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At least one in four older adults experiences some sort of mental health condition, such as depression or anxiety, according to the Pan-American Health Organization[1].
Mental health is closely linked to physical health, and the risk of experiencing complications with both mental and physical health at the same time can increase with age. For example, according to the World Health Organization, older adults with heart disease have higher rates of depression than those who don’t have heart disease. Unfortunately, mental health conditions in older adults are often under-identified by medical providers, and stigma associated with mental health conditions can prevent people from seeking help.
Given that the population of older adults is rapidly expanding worldwide, addressing the mental health of older adults is increasingly important.
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Mental Health as We Age
There are several physical and cognitive changes associated with aging that can have an impact on mental health.
Hearing and vision impairment, two common sensory changes associated with aging, can contribute to social withdrawal, isolation, anxiety and depression and may cause an older person to restrict activities like driving, reading or playing games. Isolation and anxiety can also exacerbate other chronic conditions, such as diabetes and heart disease, and decrease a person’s ability to perform activities of daily living (ADLs), which include getting dressed, eating and getting out of bed.
Physical changes to the brain can also lead to cognitive decline and increase the risk of a mental health disorder. Brain volume decreases with age, as well as specific areas of the brain responsible for cognitive functions, including memory, learning and emotional control. These cognitive functions are housed in areas of the brain that are prone to brain shrinkage, including the frontal lobe and the hippocampus. Some of these changes are age-normative but can nevertheless be frustrating to the individual when they can’t recall names and events as readily or learn new things with ease. However, when these changes are more severe and represent a form of dementia, that can increase the risk of other mental health concerns such as a diagnosable depression or anxiety disorder.
Sensory changes along with slowed cognitive processes may cause an older adult to feel a loss of control, which can lead to negative emotions such as sadness, loneliness and anxiety. There is some research to suggest that these natural aging changes may increase a person’s risk of chronic, persistent depression. Loss of prior physical function is another risk factor for mental health concerns. For example, there is an increased prevalence of suicidal thoughts among older adults who have feelings of hopelessness and isolation, particularly those with disabilities or who have very limited mobility.
Negative changes in sleeping patterns and sleep disruption can occur as we age and can lead to increased emotional distress, mood disorders and memory deficits. Almost half of older adults report poor sleep quality, according to a study in Sleep Medicine Clinics[2]. </em
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Common Mental Health Conditions Facing Older Adults
Feeling down or occasionally worried is a normal part of life. But if these feelings last more than a couple of weeks, or if they are severe enough to disrupt everyday tasks, it may be a sign of something more serious. It is important to keep an eye out for warning signs of depression and anxiety, as these are two of the most common mental health challenges facing older adults.
Depression
More than two million of the 34 million U.S. adults aged 65 and older have from some form of depression—which is a significant predictor of suicide among adults 65 and over in the U.S., who account for 20% of all suicide deaths, according to Mental Health America[3]. Symptoms of depression in older adults can include:
- Persistent sad mood occurring most of the day, nearly every day
- Loss of interest or pleasure in activities on used to enjoy
- Feelings of hopelessness and/or pessimism that last for several weeks
- Feelings of guilt, worthlessness and/or helplessness
- Irritability, restlessness
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Insomnia, early-morning wakefulness or excessive sleeping
- Increased appetite—or loss of appetite
- Thoughts of suicide, planning suicide, and/or suicide attempts
- Persistent aches or pains, headaches, cramps or digestive problems that don’t improve over time, even after treatment
Older adults experience all the same stressors that other age groups experience, but additional stressors can mount in later life. These risk factors may include mobility challenges, chronic pain and loss of independence. Older adults may also experience more social isolation and loneliness, bereavement and a decline in financial status after retirement.
Anxiety
Nearly 14% of older adults meet the criteria for a diagnosable anxiety disorder, but many more may have symptoms of anxiety severe enough to affect their functioning, according to a study published in the International Journal of Geriatric Psychiatry[4]. Symptoms of anxiety can include excessive nervousness, fear and worry that can sometimes lead to other physiological symptoms such as chest pains, headaches, sweating, gastrointestinal problems, insomnia, nightmares, dry mouth, nausea, shortness of breath and rapid heartbeat. Mental Health America and the National Council on Aging note that generalized anxiety disorder—the chronic, exaggerated worry about routine experiences that lasts longer than six months—is one of the most common anxiety disorders among older adults. Obsessive compulsive disorder, panic attacks and post-traumatic stress disorder are also forms of anxiety disorders but are less common among older adults.
Substance Use and Abuse
Nearly one million adults aged 65 and older are diagnosed with a substance use disorder, according to the National Institute on Drug Abuse, and about 65% of people 65 and older report high-risk drinking, which is defined as more than 14 drinks per week for men and 7 drinks per week for women[5]. Older adults typically metabolize substances at a slower rate than those under the age of 65, making them more sensitive to the effects of drugs and alcohol. These substances can also exacerbate existing physical conditions and impair coordination and judgment, increasing the risk of accidents and injuries.
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Mental Health Warning Signs
Warning signs of mental health conditions frequently seen in older adults include the following, according to the National Institute of Mental Health:
- Noticeable changes in mood, energy level or appetite
- Having trouble feeling positive emotions
- Difficulty sleeping
- Sleeping too much
- Difficulty concentrating
- Feelings of restlessness or being on edge
- Feelings of increased worry or stress
- Anger, irritability and/or aggressiveness
- Ongoing headaches, digestive issues or pain
- Misuse of alcohol or drugs
- Sadness or hopelessness
- Suicidal thoughts
- Engaging in high-risk activities
- Obsessive thinking or compulsive behavior
- Thoughts or behaviors that interfere with work, family or social life
- Engaging in thinking or behavior that is concerning to others
- Seeing, hearing and feeling things that other people do not see, hear or feel
“There are behaviors and complaints that friends and family may dismiss at first as lazy or dramatic, things like hoarding and frequent somatic complaints,” says Lisa McLinden, a licensed clinical social worker in Maryland specializing in mental health and homelessness. “It’s important to dig a little deeper and see if anything else could be going on.”
Symptoms of mental illness may present differently among older adults and can be disguised as other conditions, McLinden notes. They also have a variety of causes. “Sometimes pain is related to sleeplessness, and depression is related to isolation and lack of stimulation,” she says. “Sometimes apathy is due to inadequate nutrition, dehydration or medication, and sometimes it’s related to progressive cognitive decline. Sometimes poor self-care is related to a physical condition and sometimes it’s due to paralyzing anxiety.”
Top Tips to Help Prevent or Alleviate Mental Health Conditions
Isolation is a leading cause of mental illness in older adults, according to Martha Pierce, M.D., a board-certified internist specializing in geriatrics and based in Maryland. “We really noticed an uptick in anxiety and depression in the elderly due to the isolation imposed by quarantines,” she says. “People really declined mentally and emotionally from the lack of contact with friends and family. That’s when it became obvious to me that social connection is vital to human mental health.” She adds that you should always speak to your doctor if you or a loved one is experiencing any symptoms of mental illness.
To proactively bolster and support mental health for older adults, McLinden says being supportive is a great start. “Provide a support system. Sometimes just having someone in your corner lowers stress and anxiety,” she says. “Older adults need to have a sense of security: financial, physical and emotional. Check in frequently, listen openly to concerns and complaints, and don’t dismiss symptoms just because they may seem baseless or inconsistent.”
Maintaining connections is crucial as well, according to Dr. Pierce. “Obviously good medical care is key, as well as exercise, diet and sound medication management, but the most important thing for older adults’ mental well-being is to have a close, personal connection with someone or something,” she adds. “If it can’t be another human, let it be a pet. A dog or cat is a wonderful way to feel connected and loved.”
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