Good Things Come in Old Packages

Right from an early age, we get a clear message from the world around us that being old isn’t so great, at least in Western society. Our mothers worry about getting wrinkles and use day creams, night creams, vitamin creams and highly scientific, or perhaps natural and organic, concoctions to cover up the visible signs of ageing. Our fathers often resist retirement. I remember my Nana once saying to a young garage attendant, “I am not an old woman! I can do that myself!”, as he offered to help her with the fuel pump. She was about 80 years old at the time.

I once worked as a counsellor at Kids Helpline, and the “how old are you?” question was a common one. A teenage caller once guessed that I was 27, “not that old”. I asked what “old” would be, and the caller replied that “40 is old”. I had just turned 40. Of course on the inside, I still felt very much like 27, and I wondered what being 40 was supposed to feel like.

But the messages we get are mixed. On the one hand, getting old isn’t great, but at the same time our world tells us to look forward to the “golden years” and to extend our lives as much as possible. According to marketing paraphernalia, retirement living is supposed to be great, full of socialising and relaxation, holidays and good times. We can hope for a long period of good health and a return on the investment of time and effort that we have put in over the years. Medical research is also driven towards prolonging our life expectancy, keeping us alive by finding new treatments for the diseases and ailments that inevitably arise as our bodies age and become more vulnerable and less able.

So what is it really like as an older person? Is living longer better, or is it often more difficult?

According to research (Shtompel, Whiteman & Ruggiano, 2014; WHO, 2013), the elderly who have physical health conditions such as diabetes or heart disease, also have higher rates of depression. When such depression is untreated in an older person it is negatively related to the management and outcome of the disease, and patients have a higher mortality risk. According to the Australian Institute of Health and Welfare (2013), 60% of persons aged 75-84 years, and 70% of persons aged 85 years or over have some form of cardiovascular disease. What is even more important to know is that depression is both under diagnosed and undertreated in primary aged-care settings (WHO, 2013). This is likely because the symptoms of depression in older adults are often overlooked by professionals because they co-occur with other issues or events that are common in later life, such as bereavement and decreasing physical health (this concept is further explored in one of the featured articles in this edition).

As can be seen in the table below, according to a survey by the Australian Bureau of Statistics (2009) of people aged 16-85 years with mental disorders, while a greater proportion of older adults accessed care from a General Practitioner compared with younger and middle-aged adults, fewer sought help from a psychologist or other mental health care provider.

*Includes consultations with: psychiatrist, mental health nurse, social worker, counsellor, medical specialist, and complementary/alternative therapist. Source: Australian Bureau of Statistics. (2009).

So if depression is often overlooked in older adults by professionals, do they also overlook their own mental health? Being able to recognise one’s own health issues is an important factor in accessing care, as well as the willingness or capacity to seek help.

A recent study by Shtompel, Whiteman and Ruggiano (2014) which investigated older adults experiences of ill health, mental well-being and help-seeking found that the most common factor in deciding whether they could talk to someone about their negative experiences was whether or not the person understood how they felt. Many participants in the study reported feeling like care providers would not understand. They are often much younger, and are perceived not to understand what the older person is going through. Moreover, with regards to discussing mental health with their doctor, many felt that this would result in additional prescriptions, adding to already increasing load, and with a belief that medication would not help.

Participants also reported perceiving that discussing their negative feelings with someone was burdensome, especially for family members. These older adults still took on the role of parent and wanted to protect their now adult children from the realities of their ill health and well-being (Shtompel, Whiteman & Ruggiano, 2014). Research has also indicated that older adults tend to rely on informal sources of support, such as talking to friends, family, or members of the clergy (Wacker & Roberto, 2014; Woodward, Chatters, Taylor, Neighbors, & Jackson 2010). However, increasing social isolation is also a serious issue experienced by older adults (Nicolson, 2012).

So what can we do to best support the older adults in our society? As we come into the Christmas and New Year period, the realities of being another year older are most likely at the forefront of many people’s minds as they look back on the year that was. For those who are alone, isolated from family, friends and the broader community, it is likely a sad and difficult time. Coincidentally, the death rates over this period are significantly higher than other months, with spikes around Christmas and New Year’s Day (Phillips, Barker & Brewer, 2010). Some believe it could be because people experience more stress or sadness, or that access to health care is reduced due to closures and fewer available staff.

I am reminded of the simple message of “R U OK?” from the national not-for-profit organisation (www.ruok.org.au) with a mission to encourage and equip everyone to regularly and meaningfully ask “are you ok?”, where a simple cup of tea and long conversation can make a difference to someone’s well-being. Perhaps we could also take a leaf from the many cultures, including Australian indigenous culture, in which the elderly are honoured and maintain an important and respected role in the family and broader community. Enjoying hearing a life story, the sharing of wisdom, and demonstrating an appreciation of how difficult it is right now for an older person you know, might make all the difference. Good things do come in old packages.

Written by Dr Debra Bath B. Arts (Hons), PhD (Qld.), MAPS

References:

• ABS. (2009). Australian Social Trends: Mental Health. Canberra, Australia: Australian Bureau of Statistics.
• Australian Institute of Health and Welfare (2013). How many people have cardiovascular disease? Retrieved from: hyperlink.
• Nicholson, N.R. (2012). A review of social isolation: an important but underassessed condition in older adults. Journal of Primary Prevention, 33(2-3), 137-52.
• Phillips, D., Barker, G. & Brewer, K.M. (2010). Christmas and New Year as risk factors for death. Social Science & Medicine, 71 (8), 1463-1471.
• Shtompel, N., Whiteman, K. & Ruggiano, N. (2014). Negative feelings and help seeking among older adults with chronic conditions. Journal of Gerontological Social Work, 57 (8), 810-824.
• Wacker, R. & Roberto, K. (2014). Community resources for older adults: Programs and services in an era of change. Thousand Oaks, CA: Sage Publications.
• Woodward, A. T., Chatters, L. M. Taylor, R. J., Neighbors, H. W., & Jackson, J. S. (2010). Differences in professional and informal help-seeking among older African Americans, Black Caribbeans, and non-Hispanic Whites. Journal of the Society for Social Work and Research, 1(3), 124-139.
• WHO (2013). Mental health and older adults: Fact sheet N-381. Retrieved from: hyperlink.