For half a century, from the age of 20 to 70, Beryle Garvin suffered from bouts of depression that grew increasingly frequent, severe and difficult to treat. Repeated infections with pneumonia made matters worse, deepening her depression and threatening her life.
Then, the Brockville, Ont., resident finally got the right combination of help: a prescription for lithium, psychological counselling and regular home visits by a nurse. As the fog of depression lifted, her respiratory problems disappeared and, for the first time since forever, she felt mentally and physically well.
“I didn't really believe I could get better at age 70, but I did,” said Mrs. Garvin, who is now 75. “I've reclaimed my life and life is so much better than I ever hoped it to be again.”
Marie-France Tourigny-Rivard, clinical director of geriatric psychiatry at the Royal Ottawa Health Care Group, said there is a common misperception that older adults with mental-health problems – whether they have long-term issues or are newly diagnosed – cannot recover. As a result, seniors are grossly under-diagnosed and under-treated.
“People think that, at a certain age, it's not possible to get better, or it's not worth it to treat. That's nonsense,” she said. “A woman today, at age 65, still has a life expectancy of at least 20 years. We can't just give up. We have a moral obligation to treat people and we have the ability to make them better at any age.”
Mrs. Garvin, like many who suffer from severe mental illness in their golden years, had pretty well given up hope. But her family and doctor had not and they turned for help to the Geriatric Mental Health Community Team of the Brockville Mental Health Centre.
The innovative program – with a team consisting of a geriatric psychiatrist, psychiatric nurses, a neuropsychologist, social worker and occupational therapist – seeks out and treats the most difficult cases of seniors with mental-health problems.
Team members do home visits – in private residences, nursing homes and long-term-care facilities – and spend a lot of time educating physicians, nurses and other caregivers.
Dr. Tourigny-Rivard said that by averting mental health and related physical health crises and keeping people out of hospital, the program more than pays for itself.
More important, no matter how sick people are with dementia, psychiatric illnesses such as depression or a combination of the two, treatment can improve their quality of life and that of their caregivers, she says.
“A lot of people fall through the cracks because of the false assumption that nothing can be done,” Dr. Tourigny-Rivard said.
Nathan Herrmann, head of the division of geriatric psychiatry at Sunnybrook Health Sciences Centre in Toronto, said another pervasive myth is that depression (and other psychiatric illnesses) is a normal part of aging and nothing much can be done about it. “The truth is that your average older person is no more likely to be depressed than your average younger person,” he said.
There are confounding factors that skew public perceptions, Dr. Herrmann says. Many, if not most, seniors who develop mental-health problems later in life have physical health problems. For example, 20 to 40 per cent of people who suffer a heart attack or stroke suffer severe depression afterward, and that is one of the principal factors that hamper their recovery.
Similarly, people with debilitating chronic conditions such as chronic obstructive pulmonary disorder or neurological conditions such as Parkinson's and dementia have high rates of depression and those with long-time mental-health problems often see symptoms worsen as they age, or their medications precipitate problems such as falling that lead to broken hips.
There is also a powerful stigma that prevents people – particularly older people – from talking openly about their illnesses, said Randi Fine, former executive director of the Older Persons' Mental Health and Addictions Network.
“It's all very quiet and swept under the carpet – the illness and the recovery,” she said.
Ms. Fine, who is now a consultant because the group lost its funding from the Ontario government, said far too many people, including health professionals and policy-makers, believe that older people are hopeless and burdensome, so they make little effort.
And when seniors do get treated, it is invariably with prescription drugs. “I'm not anti-medication, but drugs are not the be-all and end-all. They need to be used appropriately.”
Ms. Fine said that, contrary to popular belief, seniors respond well to psychological counselling and they can also be helped enormously by support groups. “You hear it said often that older people keep it all inside. But in my experience, a lot of older people want to talk. The problem is nobody wants to listen.”
Ms. Fine said that, instead of merely bemoaning the rising rates of mental illness in seniors and its cost, there needs to be a much greater investment in prevention. “We need to reach out and help, not just abandon people to mental illness because they're older.”
André Picard is The Globe's public health reporter.
