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, mental health in the elderly is also a crucial area of focus as the world’s population ages.
Mental health in the elderly
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 are identified as having 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.
Older adults are more likely to have depression that goes undiagnosed and untreated
Contrary to what may be believed by many, 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.
Older adults are more likely to be offered medications and 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.”
Mental health in older adults 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 are also skilled at working 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.
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 are not diagnosed with 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. Our current population of people over the age of 60 took us to the moon, made the miracle of the internet possible, and revolutionized the way we do everything from business to art and entertainment. 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.