needs, for example, by providing smoke detectors, safety devices on the cooker, and sufficient light, and by removing any trip hazards. Increasingly, there are also “smart” technical aids that can help, for example a sensor that shows when a person with dementia has got out of bed. It is important to find out all about these new technical options. In addition to the Alzheimer associations, there are advice centers in many federal states now.

Planning ahead is beneficial, in order to be well-armed when changes occur, and to make wishes clear. Sufferers should be told that living wills and lasting powers of attorney for health and welfare that have been given can be revoked.

After an operation under anesthetic, sudden confusion, also called “delirium”, can occur in the hospital. This is not dementia, even though it is sometimes difficult to distinguish between the two. 

Delirium can also be caused by drugs, lack of fluids, the unfamiliar surroundings in the hospital, and stress. Loved ones can support the sufferer by transmitting a sense of security and a feeling of solidity in the unfamiliar environment. A photo of family members and personal objects can help. A clock and an up-to-date calendar can help orientation. News about neighbors and family events break down feelings of isolation and help the sufferer to return to reality. If the person normally needs spectacles or a hearing aid, they should also be used in the hospital. 

In general, standard hospitals are not well enough set up for older people with dementia. So, especially when a loved one with dementia is admitted to hospital, stay in close contact with them and let the medical staff know about any particular details that might help.