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In this article, our experts will explore how dementia can effect mental health. As we age, there are many different things, such as family dynamics, home moves, physical illnesses, retirement, isolation and bereavement which can affect our mental health. A dementia diagnosis can also affect the persons mental health. We recognise that dementia also impacts carers and wider family members and later blogs in this series will look in more detail at the emotional impact of dementia on carers.
Mental Health & Wellbeing or Mental Illness
Mental health is not the same as mental illness. Everyone has a varying degree of mental health; it is a spectrum of mental wellbeing which can fluctuate with good and bad days and differing emotions. Mental illnesses, however, are diagnosed conditions such as depression or anxiety, as well as other mental illnesses like bipolar disease, schizophrenia or psychosis which can co-exist alongside dementia. Some of the symptoms of these illnesses, such as withdrawal, difficulty with attention and focus and low levels of motivation can be hard to differentiate, with the cognitive and behavioural changes experienced in dementia making a diagnosis difficult. This can mean that some mental illnesses might go un-diagnosed in people living with dementia, resulting in a lack of appropriate support and understanding. When well-managed, with correct treatment and supportive networks, people with a mental illness can still have good mental health.
Recognising Mental Health and Wellbeing in a Person Living with Dementia
In some cases, it may be that the only way to identify a person’s mental health state is through observation, usually by the person’s partner or closest relative or carer. Whilst this is acceptable, especially where the person is unable to communicate effectively, it is always more appropriate to allow the person with dementia to have a voice and describe their own well-being. One method to use is a self-reporting quality of life measure where lower scores indicate poorer mental health and possible depression and/or anxiety.
It is important that mental illness or poor mental health is addressed in order to improve the person’s quality of life. This can be achieved by increasing social contact, ensuring good nutrition and sleep habits and finding ways to enhance motivation.
People living with dementia can have good mental health. Receiving a diagnosis of dementia does not mean that the person will have poor mental health. Some people may experience mental illnesses, especially if prior to their diagnosis they were already living with a mental illness or had previously experienced one. Some people may find that their mental health worsens whilst they come to terms with a diagnosis, but it is important to remember that mental health can improve with support and it does not necessarily lead onto a mental illness.
Signs of Deteriorating Mental Health:
Apathy, losing interest in activities that were previously enjoyed
Reduced self-esteem & confidence
Increased difficulties with focus and attention
Noticeably sad and tearful
Increased agitation
Increased anxieties
Change in sleep patterns either waking early, sleeping more in the day or struggling to get to sleep
Changes to appetite levels
Reluctance to engage socially
Less interest in appearance and signs of self-neglect
Increased anxieties
Complaints of physical aches and pains
Why Dementia May Cause Poor Mental Health
Receiving a diagnosis – To better understand and come to terms with a diagnosis it is important to be surrounded by good support networks.
Stigma around dementia – Everyone needs to play a part in reducing the stigma around dementia, creating dementia friendly accessible environments and ensuring that people with dementia are seen and included. This would help alleviate anxieties some people have around sharing their diagnosis.
Cultural needs – Some communities face increased stigma within their own families due to cultural perceptions of dementia where more education may be needed. They may experience poorer access to services partly due to language barriers and anxieties around religious and cultural needs being met.
Loneliness – This might be from living alone and potentially distanced geographically from family and friends. It can also be from a gradual withdrawal from society following a diagnosis. This needs to be counteracted with efforts to build connections and increase social interaction.
Purpose – A dementia diagnosis can leave some feeling as though they are losing control and meaning in their lives. It is important to continue to engage in meaningful activities to retain a sense of purpose, this could be existing activities, adapted activities or trying something new.
Carers – Carers’ mental health is as important as the person with dementia and they should access their own assessments and support. Any decline in a carer’s mental health can negatively impact the person with dementia and the quality of life for both.
Practicalities – Stress and anxiety around financial concerns and future care options can severely impact a person’s mental health. It is important that discussions and planning take place early, following a diagnosis, so the person can focus on living their best possible life without additional stresses.
Promoting Good Mental Health
There are certain lifestyle changes, which are beneficial for everyone, that can be made to promote good mental health and wellbeing. Self-care is a holistic approach, focussing on staying healthy and doing things to live well which together can have a huge impact on mental health and quality of life. As dementia progresses, a person may need the support and encouragement of carers, family and friends to ensure that their physical, emotional, psychological and social needs are met.
Healthy diet – Research suggests that a Mediterranean diet is associated with a decreased rate of cognitive decline and lowers the risk of depression.
Regular exercise – Enables a person to continue to function independently for longer. Exercise can improve mood and promote better sleep.
Outdoor activity – Time in nature is good for both physical and mental health. Gardening and walking are both good options, proven to improve mental health.
Sleep – Ensuring that activities are planned to allow for rest periods and good sleep routines are followed.
Social interaction – Engaging in social activities can reduce loneliness, stress levels and stimulate cognitive function.
Mental stimulation - Cognitive exercises such as puzzles and games as well as meditation or mindfulness all benefit mental health and wellbeing.
Purpose – Encouraging a person to contribute either in their own home, with family or in the community if able provides purpose which is associated with greater wellbeing.
Activities – Participation in pleasurable activities and hobbies can increase happiness and reduce stress levels creating better mental health and wellbeing.
People living with dementia, like everyone, should be encouraged to focus on their mental health, make positive lifestyle choices and be supported to keep actively engaged in family and community life.
Promoting independence, purpose and self-care will enable better cognitive and mental health and provide greater quality of life.
To find out more, contact the Sage House Wayfinding team on info@dementiasupport.org.uk.