The aging of humans is a physiological and dynamic process ongoing with time.

In
accordance with most gerontologists’ assertions it starts in the fourth decade of life and leads
to death. The process of human aging is complex and individualized, occurs in the biological,
psychological and social sphere. Biological aging is characterized by progressive age-
changes in metabolism and physicochemical properties of cells, leading to impaired self-
regulation, regeneration, and to structural changes and functional tissues and organs. It is a
natural and irreversible process which can run as successful aging, typical or pathological.

Biological changes that occur with age in the human body affect mood, attitude to the
environment, physical condition and social activity, and designate the place of seniors in the
family and society. Psychical ageing refers to human awareness and his adaptability to the
ageing process. Among adaptation attitudes we can differentiate: constructive, dependence,
hostile towards others and towards self attitudes.

With progressed age, difficulties with adjustment to the new situation are increasing, adverse
changes in the cognitive and intellectual sphere take place, perception process involutes,
perceived sensations and information received is lowered, and thinking processes change.
Social ageing is limited to the role of an old person is culturally conditioned and may change
as customs change. Social ageing refers to how a human being perceives the ageing process
and how society sees it.

Acute confusional state (Delirium). Characteristically occurs over hours or days, usually
accompanied by acute physical illness. Levels of alertness fluctuate, being worse at night,
with lucid spells during the day, although the person can be disorientated to time and place.
They may be fearful, irritable and aggressive. Paranoid ideas are common as are visual and
auditory hallucinations. Symptoms generally resolve when the underlying cause is treated.

Depression, characterised by abnormally lowered mood may develop over weeks or months.
The signs include loss of interest in life, neglect of personal appearance and hygiene plus
expression of recurrent thoughts of death or suicidal ideas. Concentration levels are low,
decisions difficult to make as are the carrying out of daily tasks. The person may complain of
multiple physical symptoms, sleep (insomnia or hypersomnia) and appetite also become
affected with a resultant decrease in energy.

Paraphrenia is not universally accepted as a distinct syndrome. The person is often female,
lives alone, and has evidence of difficult social interactions earlier in life. They report of plots
against them, focusing on family members, which are persistent, extreme, and elaborate.
Usually, cognitive impairment is not present, but a hearing impairment is common. Although
the person is physically independent (diet and hygiene are rarely compromised), social
functioning and cooperation with staff members are greatly impaired.

Dementia is an umbrella term used for signs and symptoms characterised by a generalised
and irredeemable impairment of intellect, memory and personality. The decline is permanent
and progressive. The three most common types of dementia are:
Alzheimer’s disease: a neurodegenerative disorder with generalised brain cell loss, especially
in the cortex, plus extracellular plaques and intracellular neurofibrillary tangles. It has a
progressive unremitting course with widespread loss of function and abilities. Alzheimer’s
disease is slightly more common in women than in men.
Vascular dementia: small or large vascular lesions cause focal damage in the brain with
resultant focal neurological signs. Stepwise deterioration in cognitive and physical function
occurs. It is more common in men than in women, and there is usually past history of
cardiovascular pathology (e.g. hypertension).

Lewy Body dementia: presents with a very different patterns of symptoms including clouding
of consciousness, paranoid delusions, complex visual hallucinations, falls, depressive
symptoms and auditory hallucinations.

As people get older there is an increased likelihood of them experiencing bereavement. Most
come through the experience without the need for professional help, but for some there are
longer lasting detrimental effects on physical and mental health. This may leave someone in a
pattern of grief and mourning, experience some or all of the following:
An initial experience of numbness (sense of isolation, withdrawal, loss of appetite) and denial
(constant reminiscing, expects the return).
In the first 3 months it could be anxiety (sense of insecurity, often irrational fears), anger
(‘why me’), pain, guilt (self-recrimination)
From 3 months onwards, depression is more likely, exacerbating existing personality
problems, apathy (neglects own best interests, lack of will) and possible a loss of identity
Consider the psychological factor of adjustment to physiological change that has left a
disability, e.g. a stroke. It may mean lifestyle changes such as having a bed downstairs,
leading to loss of privacy, or having to give up driving, leading to isolation. A major
disability may also alter the person's position or status within the family, for example, a
change from being a carer to being cared for may lead to low esteem. Healthcare
professionals may sometimes overlook the acceptance of these changes as the priority is
normally to deal with the physical disability. If the physiotherapist has knowledge of the
possible psychological consequences they can refer on to colleagues and ensure a holistic
approach to person-centred care is maintained. Occasionally however, the effects of mental
health problems can be such that they hinder and limit a person’s participation and
progression with physiotherapy, and a different course of management must be sought.

For most of us who are in a general setting, dealing with complex emotions in rehabilitation
is vital, as many factors will affect involvement and participation with treatment. The range
of patients you will see encompasses people with anxieties born of their pathologies of a non-
organic nature; e.g. someone with osteoporosis with a great fear of moving in case they fall
and fracture a bone.

How would your response differ to a patient who has anxiety centred on falling, compared to
a person with dementia and anxiety about walking outside? Physiotherapy for mental health
problems varies depending on the reason for the condition, and the stage it is at. Some
physiotherapists specialise in this clinical area following further post-qualification study. The
physiotherapists in mental health are uniquely placed through their knowledge of mental
health conditions and their expertise in the management of physical conditions to provide an
extensive range of approaches to treatment aimed at relieving symptoms and improving
quality of life.