Mental Health First Aid for Older Adults

1. Mental Health First Aid for Older Adults Betsy Chivers, Training Coordinator The Alaska Training Cooperative

2. Objectives • Interactive and participatory • What is Mental Health First Aid • Who should be a ‘Mental Health First Aider’ • Facts about Mental Illness • Common Mental Health Illnesses • Terms • Symptoms • Risk Factors • Why Older Adults are at risk • Sharing story Mental Health First Aid for Older Adults

3. Mental Health First Aid is the help offered to a person developing a mental health problem or experiencing a mental health crisis. The first aid is given until appropriate treatment and support are received or until the crisis resolves. Mental Health First Aid for Older Adults

4. Stand up/raise your hand/shout out if you knew or know your • Great grandparents • Grand parents • Parents • Aunts, uncles, cousins, nieces, nephews • Friends We all have family…someone we care about Mental Health First Aid for Older Adults

5. Who Makes a Successful ‘Mental Health First Aider’ • Do you have concern and empathy for other people • Would you like to create a sense of community and belonging for others • Are you warm, accessible, enthusiastic and caring • Can you shift gears when circumstances change • Do you ask and/or seek help when you need it Mental Health First Aid for Older Adults

6. Take a moment to consider these questions Would you like to CELEBRATE your birthday next year? How about CELEBRATING it in 5 years? How aboutCELEBRATING it in 10 years? How aboutCELEBRATING it in 15 years? How aboutCELEBRATING it in 20 years? If you answered YES and you do celebrate any of the above – Chances are GOOD, you will become an OLDER ADULT, you may have family and friends who will be too! Mental Health First Aid for Older Adults

7. YOU MAY WANT TO CONSIDER BECOMING A CERTIFIED MENTAL HEALTH FIRST AIDER FOR OLDER ADULTS…. What does it take? A commitment of 8 hours Mental Health First Aid for Older Adults

8. Facts Regarding Mental Illness, why Mental Health First Aid • Mental health problems are common • Stigma and bias are associated with mental health problems • Many people are not well informed about mental health problems • Professional help is not always on hand • People often do not know how to respond • People with mental health problems often do not seek help Mental Health First Aid for Older Adults

9. A mental disorder or mental illness is a diagnosable illness that: • Affects a person’s thinking, emotional state, and behavior • Disrupts the person’s ability to • Work • Carry out daily activities • Engage in satisfying relationships Mental Health First Aid for Older Adults

10. The Impact of Mental Illness • Mental illnesses can be more disabling than many chronic physical illnesses • “Disability” refers to the amount of disruption a health problem causes to a person’s ability to • Work • Carry out daily activities • Engage in satisfying relationships Mental Health First Aid for Older Adults

11. Why Mental Health First for Older Adults

12. Recovery from Mental Illness “Recovery is the process in which people are able to live, work, learn, and participate fully in their communities.” “For some, this is the ability to live a fulfilling and productive life despite a disability.”  “For others, recovery implies the reduction or complete remission of symptoms.”  — President’s New Freedom Commission on Mental Health Mental Health First Aid for Older Adults

13. Mental Health First Aid for Older Adults Decrepit Senior Moment Osteoporosis Lung Disease Arthritis Senior Shriveled Geezer Senile Grumpy Heart Disease Cancer Macular Degeneration Hypertension Stroke Rumpled LittleOldLady Old coot Alzheimer’s Disease Pneumonia Type 2 Diabetes Common Terms & Illnesses Associated with Older Adults Oldster Cataract Parkinson’s Disease Mature Dementia Elderly Cranky Kidney Disease Coronary Artery Disease Sage

14. Depression and Anxiety • Are among the most common mental illnesses • Can have some similar signs and symptoms • Can frequently co-occur Mental Health First Aid for Older Adults

15. Depression • Major depressive disorder lasts for at least 2 weeks and affects a person’s • Emotions, thinking, behavior, and physical well-being • Ability to work and have satisfying relationships Mental Health First Aid for Older Adults

16. Anxiety • An anxiety disorder differs from normal stress and anxiety • An anxiety disorder is more severe, lasts longer and interferes with daily activities and relationships Mental Health First Aid for Older Adults

17. Risk Factors for Depression and Anxiety • Distressing and uncontrollable event • Stressful or traumatic events • Difficult childhood; history of childhood anxiety • Ongoing stress and anxiety • Another mental illness • Previous episode of depression or anxiety • Family history Mental Health First Aid for Older Adults

18. Risk Factors for Depression and Anxiety • More sensitive emotional nature • Illness that is life threatening, chronic, or associated with pain • Medical conditions • Side effects of medication • Lack of exposure to bright light in winter • Chemical (neurotransmitter) imbalance • Substance misuse; intoxication, withdrawal Mental Health First Aid for Older Adults

19. Risk Factors for Depression and Anxiety • Perceived poor health • Progressive/disabling sensory loss • History of recurrent falls • Cognitive impairment or dementia • Extended or long-standing bereavement • Dissatisfaction with social network • Preoccupation with somatic (physical) symptoms Mental Health First Aid for Older Adults

