Mental health in an aging population

The American Psychiatric Association defines mental illness as health conditions involving changes in emotion, thinking, and behaviors.

Mental illnesses can be associated with distress and/or functioning in social, work or family activities. It is estimated that 20% of those age 55 or over will experience some sort of mental health issue. Those numbers are expected to double by 2030 due to the approximately 75 million Americans being over the age of 65. The most common disorders include dementia, cognitive impairment, anxiety, and mood disorders (depression or bipolar disorder). A little known but disturbing fact is that people aged 85 or older have the highest rates of suicide of any age group. According to the Centers for Disease Control and Prevention (CDC), suicide rates are as follows per age group:

• 21% Ages 85+

• 18% Ages 75-84

• 15% Ages 64-74

• 17% Ages 55-64

• 18% Ages 45-54

• 17% Ages 35-44

• 18% Ages 25-34

• 14% Ages 15-24

• 3% Ages 10-14

Older adults can often feel overlooked and unheard when it comes to receiving mental health treatment. Douglas Lane, a clinical psychologist in geriatric psychology, spoke about the implicit biases medical providers may carry when dealing with older adults. “Ageism often plays in one of three ways: They may be infantilized by providers. Providers can also be dismissive, assuming that older people can’t be suicidal or have intimate relationships. Other times, issues among older people get normalized as a so-called routine part of aging.” He went on to say, “Well of course they’re frail. Of course they’re depressed. Of course, they don’t remember things as well as they used to.” Aging stereotypes are pervasive in the culture but can also reside in ourselves. Older adults as well as their medical providers tend to normalize the physical and mental conditions that come along with getting older but it doesn’t have to be that way. Being sad and depressed doesn’t need to be a normal aspect of aging. Medical providers need to reinforce hope and remind their patients that once they get help, they can overcome those negative feelings and emotions.

There are two main subgroups of the aging population who deal with the issues of ageism and health stigma. The first group includes those who have suffered with mental illness throughout their lives. The National Association of State Mental Health Program Directors conducted a study in 2006 that demonstrated that people with serious mental illnesses lived 25 years less than those without. The majority of deaths were caused by heart disease, respiratory disease, and diabetes, which are largely preventable. The second group consists of elderly persons who are newly diagnosed with mental illness/es. They are at risk of being misdiagnosed with dementia when they are actually dealing with substance abuse issues and depression. Physical complaints, irritability, and cognitive impairment can present as depression in this population as opposed to more common signs such as sadness and crying. Treatment options can vary between the groups and traditional community health programs should provide multiple options ranging from therapy to supported employment.

Aside from stigma and ageism, older adults face many other issues that result in care not being sought. Insurance companies play a major role in coming between an elderly patient and the care they need. Doctor’s appointment times have been minimized to increase volume, much-needed prescriptions are not covered, and pre-authorizations are denied based on not meeting narrowing criteria. Primary care physicians (PCP) have also become the gatekeepers to care for many managed and private plans. The PCP may miss signs and symptoms of a mental illness or attribute them to a physical ailment due to a lack of time to adequately explore all of the patient’s complaints.

Older adults deserve the same level of care and respect as their younger counterparts. They deserve happiness and to feel like their mental health needs are being met. It is the responsibility of the providers to work with these patients collaboratively and to choose the least invasive treatment options with minimal side effects. Society needs to address the stigmas associated with aging and mental health in order to create a culture where seeking treatment is accepted and encouraged. We should all remember that we will someday grow old and may face these challenges ourselves.

Author Jacqueline Woodson put it best, “Time comes to us softly, slowly. It sits beside us for a while. Then, long before we are ready, it moves on.”