Aging & Mental Health

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• QWhat is the effect of aging on driving ability?

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  A Mercy Health answered

  Not all people will experience the same effects of aging on driving ability. Common effects of aging that could impact driving ability include the following: 

  • Changes in vision and mobility could affect driving ability.
  • Medications can affect a person's ability to react to driving conditions and to make decisions while driving. People should check with a doctor or pharmacist to ask questions about driving while on medication, and be alert to any restrictions medications place on driving.
  • Skeletal changes in the body (bones becoming more porous, for example) can affect how people sit in car seats, how they wear (or don't wear) safety belts, and whether they can turn their head to see those blind spots. 
  • Cognitive changes may occur during the aging process, affecting the way people process information. This is important when it comes to driving because it is estimated that the average person makes approximately 200 decisions per mile! 
  • Slower reaction times, declining hearing and other changes can affect the driver’s safety (and that of others).

  Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site. In case of emergency call 911. This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified healthcare provider.

• QWhat is the difference between normal aging and dementia?

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  A Dr. Gary Small, MD , Psychiatry, answered on behalf of UCLA Health

  Everyone has gradual decline of memory as they grow older. Doctors have established three major points to tell the difference between normal memory decline, cognitive impairment and dementia. 

  • Normal aging. You might not be able to find your keys or remember someone’s name. This is normal, age-related memory loss. Symptoms do not seem to disrupt your life. 
  • Mild cognitive impairment (MCI). If normal, age-related memory loss worsens, doctors call it mild cognitive impairment. People with MCI are still functionally independent. They can make up for memory losses. However, they are at greater risk for dementia.  A person with MCI has a one in 10 risk of developing dementia.
  • Dementia. Memory loss or cognitive impairment is so severe that the patient is no longer independent and relies on others for help. Alzheimer's disease is the most common type of dementia. 

  A doctor’s exam (clinical assessment) is necessary to tell the difference between normal aging, MCI and dementia. This critically important part of an exam will help determine whether a person is functionally independent or needs help from others.

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• QHow does language change with aging?

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  A Dr. David A. Merrill, MD , Psychiatry, answered on behalf of UCLA Health

  Language is an aspect of cognition that changes with normal aging. For example, if you are shown house keys, you may be able to tell what they are, what they do, even how to use them, but you might forget their name. This is the so-called tip-of-the-tongue phenomenon, which is the borderline of normal. Keys are a very common object. Usually, it's more rare stuff that people have trouble finding the right word for, like a descriptive adjective or something to do with the conversation they're having.
• QHow does cognition change as we get older?

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  A Dr. Philip Lisagor, MD , Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of The Rest of Your Life (ROYL)

  Cognition is a vital part of healthy aging and quality of life. Cognition is a combination of mental processes that includes intuition, judgment, language, remembering and the ability to learn new things. Elders and others experiencing cognitive decline may be unable to care for themselves or to conduct necessary activities of daily living, such as meal preparation and money management. Limitations with the ability to effectively manage medications and existing medical conditions are particular concerns when an individual is experiencing cognitive decline or dementia. If cognitive decline can be prevented or better treated, quality of life improves.
• QWhy is geriatric depression overlooked?

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  A Discovery Health answered

  The main reason that depression is frequently missed in geriatric patients is that caregivers and physicians don't make the innate link between the body and the mind. We affiliate old age with body aches and pains. Arthritis causes joints to be less flexible. Teeth wear down. Eyesight declines. At the same time, the mind is affected by the loss of mobility and independence.
  Often, physical disability is considered a separate risk factor for depression. For example, as many as 40 percent of stroke victims will suffer from depression. Parkinson's disease, Alzheimer's, heart disease and other medical ailments have also been strongly connected to geriatric depression. Additionally, the medications used to treat late onset illnesses can also modify brain chemistry and trigger depression.
  As we age, our brains undergo numerous changes, including a declining number of neurotransmitters, a shrinking cerebral cortex and injured blood vessels. When brain function declines, it can result in a depressive state, which doctors may diagnose and treat as a cognitive impairment or dementia.
  For geriatric patients, this connection between physical and mental health can mask depression, and only one in six cases of geriatric depression may be treated. Instead of expressing clear cut changes in mood, the elderly more openly discuss bodily ailments. Consequently, doctors may attribute increased irritability or sleeping difficulties to a physical illness instead of depression. In that case, the patient may receive remedies for the physical problems exclusively.
  Failing to treat depression can worsen and aggravate medical issues. Depression can impede the body's healing process, heighten symptoms and even produce new illnesses. On the other hand, studies have revealed that treating depression can increase one's mental and physical health and reduce the risks of injury. So long as an elderly person's mentality stays positive, he or she can profit physically. For instance, people can carry on building muscle strength into their 90s.
  But doctors aren't the only ones who overlook the symptoms of geriatric depression. It can require a community of caregivers, healthcare workers and the patients themselves to identify and treat the mental illness.

