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Scott Webb (Host): It's one thing for someone to forget where they left their keys. But there's reason for concern when you or a loved one doesn't really remember what those keys are for. And joining me today to discuss mental decline in seniors, both the signs and treatment options is Theresa Chapman. She's the Program Director for McLaren McComb's Inpatient Behavioral Health Center. This is McLaren's In Good Health, a podcast from McLaren. I'm Scott Webb. So, Theresa, thanks so much for your time today. I just want to start off by asking, as we get older, we do sometimes experience forgetfulness. I'm 53 and I do that and sometimes it takes us a little longer to remember things. So, you know, in your expert opinion, Theresa, how do we know what's a normal part of aging and what could be something more serious?

Theresa Chapman, LMSW (Guest): When you're talking about aging, you're right, there are some normal things that happen with aging. We slow down, we might be a little bit forgetful. But the things that I like to tell people is it's when the forgetfulness is causing a change in behavior, or it might be putting your loved one at risk for their safety. It could be simple as sometimes we all forget where we put our keys, but with somebody that's showing significant memory issues, if they forget what keys are for, there's a distinct difference there. So, it's recognizing those types of forgetfulness and really looking at changes in behavior.

If you have a loved one that used to be very active, and suddenly they're isolating and staying home, or they used to takr great care of their appearance and they're not showering or maybe not doing their hair consistently. Things like that are some behavioral indicators that there's likely something more than just forgetfulness going on. If that makes sense.

Host: It does. And it's funny, you used keys as the example, because that's what I was thinking about. I was thinking about, okay, where did I put my keys? Right. But as you say, it's not just that you can't remember exactly where your keys are, it's that you might have trouble remembering what the keys are for. Right. So, a real, a real, yeah, a real change in behavior. So, great to understand the distinction between the two and when maybe we should be concerned. So, I think a natural follow-up is, you know, how prevalent is mental illness in seniors and what are the most common mental illnesses that seniors experience?

Theresa: Studies say about 20% of those 55 and older have some sort of a mental illness or behavioral health issue. So it's pretty prevalent. In the elderly, we see a lot of depression. We see anxiety. There can be cognitive issues in terms of memory, dementia, things like that, that can lead to delusions and paranoid behavior. All of those type of illnesses. And it's really looking at as you age, you face a lot of loss, is what I say. As people age, we face losses, loss of loved ones, loss of independence, maybe our ability to function and do things like we used to. And with that can come a sadness or a depression, but when a depression develops, again, I always look at behavioral clues.

You know, like I described before, they not doing things they used to. Do they not have interest? You know, are they not eating and not sleeping like they used to? Sometimes those behavioral things are easier for families to see. And even sometimes patients themselves will say, I just don't feel like going out anymore, you know? And they haven't seen their friends or, been in regular activities for weeks. More though, than they would say, you know, I'm really sad and I'm thinking maybe life isn't worth it. A lot of times I say, look for those behavioral clues first, the elderly are not always necessarily going to be expressing what they're feeling or thinking. Typically you'll notice it in behaviors.

Host: Yeah. That does seem to be the common thread today is that we need to be on the lookout for, you know, changes in behavior, changes in habits and patterns and interest level and so on. So, what are some of the other symptoms of mental illness that may be experienced by seniors that family members hopefully will notice, but should be on the lookout for, at the very least?

Theresa: If there's some uncontrolled crying, or if their mood seems more labile, they're more up and down in it's consistency. I always talk about duration and frequency. We all have a bad day, but it's when you're having more of those days. And then duration and the frequency of the symptoms, are coming more often or are prolonged versus how they've may have been, in the past.

I think the other thing to be aware of too, is we'll see with the elderly, they'll be going to the doctors a lot more with a lot of sort of vague aches and pains. And the doctor really can't pinpoint what's going on with them. And often it's the primary care physician that's saying, well, how's your mood been? Have you been more depressed? Have you been more anxious looking at things like that? You know, it can be that they're doing really bizarre things that they've never done before. They think that the FBI's in their home or, that people are after them or you're suddenly poisoning their food.

Those are other things that they may be saying, or maybe doing, they may be talking to themselves more and it not making any sense. And the challenge with that is if they're believing those things, that their behavior is going to often respond to what they're believing. So, their behavior is going to change.

If they think someone's poisoning them, they might not eat or if someone's coming in their house, they might put up things on the windows and the door so people can't get in. So it's really, again, looking at what those thoughts, what kind of behavior is causing.

Host: Yeah, for sure. And a lot of that would be alarming if we see that in our moms and dads and grandmas and grandpas, and maybe even neighbors, things like that. And we've kind of focused here on behavioral changes related to mental health, but you mentioned aches and pains and going to the doctor for more of those sort of non-specific aches and pains. So, I'm guessing that the physical health conditions can also lead to behavioral changes as well?

Theresa: Oh, absolutely. Absolutely. They can go hand in hand. I always say, when we're talking about mental illness, it's an illness, just like a physical illness. It's an illness in the brain and it needs treatment. Just like we go to the doctors when we're not feeling well, we should go to the doctors if we're depressed and anxious and all of those things, but you will see with depression too often, there is a physical component to depression where patients are very tired, very fatigued, and they will have sort of more aches and more pains and they can't really come to a conclusion why? But then as you start to kind of put the pieces of the puzzle together, you see that there's, you know, potentially more going on than just feeling the aches and pains of getting older. But you know, there's, more to it.

