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Health 411 Mental health 411 Hoarding Hoarding is the tendency to collect items coupled with the inability to discard them. The most common items that people hoard are newspapers, books, mail, lists, notes, old clothing, and bags. While hoarding has been classified as a symptom of obsessivecompulsive disorder, new research is bringing that into question. A study published in The American Journal of Psychiatry in May 2008 found that hoarding may be a “distinct syndrome” that affects people who don’t necessarily

have obsessive-compulsive disorder. All participants in the study—both those who had obsessive-compulsive disorder and those who didn’t— hoarded as a result of fear that they may need items in the future and felt a strong emotional attachment to their possessions. The only difference was that 25% of those who had obsessive-compulsive disorder tended to hoard bizarre items such as nail clippings and had more severe behaviors (checking rituals) or thoughts (something bad would happen if the items were lost) about their possessions. While hoarding behavior usually appears in the 20s and 30s, for older adults it can be more pronounced because they have accumulated years’ worth of items. If the clutter inhibits movement around living spaces, hoarding can become a health hazard and increase the risk of falls.

While hoarding behavior usually appears in the 20s and 30s, for older adults it can be more pronounced because they have accumulated years’ worth of items.

In winter, people may experience signs of depression, otherwise known as seasonal affective disorder (SAD). Symptoms can include social withdrawal, weight gain, carbohydrate cravings, lack of interest in normal activities, and fatigue. Not all of these need to occur to indicate that someone is suffering from SAD. Fewer daylight hours may trigger SAD, which is caused by a chemical imbalance in the brain. When it is dark, people tend to produce more melatonin, a sleep-related hormone associated with depression. Clinicians can diagnose SAD and provide options for therapy. One solution is to get outside more to increase exposure to light. Another alternative is 30 to 90 minutes of light therapy with the aid of a light box. For more severe cases doctors may prescribe antidepressants to alleviate symptoms. 4 5630065 - EH 2008-11 Nov final.indd 1

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Erickson Health empowers you to live even better, no matter what your health. ERICKSON HEALTH is an extensive array of people, resources, and programs specializing in health care for older adults.

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Seasonal affective disorder

The clutter of hoarding can become a health hazard.

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Good Health Starts Here Newsletter

Compliments of Erickson Health, exclusively at Erickson communities

ENHANCE YOUR MENTAL HEALTH It used to be hard to find ways to feel better psychologically. Not anymore. There are ways to fight mental health issues, like stress. Here are some simple ways to enhance your mental health.

Don’t Obsess, Make Stress Less Stress can be a good thing, protecting us against danger. “Hormones like cortisol and adrenaline are stressrelated,” says Bruce McEwen, Ph.D., head of Rockefeller University’s Lab of Neuroendocrinology in New York, N.Y. Short-term, these hormones protect us. “When cortisol is doing the right thing, it promotes our immune system’s function, helps restore energy we have lost (like after running), and can enhance our memories,” he adds. Stress’ Negative Health Effects But an overload of these hormones is dangerous. Excess cortisol has been shown to cause bone loss and contributes to obesity. It impacts mental health, increasing the risk of depression, anxiety, and panic attacks. “Your doctor won’t detect elevated cortisol, but he might see elevated blood pressure,” McEwen says. “You name the disease, and stress affects it,” says Thomas Morris D.O., Erickson Health physician at Monarch Landing, an Erickson community in Naperville, Ill. Stress compromises your immune system, making you more prone to illness. If you’re already sick, it will impede your recovery. It may also

INSIDE Depression ..................................2 Anxiety .........................................3 Health 411 ...................................4

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affect how some medications work. In one study, when cancer cells in mice were exposed to a stress hormone, adrenaline, the cancer cells became more resistant to treatment. That could make a stressed cancer sufferer’s treatment less effective. Making Stress Less Destructive “The things in life we call ‘stressors’ are not really the problem. It’s how we react to these stressors,” says Steven M. Sultanoff, Ph.D., adjunct professor in psychology at Pepperdine University in Los Angeles, Ca. Salvatore Maddi, Ph.D., a professor of psychology and social behavior at the University of California, Irvine, has a name for the right attitude: hardiness. “It isn’t optimism— that is often just naive complacency,” he says.

“You name the disease, and stress affects it.” —Dr. Thomas Morris, Erickson Health physician

People who exhibit hardiness combine three factors to turn stressful situations into opportunities. “They show commitment, determined to stay involved no matter how bad things get; they take control, refusing to feel powerless; and they are willing to rise to challenges, seeing them as just a normal part of living and something to help them grow,” Maddi says.

A good social network helps to buffer the effects of stress.

There are lots of simple steps you can take to fight stress. Laughing, doodling, and deep breathing are ways to release tensions and lower stress levels. A good network is critical. “We see that in continuing care all the time. A strong social aspect is a big part of keeping people well, providing a safety net to help people absorb the shocks of life,” Morris says. “We tend to underestimate the preventive benefits of fighting stress through social and psychological solutions,” McEwen says. “Medications are important tools, but prevention is always better than medication.”

