Dr. Dawn-Elise Snipes presents on how physical changes of aging—particularly hormonal declines beginning around age 40—affect mental health, cognition, mood, motivation, libido, and behavior. The talk links reduced estrogen, testosterone, and progesterone to lowered neuroprotection and declines in neurotransmitters (serotonin, dopamine, norepinephrine, GABA), describes resulting grief, irritability, and depression, and emphasizes the need for empathetic, strengths-based approaches to older adults.
Chapters
I'd like to welcome everybody to today's presentation on mental health and aging, how physical changes impact mental health. I'm your host, Dr. Donnellice Snipes. In this presentation, we're going to explore physical changes that result from aging and discuss how those physical changes impact each piece of a person's life. Beginning at about age 40, our mind and body start to slow down a bit. And that includes how quickly we are producing human growth hormone, estrogen, testosterone. We start slowing down and that's not necessarily a bad thing, but we need to recognize it and figure out how to adapt to it instead of digging in and pretending that we still have the body of a 20 year old, because we don't. And that's in and of itself a whole grief issue. For a lot of people. There are changes in every aspect of our bodies. These changes themselves can contribute to mood and cognitive issues. For example, reductions in testosterone and estrogen actually directly impact cognition and you lose a level of neuroprotection. And they also, these issues also contribute to grief over loss of functioning. As we realize that we're thinking more slowly, as we realize we ain't 20 anymore, there's a grieving period now. Some people kind of shake it off. Some people have what we'll call a midlife crisis. Some people go into a deep depression and have difficulty feeling empowered and hopeful about the future. So that's really what we're going to talk about today. Think about it, older people and just think about older people that are in your life. And when I'm thinking about it, I'm thinking about my grandparents and, you know, my mom and, and stuff. So they tend to be more set in their ways. Well, that's kind of a, that's a generalization, but it's very true for a lot of people. Why is that? Well, cognitively they've slowed a little bit. And that slowing means it takes more time to register new things. And people who, when they keep their ways the same, when they're more set in their ways, it's more predictable. So it's easier. It doesn't take as much cognitive energy. It makes sense when you think about it, but we need to think about why is grandma so rigid about these different things? They can be resistant to change for that same reason. And another thing that we see, and I'm getting ahead of myself, but that's okay, is a lot of people, as they start to notice their aging, they want to retain control. They want to prove that they've still got it. They want to not experience physical change. They're going to deny that they need grab bars. They may deny that they need hearing aids, for example. Part of that is because for some people is because those things represent weakness to them. Those things represent their impending physical failure. In some way they can be irritable. Well, if things are more difficult to do on a daily basis, if you're frustrated about it, if you feel powerless because your body's just kind of starting to give out a little bit, then it can make you more irritable. If people are trying to change things and take your power away, of course you're probably going to get irritable. Even if their heart is totally in the right place, it can feel disempowering. Some people will feel depressed. And a lot of older adults go through periods where they feel depressed because they've had a significant loss physically, for example, or they have had a set of friends pass away. And my stepfather, he was much older than my mother and his colleagues and his friends were dying for the last 10 years of his life. And he was, he was the one that kept going. And every time one of them passed away, it was very poignant for him. And sometimes older people can seem. I should, I should have put seem in front of that. Irrational. And we need to back up because behaviors, communication, what are they communicating? What are they believing? We recently had a caseworker come in to try to help my, my grandparents. And the caseworker did not approach them with an empowering, strengths based attitude and came in and did an assessment and then said, okay, we're going to do a cognitive assessment right now. To my grandmother, that meant you're trying to prove that I'm crazy and put me in a home. And she kicked the caseworker out of the house. From the objective standpoint, I know what she was trying to do, but. And, and I think my parents knew what she was trying to do. But granny was already stressed out. She was already feeling disempowered because somebody was having to come in to figure out how to help her age in place. And then they start talked about a cognitive interview. They that's jargony. And without telling the person why you're doing it ahead of time, I can see how she would jump to that conclusion and act to what it felt to the caseworker was irrational. It was perfectly rational. She's like, oh, heck to the no, I'm not going anywhere. I'm aging in place. I don't care what you say, okay, we need to back out, get the bigger picture. Put yourself in their position and think, what did that mean? What. When the caseworker said that, what did that mean? When you found out that you were going to have to have a pacemaker put in, what did that mean to you? So let's talk about some of these physical changes. Hormone changes, that's the one that a lot of people talk about. So we're going to start with that one. But as you know, if you've watched prior videos, these hormone changes impact every aspect of life. Hormones are not just for reproduction. As we lose estrogen, we lose neuroprotection. When we get stressed, remember, it creates a, an excitotoxic toxic environment in our brain. And estrogen helps buffer against that toxicity. As we lose estrogen, we, we lose that buffer. So it becomes more fragile, if you will, in the, in the brain. That's why stress management can be so important for people, to help them slow cognitive decline, to help them strengthen the neurons that are there. And they can, you can still, if you're breathing, you can still build neurons, you can still cause or create neurogenesis. When we have low estrogen, we see reduced serotonin, our feel good chemical. We see reduced dopamine, which is involved in energy and motivation, among other things. We see reduced glutamate, that's our main energy excitatory neurochemical. And that goes down. So you're starting to see somebody who may start feeling depressed. We see reduced norepinephrine, which is partly for energy, partly for focus and attention. As those things go down, you're seeing mood go down. Motivation, energy and attention, those are all things that in a younger person we would start throwing diagnoses at. This is a normal course of life. And some people will choose to go on hormone replacement therapy. I know somebody's going to say that, and that's true. And that is a choice for people to make with their doctor. However, for those who don't, we need to educate them about what's going on and then try to help them find ways to potentially increase, naturally increase some of these neurotransmitters. Dopamine is increased when we do things that are pleasurable, that are good for us because our body says, hey, I like that, or that's good for us. Let's do it again. Help them look forward to things. When we are motivated to do something because there's a reward out there, it, it can help a lot. So there are a lot of different ways and we're going to talk a lot more about this next week, but. But we can help people sort of hack their neurotransmitter system, if you will. And when estrogen goes down, there's a reduced libido. There's also changes in the tissues in the gonadal area. Not going to get into that right now. But that can also make sex more painful or less enjoyable. And even if somebody is still wanting to have sex, testosterone reduce. Less testosterone again means reduced serotonin, reduced dopamine, and reduced acetylcholine. And again, reduced libido. We want to recognize, and I have those separated out knowing that both sexes have estrogen and testosterone. However, in the male sex, the predominant hormone is testosterone, so they are going to be more strongly impacted when it starts to plummet. Likewise, the predominant gonadal hormone in females is estrogen. So when they start to reduce their estrogen production, then they're going to feel those feelings more. Progesterone is another gonadal hormone that we don't talk a lot about, but when we don't have enough progesterone, we actually see decreased GABA activity.
