Growing older is uncomfortable: uncomfortable to talk about, uncomfortable to do. Mental health problems for those who have never had mental illness or worsening symptoms for those who have struggled with mental illness in the past can confuse and frighten not only the individual but also those in relationships with the individual. It also just seems wrong that having come so far in life any one of us may be confronted by deteriorating mental health at a time when we expected to relax and enjoy life. On the positive side, what is sure is that most elderly do not exhibit symptoms of or require treatment for mental illness, even given advanced age. Many elderly live to be near-centenarians with few debilitating illnesses.

This article looks at mental illness from two perspectives, as pre-existing disorders and as conditions brought on by aging.

Along the line of pre-existing mental health conditions are those that have existed for extended periods throughout life and those that are made worse by life changes. These include all previous mental illnesses for which the individual may have received treatment in the past, including substance abuse.

What is known is that the effects of these disorders often decrease after retirement, due in some part to a decrease in stress because of fewer job- and work-related responsibilities (even just the commute!). Also on the positive side, there is sometimes a "maturity" effect (or aging out) that is signaled by a decrease in the intensity and/or frequency of mental illness symptoms. On the other hand, symptoms may worsen for a similar reason: stress following retirement due to the collapse of structure that has helped to contain or moderate symptoms. In addition, feelings of hopelessness, helplessness, and uselessness that may occur with age may make symptoms of ongoing mental illness worse.

With regard to new mental illness, physical processes can lead to deteriorating mental health in the elderly and may occur without any warning, although a family history of late-onset mental illness portends a difficult period ahead. Age is a key factor in new mental illness, especially the biological effects of the degeneration of the nervous system, a certainty to some extent for everyone, but a serious problem for increasing numbers of the elderly. Greater numbers of individuals living longer results in more people who are more seriously affected by aging and dying cells. The combination of mental illness and physical deterioration leads also to a decrease in an individual’s abilities to manage activities of daily living (ADL’s), such as arranging for and attending to appointments, prescriptions, and transportation, and even such basic activities as eating, hygiene, and recreation.

However, there is no sure way to determine who is at risk and how great the risk is. For those who have problems, treatment can lessen symptoms and prevent complications. Ongoing consultation with a health care provider is essential, now more than ever. Changes in mental health status are especially critical events in the elderly. Changes that indicate improvement in a preexisting condition can be reinforced and, if a need for additional supports—individual, group, drug, or other therapies—is indicated, it is imperative to put these in place as soon as possible in order to limit the long-term effects of the mental-health status change.

For elderly members of the GLBT community, targeted mental health care is almost completely nonexistent and it is usually necessary to turn to the larger community to meet needs. And though there is no reason to believe that health care professionals in general purposely discriminate against sexual-minority elderly, the individual needs of GLBT’s may go unmet, either because they are not recognized or because they are not given priority. Norms within health care facilities are set to a homogenized and heavily heterosexualized standard, and individuality among all seniors is suppressed.

How to address concerns for treatment is multidimensional, and this will be the focus of the future articles in this series, but one key is continued contact with others.

In this regard, a meeting of GLBT seniors was recently held at the Community Center in Rehoboth Beach to consider the need for a greater degree of GLBT senior "presence" and activity in "lower, slower." Although just an exploratory meeting, it became quickly apparent that there is great interest among those who attended in putting together ways for seniors to give back to the community. One of the ways suggested is to become a resource for others with questions about GLBT concerns, and the group has decided to begin by going on-line in order to meet this need.

Beginning in a few weeks, members will make themselves available to provide feedback and information for persons who have general concerns about being a member of a sexual minority.

The exact ways in which this will be done remain to be worked out, but attendees are excited about this initial effort, so stay tuned for further details.

The group also discussed obtaining and utilizing resources, developing ways of providing mutual support, and methods of sharing information that will make our lives easier and more rewarding.

The group was enthusiastic in its belief that there is much more to retirement than retiring, and plans to pursue ways for members to become connected, with each other and with the

community at large, as well as to explore the role of seniors in the GLBT community.

The group plans to continue to meet on Monday evenings at 7:00 p.m. at the CAMP Rehoboth Community Center. Seniors (your definition) are invited to attend. Call 302-684-5195 for more information.