Between 2015 and 2050, the number of adults aged 60 or over worldwide is set to nearly double from 900 million to two billion. This will make them the largest demographic in the world. With advances in technology helping us lead longer lives, this means that more people may begin to experience chronic conditions. While physical health is an important consideration, elderly mental health is also a crucial area of focus as the world’s population ages.
What’s the state of elderly mental health?
Currently, just over 20% of adults over the age of 65 have been diagnosed with a mental condition that requires treatment. This can include dementia, depression, and anxiety. In nursing home situations, over 50% of residents have some type of cognitive impairment that may exacerbate other health conditions.
Even with the understanding that mental health in the elderly remains a concern, people over the age of 65 are less likely to seek treatment for mental health conditions. This could be due, in part, to a variety of factors.
- Lack of access: If transportation is difficult, older adults may choose not to seek out treatment. Likewise, seniors on a fixed income may not be able to afford medications or treatments.
- Social stigma: The Greatest Generation was raised to keep their business private. They may be uncomfortable seeking help. Baby boomers, currently the largest segment of the population, may also feel that seeking help for mental health issues is a sign of weakness.
- Lack of resources: Mental health resources in general are scarce, and resources that focus on mental health in the elderly are even more rare.
Protecting good mental health in the elderly carries a few special considerations.
Increased risk of depression
Contrary to popular belief, depression does not have to be a normal part of aging. The process of physical, mental, and emotional change as we age can be difficult to navigate, but it needn’t necessarily result in clinical depression.
Unfortunately, older adults who do experience depression and other mood disorders are less likely to seek help for their symptoms. Early diagnosis and prevention of depression is key to successfully managing it, but many older adults do not receive the help they need.
In addition to the risk of depression, nearly 80% of people over age 60 have another chronic health condition. Many studies indicate that depression can negatively impact any other pre-existing illnesses, yet mental health in older adults is rarely considered in a treatment plan. This lack of treatment can result in a worsening of symptoms for both.
For example, patients with coronary artery disease and depression experience more frequent and severe chest pains even after their coronary artery disease is resolved. Only those patients who had their depression treated felt relief from their pain after treatment.
Less likely to see a psychiatrist regularly
A study from the University of Michigan Health System found that older adults receiving treatment for mental health issues were prescribed prescription medications (such as sedatives and anti-psychotics) at twice the rate of the general population. At the same time, they were much less likely to see a mental health specialist, working instead with a primary care physician for treatment.
Donovan Maust, M.D., M.S., the geriatric psychiatrist who led the analysis, believes that this trend is over-prescribing medications for conditions that might be better resolved with other therapies, especially when drug interactions are a concern:
“Our findings suggest that psychotropic medication use is widespread among older adults in outpatient care, at a far higher rate than among younger patients. In many cases, especially for milder depression and anxiety, the safer treatment for older adults who are already taking multiple medications for other conditions might be more therapy-oriented, but very few older adults receive this sort of care.”
Requires more specialized therapists
Geropsychologists are mental health professionals who specialize in the study and treatment of mental health in older adults. In addition to receiving specialized training on the physical and mental health needs of those over 60, geropsychologists also work with families to ensure productive, engaged later years of life.
In the U.S., there are less than 20 specialized programs for geropsychologists. Just over 4% of practicing psychologists identify themselves as geropsychologists, but 39% pf psychologists seeing patients report that they are treating the elderly. With a rapidly growing older population, the shortage of qualified geropsychologists is set to exponentially increase over the next 25 years.
Risk factors for poor mental health
Other risk factors for poor mental health in adults over 60 include:
- Other chronic conditions, such as chronic pain
- Loss of independence
- Changes in financial outlook
- Death of a spouse or friends
The two predominant mental health issues that affect adults over 60 are dementia and depression.
The key characteristic of dementia is a decline in cognitive ability that impacts daily life. This can include memory loss, fuzzy thinking or inability to focus, loss of balance or motor control, and confusion. Alzheimer’s is a type of dementia. Worldwide nearly 48 million people are diagnosed with dementia, with many more going undiagnosed and untreated.
Depression is a condition that can cause tremendous suffering among people of any age. Deep sadness, fatigue, irritability, and inability to concentrate are characteristics of this disease, which affects an estimated 7% of older adults.
Elderly mental health is a public health issue
Over 61 million adults in the U.S. live with a mental health condition, just under 14% of whom experience a serious mental illness such as schizophrenia, bipolar disorder, or major clinical depression. Even if you don’t suffer from a mental health condition, chances are good that you know someone who is directly or indirectly affected.
