Older Adults & Mental Illness

October 9, 2020– Our attention today turns to older adults and mental illness.

Not only is it just as important that we identify and treat mental illness among our older folk than our younger population, it’s necessary. NAMI warns that the “impact of depression on health in older adults can be severe: much research has reported that depression is associated with worse health in people with conditions like heart disease, diabetes, and stroke.”

How common is mental illness in older populations?

More than two million of the 34 million Americans age 65 and older suffer from some form of depression.

The World Health Organization (WHO) reports that over “20% of adults aged 60 and over suffer from a mental or neurological disorder (excluding headache disorders) and 6.6% of all disability (disability adjusted life years-DALYs) among people over 60 years is attributed to mental and neurological disorders.” Further, the most common disorders are “dementia and depression, which affect approximately 5% and 7% of the world’s older population, respectively.”

The infograph included is from SAMHSA’s report on “Older Adults Living with Serious Mental Illness: The State of the Behavioral Health Workforce.

As America’s population grows older, it’s crucial to increase access to care and to improve the capabilities of our healthcare system to treat mental illness among older adults.

Unfortunately, there’s a number of barriers that stand in the way. From the same report, SAMHSA identifies a number of variables to address:

And for those receiving treatment:

  • More than 55% of older persons treated for mental health services received care from primary care physicians. Less than 3% aged 65 and older received treatment from mental health professionals
  • Primary care physicians accurately recognize less than one half of patients with depression, resulting in potentially decreased function and increased length of hospitalization

It simply isn’t enough to ask our primary care physcians to include mental health assessments during fast-paced 15 minute visits, and it does a disservice to both patient and provider.

Fortunately, SAMHSA also provides initiatives that can help address the barriers and increase treatment rates in older adults:

But first, we have to identify who needs treatment. WHO recommends mental health-specific health promotion for older adults and the creation of programs that meet absolute needs like:

  • providing security and freedom
  • adequate housing through supportive housing policy
  • social support for older people and their caregivers
  • health and social programs targeted at vulnerable groups such as those who live alone and rural populations or who suffer from a chronic or relapsing mental or physical illness
  • programs to prevent and deal with elder abuse
  • community development programs.

Once identified, intervention programs can be implemented. These programs would ideally promote:

  • early diagnosis, in order to promote early and optimal management
  • optimizing physical and mental health, functional ability and well-being
  • identifying and treating accompanying physical illness
  • detecting and managing challenging behavior
  • providing information and long-term support to carers

What are the signs that intervention and treatment may be necessary?

NAMI offers a series of warnings signs that an evaluation may be needed:

  • Noticeable changes in mood, energy level, or appetite
  • Feeling flat or having trouble feeling positive emotions
  • Difficulty sleeping or sleeping too much
  • Difficulty concentrating, feeling restless, or on edge
  • Increased worry or feeling stressed
  • Anger, irritability or aggressiveness
  • Ongoing headaches, digestive issues, or pain
  • A need for alcohol or drugs
  • Sadness or hopelessness
  • Suicidal thoughts
  • Feeling flat or having trouble feeling positive emotions
  • Engaging in high-risk activities
  • Obsessive thinking or compulsive behavior
  • Thoughts or behaviors that interfere with work, family, or social life
  • Unusual thinking or behaviors that concern other people

Mental illness can affect us all, regardless of age, economic status, gender, or race.

The good thing is that it’s completely treatable! Mental Health America wants us all to know that “more than 80% of all people with depression can be successfully treated with medication, psychotherapy or a combination of both.”

The first step is to just reach out and talk to someone.

Follow the links below for more information!

Free resources on mental health and substance use disorders among older adults: