Maintaining Mental Wellness

Carolyn L. Rosenblatt, R.N., Attorney at Law

Aging involves enormous changes. How do we stay mentally healthy with all this change going on?

Posted June 30, 2009

By Carolyn L. Rosenblatt, R.N., Attorney at Law

This article is co-authored by Dr. Mikol Davis, Ed.D, clinical psychologist, and Carolyn L. Rosenblatt, R.N., Attorney at Law.

The challenges of maintaining mental wellness and getting older involve increasing effort with the passing years. It is quite common for us to experience a sense of loss, as our physical body diminishes in strength and function. In addition we experience loss in our families and friends as those close to us pass away and we live on. How do we stay mentally healthy with all this change going on?

Maintaining a sense of purpose in life is critical to maintaining mental wellness.
People sometimes lose their sense of purpose when they stop working. Particularly for men, the loss of identity as a worker can be very difficult. Men may not have a strong identity outside the role of worker and provider. Once they stop working, they may find themselves having trouble structuring their time, looking for things to do, and generally feeling lost. This often leads to increased tension or friction in relationships, specifically, marriages. Consequently, the individual experiences frustration, fear, self-doubt, feelings of worthlessness, difficulty sleeping, and a belief that things will only get worse. It is therefore imperative that an individual in this state seek help. The best place to get this is from a medical provider. It is wise to start with your regular physician. The doctor who knows you can help you find out it there is any physical process or disease process which could be contributing to the problem.

Once physical problems have been ruled out, one must ask for a referral from your doctor to a medical specialist who deals with the emotional challenges of getting older. The importance of finding something that one can do to contribute in the community is essential to regaining a sense of purpose. Most communities provide volunteer bureaus or organizations which give one a choice of volunteer options. Get involved in your favorite organization. If you do not have a favorite organization, consider your church or temple, your local school, your local social service or homeless help organizations. You will never run out of places to volunteer. It is important to do volunteer work you like doing. If, for example, you hate physical labor, it does not make sense to volunteer to clean the local homeless shelter. If you dislike paperwork, it is unwise to volunteer to stuff envelopes or fill out forms for an organization in the community. If computers are not for you, choose volunteering that does not involve them. Match what you like with what is needed. If you have talent for something that can be shared, consider doing it on a volunteer basis.

The loss of a sense of purpose can also be overcome by learning something new. Most communities have adult education programs through the local high schools, community colleges, community centers, senior centers or other locations. Sign up for a class. Discover something you might have been curious about but never had time to pursue when working. The benefit of getting involved not only restores a sense of purpose, but it enables an individual to socialize with other people in a way that creates a new support system outside the former workplace. You might make a friend who has an interest in common with you.

As elders experience loss in their lives, including loss of friends, loss of family members, and loss of spouse, they can also lose a sense of connectedness, which equates to loss of a sense of purpose. It is important to recognize the normal grieving process all human beings experience with loss. Mourning takes time and must be respected. It is critical to understand that if the mourning process exceeds a year or so, and the person is still very immobilized by sadness, a sense of loss, crying, anger, and the inability to move forward, the grieving process has led to depression that needs to be treated. If you or your loved one is unable to move forward after the normal sort of grieving that most people do, it can be very dangerous. Untreated depression among seniors leads to suicide more frequently than among other age groups, partly due to the overall sense of loss in numerous areas of life, including loss of good health, loss of purpose, and inability to address these without help. Fortunately, depression is highly treatable, especially for seniors. Seniors have a tendency to respond well to anti-depressant medication. Research supports that seniors who are successfully treated for depression live longer than those who are not treated for this illness, and their quality of life is better, as well.

Structure is another essential element to maintaining mental wellness.
With retirement, some may lose the structure that has governed their lives for most of their adulthood. Before adulthood, most had school to provide structure for their days. In older age groups, with neither work nor school nor child raising responsibilities, the loss of structure can directly affect self esteem. Self esteem is promoted by individuals feeling productive in their world. When one feels productive, self esteem can thrive. When the feeling of productivity is lost or diminished, the sense of self esteem can erode. Without structure, it is difficult to be productive, so self esteem and structure go hand in hand. When structure is not imposed by school, family, or work, one must strive to create structure in life. Because we are mostly creatures of habit, creating structure is easier than it may seem. If, for example, one is used to getting up every day to go to work, one can substitute fun activities, volunteer work, or physical activity in the time which was previously occupied by work or other structure. However, maintaining structure is much more difficult than simply creating it. Maintaining structure requires a different kind of self discipline than it does to cook the family meals or work for a paycheck. One might, in older years, have to deal with physical pain, transportation issues, chronic illness, or lack of familiar companions to initiate and maintain structure. Self discipline to maintain structure poses these and other obstacles.

