Old Age and Stress

Depression in Later Life

Anxiety Disorders in Later Life

Substance Misuse in Later Life

Psychotic Disorders in Later Life

Disorders of Cognition

Delirium

Alzheimer’s Disease and Other Neurocognitive Disorders

Issues Affecting the Mental Health of the Elderly

Putting It Together: Clinicians Discover the Elderly

Harry appeared to be in perfect health at age 58…. He worked in the municipal water treatment plant of a small city, and it was at work that the first overt signs of Harry’s mental illness appeared. While responding to a minor emergency, he became confused about the correct order in which to pull the levers that controlled the flow of fluids. As a result, several thousand gallons of raw sewage were discharged into a river. Harry had been an efficient and diligent worker, so after puzzled questioning, his error was attributed to the flu and overlooked.

Several weeks later, Harry came home with a baking dish his wife had asked him to buy, having forgotten that he had brought home the identical dish two nights before. Later that week, on two successive nights, he went to pick up his daughter at her job in a restaurant, apparently forgetting that she had changed shifts and was now working days. A month after that, he quite uncharacteristically argued with … the phone company; he was trying to pay a bill that he had already paid three days before….

Months passed and Harry’s wife was beside herself. She could see that his problem was worsening. Not only had she been unable to get effective help, but Harry himself was becoming resentful and sometimes suspicious of her attempts. He now insisted there was nothing wrong with him, and she would catch him narrowly watching her every movement…. Sometimes he became angry—sudden little storms without apparent cause…. More difficult for his wife was Harry’s repetitiveness in conversation: He often repeated stories from the past and sometimes repeated isolated phrases and sentences from more recent exchanges. There was no context and little continuity to his choice of subjects….

Two years after Harry had first allowed the sewage to escape, he was clearly a changed man. Most of the time he seemed preoccupied; he usually had a vacant smile on his face, and what little he said was so vague that it lacked meaning…. Gradually his wife took over getting him up, toileted, and dressed each morning….

Harry’s condition continued to worsen slowly. When his wife’s school was in session, his daughter would stay with him some days, and neighbors were able to offer some help. But occasionally he would still manage to wander away. On those occasions he greeted everyone he met—old friends and strangers alike—with “Hi, it’s so nice.” That was the extent of his conversation, although he might repeat “nice, nice, nice” over and over again…. When Harry left a coffee pot on a unit of the electric stove until it melted, his wife, desperate for help, took him to see another doctor. Again Harry was found to be in good health. [However] the doctor ordered a [brain scan and eventually concluded] that Harry had “Pick-Alzheimer disease.” … Because Harry was a veteran … [he qualified for] hospitalization in a … veterans’ hospital about 400 miles away from his home….

At the hospital the nursing staff sat Harry up in a chair each day and, aided by volunteers, made sure he ate enough. Still, he lost weight and became weaker. He would weep when his wife came to see him, but he did not talk, and he gave no other sign that he recognized her. After a year, even the weeping stopped. Harry’s wife could no longer bear to visit. Harry lived on until just after his sixty-fifth birthday, when he choked on a piece of bread, developed pneumonia as a consequence, and soon died.

(Heston, 1992, pp. 87–90)