时间：2026-10-12     【转载】

今年10月10日是第35个世界精神卫生日，今年全国活动主题为“悦纳情绪，心有阳光”。随着我国老龄化程度不断加深，老年群体的精神心理健康问题日益受到关注。不少子女发现家里老人突然变得易怒、多疑、健忘，常常误以为是“年纪大了脾气变怪”“老糊涂了”，却忽略了这些情绪变化背后可能隐藏的疾病信号。南京市中西医结合医院（南京市中西医结合老年医院）专家提醒，关注老年群体常见的情绪异常表现，有助于及早识别、及时干预，为老年人的晚年心理健康保驾护航。

“老年人的情绪变化往往和躯体疾病、认知退化密切相关，不能简单归因为‘性格变了’。”脑病科副主任医师缪冬梅介绍说，很多老年认知障碍、脑血管疾病、内分泌疾病患者，首发症状都包含情绪行为的异常，等到老人出现明显的记忆力下降、生活不能自理才就诊，往往会错过最佳干预窗口。她提醒，当老人短期内出现性格突然反转；多疑、被害妄想；情绪持续低落、消极；焦虑、坐立不安；行为幼稚、无逻辑等异常表现时，家属就要高度警惕，及时带老人就诊排查。如果老人的异常情绪持续超过2周，且已经影响到正常的吃饭、睡觉、社交，就不属于正常的“老化表现”，要第一时间到老年精神科、神经内科就诊，排查躯体和精神疾病。

对于老人来说，要保持情绪健康，既需要自身的调节，也需要家庭、社会的共同支持。缪冬梅结合临床经验，建议老人每周至少参加2-3次集体活动，比如社区的老年大学、广场舞、棋牌活动，多和同龄人交流，避免长期一个人在家闷着；子女每周至少视频通话2次，多和老人聊聊生活里的小事，让老人感受到被关心。此外，老人可以根据自己的兴趣选择一些用脑的活动，比如看书、下棋、学新技能（比如用智能手机、画画、弹乐器），每天坚持15-30分钟的认知训练，能有效延缓大脑功能退化，减少情绪异常的发生。

很多老人觉得“心情不好是自己的问题”，不愿意告诉子女，也不愿意去看医生，这种想法也是错误的。要是心情不好超过2周，自己调节不过来，一定要主动和家人说，及时找医生帮忙。当然，规律作息和坚持适度运动对于情绪健康也很重要，每天坚持30分钟左右的轻中度运动，比如散步、打太极拳、做八段锦等，不仅能有效改善低落、焦虑的情绪，同时还能增强体质，减少躯体疾病的发生。

远离认知误区！这些错误应对反而会加重老人病情

误区一：和老人“讲道理”，争论对错

“很多家属遇到老人多疑、说胡话的时候，第一反应是和老人讲道理，反复证明老人的想法是错的，结果反而让老人情绪更激动。”缪冬梅解释，老人出现异常的想法、情绪，往往是因为脑部功能受损，无法像正常人一样逻辑思考，这时候讲道理、争论对错，只会让老人觉得不被理解，加重焦虑、易怒的情绪，甚至引发老人的敌对心理。

正确的做法是先共情，比如老人说“有人偷我钱”，不要直接反驳“没人偷你钱，你自己记错了”，可以先回应“我知道你找不到钱肯定很着急，我帮你一起找”，先安抚老人的情绪，再慢慢引导，或者转移老人的注意力。

误区二：觉得“精神病丢人”，回避正规治疗

不少家属发现老人出现情绪、精神异常，就觉得“家丑不可外扬”，不愿意带老人去医院就诊，还有的家属觉得“老年痴呆治不好，去医院也没用”，直接放弃干预。

“其实大部分老年精神心理问题，通过规范治疗都能得到有效缓解。”缪冬梅介绍说，早期轻度认知障碍通过药物干预、认知训练，能延缓病情发展5-10年；老年抑郁障碍规范用药2-4周，情绪就能得到明显改善，完全可以让老人保持较好的生活质量。如果一直回避治疗，等到病情发展到中重度，不仅治疗难度大，老人的生活质量也会严重下降，还会给家庭带来极大的照护负担。

误区三：只关注躯体疾病，忽略情绪变化

还有些家属带老人看病，只关注血压、血糖这些躯体指标，老人说心情不好、睡不好觉，就觉得是“想多了”，不用治。实际上，情绪问题反过来也会加重躯体疾病。比如，长期抑郁、焦虑的老人，高血压、糖尿病的控制难度会增加，中风、心梗的发病风险会提高。

缪冬梅建议，子女带老人做年度体检时，建议增加认知功能筛查、精神心理评估的项目，尤其是有高血压、糖尿病、脑卒中病史，或者有老年痴呆家族史的老人，最好每半年做一次相关筛查，做到早发现、早干预。

This year, October 10 marks the 35th World Mental Health Day, and this year's national theme is "Embrace Your Emotions, Keep Sunshine in Your Heart." As China's population continues to age, the mental and psychological health of older adults is drawing growing attention. Many adult children notice that an elderly parent has suddenly become irritable, suspicious, or forgetful, and often assume it is simply "getting cranky with age" or "just getting senile" — overlooking the possibility that these emotional changes may be hidden warning signs of illness. Experts at Nanjing Integrated Traditional Chinese and Western Medicine Hospital (Nanjing Integrated Chinese and Western Medicine Geriatric Hospital) remind the public that paying attention to the common emotional abnormalities seen in older adults can help with early identification and timely intervention, safeguarding their psychological well-being in later life.

