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Mental Health of the Elderly. Mohamed Hatta Shaharom Forensic Psychiatrist & Founding Dean Faculty of Medicine Cyberjaya University College of Medical Sciences Malaysia 28 th FIMA Council Meeting Indonesian Islamic Medical Association Scientific Convention YARSI University Jakarta

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slide1

Mental Health of the Elderly

Mohamed Hatta Shaharom

Forensic Psychiatrist & Founding Dean

Faculty of Medicine

Cyberjaya University College of Medical Sciences

Malaysia

28th FIMA Council Meeting

Indonesian Islamic Medical Association Scientific Convention

YARSI University

Jakarta

September 2011 / Shawwal 1432

slide2
بسم الله الرحمن الرحيم

وَلَوْ جَعَلْنَاهُ قُرْآنًا أَعْجَمِيًّا لَّقَالُوا لَوْلَا فُصِّلَتْ آيَاتُهُ أَعْجَمِيٌّ وَعَرَبِيٌّ

قُلْ هُوَ لِلَّذِينَ آمَنُوا هُدًى وَشِفَاء وَالَّذِينَ لَا يُؤْمِنُونَ فِي آذَانِهِمْ وَقْرٌ وَهُوَ عَلَيْهِمْ عَمًى

(٤٤) أُوْلَئِكَ يُنَادَوْنَ مِن مَّكَانٍ بَعِيد

Had We sent this as a Qur’an (in the language)

other than Arabic,

they would have said:

"Why are not its verses explained in detail?

What! (a Book) not in Arabic and (a Messenger) an Arab?"

Say: "It is a Guide and a Healing to those who believe;

and for those who believe not,

there is a deafness in their ears,

and it is blindness in their (eyes);

They are (as it were) being called from a place far distant!"

Fussilat (Explained in Detail) 41:44

slide3

Muqaddimah

The Elderly (Mental Health & Illness)

Mental health, medicine and sociology

Psychiatric disorders and management

Islamic care of the elderly.

slide4

PencegahanLebihBaikDaripadaRawatan

Prevention is Better Than Cure

slide5
1

Mental Health, Medicine and Sociology

slide6

الَّذِينَ آمَنُواْ

وَتَطْمَئِنُّ قُلُوبُهُم بِذِكْرِ اللّهِ

أَلاَ بِذِكْرِ اللّهِ تَطْمَئِنُّ الْقُلُوبُ

"Those who believe,

and whose hearts find tranquillity in the remembrance of Allah;

for in the remembrance of Allah do hearts find tranquillity.

Ar-Ra‘d (The Thunder) 13:28

slide7

Experiencing Old Age

Retirement

Dependence and independence in old age

Alan Clarke, 2001. The Sociology of Healthcare. London: Prentice Hall. Pp

155-179.

slide8

Sociology and Older People

Disengagement theory

Structured dependency theory

Theory of the third age

Cultures of ageing

Paul Higgs, 2008. Later life, health and society. In Graham Scambler (ed).

Sociology as Applied to Medicine. Edinburgh: Saunders. Pp 176-189.

slide9

Fact 1

Many gerontologists are

substituting age 85 for age 65

as the new chronological

definition of old age.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide10

Fact 2

There are more differences

among elders than any other

segment of the U.S.

population.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide11

Fact 3

Elders are the least likely to be

lonely of any age group; and

those who live alone are likely

to be in close contact.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide12

Fact 4

It is only in the last half of the

twentieth century that a large

portion of the U.S. population

lived to be 65 years old.

slide13

Fact 4 (cont)

If people did live to be old,

they were not treated any

better than they are today.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide14

Fact 5

Senility is the result of disease

and only affects about 5% of

elders living in non-

institutional setting.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide15

Fact 6

Though elders do gain certain

advantage when they retire

and when their children leave

home, they still face a number

of concerns.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide16

Fact 7

Most older people do have at

least one chronic health

problem, but the majority of

elders live active lifestyles.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide17

Fact 8

Sexual interest does not

diminish with age, but there is

an alteration in sexual

response.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide18

Fact 8 (cont)

Nonetheless, many elder in

reasonably good health have

active and satisfying sex lives.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide19

Fact 9

Only approximately 4% of

those above the age of 65 live

in nursing homes, homes for

the age, or other group

quarters.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide20

Fact 10

Older adults are more likely to

be retired, but they are very

likely to be productively

engaged at home and in the

community.

