Mental stability can be challenge for aging

Isolation, depression key issues as seniors go through life changes

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Toward the front of a crowded conference room at Legacy Village senior community in Castle Pines, 82-year-old Marilyn McQueary sat quietly through a presentation on finding purpose in life after retirement.

Then the speaker asked the gathered seniors a question: What were their needs?

McQueary wanted to share. She knew from personal experience that connection to resources and social interaction can be key to healthy aging.

She has lived in Castle Rock with her son and daughter-in-law for about 14 months, moving from Florida after the death of her husband. The transition to her new hometown was difficult. She believed she was on the road to depression had she not pushed herself to make friends, find new activities and become involved in the community.

“I became very lonely,” McQueary said, to nods and sympathetic looks from those listening. “I just knew I couldn’t go on the way I was going.”

A growing demographic

Most seniors feel they are faring well — they are satisfied, or very satisfied, with their lives, local and national studies say.

Nearly 95 percent of adults 50 and older reported feeling that way, and nearly 90 percent said they receive adequate amounts of support, according to The State of Mental Health and Aging in America report from the Centers for Disease Control and Prevention from 2008.

But for the small percentage that isn’t OK, finding and asking for help is difficult, and the consequence means increasing isolation and a higher risk for mental illness such as depression and anxiety, say professionals from local aging resource organizations.

The reasons, they say, are varied: With advancing age comes more illnesses that may limit physical mobility, curtail independence and lead to isolation. Friends and family members die, leading to loneliness and loss of purpose. Cultural and social norms, particularly among those in their 80s or older who grew up with the Great Depression tough-it-out mentality, make it difficult to ask for help. And many still believe a stigma exists to admitting to a mental illness.

But just as mental health is a public health issue for Americans nationwide — one in five adults live with a mental illness — so it is for older adults, who are at an increased risk of depression, the CDC reports. And, the agency’s website points out, their depression is often misdiagnosed or under-treated because symptoms can be mistaken “as just a natural reaction to illness or the life changes that may occur as we age.”

An estimated 20 percent of people 55 or older experience some type of mental health concern, the CDC says. The most common conditions include anxiety, severe cognitive impairment and mood disorders, such as depression or bipolar disorder. And older men, 85 and older, have the highest suicide rate of any age group, according to the nonprofit Mental Health America.

If demographic projections hold true — that by 2030, largely because of aging baby boomers and longer lifespans, seniors will account for 20 percent of the U.S. population, the CDC reports — then the need for and access to mental health resources will become even more crucial for healthy aging, said Linda Efird, director of behavioral and mental health for InnovAge Colorado. InnovAge is a medical company that provides a range of health care services to older adults to help them remain in their homes and live independently.

Those resources are already lacking because of a shortage of health care professionals, including those working in geriatrics, and too few psychiatric beds in general and specifically for geriatric patients, Efird said.

“We are already feeling the effects of the older population and the need for mental health intervention,” she said. “I think we have to make an effort — more of an effort — to educate our younger students about the aging process, about what they can expect to see, and make sure that our health-care professionals, the programs, have a focus on aging, in geriatrics, in what the needs are.”

‘We want to feel connected’

Douglas County data reflects the national aging trend, with estimates that one in four residents will be 60 years or older by 2030, according to the Colorado State Demography Office.

The proportion of Douglas County residents who are age 60 or older grew by more than 4 percentage points from 2010 to 2016, according to annual population estimates from the American Community Survey of the U.S. Census.

Colleen Morton, wellness coordinator at the Castle Rock Senior Activity Center, works with many of the more than 1,000 seniors who come to the center at 2323 Woodlands Blvd. where they can share meals, play games and take classes. She sees firsthand how life’s changes can alter people’s mental condition.

“Often, they’re states away from where they were living and their emotional support system,” Morton said. “Their friends that they’ve known their entire lives, the community that they grew up in — they’re no longer there.”

Karie Erickson, executive director of Neighbor Network, an aging resource center that serves Douglas County residents, identifies isolation as a key issue for residents — which can lead to mental health conditions such as depression and anxiety.

“When you’re socially isolated,” she said, “that really can lead to a multitude of issues.”

Neighbor Network offers numerous services, but one of its most requested is a companionship program, Erickson said, which as the name suggests connects volunteers with seniors to provide them company. They will visit seniors in their homes, on social visits or make phone calls to help prevent isolation.

“I’m constantly surprised by how many people will say, ‘I want somebody to come visit me,’ ” Erickson said. “They get that renewed sense of friendship and that makes a huge difference.”

Gretchen Lopez is vice-chair of the Seniors’ Council of Douglas County, a volunteer advocacy group for people 60 and older, which hosted the presentation McQueary attended at Legacy Village.

“Sometimes,” Lopez said, “as we age, our world gets much smaller.”

Early in life people find purpose in their career, or their family, but after retirement, things can change. Children have become adults, spouses may have passed, and it can be difficult to find new activities that provide fulfillment.