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Beating ‘The Blues’ According to the National Alliance for the Mentally Ill, “Among all medical illnesses, major depression is the leading cause of disability in the United States.” Older adults can be especially prone to depression; in fact, estimates are that depression may affect nearly 30% of people age 65-plus. Chronic disorders, retirement (even when one has looked forward to it), social isolation, and medication side effects are a few factors that can make older adults vulnerable. Getting a diagnosis can be tricky in someone older. “The symptoms and signals can be different in older adults. They may simply say they’re ‘feeling anxious’ or it might be more subtle, like telling me they’re not enjoying their usual activities,” says William Russell, M.D., Erickson Health vice president and regional medical director. The Mind-Body Connection Depression can predispose one to inactivity, which has been associated with reduced immune system response, which can lead to a greater risk of illness. “Chronic disorders are all affected by diet and exercise. Well, guess what depression affects? Appetite and physical activity. So depression is going to have a devas-

Counseling is critical in treating depression.

tating impact on any chronic condition,” Russell says. Heart trouble is linked to depression; one out of three heart attack victims suffers from depression before their attack. “It is not clear whether the problem is the depression itself or other factors that result from depression, such as poor eating habits, not complying with your health routine, and physiological disturbances of the heart function,” says Thomas Morris, D.O., Erickson Health physician at Monarch Landing, a community by Erickson in Ill. “Also, some of the more popular antidepressants can cause heart irregularities.”

It’s estimated up to 30% of older adults suffer from depression.

Medication side effects and chronic health problems are some of the reasons depression begins in older adults.

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Open a Dialogue One of the first steps toward fighting depression in older adults is willingness to discuss it. Experts agree that counseling is critical for truly fighting depression. “Yes, I can give you an antidepressant, but remember, it’s no good without talking therapy,” Russell

says. “The harmful nature of the disease is that people tend to cut off their options for proper treatment.” Financial difficulties may play a role; many health plans don’t cover mental health counseling. A Team Effort Treating depression successfully involves a team approach. The patient has to be willing to recognize the problem and accept treatment. The doctor has to look for less-thanobvious signs. “We need to periodically screen older adults for mood disorders,” Russell says, noting there’s a test involving a few simple questions that any doctor can do in the office quickly. Your doctor’s attitude can play a critical role. “Many people suffering from depression feel unworthy, and a physician who can show compassion is more likely to break through that,” he adds. The family should also be involved, especially if the person refuses treatment. “The physician has to help family members come to grips with their loved one’s problem and the effect it has on the family,” Russell says.

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Getting a Grip on Anxiety Anxiety is a catch-all term for several different types of disorders. It is estimated that one in ten older adults suffers from some form of anxiety disorder. Uncontrolled, anxiety can lead to feelings of hopelessness and depression. Fortunately, even if you’ve been living with your anxiety for decades, there are ways to change your responses and take control. Anxiety Is NOT Fear Anxiety has the same elements as fear. “There’s a physical element, like increased heart rates and blood pressure. There’s an emotional element; it’s uncomfortable and distresses you. And there’s a mental element; you are aware of it,” says Gary Kennedy, M.D., director of the division of geriatric psychiatry at Montefiore Medical Center in Bronx, N.Y. But fear usually has a specific cause, like an attack dog barking at you. Once the fear producer is gone, your responses (like heightened blood pressure) dissipate. Anxiety, by contrast, often has no identifiable cause. Even when anxiety starts with a specific cause, like a bad fall, the anxiety often remains beyond what’s caused it. If your fear of falling remains although there’s no longer any immediate danger, you have what’s called generalized anxiety disorder (GAD). GAD is the most common form of anxiety, and it’s the kind that leaves many older adults housebound. Other anxiety disorders include phobias, seemingly unreasonable fears (like terror of elevators), and panic attacks, in which you feel a sudden, uncontrolled terror. Panic attacks often come with physical symptoms, like shortness of breath and heart flutterings. Getting a Diagnosis Experts agree that it’s never too late to start fighting anxiety. The first step is proper diagnosis, usually through your primary care physician

(PCP). “You have to be sure your jumpiness is truly from anxiety, and not from a physical problem like hypothyroidism,” Kennedy says. Getting a proper diagnosis from your PCP can be difficult because your doctor may not be getting all the feedback necessary, either from you or other experts. “Your doctor needs to get a complete history, plus find out what’s currently going on in your life,” says Leslie Rigali, D.O., Erickson Health medical director at Brooksby Village, an Erickson community in Peabody, Mass. “Many older adults are seeing multiple doctors, and each doctor may be getting a different part of the story,” says Linda Carpio, L.C.S.W., a social worker specializing in senior mental health issues at Peninsula Counseling Center in Woodmere, N.Y.

Relaxation techniques are one option. Other steps you can take include: t#SFBUIJOHFYFSDJTFT t5IPVHIUTUPQQJOH SFDPHOJ[JOH the anxious thought and deliberately stopping it) t,FFQJOHBSFHVMBSTMFFQXBLFDZDMF t'JOEJOHTPNFGPSNPGQIZTJDBM activity to take your mind off anxious thoughts t"WPJEJOHPSNJOJNJ[JOHDBGGFJOF and nicotine Find a counselor. “I’d start with a referral from your PCP, preferably to someone with geriatric mental health skills,” Feldhausen says. Also consult your local mental health association or department of aging.

One in ten older adults suffers from some form of anxiety disorder. More Than Pills Alone Medications are still the first treatment route, but finding the right one for older adults can be tricky. “The old class of drugs called benzodiazepines, like Valium, are great, but can slow thinking and reflexes and be sedating,” says Kennedy. “They can cause balance problems, so if you take them before bedtime and have to get up during the night, you’re more likely to fall,” Rigali says. Instead of antianxiety medicines, Kennedy’s first choice of drugs with older patients is a group of antidepressants called SSRIs (selective serotonin reuptake inhibitors), like Prozac and Zoloft. “It’s combining medicine with lifestyle and attitude changes that conquers anxiety,” says Roberta Feldhausen, A.P.R.N.-P.M.H., Erickson Health director of mental health services. Anxiety is very responsive to behavioral changes.

Breathing exercises and physical activity can help take your mind off anxious thoughts.

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Mental Health: Good Health Starts Here