"Emotional changes in older adults are often closely tied to physical illness and cognitive decline, and cannot simply be attributed to 'a change in personality,'" said Miao Dongmei, associate chief physician in the Department of Brain Diseases. She explained that for many patients with age-related cognitive impairment, cerebrovascular disease, or endocrine disease, abnormal emotional and behavioral symptoms are among the very first signs. By the time the patient shows obvious memory loss or can no longer manage daily life on their own, the optimal window for intervention has usually already passed. She cautioned that families should be on high alert and bring the older adult in for evaluation promptly if they suddenly show signs such as a complete reversal of personality; suspiciousness or delusions of persecution; persistent low mood and negativity; anxiety and restlessness; or childish, illogical behavior. If the abnormal mood lasts more than two weeks and is already affecting eating, sleeping, and socializing, it is not a normal part of "aging" — the person should be taken to a geriatric psychiatry or neurology clinic without delay for screening for physical and mental disorders.

For older adults, maintaining emotional health requires both self-regulation and the joint support of family and society. Drawing on her clinical experience, Miao Dongmei recommends that older adults take part in group activities at least two to three times a week — for example, community senior colleges, square dancing, or chess and card games — and interact more with peers, rather than staying cooped up at home alone for long periods. Children should video-call their parents at least twice a week and chat about the small things in daily life, so the older person feels cared for. In addition, older adults can choose brain-stimulating activities based on their interests — reading, playing chess, learning new skills (such as using a smartphone, painting, or playing an instrument) — and stick to 15 to 30 minutes of cognitive training each day, which can effectively slow the decline of brain function and reduce the occurrence of emotional abnormalities.

Many older adults feel that "being in a bad mood is my own problem," and are unwilling to tell their children or see a doctor. This way of thinking is also mistaken. If a low mood lasts more than two weeks and you cannot manage it on your own, you must speak up to your family and seek a doctor's help in good time. Of course, a regular daily routine and consistent, moderate exercise are also important for emotional health. Insisting on about 30 minutes of light-to-moderate exercise a day — such as walking, practicing Tai Chi, or doing Baduanjin (Eight-Section Brocade) — not only effectively improves low mood and anxiety but also strengthens the body and reduces the occurrence of physical illness.

Stay away from these misconceptions! These mistaken responses can actually make an older adult's condition worse

Misconception 1: "Reasoning" with the older adult and arguing over who is right.

"When many family members encounter an older adult who is suspicious or talking nonsense, their first reaction is to reason with them and repeatedly prove that their thinking is wrong — which only makes the older person more emotionally agitated," Miao Dongmei explained. When an older adult has abnormal thoughts or emotions, it is often because brain function has been impaired and they can no longer think logically the way a healthy person can. At such times, reasoning and arguing over right and wrong only make them feel misunderstood, worsening anxiety and irritability, and can even trigger hostility.

The right approach is to empathize first. For example, if the older person says, "Someone stole my money," do not directly contradict them with "No one stole your money, you just remembered it wrong." Instead, respond first with something like, "I know it must be very upsetting not to be able to find your money — let me help you look." Calm the person's emotions first, then gently guide them, or redirect their attention.

Misconception 2: Thinking "mental illness is shameful" and avoiding proper treatment.

Many family members, upon noticing emotional or psychiatric abnormalities in an older adult, feel that "family scandals should not be aired in public" and are unwilling to take them to hospital. Others feel that "there's no curing dementia, so going to hospital is useless" and simply give up on intervention.

"In fact, the vast majority of mental and psychological problems in older adults can be effectively alleviated through standardized treatment," Miao Dongmei said. Early mild cognitive impairment, through medication and cognitive training, can have its progression delayed by five to ten years; and with standardized medication for two to four weeks, late-life depressive disorder can improve markedly, fully allowing the older adult to maintain a good quality of life. If treatment is avoided all along, and the illness progresses to a moderate or severe stage, not only does treatment become much harder, but the older person's quality of life drops sharply and the family bears an enormous caregiving burden.

Misconception 3: Focusing only on physical illness and ignoring emotional changes.

Some family members, when taking an older adult to the doctor, focus only on physical indicators such as blood pressure and blood sugar. When the older person says they are in a low mood or sleeping poorly, they dismiss it as "overthinking" and not needing treatment. In reality, emotional problems in turn worsen physical illness. For example, in older adults with long-term depression or anxiety, high blood pressure and diabetes become harder to control, and the risk of stroke and heart attack rises.

Miao Dongmei suggests that when children take their parents for an annual health check-up, they add cognitive function screening and psychological assessment. Older adults with a history of high blood pressure, diabetes, or stroke, or with a family history of dementia, should ideally undergo the relevant screening every six months, so that problems are detected and addressed early.