That’s why the council held the “finding purpose” event, Lopez said, and why she says McQueary’s determination to change her situation is so important.

“The very nature of human beings is seldom to be alone,” Lopez said. “We want to feel connected to other people.”

Determined to make a change

For McQueary, isolation came after leaving her Florida home.

“I always knew I would come to Colorado, but I thought it would be from the hospital to the plane to the nursing home,” she said. “I just never expected to live with my children.”

She had deep roots in her Florida church, volunteer work she loved and a home she had shared with her husband for more than three decades.

McQueary chose to leave at the invitation of her son, she said. They were building a house and had room for her to live in the lower level. Knowing he wanted her there was an immense comfort, but it didn’t make the transition easy.

The move itself exhausted McQueary. She had three garage sales before selling her home. When she began unpacking in Castle Rock, she faced what felt like endless decision-making, something she used to share with her husband.

As weeks passed, McQueary worried about asking too much time of her son and daughter-in-law. She avoided calling friends so she wouldn’t drive up the phone bill. She found a new church but didn’t go as often as she wished. And, although she still drove, she and her son agreed she wouldn’t do so in inclement weather.

In June 2017, McQueary traveled to Wisconsin for a family reunion and while there decided to rebuild her life in Castle Rock.

“I was determined — ‘When I come back, I’m going to make a change’ — because I really don’t like this,” she said. “I don’t like this isolation.”

Looking for help

For some seniors, stigma around mental health can be a particular barrier to seeking treatment.

“I think there is some obvious hesitation to get help or support, just because we didn’t talk about these things in previous times like we do now,” said Jason Hopcus, president of the National Alliance on Mental Illness for Arapahoe/Douglas Counties.

The reluctance to talk about mental health can be more common among seniors 70, 80 and older, Morton and Lopez said.

“Mental health was not talked about,” Morton said of World War II veterans and people born during the Great Depression in the 1930s. “It’s still an uphill battle with the older senior group.”

Those eras produced a culture in which mental health and mental illness were highly stigmatized, Efird said, explaining that people faced discrimination, could be seen as “less than perfect” and, in many cases, mental illness was equated with intellectual disability.

Institutions treated mental illness inhumanely, she said, and early variations of antipsychotic drugs had serious and sometimes lifelong side effects. For that reason, some older seniors still fear taking medication for mental health conditions, Efird said, and avoid considering that as a treatment plan.

But seniors in younger age brackets may help reduce the stigma, Morton said. Many text from their smartphones, still work and are more attuned to current social issues — such as the greater willingness to speak about mental health than in decades past.

That change in attitude, along with the growing senior population, makes the existence of more resources even more important, Morton said. That could mean making seniors aware of what resources are specifically available for mental health. Seniors tend to rely on primary care providers for their health, Hopcus said, and will seek mental health support from them as well.

“So,” he said, “it’s limited to whatever resources they give them, which is often an antidepressant.”

Efird said primary care providers “don’t often have a lot of experience or education around mental illness,” and that mental health professionals are best-suited to suggest treatment and prescription options because psychiatry is its own specialty.

Douglas County has identified potential gaps in mental health services for seniors living in the county through its Mental Health Initiative, a partnership of more than 30 private, public and community-based organizations formed four years ago to streamline the county’s mental health system.

The gaps, Deputy County Manager Barbara Drake said, center on three general areas: geriatric mental health services, services for people living with dementia and better or more accessible services within Human Services’ Adult Protection program for at-risk adults and the elderly.

The county is working with consultants to help develop a health delivery system that better addresses geriatric mental health, Drake said. It is also building new case management practices, or an improved network of care, to better address at-risk and elderly adults.

‘The best thing that I have ever done’

After McQueary’s husband died, she turned to her church and a grief program it offered.

“I really didn’t expect him to die,” she said. “I really did not.”

After 51 years of marriage, she made herself a mantra for life without him: Each day, she would get up, get dressed, make her bed — and stay off of ladders.

She was determined to maintain a happy lifestyle — she had seen many other people her age suffer once they lost their spouse. She saw that especially among couples who did everything together, from shopping for groceries to church.

“You just give up. You don’t want to get out of bed. You don’t want to get dressed. You don’t want to do anything,” she said. “There are so many people out there that just lose it. I couldn’t do that.”

McQueary went through her church’s grief course four times, each time in a different stage of grief. Her faith, she said, was largely what helped her through the loss and in adjusting to life in Castle Rock.

She found a transforming lifeline in the senior center. It didn’t just give her something to do, she said. It connected her with real people and real friends.

“It was the best thing that I have ever done,” she said.

At the center, she enjoys a Tuesday and Thursday “Sit and Fit” exercise class, $2.50 lunches, presentations, art classes and simply sitting with friends to talk.

“I just absolutely feel it’s opened up my life,” she said. “I’m just thrilled.”

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