James McKenzie, Robert Pinger, Jerome Kotecki, 2008. An Introduction to

Community Health. Boston: Jones and Bartlett. Pp 236-237.

slide21

Mental State Examination

Memory impairment

Disorientation

Needs physical help

Risk in the home

Risk outside

Apathy

slide22

Mental State Examination

(cont)

vii. Poor communication

viii. Repetitiveness

ix. Uncontrolled behavior

x. Incontinence

xi. Emotional reactions

slide23

Mental State Examination

(cont)

Other reactions

Mistaken beliefs

Decision Making

Burden on family

Neil Anderson, Alan Jacques, 2004. Old-age psychiatry. In Eve Johnstone, D.

Owens, S. Lawrie, M. Sharpe. C. Freeman. Companion to Psychiatric Studies.

Edinburgh: Churchill Livingstone. Pp 613-660.

slide24

Investigations and Differential diagnoses

Physical examination

Full blood count

ESR

Urea and electrolytes

Liver function tests

slide25

Investigations and Differential diagnoses (cont)

Thyroid function test

Calcium and phosphate

Midstream urine

Glucose

Chest X-ray

slide26

Investigations and Differential diagnoses (cont)

ECG

Vitamin B12and folate

Syphilis serology

HIV testing

Autoantibody screen

slide27

Investigations and Differential diagnoses (cont)

xvi. Copper studies

Heavy metal screen

Lumbar puncture

EEG

CT scan

slide28

Investigations and Differential diagnoses (cont)

xxi. MRI scan

xxii. SPECT scan

Neil Anderson, Alan Jacques, 2004. Old-age psychiatry. In Eve Johnstone, D.

Owens, S. Lawrie, M. Sharpe. C. Freeman. Companion to Psychiatric Studies.

Edinburgh: Churchill Livingstone. Pp 613-660.

slide29

Neuroimaging in dementia

Alzheimer’s disease

Vascular dementia

Dementia with Lewy bodies

Frontotemporal dementia

Neil Anderson, Alan Jacques, 2004. Old-age psychiatry. In Eve Johnstone, D.

Owens, S. Lawrie, M. Sharpe. C. Freeman. Companion to Psychiatric Studies.

Edinburgh: Churchill Livingstone. Pp 613-660.

slide30
2

Psychiatric Disorders and Management

slide31
بسم الله الرحمن الرحيم

فِي قُلُوبِهِم مَّرَضٌ

فَزَادَهُمُ اللّهُ مَرَضاً

وَلَهُم عَذَابٌ أَلِيمٌ بِمَا كَانُوا يَكْذِبُونَ

In their hearts is a disease;

and Allah has increased their disease;

and grievous is the penalty they (incur), because they are false.

Al-Baqarah (The Cow) 2:10

slide32

The Elderly and Mental Illness

  • From 15 to 25 percent of elderly people suffer from significant symptoms of mental disorders
  • Ratio of Moderate organic disorders :
  • Severe organic mental disorders
  • (Ratio of 2 : 1).
slide33

The Elderly and Suicide

  • The highest suicide rate in America is among those aged 65 and older. In 1985, this age group represented 12 percent of the total U.S. population, but accounted for 20 percent of suicides nationwide.
slide34

The Elderly and Mental Illness

  • Worldwide, elderly people lead the World Health Organization's list of new cases of mental illness: 236 elderly people per 100,000 suffer from mental illness, compared to 93 per 100,000 for those aged 45 to 64, the next younger group.
slide35

Nearly 25% of elderly persons suffer from symptoms of mental illness,

  • Only 4% of the patients in community mental health centers, 2% of the patients seen in private practitioners' offices or hospitals are elderly
  • Less than 1.5% of the direct costs for treating mental illness is spent on older people living in the community.
slide36

Depression (Epidemiology)

Most common mental disorder, afflicts up to 5% of people aged 65 and older

Can mimic dementia

About 10% of those diagnosed with dementia actually suffer from depression that, if treated, is reversible