20. The Snowball Mental Health First Aid for Older Adults

21. MENTAL ILLNESS - Mental Health First Aid for Older Adults

22. Psychosis • Psychosis is a condition in which a person has lost some contact with reality • The person may have severe disturbances in thinking, emotion, and behavior • Disorders in which psychosis can occur are not as common as depression and anxiety disorders • Psychosis usually occurs in episodes and is not a constant or static condition Mental Health First Aid for Older Adults

23. Changes in Emotion and Motivation • Depression • Anxiety • Irritability • Suspiciousness • Blunted, flat, or inappropriate emotion • Change in appetite • Reduced energy and motivation Common Symptoms When Psychosis is Developing Mental Health First Aid for Older Adults

24. Risk Factors of Psychosis in Older Patients • Thyroid disease • Diabetes • Vitamin B12 and folate deficiency • Sodium-potassium imbalance • Sleep deprivation • Dehydration • Dementia • Drug-induced psychosis/delirium • Chronic illnesses • Schizophrenia • Bipolar disorder • Psychotic depression Mental Health First Aid for Older Adults

25. MENTAL ILLNESS - Mental Health First Aid for Older Adults

26. Features • Inability to sustain focus or attention • Disorientation to time, place and people • Impaired judgment • Poor impulse control  • Causes • Adverse medication side effect • Drug-drug interaction • Disturbance in body function (high fever, infection) • Reaction to anesthesia • Requires immediate medical attention Delirium Symptoms Mental Health First Aid for Older Adults

27. Behavior changes • Seeing things that don’t exist • Restlessness, agitation, combative behavior • Calling out, moaning, or making other sounds • Being quiet and withdrawn – especially in older adults • Slowed movement or lethargy • Disturbed sleep habits • Reversal of night/day sleep/wake cycle Delirium Mental Health First Aid for Older Adults

28. Risk factors/causes • Adverse medication side effect • Drug interaction • Disturbance in body function (high fever, infection) • Reaction to anesthesia • Requires immediate medical attention Delirium Mental Health First Aid for Older Adults

30. Characteristics of Dementia • Deterioration in brain function beyond the normal range of age-related brain changes • Has many causes - stroke, brain injury, alcoholism, disease (HIV, Parkinsons, Multiple Sclerosis) • Alzheimer’s disease is the most common irreversible type • Degree of impact and progression varies from mild to severe according to cause, disease course, area of brain affected, etc. • Important to address quickly and may be treatable Mental Health First Aid for Older Adults

31. Symptoms of Dementia Depending on the cause, type and severity, people may experience any or all of the following symptoms: • Struggles with problem solving and/or decision making • Difficulty planning and carrying out complex tasks • Problems with memory and recognizing familiar people and places • Disorientation to time and place • Decline in self-care • Difficulty learning or retaining information • Poor judgment or decision making skills • Changes in sensory perception, hallucinations, delusions • Difficulty with communication and language • Behavioral and mood changes • Impulsiveness and poor insight to behaviors Mental Health First Aid for Older Adults

32. Risk Factors of Dementia • Age • The risk of Alzheimer’s disease, vascular dementia, and other dementias goes up significantly with advancing age • Genetics/ family history • Smoking and alcohol use • Atherosclerosis • Cholesterol, high levels of “bad” cholesterol (LDL) • Diabetes • Mild cognitive impairment Mental Health First Aid for Older Adults

34. Mental Health First Aid for Older Adults

35. Suicide Risk Assessment for Older Adults • Marked feelings of hopelessness • Pain and/or medical conditions that significantly limit functioning or life expectancy • Co-morbid general medical conditions that significantly limit functioning or life expectancy • Social isolation • Family discord or losses (recent death of a loved one) • Inflexible personality or marked difficulty adapting to change • Access to lethal means (firearms) • Impulsivity in the context of cognitive impairment Mental Health First Aid for Older Adults

36. Warning Signs of Suicide • Threatening to hurt or kill oneself • Seeking access to means • Talking or writing about death, dying, or suicide • Feeling hopeless • Feeling worthless or a lack of purpose • Acting recklessly or engaging in risky activities Mental Health First Aid for Older Adults

37. Warning Signs of Suicide (continued) • Feeling trapped • Increasing alcohol or drug use • Withdrawing from family, friends, or society • Demonstrating rage and anger or seeking revenge • Appearing agitated • Having a dramatic change in mood Mental Health First Aid for Older Adults

38. Suicide mortality rate per 100,000 population - by age group - all Alaskans 2003-2017 (15 year average)

39. Why Mental Health First Aid for Older Adults • Gerontologists in Alaska • 3 listed in Anchorage • 3 listed in Fairbanks • 2 listed in Juneau • Gerontologists in Vermont • 7 listed in Brattleboro • 10 listed in Burlington • 22 listed in White River Junction • Gerontologists in North Dakota • 9 listed in Fargo • 7 listed in Bismarck Aging Challenges in Alaska

40. Why Mental Health First Aid for Older Adults

41. Why Mental Health First Aid for Older Adults

42. Why Mental Health First Aid for Older Adults

43. The power of our story and sharing that story My story starts with my great-parents and my parents story Why Mental Health First Aid for Older Adults