Separate from the emotional impact of mental health conditions, direct mental health costs in terms of lost wages total over $193 billion dollars annually. Mental illness also impacts everything from the likelihood of imprisonment, homelessness, and early death.
Mental health in the elderly is also a vital part of our identity in the U.S. The cost of ignoring mental health in in the elderly is high, not just in terms of dollars but also in terms of the contributions that they have made and continue to make to our society. A thriving, vibrant senior community is an important resource. For more on this issue, visit the Center for Disease Control’s report on the state of mental health and aging in America.
How to improve elderly mental health
Elderly mental health issues carry high costs. Directly, those with dementia and depression have poorer health outcomes when also faced with chronic illness such as hypertension and diabetes. Indirectly, mental health conditions can cost families and friends time with their loved ones. Workplaces that can benefit from the experience and skill of older adults lose out on their expertise.
Mood and neurological disorders are not inevitable as we age. There are concrete steps we can take to improve mental health, before and after age 60.
1. Consider pet ownership
Especially for those older adults who find themselves with no relatives or friends living close by, pet ownership can offer tremendous benefits. One study in 1990 found that older adults with pets utilized medical care far less frequently than those without pets. Dogs in particular seemed to foster a sense of responsibility and connection among their owners, a connection that resulted in fewer doctor visits.
Researchers at Taylor & Francis have also found that owning a pet can increase physical activity and reduce isolation. Study author Keith Anderson from the University of Montana noted that there are some barriers to pet ownership, especially for low-income people, but that shelters and other programs are working creatively to find solutions. Many older adults worry about fees associated with pet ownership and who will take care of their pet if they fall ill.
Anderson noted that resources to address these concerns were increasing in number and availability, saying:
“Programs are emerging that facilitate the adoption of pets by older adults. These programs match older adults with adult shelter animals and provide support throughout the adoption and ownership processes. Lower-income older adults often live in buildings where there are fees and deposits associated with owning pets. We need creative solutions to address these financial barriers.”
2. Pick up the phone
For those for whom pet ownership is not an option, simply picking up the phone can improve elderly mental health.
A study from the Wake Forest School of Medicine in conjunction with Washington University in St. Louis found that talk therapy conducted via telephone is effective for treating anxiety disorder among older adults. These are important findings, especially for the elderly in rural areas, where mental health services are scarce and the treatment protocol leans heavily on sedative drugs.
Eric J. Lenze, MD, at Washington University School of Medicine in St. Louis, pointed out that as the baby boomers age, the current understaffed mental healthcare system is woefully inadequate to meet their needs. Relying on medication to improve mental health can result in other serious consequences:
“The drugs that many older adults receive, particularly benzodiazepines for anxiety, can cause cognitive impairments and motor problems. But seniors who are anxious or have insomnia are receiving a skyrocketing number of prescriptions for these drugs, particularly in rural America. That’s a recipe for disaster because giving seniors benzodiazepines can contribute to serious and expensive consequences, such as broken hips, an acceleration in dementia and a general decline in an older person’s ability to function.”
This type of therapy is at least as successful as face-to-face therapy when it comes to minimizing the use of medications for mental health issues.
3. Get social
As we age, we may feel less like living it up and staying out until the wee small hours of the morning. While all-nighters are not necessary to improve mental health, new research is finding that an active, involved social life, complete with social goals, are key to better mental health. A study published by the American Psychological Association found that even for those seniors with other health challenges, an active social life helped increase study participants’ sense of well-being later in life.
Interestingly, family involvement and socialization were not directly connected to an increased sense of well-being.
Gert Wagner from the German Institute for Economic Research, one of the co-authors of the study, pointed out that while social goals and engagement may result in feelings of competence and the idea that seniors are contributing to society, families don’t necessarily offer the same rewards:
“A socially engaged lifestyle often involves cognitive stimulation and physical activity, which in turn may protect against the neurological and physical factors underlying cognitive decline, [but family] life is often a mixed bag and represents not only a source of joy, but also of worry and tensions, stress, and sorrow.”
It can be difficult to find balance between social events that are enriching and those that are obligatory, but the bottom line is that staying engaged is a crucial step to improve mental health.
With new studies showing that loneliness and isolation are just as much of a threat to longevity as obesity, it is important to take concrete steps to improve elderly mental health. If you are a senior, what makes you feel more connected and mentally healthy?