Mental Health Conditions In Older Adults

Why Mental Health in Older Adults Is an Issue

Life expectancy has increased over time, meaning that our population is made up of an increasing number of older adults.

Untreated mental health conditions increase the risk of development and progression of other medical conditions, most notably heart-related conditions. As our society ages, older adults also make up a significant part of the workforce. Untreated mental health conditions can lead to missed work, decreased productivity, and a huge financial impact.

Older adults have the highest rate of suicide compared to other age groups, which suggests the severity of mental health conditions in older adults is higher. According to 2021 data from the National Vital Statistics data system, men over 85 had the highest rate of suicide at 55.7 deaths per 100,000 people.

Common Mental Health Issues Faced by Older Adults

The most common mental illnesses in the elderly are depression, anxiety, and dementia. However, mental health conditions are often underrecognized in older adults. There is a tendency to attribute symptoms of depression, such as poor sleep, lack of energy, and loss of interest, to the normal aging process, and older adults may minimize their symptoms. They may think these symptoms are not worth mentioning to their doctors.

Mental illness symptoms in the elderly can present in a more subtle, nonspecific manner that can miss detection. Older adults can experience:

• Fatigue
• More frequent medical illnesses
• Unexpected weight changes

Older adults also face challenges with accessing healthcare. The aging process can lead to some loss of independence as older adults experience issues with mobility and transportation. Many older adults have difficulty driving longer distances. They may miss out on seeing their primary care doctor because they are unable to go to the clinic or endure long wait times.

Prevalence of Mental Health Disorders in Elderly Adults

Overall, the Global Health Data Exchange found that nearly 14% of adults over age 60 have a mental disorder.

Based on a 2022 meta-analysis out of Hubei University, the combined global prevalence of depression in older adults is estimated to be 28.4%. Additionally, in an online survey of the US conducted in 2023, 11.9% of respondents over 65 reported being treated for depression.

Depressive disorders and anxiety disorders rank among the top 20 leading causes of disability in the world, with depression being the second leading cause and anxiety the sixth leading cause. The latest release of the US Census Bureau’s Household Pulse Survey from 2024 has found that 32.3% of adults reported suffering from anxiety; 20% of those adults are over the age of 65.

Warning Signs of Mental Health Issues

Signs of depression may be less obvious in older adults. They are less likely to report feeling sad and are more likely to experience an increase in physical symptoms, such as having little energy, more pain, difficulty sleeping, and getting physically ill more often. In older adults, severe depression can also look like dementia. They may experience short-term memory loss and be more easily irritated and angry. Older adults are less likely to report feeling anxious and may present to the hospital more frequently, thinking they are experiencing stomach or heart issues.

Warning signs of possible mental health issues include:

• Difficulty falling asleep, waking up too early, or sleeping too much
• Constantly feeling tired and having little energy to do anything
• Being very restless and having trouble relaxing
• Loss of motivation to do anything, including showering and brushing teeth
• Avoiding going out and not wanting to see friends or family
• Loss of interest in previous hobbies
• Changes in mood, such as crying suddenly for no reason or being easily angered
• Forgetting things more easily, appearing more distracted and scatterbrained
• Change in appetite leading to significant weight loss or gain
• Moving and talking much slower than usual
• Speaking about death and making statements about life not being worth living

Any statements relating to death and, in particular, any attempts to act on any thoughts of suicide should be addressed immediately. Bring your older adult to the nearest emergency room to be evaluated if they have been expressing thoughts of suicide or making plans to act on those thoughts.

Risk Factors and Causes of Health Issues In Seniors

Older adults are vulnerable to the development of mental health conditions due to many factors.

Age

Age alone increases the likelihood of having other medical conditions, which can contribute to pain, decreased energy, and sleep (too much or not enough), all of which can negatively impact mood.

Dementia

With increasing age comes an increased risk of dementia. According to 2022 National Health Statistics Reports, the percentage of adults diagnosed with dementia in the US progressively increased with increasing age, with 1.7% of adults 65-74 carrying a diagnosis of dementia, 5.7% of adults 75-84, and 13.1% of adults over 85.

Social Isolation

Older adults are more likely to have experienced the death of a loved one and subsequently feel lonely, disconnected, and isolated.

Financial Strain

Many older adults have retired from actively working, leading to decreased financial stability. This can cause a loss of sense of purpose and a lack of a structured daily schedule.

Loss of Mobility

Their vision and hearing become less sharp, their reflexes become slower, and their memory isn’t as good. Sometimes, they can no longer drive, and with that comes a loss of independence. There is frustration with not being able to do the things they once did. Things that used to be easy to accomplish become harder and more challenging to complete.

Barriers to Treatment

Treatment in older adults is also more complicated than treatment of younger adults due to the higher likelihood of seniors having additional medical conditions and being on other medications that can increase drug interactions. As individuals age, medications affect the body differently. They often remain in the system longer, which can cause increased side effects. Dosages have to be started lower, and increases must be made slowly. The increased time it takes to start feeling the positive effects of medications can lead to discouragement and a desire to stop treatment.

What You Can Do

Fortunately, there are many ways that older adults can improve their mental health. The biggest protective factor for the development of mental health disorders in older adults relates to the level of social support. The more connected you are with your older adult, the less likely they are to experience depression and anxiety.

You can help keep your older adult active by regularly getting them out of the house. Increasing exercise helps reduce pain and releases positive endorphins that help mood and sleep. Spend meaningful time with them and call them regularly to check on them. This also makes it easier to pick up on any changes in mood and behavior. Try to get them connected with others in their peer groups. Senior centers are a good place to meet similar-aged individuals with whom to socialize.

Help your older adult budget their money if they are worried about paying their bills. If they are having trouble managing their bills, you may need to step in.

Ensure your older adult is seeing their doctor regularly for routine healthcare and have a doctor they trust who they can talk with if they do start experiencing symptoms of a mental health condition.

When to Seek Professional Help

If you notice concerning changes in your loved one’s behavior, it is never wrong to bring it to the attention of a physician. It is their job to identify the diagnosis and determine the next steps. Some concerning changes to bring up:

• If you notice that an older adult is crying a lot for no apparent reason, or is easily angered
• If they are sleeping much more than usual, appear very tired, and have little energy
• If they are more withdrawn and isolated
• If their weight changes dramatically or you notice they are eating very little or much more than usual
• If they are much more forgetful than before, have trouble getting to familiar places, and appear disoriented at times
• If they mention having thoughts of suicide or speak a lot about death and life not being worth living

For most concerns, an appointment with your older adult’s regular doctor is appropriate, but if they mention death or suicide or indicate they have started working on a plan to act on their thoughts, this is an emergency that needs to be addressed immediately at the nearest emergency room.

Challenges of Mental Health Conditions in Older Adults

Older adults are more vulnerable to the development of mental health conditions. They may fall under the radar because they are less likely to present to the doctor reporting feeling depressed or anxious. Therefore, vigilance is needed to detect mental illness symptoms in the elderly.

Fortunately, mental health treatment is readily available for this treasured population to make their golden years happy and healthy.