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• QWhat is homeostenosis?

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  A Dr. David A. Merrill, MD , Psychiatry, answered on behalf of UCLA Health

  As people get older or develop chronic diseases like dementia, there's a narrowing (or stenosis) of reserve capacity; when something that used to be a nuisance suddenly becomes a major problem. This phenomenon has been called homeostenosis, which is a decreased ability to maintain homeostasis (balance) under stress.
• QWhat is senescence?

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  Most serious aging happens at the cellular level. The simple act of bending your knee, for example, exposes the cells of your cartilage to physical damage and damaging chemicals. Sometimes those cells are killed directly by the damage (that's called necrosis), while in other instances, damage accumulates over time, and the cells eventually go into retirement. That process is called senescence, when the cells stop dividing permanently, or they undergo apoptosis, in which they're broken up and reabsorbed.
  
  As cells become senescent, tissues slowly lose their ability to repair and regenerate themselves efficiently and perfectly. Imperfectly repaired cells accelerate damage, which in turn causes more cells to become senescent, which causes even more damage. Imperfectly repaired or replaced or retired cells build up—like those in arthritic joints. And so the vicious cycle of old age keeps spinning, unless you know how to stop it or keep it from starting in the first place.
• QIs a regular mental workout valuable as I age?

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  A Sharine Forbes , Geriatric Medicine, answered

  Research to-date clearly supports the idea of “use it or lose it” and even expands on the original hypothesis; not only can a holistic lifestyle help prevent mental decline in old age, it can also contribute positively to its sustainability and quality of life. Thus, a holistic lifestyle and challenging the brain encourages the neurological processes to keep working by fostering intellectual functions (Williams & Kemper, 2010). This includes, but is not limited to, learning a new language, or learning to use the computer, crossword puzzles and “brain games”, such as bridge or chess (Williams & Kemper, 2010). By maintaining the mental mechanisms engaged an individual can “use-it” and not “lose-it”.  Therefore, people should be encouraged to engage in life-long learning opportunities as a means to stay fit. 

  This article by Williams and Kemper (2010), states that training the working memory can help maintain fluid and crystallized intelligence. Fluid intelligence (Gf), thought to be determined by genetic factors (Schaie ,1993), is regarded as an individual’s capability to comprehend the world around them, without the use of any current knowledge or skill, to help them solve a problem. Crystallized intelligence (Gc), although somewhat dependent on fluid intelligence, is measured differently, as it is regarded to as being the extent to which ones environment, i.e. education, and even culture, has contributed to ones mental abilities (Schaie, 1993). Crystallized intelligence (Gc) helps explain the differences within a given age range as there are a lot of variations in intelligence due to influences which can impact cognitive mechanism outside of age (Horn & Cattell, 1967).

   

  Williams, K.N. & Kemper, S.  (2010). Interventions to Reduce Cognitive Decline in Aging. Journal of Psychological Nursing, 48, 42-51.

   

• QCan aging affect my balancing capability?

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  A Dr. Kelly Traver , Internal Medicine, answered

  Balance also declines with age due to a reduction in nerve connections in the cerebellum as well as in the joints. These nerves are important because they give your brain valuable information about your position in space. The two best things a person can do to preserve balance are to keep the core muscles strong and to participate in tai chi or chi gong, which are slow, rhythmic Eastern movements that build strength and balance.

• QHow can we motivate aging patients?

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  A Sharine Forbes , Geriatric Medicine, answered

  Research to-date clearly supports the idea of “use it or lose it” and even expands on the original hypothesis; not only can a holistic lifestyle help prevent mental decline in old age, it can also contribute positively to its sustainability and quality of life. Thus, a holistic lifestyle and challenging the brain encourages the neurological processes to keep working by fostering intellectual functions (Williams & Kemper, 2010). This includes, but is not limited to, learning a new language, or learning to use the computer, crossword puzzles and “brain games”, such as bridge or chess (Williams & Kemper, 2010). By maintaining the mental mechanisms engaged an individual can “use-it” and not “lose-it”. Therefore, people should be encouraged to engage in life-long learning opportunities as a means to stay fit.