Getting mental health care makes the body healthier — especially for the elderly
Taking care of our minds is an often neglected aspect of aging. What are we going to do about it?
- Studies have shown that depression can worsen in our old age.
- Other mental health concerns, too, are not only debilitating on their own but they can often make it more difficult to treat other health conditions.
- However, recent advances in how we treat mental health in the elderly are making a big difference. Here's how.
It's an unfortunate fact of life that as we grow older, our bodies stop working as well as they once did. Our muscles weaken, tying our shoes can send our backs into spasms, our hearing and vision isn't as sharp as it used to be. It's a time when taking care of yourself is more important than ever.
But we often forget that our minds, too, need to be taken care of. According to the CDC, 20% of people over 55 have some kind of mental health concern. Yet only two-thirds of this group receive treatment for their condition. Out of any other group, older men have the highest suicide rate. One study found that older patients were more likely to be diagnosed with a major depressive disorder, and that their depression grew worse with age. Older participants were more likely to have chronic depression, took longer to be in remission, and experienced depression with greater severity, according to the same study.
While mental health is enough of a concern on its own, it can also make treating physical health issues more difficult. "There is no clear-cut demarcation where behavioral health comorbidities start and where physical comorbidities end," said Dr. Joseph Conigliaro, Northwell Health's chief of general internal medicine. "When a patient with diabetes or congestive heart failure or any number of issues also has depression, anxiety, or schizophrenia, providing consistent care becomes much more challenging."
Percentage of older adults who claim they don't receive the social and emotional support they need by state, which can put individuals at risk for developing mental health conditions.
Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Atlanta, GA: National Association of Chronic Disease Directors; 2008.
Bringing psychiatry to primary care
How can we better meet the mental health needs of elderly patients? In his book, Healthcare Reboot, Michael J. Dowling points to the divide between psychiatry and primary care as a major issue. "While it was true that psychiatrics went to medical school," he writes, "their subsequent clinical training was so far removed from other doctors that they tended to live in a psychiatric silo. In many ways, psychiatrists had walled themselves off from the rest of the medical profession."
A Gallup poll on the perceived honesty of various professions shows another way in which psychiatry has been pushed aside. 85%, 75%, and 70% of respondents reported that nurses, pharmacists, and medical doctors had very high ethical standards, respectively. Only 41% of respondents reported that psychiatrists had very high ethical standards.
One way to bring psychiatry back into the domain of primary care is to do just that; tighten the connections between psychiatrists and general practitioners through the collaborative care model. In this system, a behavioral health care manager and a psychiatrist are incorporated into the primary care setting. The psychiatrist serves as a consultant for the primary care physician and the behavioral health care manager, who could be a psychologist or a nurse trained in managing mental health. The primary care provider has some training in screening patients for mental health issues. Rather than refer them to a psychiatrist, they can instead point them to the behavioral health care manager. This helps normalize the relationship between mental health and primary care and can reduce the stigma associated with seeking help for mental health conditions.
A study on the use of this model for older adults suffering from depression showed resounding success — using the collaborative care model doubled the efficacy of depression treatment. Over twelve months, half of the patients reported an at least 50% reduction in their depression symptoms compared with a 19% reduction in the control group. What's more, the system saves money. For every $1 spent on implementing the collaborative care model, hospitals get $7 back over the course of four years. Today, Northwell Health and other health care organizations have incorporated psychologists and other mental health professionals in their primary care clinics to help deliver the mental health care that elderly patients need.
Virtual reality: Not just for gaming
Addressing mental health issues in the elderly doesn't just have to take place in hospitals and clinics, however. Advances in technology are blurring the lines of where treatment can happen. Rendever, for instance, is a new project by MIT graduates that uses VR to help provide the elderly with mental health treatment. VR has the potential to serve as a powerful therapeutic tool for older adults, especially those in assisted living. Often, older adults in assisted living can feel isolated and trapped in their conditions; VR offers an avenue out of those conditions. In an interview with AARP, a co-founder of Rendever related a story about an isolated former pilot flying a simulated aircraft: "All of a sudden he was sitting in a pilot seat again, and all these stories started bubbling out of him." VR technology like Rendever have been used to treat PTSD, chronic pain, phobias, depression, and drug addiction. There's even some preliminary evidence that VR could be used to keep cognitive function sharp in old age.