Seniors experience much difficulty, when they have been very independent in their lives, in permitting others to create structure for them, and to accept this. Self acceptance is key to dealing with the diminished independence that often accompanies aging. We simply have to give up seeing ourselves as we once were, totally on our own, if we are to maintain mental wellness when aging changes us. Planning a day ahead of time, at least, scheduling activity every day, using a visual cue such as a calendar to track schedules, and not allowing oneself too much empty time can be very protective of your mental health. Too much empty time on one's hands can lead to depression, for the reasons mentioned above.

Creating or maintaining a sense of community is another cornerstone of maintaining mental wellness.
Being a part of a community can serve a multitude of needs. Mental stimulation, socializing, a sense of spirituality, a forum for physical activity, and a feeling of belonging are some of the benefits of community. Our society is mobile, and the sense of community once provided by families has changed over time for many, because families are scattered. Daily or weekly time with family may not be available to the aging person. Most elders in our society do not live with their adult children or other family. As physical decline occurs, the family home may be sold, and the senior moves elsewhere, giving up proximity to neighbors and others with whom one had a sense of belonging in a younger day. It may not be a quick process to adapt to communal living in a care facility. There are issues regarding territoriality, privacy, noise, and the loss of independence one must exchange for the needed physical help one receives in the facility. For persons who are not habitual joiners, and those who did not gravitate to groups when they were younger, it may be much more challenging to feel a sense of community than for those whose habits were always to join groups. Lack of religious affiliation is another obstacle to feeling a sense of community, as religious organizations are of themselves a kind of community. Some elders feel reluctant to bother others for transportation or company to attend a new group activity. Some may be embarrassed to have to rely on others. For some, joining a seniors' group, for instance, may be unpleasant, as it means they are "old". Not everyone is ready to face the thought. Seniors may need to push themselves, or to be pushed by those who love them to become part of a community. Their mental health is at stake, and it is worth pushing for, so that resistance can be overcome. We do not advocate forcing anyone to do or join something the senior does not want. We do, however, suggest that urging the elder to take care of his or her mental health by being a part of something larger than himself/herself is worth doing.

Mental wellness usually co-exists with some degree of physical wellness. Physical wellness, in this context does not mean freedom from impairments, nor being free of chronic illnesses. Most elders have some physical limitation, or must manage chronic conditions. However, one of the worst threats to mental wellness is poor nutrition, which includes fluid intake. The brain needs food. If we think of mental wellness as a product of our efforts to maintain it, just as a healthy body is partly a product of our efforts to be well, we understand that mental wellness is not a passive gift we get. We do have to work at it. We have to exercise our bodies, sleep enough, get good nutrition, and try to maintain a proper weight to be physically healthy. The same factors apply to mental health, as well. A routine for maintaining mental wellness is part of good overall health practice. Inadequate nutrition or the wrong foods can wreck our bodies, but these problems also damage our mental health by depriving our brains of the nutrients we need to think, make mental effort, participate in activity, and keep connections with others. "A healthy mind in a healthy body" is an old adage, but it is true. The "spirit" of a person is more than a healthy mind. It is more than thinking. Mental wellness is a combination of a healthy spirit, in a healthy organism that makes the whole of us.

Mental wellness, like good oral hygiene, like muscle tone, like proper weight, is achievable at any age for most of us. Like those other healthy conditions, it takes work, and regular vigilance. It takes doing what we may not feel like doing every day. Mental wellness allows us the ability to love, to enjoy, and to make the most of who we are.

Ms. Rosenblatt is a registered nurse, who practiced nursing for 10 years, working mostly with elders, before becoming a lawyer. She has practiced law for 30 years, as an advocate for individual rights. In 2005, she and her psychologist husband, Dr. Mikol Davis, founded AgingParents.com, a consulting and mediation service for families with aging loved ones. Dr. Davis’s practice of 35 years has focused on anxiety and depression. Together, they form a team to assist with legal, health care and mental health aspects of aging. Ms. Rosenblatt is the author of The Boomer’s Guide to Aging Parents, available at AgingParents.com.