Host: Yeah, it sounds like there can be more to it. And, you know, it's just one of the things as we get older, we feel like we, you know, sort of break down a little bit and our physical health begins to suffer a little bit and then possibly our mental health and maybe add a little bit of COVID and you've mentioned all the losses and it's a lot, right? It's just a lot for anyone to handle, especially someone as they're getting older. Yeah, are there are any things that we can do? Are there ways that we can reduce the likelihood of mental illness as we get older?

Theresa: I think it's like everything else. It's doing all those preventative measures we hear about all the time. Looking at taking care of your physical health, eating and drinking properly, getting the good, you know, amount of rest that you need. It's also dealing with stress, whatever helps that person, whether it's going for a walk, reading a book, whatever it is to help reduce that stress.

I think the other component that's really important is when somebody starts to notice, they're just not themselves or their mood is a little off or that they get treatment sooner than later. Because the sooner you get into treatment, whether it's counseling outpatient or medication, or even, you know, when we bring patients inpatient; it's really about getting the treatment as soon as you can, and then being compliant with what that treatment is. That's when we typically see our best results in terms of people feeling better.

Host: Yeah. And I'm sure maybe you mentioned the compliance there and that kind of stuck out to me because it does seem to me in my experience with older people, older relatives that compliance and getting their compliance with these things that we want to do to help them and, and have them want to help themselves, that that can be a real battle, right?

Theresa: Yes, yes it can. And I think when we're talking about mental illness, there's also a lot of stigma that still is out there around mental illness. And I think particularly for the elderly, they, they grew up, many of them with that mindset of you just kind of pull yourself up by your bootstraps. Right? You don't talk about how you feel, you just go and you get it done.

So they're not as, willing to necessarily engage in treatment. So it's being able to help them identify that it's okay going to see a psychiatrist or going to see a therapist doesn't mean you're crazy. It doesn't mean we're going to lock you up and throw away the key. It means that your brain, the chemicals in your brain just aren't working right now. And we can fix that and help that just like if your blood sugars were off and you'd go to the doctor. So, I think it's really important to try to take some of that stigma away. Particularly again for the elderly, because there's such a resistance. I think there's just not a clear understanding of what is thiepsychiatrist going to do to me.

I important to help them understand they're not going to poke and prod or, you know, do these things that, you know, unfortunately, a lot of people think there's a lot of myths out there. So I think it's really important to try to minimize that stigma and normalize that it's another treatment specialist to go see.

Host: Yeah, it's interesting what you're saying about the stigma. I totally get what you're saying. And you're the program director for McLaren McComb's inpatient behavioral health care center. And you mentioned inpatient care previously. So when should families consider inpatient care for seniors as opposed to outpatient mental healthcare?

Theresa: Uh, family should consider inpatient care when either you've tried outpatient care and you're not getting sort of that amount of improvement that you'd like to see. I think also inpatient care can be particularly helpful when you're trying to keep somebody safe. Our facility is set up to keep our patients safe, either from themselves, because they're actively wanting to harm themselves or because their behaviors are so dysregulated that they need an environment that will keep them safe from inadvertently hurting themselves.

So, I think whenever there's a significant safety risk or concern for your loved one that inpatient is designed specifically to help with that. I think inpatient also gives you a thorough assessment. We are an interdisciplinary team, so I have a board certified geriatric psychiatrist, but I also have clinical social workers and rec therapists and psych nurses.

And so it's a team approach so that we can all look at the patient, and a lot of times the family as a whole unit, to develop the best treatment for them while they're here. And then also sort of have a good, solid discharge plan so they know what they need to do when they leave here. So that they can continue to be compliant and continue to get that follow-up and that monitoring.

Host: Yeah, I'm sure there's some real value in not just really assessing the patient, but also the whole family and the family dynamic. And as you say, safety is really the key focus here, right. For everybody involved. Yeah. So, this has been really educational, as I said, you know, I'm getting older, my mom, my folks are getting older.

So I really appreciate your compassionate approach to this. And as we wrap up Theresa, what advice can you share with listeners who may be concerned, you know, regarding their mental health or the mental health of someone in their family?

Theresa: I think I would encourage them to seek out help. I think sometimes people don't get help because they don't know that it's out there. I think that there's several outpatient clinics out there. There's community mental health, that has a hotline. Any of the crisis center numbers that you can easily find, they have resources available so they can tell you clinics, maybe that you could check out. I would encourage people to talk to their primary care doctors and let them know, you know, I'm concerned about my mood or my mental health or my loved one's mental health. You know, what are your suggestions? Is there anybody you can refer me to? So I think it's really just starting to ask, you know, and say I need some help here. And then those people that you could trust can direct you in those ways to find that.

Host: Yeah, definitely. I mean, you would hope that folks would advocate for themselves, but as you say that there are a lot of factors here. There's a lot of moving parts and the stigma and compliance. And there's just a lot to manage here and a lot to really understand as you do, obviously. So, you know, if a family member or friend or someone can't advocate or won't advocate for themselves, hopefully we can step in and do that for them and do it all sort of peacefully and nicely. So I really do appreciate your time today. This was really informative. I love your compassionate approach, the great team comprehensive approach you have at the inpatient behavioral health center is really awesome. So thank you so much and you stay well.

Theresa: Okay. Thank you. You too.

Host: To learn more about the McLaren McComb's Senior Behavioral Health Center, visit mclaren.org/mccombgeropsych. That's M-A-C-O-M-B-G-E-R-O-P-S-Y-C-H. And if you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for additional topics of interest. This is McLaren's In Good Health, the podcast from McLaren. I'm Scott Webb. Stay well.