Abstract
This project aims to understand the factors contributing to the psychological vulnerability or vitality of older adults (aged 80 and above). It will investigate various influencing factors, including older adults' medication status concerning anticholinergic burden and prescribing cascades, as well as determinants of psychological vulnerability/mental vitality, particularly focusing on their living environment.
Mental health problems affect up to 40% of older adults and often have a greater impact on their overall health status than chronic physical conditions. Common mental health issues include anxiety, depression, psychotic experiences (e.g., delirium), and harmful personality dynamics. Despite efforts, some mental health needs, particularly depression and anxiety, go unrecognized among older adults, leading to misdiagnosis or underdiagnosis. In Belgium, the predominant approach to mental health issues is biomedical, with pharmacotherapy as the primary treatment, resulting in high rates of psychoactive medication prescriptions among older adults.
While pharmacotherapy has merits, it also poses risks, especially for older adults, including severe side effects on somatic and cognitive levels due to increased anticholinergic burden. Psychoactive medications often lead to adverse effects such as cognitive decline, confusion, and delirium, which can exacerbate existing mental health issues or trigger new ones, necessitating third-line services' intervention. Additionally, prescribing cascades, where medications are prescribed to counteract the side effects of other medications, are common among older adults and contribute to hospital admissions. Older adults with mental health vulnerabilities often have multiple vulnerabilities, including multimorbidity and polypharmacy, highlighting the need for personalized interventions that go beyond medication.
Furthermore, the impact of living environments, including interior design and neighborhood characteristics, on the mental well-being of older adults with psychological vulnerabilities, is understudied. A tailored living environment that promotes autonomy and integrity is crucial for their well-being. Access to outdoor spaces and contact with nature are particularly important, as limited access predicts depressive symptoms. This project seeks to answer key research questions regarding the factors contributing to psychological vulnerability/vitality in older adults, the bi-directional relationship between living environment and mental health, the impact of reducing polypharmacy on mental health, and the development of a tailored intervention mix for psychological vulnerability/mental vitality.
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