Dr. Vincent Wong Choong Wai MBBS, M.Med(Psych) 王 忠 威 心 理 精 神 专 科 医 生 Consultant Psychiatrist www.brainmindspecialist.com

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You Know You Are Getting Older When . . .

 At the breakfast table you hear snap, crackle, pop and you're not eating cereal.

 When happy hour is a nap.

 When you're on vacation, and your ENERGY runs out before your money does.

 Your idea of weight lifting is standing up.

 Your address book has mostly names that start with Dr.

 Counting the number of daily pills with both hands  Getting "lucky" means you found your car in the parking lot.

 You finally get your head together and your body starts www.brainmindspecialist.com

falling apart.

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 30% of cases : middle age and elderly.

 Public mental health concerns.

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Overview

 What is Aging?  Common mental health issues : Depression Anxiety Dementia Psychosis Bitterness  Conclusion DR VINCENT WONG (www.brainmindspecialist.com) 5

Dr. James Dobson

 Healthy aging www.brainmindspecialist.com

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 “ We do not grow old ; we become old by not growing” Dr. Ida Davidoff 93-year-old marital and family therapist www.brainmindspecialist.com

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 Age is nothing but numbers ; and how you think will determine how you feel Kathryn Zane ( Age : 100 ) www.brainmindspecialist.com

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What is Aging?

 Definition : Ageing is the accumulation of changes over time.

[1] in a person  Changes in physical, mental ( mind and emotions ) , social, spiritual.  However, research shows that even late in life, potential exists for growth and development, in spiritual physical, mental, and social www.brainmindspecialist.com

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Final Psychosocial stage ( Erik Erikson )

  Stage 8: Integrity vs Age between 65 and over Despair and Isolation www.brainmindspecialist.com

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Integrity vs Despair

 Integrity is the sense of one feels in reflecting on a life productively lived.

satisfaction that VS  Despair is when there is the sense that life had little or no meaning. Presence of insecurities,depression,regrets,bitterness and fears. www.brainmindspecialist.com

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Self esteem

 Older people must continually cope with losses they attempt to adapt to biological, psychological, social and economical changes associated with aging.

 So do we have enough ‘fixed deposits’?

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Needs and ‘Fixed deposits’

1 ) Physical health 2) Mental health ( Resilience and coping ) 3) Close relationship with family and community.

5) Spiritual : intimate relationship with our Creator www.brainmindspecialist.com

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Self Assessment-5 mins

 Elderly mental health assessment  Handouts www.brainmindspecialist.com

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Dr. Vincent Wong, Consultant Psychiatrist 17

Depression

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Negative view of self

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Negative view of future

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Symptoms of Depression

Behavioural

 Social withdrawal  Desire to escape  Crying without reason  SUICIDE

Emotional

 Depressed  Loss of interest / motivation  Irritable

Physical

 Sleep problems  Change of appetite  Tiredness  Painful symptoms ( Masking Effect ) www.brainmindspecialist.com

Thoughts

 Guilt feelings  Loss of self confidence  Decreased concentration  Hopelessness 19

Who are at risk of depression?

 Prior history of depression  *Bereavement ( loss of spouse )  *Living alone  Lack of social supports  Burden of caregiving  Chronic Medical illness  Genetic risk www.brainmindspecialist.com

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Brain Scan changes ( comparison between Normal vs Depressed individuals Dr. Vincent Wong, Consultant Psychiatrist 21

Treatment of depression and suicide prevention

2) 3) 4) 5) 1) Medical Treatment ( moderate to severe Depression ) Identify the stress and conflicts Social and Family support Spiritual support Counselling www.brainmindspecialist.com

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Common causes

        Post menopausal Loneliness Medical illness Underlying anxious personality ***Insomnia Family and marriage conflicts Lack of social support Fear of death www.brainmindspecialist.com

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Symptoms checklist

 Refer handout www.brainmindspecialist.com

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Treatment of anxiety disorder

2) 3) 4) 5) 1) Medical Treatment ( moderate to severe Anxiety ) Identify the stress and conflicts Social and Family support Spiritual support Counselling www.brainmindspecialist.com

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Age and dementia

 Rates of dementia rise steeply with age, doubling every 5 years.

5% of person age >65 20% of those age > 80 www.brainmindspecialist.com

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AD: Degenerative Brain Disease Normal Brain Section Alzheimer’s Disease is a degenerative disease - attacks and destroys brain cells - Impairment in thought, memory & language

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Type of dementia

 Most common is Alzheimer’s disease  Dementia due to Multiple Stroke episodes  Parkinson disease dementia  Other causes www.brainmindspecialist.com

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Behavioural and psychological symptoms Adapted with permission from Jost BC, Grossberg GT.

J Am Geriatr Soc

1996;

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: 1078 –81.

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Treatment

 Medical Medication Assessment for Vision and Hearing  Environmental Orientation, music, photos, activities, socializing Self empowering activities.

 Help them regain self worth  Address caregiver’s burden www.brainmindspecialist.com

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“Alzheimer’s has corroded her brain nerves. She feels little or nothing. Her emotions appear deadened. Her response to me is cold” “Why does Alzheimer has to take away everything?” “The black veil of loneliness is all around me” www.brainmindspecialist.com

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Delusional disorder

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Suspicious

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Insecure

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Fear

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Irritable behaviour

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Aggression

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     Chronic anger and Resentment Suspicious and Distrust Long standing relationship conflict Emotionally Hurting Unforgiveness  Due to character /Personality issues www.brainmindspecialist.com

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Courtesy of Dr Yau Weng Keong www.brainmindspecialist.com

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

You don't stop laughing because you grow old ; You grow old laughing. because you stop -- Benjamin Franklin

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New England Journal of Medicine

Mentally stimulating activities - Reading - Playing cards - Board games, - Crossword puzzles - Learning something new may prevent or minimize memory loss from aging .

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 “Give a neglected child a cookie, read her a story. You may help change her entire life. So many opportunities to use our talents. What are we waiting for? Let’s get busy today” Mazo ( age 91 ) I have discovered that volunteering is a great healer. In all honesty, volunteering has given me a great deal more than I have given. leukemia ) Ruth De Han ( Age 91 : Widow for 15 years, eldest daughter died of www.brainmindspecialist.com

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 Ps 73  Yet I am always with you; you hold me by my right hand.

 24 You guide me with your counsel, and afterward you will take me into glory.

 25 Whom have I in heaven but you?

And earth has nothing I desire besides you.

 26 My flesh and my heart may fail, but God is the strength of my heart and my portion forever.

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Application and Summary

 Remember A.C.T.I.V.E

A C T I V E : Acknowledge the Creator DAILY : Community living : Think healthy thoughts : Inner peace and joy : Value Relationships and Friendships : Eat well and Exercise www.brainmindspecialist.com

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Thank you

 Slides can be downloaded from  www.brainmindspecialist.com

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