Chronic Mental Illness

The rates of serious and chronic mental illnesses are very low in the older adult population; however, they are important to understand. Improvements in mental health and general medical care have resulted in more individuals with serious mental illness living longer than ever before.

The long-term health outcomes vary for people with serious mental illnesses. For older people who have received proper treatment, experienced relief from symptoms and who have strong family and/or social support systems, late life may unfold as it would for someone without a mental illness. For older individuals who developed the disorder in their younger years without adequate treatment, a strong support network or good health practices, the outcome is less promising. Disease and disability are more likely to begin at a younger age for people with chronic mental illness. People with serious and persistent mental illness have a life expectancy that is shorter than the general population.

This tragic fact may be attributed to stressful life events, poor health care, high rates of tobacco use, obesity and other related health issues. The symptoms of serious mental illness can become less problematic for people in late life. This could be due to biological changes in the brain but may also be due to better management of the illness. Keeping stress low, seeking good medical care when indicated, avoiding alcohol or other substances, and taking medications as prescribed improve the long-term functioning of any person with mental illness.

Bipolar disorder

Bipolar disorder, formerly known as manic-depressive illness, is a mental disorder experienced by people across all races, socio-economic groups, ages, genders and ethnicities. About half of the people who will experience bipolar disorder have their first episode by age 25. It is rare for a person to develop bipolar disorder later in life and if that happens, it seems to be tied to other brain changes related to cardiovascular disease or dementia.

Neurological conditions from stroke, medication side effects and other late-life problems can mimic symptoms of bipolar disorder. Because serious mental illnesses were poorly identified and treated 50-plus years ago, it is possible that a person developed bipolar disorder as a younger adult and went undiagnosed for decades.

If an older individual is experiencing symptoms of bipolar disorder, but has no history of the condition, it is important that he/she get a very thorough physical and psychiatric evaluation, preferably by a person with expertise in geriatrics. A person with bipolar disorder typically experiences episodes of depression alongside episodes of excessive highs called “mania.” There are periods of “normal” function in between. Some people have a mixed experience whereby symptoms of depression and mania exist at the same time.

Symptoms of mania include:

• Excessively high mood
• Irritability
• Decreased need for sleep
• Increased energy
• Racing thoughts, excessive talking, inability to stay still
• Increased talking, physical movement and hypersexuality
• Disturbed decision making, recklessness, impulsivity
• Grandiose notions
• High distractibility
• Risk-taking behaviors
• Loss of touch with reality

The length and intensity of symptoms vary from person-to-person. Because of individual differences and the fact that there are different sub-types of bipolar disorder, thorough and ongoing assessments are necessary for proper diagnosis and treatment. If treatment is properly matched to the illness, symptoms can be managed and people can enjoy the fulfillment that comes with recovery.

Schizophrenia

Schizophrenia affects only one percent of the general population. It is an illness that impacts mental function resulting in disorders of thought, perception, motivation, emotion, behavior and social engagement. In its most acute form, schizophrenia can have dramatic and disabling effects on most aspects of everyday functioning. However, many people experience relief from symptoms of schizophrenia when they are properly treated. Schizophrenia is an illness that can interfere with a person’s ability to experience reality, participate in social situations, develop relationships, and function in work situations.

Schizophrenia varies in the type and severity of symptoms among different individuals and it is very important to remember that if people with schizophrenia are receiving the proper treatment, they may manage the symptoms of the disease and live wonderful lives.

Symptoms

• Social withdrawal
• Lack of motivation
• Unusual thoughts
• Difficulty communicating
• Depression
• Self-neglect
• Inability to follow through with tasks or responsibilities
• Difficulty focusing or concentrating
• Ritualistic behavior
• Bizarre expressions and behaviors
• Hallucinations (sensory perception of things not there)
• Delusions (beliefs not rooted in reality)
• Lack of insight into illness

Though uncommon, it is possible for an older adult to be diagnosed with late-onset schizophrenia. The development of late-onset schizophrenia is likely to have followed a period of severe stress or physical illness. In the early to mid-1900’s, schizophrenia in young adulthood were commonly undiagnosed – likely because of the stigma and treatment fears of past generations. There are probably many older adults with schizophrenia whose illness was not diagnosed or treated until later life – if at all.

An older person with schizophrenia is already coping with challenges to thinking. If dementia or delirium develops, things can become even more complicated. Health care professionals must evaluate for dementia and delirium in the older person before presuming that thought and behavior changes are due to the disease of schizophrenia. If an older person with schizophrenia is living successfully in a community situation, relying on a system of family and social supports, changes in that system can put the individual at risk. Stress from life events commonly experienced by older adults, such as the death of a loved one, can be devastating to an older person with schizophrenia. The individual may be more vulnerable because of challenges with coping and life skills.