From the clinic to the home
One major challenge for the elderly is mobility. It's not always practical for them to travel to a clinic, psychiatrist, or psychologist. The use of "virtual visits" has become increasingly more common for health organizations. Companies like Apple and Samsung are increasingly leveraging their smartphone technologies to provide easier access to healthcare records and tackle chronic conditions. For its part, Northwell researchers have helped pioneer the use of remote intensive care units, or eICUs, to watch over multiple patients at once from a central location.
It may seem as though technology like this wouldn't be useful for psychiatric issues; in fact, the opposite is true. For the elderly, easy access to a psychiatrist may make them more likely to reach out. For patients in assisted-living facilities or unable to travel, "telepsychiatry" is sometimes the only way they can gain access to a psychiatrist.
When it comes to the health of the elderly, a broken hip or a pneumonia diagnosis can overshadow the importance of maintaining a healthy mind in one's older years. Taking care of one's physical health will always be important, especially in geriatric patients, but it doesn't make sense to focus solely on treating a physical health issue while ignoring ongoing mental health concerns. Fortunately, advances in our institutions, systems, and technology are bringing mental health issues back into the spotlight.
Researchers detect a large lake and several ponds deep under the ice of the Martian South Pole.
- Italian scientists release findings of a large underground lake and three ponds below the South Pole of Mars.
- The lake might contain water, with salt preventing them from freezing.
- The presence of water may indicate the existence of microbial and other life forms on the planet.
Mars colony: Humanity's greatest quest | Michio Kaku, Bill Nye, & more | Big Think<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="aa931ba0f8c1152a7c32c5e09c55d138"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/KfKr5Jll88o?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
"Nothing but naked people: fat ones, thin ones, old, young…"
"The Yellow Sands", 1888, John Reinhard Weguelin; source: Wikimedia Commons<h3>Naked revolution</h3><p>Yet long before anyone knew about beach fashion, naturism was trendy. Bathing naked in the sea was going on in England as early as 1840. However, during the reign of Queen Victoria, this pleasure was outlawed. But it popped up again among the conservative Germans. In 1898, the first Naturist Club was founded in Essen and in 1900 the Wandering Birds group (<em>Wandervögel</em>) was scouring the country for uninhabited places and naked sunbathing. In the same year, Heinrich Pudor wrote <em>The C</em><em>ult of </em><em>the </em><em>Nud</em><em>e</em>, winning the hearts of contemporary supporters of naturism.</p><p>In the 1920s, on the back of this, members of the Movement for Natural Healing (<em>Naturheilbewegung</em>) organized naked sunbathing for the improvement of health. Persuaded by Pudor's theory of the healing properties of the sun and wind, which could be absorbed through the skin, they launched the naked revolution.</p><p>Pudor's book became the naturists' manifesto and soon after, not far from Hamburg, the Free Body Culture (<em>Freikörperkultur</em>, or FKK) movement was founded. This spread through other German centres and brought together thousands of people. The FKK still operates under the same name today.</p><p>The cult of the naked body even wrote itself into the ideology of fascist Germany, which advocated a pure, Aryan race. But in 1933, Hermann Göring issued an order that defined nudity as "the greatest threat to the German soul" and, with that, criminalized naturist organizations. But this wasn't the end of the movement. The naturists went underground, continuing their activities under the guise of improving physical fitness.</p><p>In 1936, the idea was even floated of having a naturist display to open the Berlin Olympic Games. It was quickly dropped. Despite this, in 1939 the naturists managed to organize their own Games in the Swiss village of Thielle.</p>
The microbes that eventually produced the planet's oxygen had to breathe something, after all.
- We owe the Earth's oxygen to ancient microbes that photosynthesized and released it into the world's oceans.
- A long-standing question has been "before oxygen, what did they breathe?"
- The discovery of microbes living in a hostile early-Earth-like environment may provide the answer.
