Mental illness in elderly presents challenges

ORONO – The challenging behavior that may be associated with old age is sometimes just the result of time and a distillation of lifelong personality traits. But often, as social workers and other participants at a mental health conference in Orono heard on Tuesday, bona fide – and treatable – mental illness is to blame.

In addition to psychotherapy, behavioral therapy and medication, electroconvulsive therapy, sometimes called “shock treatment,” can successfully improve seniors’ quality of life, those attending the conference were told.

With members of the baby boom generation entering their senior years, and because Maine continues to attract retirees, the need for clinicians skilled in the specialized field of geriatric mental health is growing, said conference organizer Marjie Harris of the University of Maine School of Social Work. This is the third and final year of a three-year grant from the New York Academy of Medicine that has enabled UMaine to offer enhanced graduate-level geriatric training for social workers and host professional programs such as the one offered Tuesday at the Buchanan Alumni House.

Harris said mental illness in the elderly is common but often goes unrecognized and untreated, making life more difficult for old people and their caregivers. Especially in nursing homes and other institutional settings, she said, “no one wants behaviors that aren’t conducive to group living.”

Erlene Rosowsky, a professor of psychology at Harvard Medical School and a clinician in private practice, told those attending the conference that longtime personal relationships may mask or enable underlying mental illness or personality extremes. A specialist on the group of disorders collectively known as “borderline personality disorder,” Rosowsky said some traits become problematic only in certain circumstances.

For example, she said, her own tendencies to be independent, idiosyncratic and private, which are assets in her professional career, would likely make life difficult for her and her caregivers if she had to live in a nursing home or other facility where compliance and passivity are valued.

For those with even more extreme personality traits, she said, the stress of living in a communal setting and being dependent on others is simply intolerable. Their psychological distress may manifest itself as aggressive, manipulative, disruptive behavior, or extreme anxiety and passivity, testing the patience of even the most dedicated family members and professional caregivers.

Also speaking at the conference was psychiatrist Dr. Daniel Price, director of the geriatric psychiatric inpatient program at Maine Medical Center in Portland. Price stressed the importance of accurately diagnosing the cause of personality changes. For example, an elderly patient who suddenly becomes lewd and inappropriate with caregivers may be suffering from bipolar disorder or from physical changes associated with a stroke or other brain injury, he said. Treatment would be different depending on the diagnosis, he noted, and identifying the cause of difficult behavior can often elicit greater understanding and compassion in caregivers.

Price discussed the appropriate use of medications and psychotherapy to treat mental illness, and spent several minutes explaining modern advances in electroconvulsive therapy. He said the therapy is tremendously valuable in treating depression, psychosis and other mental conditions, but that many people have fearful, outdated notions of how the treatment works.

An afternoon panel discussed the need for policy initiatives to promote better mental health services for the elderly. About 140 people attended the conference, most of them social workers and nurses. Attendees came from across the state, including Aroostook County and southern Maine.

mhaskell@bangordailynews.net

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