Growing older

The older a person gets, the greater the likelihood of profound changes, for example through loss or illness or simply a new stage in life. One such change is retirement. Finding new tasks and challenges, structuring the day independently and the loss of professional recognition is experienced as extremely stressful, especially by people who have defined themselves strongly through their work. Health problems become more and more present with advancing age. Periods of illness increase and last longer than in younger years. Several illnesses can occur simultaneously and serious illnesses become more frequent. In old age, physical and mental abilities may decline, leading to limitations in independence and self-determination. Many people now lack plans and goals for the future. They become more aware of the finite nature of life and begin to deal with their own death. At the same time, relationship losses become more frequent because a partner, family member or close friend dies. This is also reflected in the emotional experience of older people. According to a study by the University of Leipzig, older people feel anger, hostility and contempt less often than younger people. Sadness, however, remains the same and tends to increase somewhat in old age.

Age is not generally considered a risk factor for mental illness. However, the risk increases with the negative changes it can bring. Each individual change represents a psychological burden that can promote mental illness. As stresses accumulate, especially in old age, this has an impact on mental health. It is estimated that 17 percent of people over 75 are affected by a depressive disorder, and 7 percent suffer from major depression. In nursing homes, the residents’ mental stress is particularly high. Here, the majority of residents have a mental illness.

The most common mental illnesses in older people include the so-called "3 Ds" - dementia, depression and delirium - as well as anxiety and addiction disorders. It is typical for mental illnesses in old age that they can occur both individually and in combination. This is particularly often the case with depression and anxiety disorders, in many cases these are also accompanied by pain. Dementia also frequently occurs together with an anxiety disorder. A close interlocking of symptoms is also present in depression and dementia. Many patients become depressed in the early stages of dementia and depressed people can show symptoms of dementia such as concentration and attention problems or orientation difficulties. Only delirium can usually be easily distinguished from the other diseases. Here, cognition and attention suddenly collapse, in contrast to the slow, persistent and progressive development in dementia. In elderly people, delirium often occurs when they are in hospital or in a care facility. It is often the result of multimorbidity and multimedication. There are certain possibilities for prevention. Besides the right medication, a balanced electrolyte and fluid balance, support with hearing and seeing as well as a well-designed environment can prevent delirium.

Correctly recognising mental illness in the elderly is a challenge for relatives, care staff and medical professionals. Nevertheless, it is necessary and important to diagnose and treat those affected appropriately. Elderly people belong to the risk group for suicides. Men over the age of 65 are particularly at risk; one third of all suicides fall into this age group. In most cases, the triggers are untreated depression, which is often hidden behind addictive and risky behaviour, as well as anxiety disorders. Physical illness, chronic pain, loneliness and social isolation, the loss of close people or familiar surroundings as well as the experience of constant dependence and the desire not to burden others are considered additional risk factors.

Which therapeutic measures are used depends on the individual clinical picture. It should be noted, however, that psychotropic drugs often have a different or stronger effect on older people and are associated with different or stronger side effects than on younger patients. In addition, interactions with other medications taken must be taken into account. The age of the patient should also be considered in psychotherapy. In contrast to young patients, the focus in old age is no longer on eliminating the symptoms, but rather on achieving small changes that solve concrete problems in the daily lives of those affected. Thus, the well-being of some patients already improves when they learn to structure their everyday life in a meaningful way or find new tasks with the support of the therapist that make life worth living again.