Unassuming but remarkable microbial mats<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0NzE3Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMjk0MzE4Nn0.FhrDr5RTfRIBdf5uhnmzSPNYz-CwNiPbVYgam5eNaoY/img.jpg?width=980" id="d5e1c" class="rm-shortcode" data-rm-shortcode-id="c2e5e1b019d0bb1987ee730f91b550cc" data-rm-shortcode-name="rebelmouse-image" />
Credit: Razzu Engen/Flickr<p> Photosynthesis chiefly requires sunlight, water, and CO<sup>2</sup>. The CO<sup>2</sup> gets broken down into carbon and oxygen — the plant uses some of this oxygen and releases the rest. Without CO<sup>2</sup>'s oxygen molecules, though, how did this work? </p><p> There are known microbial mats today that live in oxygen-free environments, but they're not thought to be sufficiently like their ancestors to explain ancient photosynthesis in an oxygen-free environment. </p><p> There have been a few oxygen stand-ins proposed. Photosynthesis can work with iron molecules, but fossil-record evidence doesn't support that idea. Hydrogen and sulphur have also been proposed, though evidence for them is also lacking. </p><p> The spotlight began to shift to arsenic in the first decade of the millennium when arsenic-breathing microbial mats were discovered in two hypersaline California lakes, <a href="https://science.sciencemag.org/content/308/5726/1305.abstract" target="_blank">Searles Lake</a> and <a href="https://www.discovermagazine.com/planet-earth/mono-lake-bacteria-build-their-dna-using-arsenic-and-no-this-isnt-about-aliens" target="_blank" rel="noopener noreferrer">Mono Lake</a>. In 2014, Visscher and colleagues <a href="https://www.nature.com/articles/ngeo2276" target="_blank">unearthed indications</a> of arsenic-based photosynthesis, or ""arsenotrophic," microbial mats deep in the fossil record of the Tumbiana Formation of Western Australia. </p><p> Still, given the ever-shifting geology of the planets, the fractured ancient fossil record makes definitive study of ancient arsenotrophic photosynthesis difficult. The fossil record can't identify the role of the arsenic it reveals: was it involved in photosynthesis or just a toxic chemical that happened to be there? </p><p>Then, last year, arsenic-breathing microorganisms <a href="https://www.washington.edu/news/2019/05/01/arsenic-breathing-life-discovered-in-the-tropical-pacific-ocean/" target="_blank" rel="noopener noreferrer">were discovered</a> in the Pacific Ocean. A sulphur bacterium, <em>Ectothiorhodospira sp.</em> was also recently found to be metablozing arsenic into <a href="https://en.wikipedia.org/wiki/Arsenite" target="_blank">arsenite</a> in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064118/" target="_blank" rel="noopener noreferrer">Big Soda Lake</a> in Nevada. </p>
An ancient Earth environment, today<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0NzIxMC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1OTQwOTYyN30.v96ZRXpIAf4yzDwcvXzVV3Fa4qULtUMxanXguPHD2wI/img.jpg?width=980" id="9eec4" class="rm-shortcode" data-rm-shortcode-id="a23585c057ee50ed500b96125e4a6b05" data-rm-shortcode-name="rebelmouse-image" />
a Map of Northern Chile; b Detail of frame showing Laguna La Brava in the southern Atacama; c The channel showing the mats in purple; d Hand sample, cross-section; e Microscopic image of bacteria.
Credit: Visscher, et al./communications earth & environment<p>The study reports on Visscher's discovery of a living microbial mat thriving in an arsenic environment in Laguna La Brava in the Atacama Desert in Chile. "We started working in Chile," Visscher tells <a href="https://today.uconn.edu/2020/09/without-oxygen-earths-early-microbes-relied-arsenic-sustain-life/" target="_blank"><em>UConn Today</em></a>, "where I found a blood-red river. The red sediments are made up by <a href="https://en.wikipedia.org/wiki/Anoxygenic_photosynthesis" target="_blank">anoxogenic</a> photosynthetic bacteria. The water is very high in arsenic as well. The water that flows over the mats contains hydrogen sulfide that is volcanic in origin and it flows very rapidly over these mats. There is absolutely no oxygen."</p><p>The mats have not previously been studied, and the conditions in which they live are tantalizingly similar to those of early Earth. It's a high-altitude, permanently oxygen-free state with extreme temperature swings and lots of UV exposure. </p><p>The mats that somewhat resemble Nevada's purple <em>Ectothiorhodospira sp.</em> are going about their business of making carbonate deposits, forming new stromatolites. Most excitingly, those deposits contain evidence that the mats are metabolizing arsenic. The rushing waters surrounding the mats are also rich in hydrogen sulphide and arsenic.</p><p>Says Visscher, "I have been working with microbial mats for about 35 years or so. This is the only system on Earth where I could find a microbial mat that worked absolutely in the absence of oxygen."</p><p>Not that Earth is the only place where this could happen. Visscher notes that the equipment they used for studying the Laguna La Brava mats is not unlike the system aboard the Mars Perseverance Rover. He says, "In looking for evidence of life on Mars, they will be looking at iron, and probably they should be looking at arsenic also."</p>
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