Mental Health is a growing concern in the United States and worldwide. Current estimates from the National Institute of Mental Health show that 23.1% of the US population has a diagnosed mental illness. For adults over the age of 50, an estimated 13.9% have a mental health diagnosis. The number of older adults living with undiagnosed mental illness is unknown as these conditions can be hard to detect and treat due to stigma and hesitancy to discuss their concerns with a provider. Without proper diagnosis and treatment, older adults are at risk of expedited physical decline and death. In people over the age of 60, an estimated 27.2% of deaths globally are attributed to suicide.
What Is Considered Mental Illness?
Mental Illness is a diagnostic term that encompasses a wide variety of diagnoses. Mental illnesses alter the way you think about or process information, affect your mood, and cause changes in behavior. Changes in your mental health can be expected, especially when experiencing stressful events, during significant life transitions, and even during certain times of the year (seasonal depression). Mental illness becomes a concern and is typically diagnosed when it starts disrupting your daily life and impacts your ability to care for yourself or others.
Some of the more common mental illnesses include:
- Depression
- Anxiety Disorders
- Schizophrenia
- Eating Disorders
- Addictive Behaviors such as alcoholism
Symptoms of Mental Illness
Changes in mood and potential signs and symptoms of mental illness can appear differently in older adults. Recognizing symptoms that indicate a more serious problem is important to help identify them in yourself and those around you.
Symptoms of mental illness in older adults can include the following:
- Changes in your mood
- Changes in energy levels, such as sleeping more or overexcitability
- Appetite changes, including eating more or less than usual
- Trouble sleeping at night or excessive daytime sleeping
- Problems concentrating or completing everyday tasks
- A change or increase in feelings of stress or anxiety (excessive worrying)
- Feeling angry or irritable
- Headaches that do not go away
- Changes in your digestion or bowel habits
- New or worsening pain
- Overuse or inappropriate use of alcohol and/or drugs
- Feeling sad or hopeless
- Thinking about death or considering self-harm
- Hallucinations- experiencing things ( seeing, hearing, feeling) that other people do not
While some people may only experience a few of these symptoms, others may experience several. The impact of these symptoms on your daily life can vary greatly. If you or someone close to you is exhibiting concerning signs or symptoms, seeking help from a medical professional is important.
Why Does Mental Health Matter as You Age?
Mental illness increases your risk for other health conditions. A study focusing on multimorbidity (two or more serious health diagnoses) showed that 17.5% of people aged 65-84 years had both a physical health diagnosis and a mental health condition or disorder. This percentage rises to approximately 30% for people 85 years and older. Unmanaged mental illness can contribute to an increased risk of cardiovascular disease, obesity, and misuse of alcohol and drugs. Mental illness can also cause you to become isolated and lonely. One of the most prevalent risk factors for developing mental illness later in life is loneliness and social isolation. Additional risk factors include:
- Caring for a spouse with a chronic or terminal illness such as Parkinson’s or Dementia
- Coping with the loss of loved ones
- Declining Health
- Loss of Independence
Mental health significantly impacts overall health. There is a big emphasis on early detection and treatment. Having resources readily available if people need them is a crucial public health matter. Due to this, the US spends over 6 billion dollars yearly on programs supporting socially isolated adults. Despite this commitment, many older adults do not know how to access these programs or do not have access to the Internet or reliable transportation.
Being aware of the risks associated with untreated mental health conditions can help you avoid some of the potential health risks. Substance abuse disorders are a concern among all age groups but present additional problems for people over the age of 65. Alcohol is the most commonly used substance in this age group and is linked with several mental health conditions.
Alcohol Abuse Disorder
Alcohol abuse disorder (AUD) is a growing concern nationwide, but especially among older adults. An estimated 7.1 million people aged 65 and older reported heavy or binge drinking in the previous month. Identifying and diagnosing AUD can be difficult in this population due to many factors. Some of these factors include:
- Diagnostic criteria and screenings that were designed for younger populations
- Older adults are more likely to be retired and live alone; therefore, their alcohol abuse may go unnoticed and have less short-term impacts on others
- Symptoms of alcohol abuse can be mistaken for other diagnoses, such as cognitive impairments and normal age-related decline
- The stigma around alcohol use
- Failure of healthcare providers to ask patients and families about alcohol use as they are worried about offending or upsetting them.
Alcohol abuse disorders can happen on their own but often occur along with other mental health disorders. Other mental health diagnoses can be alcohol-induced, and it takes careful screening to diagnose each condition correctly. Common mental health disorders that are diagnosed with AUD include:
- Depressive Disorders
- Anxiety Disorders
- Trauma and stress-related disorders
- Other substance abuse disorders
- Sleep disorders
- Schizophrenia
Addressing AUD in older adults is a critical component of managing mental health, as the two conditions are closely linked. It is estimated that less than 15% of older adults are screened by their primary care provider for AUD. There is no standardized assessment protocol for older adults, which has led to a large number of people with AUD being undiagnosed and not receiving treatment.
Prevention
Developing mental illness is sometimes unavoidable, especially if you have been previously diagnosed or developed medical conditions that alter the way your brain and body function. However, there are steps you can take to lower your risk and prevent mental illness altogether.
- Reduce stress related to financial insecurity
- Maintain stable and supportive housing
- Stay socially active
- Maintain a balanced diet
- Exercise
- Avoid tobacco and other inhaled products
- Do not drink alcohol in excess
Maintaining social relationships and staying active can become more challenging as we age, but they remain critically important for maintaining good mental health.
Diagnosis and Treatment
Your primary care provider can diagnose you with a mental health illness or disorder after completing specific screenings. They may refer you to a social worker, psychologist, or licensed professional if your condition warrants further evaluation. The correct diagnosis ensures you receive treatment and support tailored to your needs. Treatment options can vary but may include some or all of the following:
- Medications
- Therapy or counseling (this can be 1:1 or in group settings)
- Alternative modalities (acupuncture, yoga, massage, meditation/mindfulness)
- Brain stimulation (less commonly used, but can be helpful when other treatment methods are not successful)
- Social support to mitigate the impacts of social isolation or limited access to resources
During your appointment, your provider will also want to screen for and rule out other conditions, such as dementia and other cognitive dysfunctions that could mimic mental health disorders. It is essential to be honest about your symptoms, medical history, and any risk factors such as alcohol/drug use, increased stress, or personal history of mental health diagnoses.
There is no definitive laboratory test to diagnose mental health disorders; diagnosis is based on screening tool results, symptoms, and the impact of your condition on your daily life. A commonly used screening tool for depression is called the PHQ-9, which screens for symptoms of depression and can give providers a starting point for assessing your symptoms.
Resources
Knowing when and how to seek help is necessary to protect yourself and others. If you ever have any concerns about your mental health, reach out to your provider or contact an emergency resource.
If you or someone close to you is experiencing thoughts of self-harm or suicide or are unable to care for themselves safely, please seek immediate assistance by contacting emergency services ( 911 or your closest emergency room) or using the Suicide and Crisis Lifeline at 988.
Additional online resources for more information and support:
- National Institute on Aging
- Silver Sneakers (access to exercise and wellness services for older adults)
- HealthinAging.org
- The Community for Positive Aging
Brooke Schmidt Nurse Writer 