Recognize the 'Four Ds' of Mental Illness in Seniors

By Wesley E. Wright and Molly Dear Abshire, as published in the Houston Chronicle Senior Living Section on May 22, 2011.

Identifying and distinguishing the characteristics of the "Four Ds" of mental health of an elderly person is crucial in obtaining treatment. The Four Ds often associated with mental health conditions prevalent among the elderly are: dementia, depression, delirium and delusion. Failure to differentiate between these four conditions can have serious consequences.

The incidence of depression rises with age. Although this ailment is treatable, among the elderly it is often overlooked or misdiagnosed. Depression among the elderly can be a result of an emotional loss or a physical illness, or it can simply occur without cause. Depression in an elderly person does not have the same characteristics as it does in a younger person. A depressed elderly person might experience a loss of interest in activities, less energy, loss of appetite, unexplained pain, irritability, agitation, and unusual preoccupation with the past. Additionally, the person might also show signs of pulling away from family and friends.

Depression unfortunately sometimes leads to the purposeful end of life. Many people think the incidence of suicide among youth as being the most frequent, but actually suicide rates are highest among the elderly, especially elderly white males.

We need to learn to listen carefully, ask questions and figure out how to get our elderly loved one to talk about his or her feelings and thoughts. Sometimes it might require making the mental health appointment and accompanying the depressed loved one to the doctor's office to help them talk about their symptoms. If properly diagnosed and treated, severe depression can often be avoided.

Unlike depression, dementia is primarily a mental health disease afflicting the elderly. Dementia is a progressive, persistent loss of cognitive and intellectual functioning. It affects memory, language, visual and spatial skills, personality and emotion. Generally, it does not affect one's perception or consciousness.

Many people think that dementia and Alzheimer's disease are synonymous. However, Alzheimer's disease is only one type of dementia. Dementia is not a normal phase of aging; it is a degenerative disease. Other types of dementia are vascular dementia, frontotemporal dementia, and Lewey Bodie dementia.

The warning signs for dementia are: inability to carry out normal daily activities, poor cognitive skills, decline in hygiene, health changes, weight loss, isolation, and loss of interest in social activities and hobbies.

Degeneration of mental functioning in its early stages is a very slow process that is difficult to detect. However, any noticeable degeneration in mental functioning is not normal and should be checked out. Early detection is key in helping the elderly person to continue to live an independent and meaningful life as long as possible.

Delirium is often confused with dementia. However, delirium is distinguished from dementia due to the following factors: rapid onset, a fluctuating course, and its potential for reversal or recovery. In contrast, dementia is irreversible and degenerative.

Delusions are sometimes seen in conjunction with dementia among the elderly. Simple delusions of theft and vague suspicions directed at relatives are common. Many of the delusions are simply an attempt to make sense out of their perception of daily life, which suddenly seems bizarre. The delusions seem real to the patient making it difficult for loved ones to understand and cope. Delusions may also include visual hallucinations. Understanding the nature of delusions and not taking it personally if one finds themselves the subject of a delusion can be helpful in caring for an elderly loved one afflicted with this type of mental health disorder. Additionally, there may be medications that could help ease the occurrence or frequency of the delusions. And, most importantly, delusions differ from dementia in that if the underlying cause of the delusions is found, there may be a cure or remedy for their occurrence.

Among people of all ages, there is a stigma against discussing or recognizing mental health diseases and disorders. This is unfortunate because the first step in getting the care needed for helping a person experiencing such concerns is admitting the issue exists. May is National Mental Health Month, and it's a good opportunity to observe your elderly loved one's behavior and talk to them about the Four Ds.