More than one third of all depressed patients seen by doctors will go untreated due to misdiagnosis

Lifetime risk for major depression is only 7-12% in men, but a whopping 20-25% in women!

slide37

Depression

  • (and Women’s Indirect Complaints)
  • The elderly are also commonly taking many
  • more medications than younger people are;
  • some of these medications:
  • Anti-inflammatory drugs
  • Progesterone
  • Anticancer drugs
slide38

Depression

  • (and Medications of the Elderly)
  • Usually women will not complain directly of
  • sadness; symptoms can include, but are not
  • limited to:
  • Alzheimer's disease
  • Cancer (including breast and ovarian)
  • Congestive heart failure
  • Parkinson's disease
  • Rheumatoid arthritis
  • Sexual dysfunction
  • Diabetes
slide39

Depression (Signs & Symptoms)

  • Feelings of worthlessness, hopelessness, helplessness, inappropriate guilt;
  • Prolonged sadness, crying spells;
  • Jumpiness, irritability;
  • Loss of interest in and withdrawal from formerly enjoyable activities, family, friends, work or sex (anhedonia);
  • Intellectual problems: loss of memory, cannot concentrate, disorientation.
slide40

Depression (presentation in brief)

  • Disturbances in sleep, self-esteem, libido, appetite, interest, energy, concentration, memory, and movement
  • Feelings of guilt
  • Suicidal thoughts, plans, or attempts
  • Physical pain
slide41

Therapies for Depression

Pharmacotherapy (anti-depressants) is fairly successful at improving the quality of life of the elderly patient.

Psychotherapy is often used in combination with anti-depressants, which can include drugs in these classes:

slide42

Anti-Depressants (Types)

  • Heterocyclics
  • Selective serotonin reuptake inhibitors (SSRIs) such as Prozac
  • Monoamine oxidase inhibitors (MAOIs)
  • Tricyclics such as imipramine, desipramine, amitryptyline, and nortriptyline.
slide43

Anti-Depressants (Side-effects)

  • (the elderly is more susceptible to)
  • Blurred vision
  • Dry mouth
  • Urinary retention
  • Confusion
  • Constipation
  • Drowsiness
  • Insomnia
  • Cardiac arrhythmia
  • Hypotension
  • Weight fluctuations
  • Gastrointestinal distress
  • Sexual dysfunction
slide44

Dementias

Characterized by confusion, memory loss, and disorientation

Only 15% of older Americans suffer from this condition (of that number, an estimated 60% suffer from Alzheimer's disease, a progressive mental deterioration for which no cause or cure has been found)

Alzheimer's being the most prevalent type (degeneration can last from 5 to 20 years).

slide45

Dementias (Causes)

About 40% of all dementias can be caused by complications of chronic high blood pressure, blood vessel disease or a previous stroke. Deterioration is in steps rather than in a steady progression.

slide46

Dementia (Symptoms)

  • Delirium
  • Depressed mood
  • Behavioral disturbances
  • Delusions
slide47

Sometimes medications are used to treat symptoms that are secondary to dementia, such as sleep disruption, depression, and aggressive behaviors. These medications are only treating the symptoms that arise out of the underlying dementia, and do not treat the dementia itself.

slide48

Dementia (and Parkinson’s)

  • Parkinson's disease, which generally begins with involuntary and small tremors or problems with voluntary movements. Dementia may occur when the disease is severe or very advanced.
slide49

Dementia (and Huntington’s)

  • Huntington's disease, a genetic disorder that begins in middle age and has symptoms of changed personality, mental decline, psychosis and movement disturbance.
slide50

Dementia and Creutzfeldt-Jakob

  • Creutzfeldt-Jakob disease, thought to be caused by a viral infection leading to rapid and progressive dementia.
slide51

DeliriumElderly patients, and especially women, are extremely sensitive to things such as surgery and anesthesia, drug toxicity, and infections like urinary tract infections (especially in women). The symptoms of delirium are often misdiagnosed as relating to other conditions. Symptoms can be reduced with Haloperidol.

slide52

Delirium (common symptoms)

