Is She Normal?

My 90-year-old mother is living alone independently, taking nine prescription drugs for diabetes, hypothyroidism, hyperlipidemia, and arthritis pain. Every day, she cooks, watches television, practices tai-chi indoors, or walks outdoors with a cane when the weather is nice. She fell three times in the past five years, luckily, without needing hospital care. Before the COVID-19 pandemic that results in a long, cruel 7 months of social distancing, the highlight of her week was a fun game of mahjong with her children and grandchildren. Mahjong is a tile-based strategy game that involves four players sitting around a table. Not only does she love the game, she is pretty good at it with frequent high-stake triumphs. For those of you who are curious about the magic of mahjong, check out another post to find out more, Melancholy or MahJong. We are thankful for mom’s mental health condition as 30% of Canadians aged 85 or older are living with some form of dementia (5). Is mom aging normally from a mental health perspective?

What is normal mental health aging

Normal aging refers to the absence of mental pathology or illness, and that cognitive functioning shows a subtle decline between the age of 60 to 80, then, with more dramatic deterioration after that point (4). The most consistent change is observed in speed of processing information, multi-tasking or attention, problem-solving activities, and working memory operations (3). There is no clear-cut definition of what constitute positive mental health, some attributes may include relatively consistent levels of competence, maturity, emotional resilience, responsibility for actions, or freedom to love and work (4). This reminds me of a kind psychologist mentor, Dr. Paul T.P. Wong, who in his early 80s, a cancer survivor, still works tirelessly to educate, inspire, and support others to pursue a life of meaning and purpose. You can check out his latest writing on overcoming COVID-19, Social Isolation, and the New Science of Adaptive Loneliness (6) here. From Dr. Wong’s reflections, he assures us all that “we can become better and stronger human beings through suffering” (6). Despite old age and physical limitations, one can remain resilient and mentally healthy.

What is abnormal mental health aging

Some psychologists suggest perceiving mental disorders as an interplay of biological, psychological, and social factors (4). Different parts of our brain are responsible for supporting various day-to-day activities that require cognitive abilities such as noticing the colors of the landscape, responding to a doorbell, etc. In general, older adults are vulnerable to experiencing anxiety, depression, and cognitive impairment due to life events, environmental triggers, and changes in multiple facets. Mental disorders can manifest in different levels of severity. A study from the United States estimated that one in five adults 65 years of age and older met the criteria for a mental disorder, including dementia (2). The study authors raised the alarm for more mental health providers and services. Dementia is the advanced stage of clinical neurodegenerative disorders involving the deterioration of cognitive abilities hence making it difficult to manage everyday life. Dementia is a complex syndrome that can be classified into fifty different forms (5). The following chart depicts some facts on aging and dementia.

We will focus on two separate posts on the topic of dementia and stigma. You can read them by clicking on the links:

• An Aging Society #4: Confronting the Rising Tide of Dementia

• An Aging Society #6: Overcoming the Stigma of Stigma of Dementia

Some positive aspects of aging

An editorial excerpt in the medical journal Lancet (1) described that despite the changes in memory and decision-making among older adults show a notable decline over time, “older adults report [a] greater level of happiness than younger people, and knowledge can increase into very old age.” Perhaps, this is where wisdom comes in.

What strategies or opportunities do you see in promoting mental wellbeing in older adults?

References

(1) Lancet, T. (2015). Cognitive ageing: wisdom in the bigger picture. The Lancet (British Edition), 385(9978), 1592–1592. https://doi.org/10.1016/S0140-6736(15)60776-0

(2) Karel, M. J., Gatz, M., & Smyer, M. A. (2012). Aging and mental health in the decade ahead: What psychologists need to know. American Psychologist, 67(3), 184-198. doi:10.1037/a0025393

(3) Klimova, B., Valis, M., & Kuca, K. (2017). Cognitive decline in normal aging and its prevention: a review on non-pharmacological lifestyle strategies. Clinical Interventions in Aging, Volume 12, 903–910. https://doi.org/10.2147/cia.s132963

(4) Segal, D. L., Qualls, S. H., & Smyer, M. A. (2018). Aging and mental health. Wiley Blackwell.

(5) Proulx, G. (2020, April). "Psychology Works" Fact Sheet: Cognitive Disorders and Dementia. Canadian Psychological Association. https://cpa.ca/docs/File/Publications/FactSheets/FS_CognitiveDisorders_EN_2020.pdf.

(6) Wong, P. T. P. (2020, October). COVID-19, Social Isolation, and the New Science of Adaptive Loneliness. Positive Living Newsletter. http://www.drpaulwong.com/covid-19-social-isolation-and-the-new-science-of-adaptive-loneliness/