Reducing the risk of late-life mental illness

It’s possible to pinpoint behaviours that can help reduce the risk of mental health disorders in older age

Source: University of Toronto
By: Dr. Robert Madan
Date: 15 February 2016

Older adults now outnumber children in Canada, and the mental health needs of our aging population are complex. We hear a lot about Alzheimer’s disease, and for good reason — rates of people living with dementia are expected to rise along with the aging population. But late-life depression, anxiety and other mental health concerns are also common. It’s my mission to change that.

Just as the Alzheimer Society of Canada’s #StillHere campaign expressed so well, those suffering from dementia or mental health conditions are very much still here. And in many cases there are tangible things people can do to improve, or to manage symptoms.

As a geriatric psychiatrist and Chief of Psychiatry at Baycrest Health Sciences, I spend much of my time focused on enhancing our quality of life as we age. It’s a complicated area, with sometimes unexpected associations. While we still have much to learn, we’ve been able to pinpoint certain behaviours that can help both reduce the risk of mental health disorders in older age—and to deal with them if or when they emerge.

The Link Between Depression and Dementia

Dementia can have various mental health repercussions, so it might be expected that struggling with dementia can lead to depression. What is particularly surprising, however, is that it seems to work the other way around as well. People who suffered from depression earlier in their lives are more likely to develop dementia as they age. In fact, based on numerous studies, an episode of major depression — even at a young age — has been shown to double the risk of developing dementia. While we have various theories, researchers are trying to understand what’s at the root of this connection.

One possible explanation is that the high levels of the stress hormone cortisol associated with depression might be causing shrinkage in an area of the brain called the hippocampus. Located in the centre of the brain, the hippocampus is involved in memory. According to this theory, the damage caused by depression leads to impairment in this area of the brain, which in turn leads to dementia.

Another theory suggests that these conditions have common risk factors—that whatever is leading someone to depression could also be increasing their chances of dementia. For example, research shows that cerebrovascular disease, like a stroke or mini-strokes, is associated with both depression and Alzheimer’s. Likewise, diabetes, hypertension and obesity are all risk factors of both cerebrovascular disease and dementia.

Alzheimer’s and Mental Health

As many of us know, Alzheimer’s disease and other forms of dementia are difficult to live with. Memory loss is upsetting, as are the changes in how we see, hear, interpret things and communicate with others — both for the person with dementia, and for their loved ones. It’s extremely common for dementia to go hand-in-hand with disorders like psychosis, depression and anxiety. And it’s important to reach out for help. For extreme cases, medication is an option. There are also community resources that provide education and support. The Alzheimer Society of Canada is a good place to start. There is no one-size-fits-all treatment, but things like physical exercise, cognitive behavioural therapy or artistic activities can be effective.

Depression is common in old age — but it doesn’t have to be

Things change as we age, and it can be unsettling. We may lose loved ones, develop health issues, experience financial stress, or any combination of these. As things change we may drop activities that once brought us joy and social connection — a disease could confine us to our home, or financial difficulties could keep us from joining a regular meal out with friends. We know that social connections, a good diet and lots of exercise are important for mental health — but sometimes these just drop out of our routines. Even if they don’t, sometimes they’re just not enough to keep depression at bay.

It’s not uncommon for people to develop depressive symptoms as they age — but I believe it doesn’t need to be. It’s important to get medical help if you think you may be depressed, no matter your age. We can treat major depression by combining medication with other types of therapies like group or individual psychotherapy. In very mild cases, counseling and lifestyle changes — such as finding ways to keep social and active — can make a big difference. We have to get past the old-age stigma and admit that it’s never too late to lead a meaningful and enjoyable life.

Dr. Robert Madan is an assistant professor of Geriatric Psychiatry at the University of Toronto and Chief of Psychiatry at Baycrest Health Sciences.

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