  • EEG shows a slowing of activity in the brain
  • Disturbed consciousness
  • Sudden reduced ability to focus, sustain, or shift attention
  • Sudden onset of misperceptions
  • Impaired judgement
  • Increased or decreased motor activity
slide53

Psychosis

Schizophrenia is a group of mental disorders that involve disturbances of thinking, mood, and behaviour

Bipolar disorders involve periods of depression followed by periods of mania (accompanied by grandiosity, lack of sleep, and excessive activity)

Elderly patients who are diagnosed with psychosis may also experience delirium or dementia, so these conditions must be treated in addition to the psychosis.

slide54

Schizophrenia

Only 3% of patients with schizophrenia experience their first symptoms in their sixties or after

The treatment of schizophrenia for elderly patients is largely the same as in other schizophrenic patients

Minor differences in treatment are the necessity to treat depression that often results in elderly patients as a result of psychosis.

slide55
3

Islamic Care of the Elderly

slide56
بسم الله الرحمن الرحيم

يَا أَيُّهَا النَّاسُ قَدْ جَاءتْكُم

مَّوْعِظَةٌ مِّن رَّبِّكُمْ

وَشِفَاء لِّمَا فِي الصُّدُور

وَهُدًى وَرَحْمَةٌ لِّلْمُؤْمِنِينَ

O mankind! There has come to you

an admonition from your Lord-Sustainer,

and a Healing for all (the diseases) that are in the breasts;

and a Guidance and a Mercy for the Believers.

Yunus 10:57

slide57

Holistic Approach

Bio-physical

Psychological

Spiritual

Social

slide59

Pantun Akal

Tundukpadikeranaisi

Kekalemastidaklahsenang

Tunjukbudidisanjungtinggi

Akal warasmenjadimatang.

slide60

PantunKalbu

Fasihlisanbiarberbudi

BukuHadismenyuluhterang

KasihTuhanberperi-peri

Kalbuikhlasmenjaditenang.

slide61

أَفَلَمْ يَسِيرُوا فِي الْأَرْضِ فَتَكُونَ لَهُمْ قُلُوبٌ يَعْقِلُونَ بِهَا

أَوْ آذَانٌ يَسْمَعُونَ بِهَا فَإِنَّهَا لَا تَعْمَى الْأَبْصَارُ

وَلَكِن تَعْمَى الْقُلُوبُ الَّتِي فِي الصُّدُورِ

Do they not travel through the land,

so that their hearts gain understanding

and causing their ears to hear?

Truly it is not their eyes that are blind,

but blind have become their hearts which are in the breasts.

Al-Haj(The Pilgrimage) 22:46

allah maha sombong maha agung
Allah Maha Sombong, Maha Agung

Dari Abu Hurairah r.a., ia berkata: Rasulullah s.a.w. bersabda, “Allah ‘azzawajalla berfirman, “Kesombongan (al-kibriyaa’) selendang-Ku, dan Keagungan itu sarung-Ku; sesiapa yang melawan-Ku dalam salah satu daripadanya, maka akan Aku lemparkan ke dalam neraka.””

(Abu Dawud)

Achmad Sunarto & Syamsuddin Noor, S.Ag., 2005. Himpunan Hadits Qudsi. Jakarta: An Nur, hal. 89-90.

slide63

Care and Therapies for the Elderly

  • Pharmacotherapy
  • Psychotherapy & Religio-spiritual therapy
  • Social therapy
pertemuan dengan allah
Pertemuan Dengan Allah

Dari Aisyah r.a., ia berkata: Rasulullah s.a.w. bersabda, “Barangsiapa yang kasihkan pertemuan dengan Allah, maka Allah kasihkan pertemuan dengannya, dan barangsiapa yang bencikan pertemuan dengan Allah, maka Allah bencikan pertemuan dengannya; sedangkan mati adalah sebelum pertemuan dengan Allah.”

(Muslim)

Achmad Sunarto & Syamsuddin Noor, S.Ag., 2005. Himpunan Hadits Qudsi. Jakarta: An Nur, hal. 83-84.

slide65

Khatimah

Care of the Elderly

Prevention better than cure

The Islamic approach is a cross pollination of different modalities (accepted by Islam)

The care-giver and care-recipient are beloveds of Allah.