In the Spotlight
Mental Health Awareness for Older Adults
By Sarii Endo, PWDF Legal Assistant, and April Banerjee, Executive Director
Beyond the challenges of physical health associated with aging, the need to understand mental health among older adults is crucial. There is great need for mental health support in this demographic, but it is often overlooked. Mood, anxiety, major neurocognitive disorders, and substance abuse, are not adequately addressed with older adults and co-morbidities are common.
The older population is growing both in absolute numbers and relative to the rest of society. At the last US census, about 1 in 6 persons were 65 years old or older.[1] The increase in life expectancies is contributing to “the rising prevalence of late-life mental, substance, and neurological disorders.”[2]
A study published in 2015 attempted to address the gap in data regarding mental disorders in older adults.[3] It found that over 5% of older adults ages 65-74 had a mood disorder, over 9% had an anxiety disorder, over 2% had a substance use disorder (excluding nicotine dependence), and over 13% had a personality disorder. Of older adults in the age range 75-84, over 4% had a mood disorder, over 8% had an anxiety disorder, just under 2% had a substance use disorder (excluding nicotine dependence), and over 10% had a personality disorder. “There was a significant difference in mental health-related quality of life across late-life age groups, with a pattern of higher quality of life among adults aged 55-74, and lower quality of life among adults aged 75-85+.”[4]
“The prevalence of Alzheimer’s disease and other dementias increases with age, with aging being the largest single risk factor for the development of dementia. Of those older adults who develop dementia, 98% also have co-occurring symptoms such as anxiety, depression, or psychosis.”[5],[6] Approximately 20-25% of cases of schizophrenia, the most common type of psychosis, or schizophrenia-like psychosis onset in late or very-late life.[7] It might surprise most people to learn that the highest rates of suicide are for people aged 85 and older.[8]
There is a lack of awareness and preparation in dealing with mental health disorders in older adults. Stress, doubt, reluctance, and fear can prevent them from exploring various options for support in their mental well-being. In addition, “…co-occurring disorders contribute to higher rates of disability, more premature deaths, and high medical costs. High quality care for older adults, particularly for dementia care, is both difficult to obtain and inadequate for most. Earlier diagnosis and related safety screening are needed, as well as education opportunities and support for family caregivers.”[9] Not only do professionals need to understand the importance of “psychological therapies for older adults with anxiety and depression,” but older adults themselves should have access to this information[10], as well as education on mental health disorders and mental health needs.
Older adults may feel ashamed or even embarrassed to admit and/or reach out for help with mental health disorders. Even if support is offered, it is difficult to say how frequently older adults accept it due to stigma. Other issues include social disconnection and loneliness;[11] health disparities with racial and ethnic minority populations, those with financial insecurity, the LGBT+ community, and others;[12] and a work force shortage.[13]
Ways to improve the quality and access of mental health services for older adults were compiled in the proceedings from a recent National Academies of Sciences, Engineering, and Medicine workshop, Addressing the Rising Mental Health Needs of an Aging Population, held in 2023. The workshop listed the Centers for Medicare & Medicaid Services’ new strategies for improving behavioral health care services:
- Strengthening equity and quality in behavioral health care by taking a holistic approach to behavioral health inequities;
- Improving access to prevention, treatment, and recovery services for substance abuse disorders;
- Improving access to and quality of mental health care services;
- Ensuring effective pain management;
- Using data to inform effective actions and measure the impact of these actions on behavioral health. This involves tracking effective interventions over time;
- Providing advanced payments that could be used to increase staffing of behavioral health care providers.[14]
Recommendations made at the National Academies of Sciences, Engineering, Medicine workshop included embedding behavioral health into primary care, partnering with paraprofessionals, and encouraging the use of telehealth, among others.[15] Reducing the cost burden to older adults seeking mental health care was another recommendation.[16] Another recommendation was to use community-based partnerships to increase access by bringing mental health care services to seniors.[17]
Workshop proceedings include recommendations from prior studies about workforce expansion and mitigating social isolation and loneliness. Videos from the workshop are posted on the workshop website.[18]
In sum, based on the research findings highlighted in this article, we must act and commit to expeditiously destigmatizing mental health needs in older adults and increase investments in research and treatments for this population. There is no better time to prioritize the mental well-being of the aging population. We can create environments that empower them to seek treatment and address the issues head on. It does not matter how old someone is; everyone deserves to live a life feeling secure about his or her mental health.
[1] United States Census Bureau, 2020 Census: 1 in 6 People in the United States Were 65 and Over, May 25, 2023 (last visited April 1, 2024).
[2] Sarah A. Nguyen, MD; & Helen Lavretsky, MD, MS, Integrative Therapies for Brain Health and Aging, December 27, 2023, Psychiatric Times, Vol. 40, No. 12.
[3] This study relied on data collected while the Diagnostic and Statistical Manual (DSM) IV was current. The DSM 5 was published in 2013, and the current version is the DSM 5-TR.
[4] Reynolds K, Pietrzak RH, El-Gabalawy R, Mackenzie CS, Sareen J. Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry. 2015 Feb;14(1):74-81. doi: 10.1002/wps.20193. PMID: 25655161; PMCID: PMC4329900.
[5] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop, p. 5, Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340 .
[6] Dementia is now listed as Neurocognitive Disorder in the DSM 5; however, the term “dementia” is still commonly used.
[7] Tampi RR, Young J, Hoq R, Resnick K, Tampi DJ. Psychotic disorders in late life: a narrative review. Ther Adv Psychopharmacol. 2019 Oct 16;9:2045125319882798. doi: 10.1177/2045125319882798. PMID: 31662846; PMCID: PMC6796200.
[8] Centers for Disease Control and Prevention, Suicide Prevention, Suicide Data and Statistics, last visited Dec. 12, 2023.
[9] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop, p. 6. Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340.
[10] Wuthrich VM, Frei J. Barriers to treatment for older adults seeking psychological therapy. International Psychogeriatrics. 2015;27(7):1227-1236. doi:10.1017/S1041610215000241.
[11] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop, p. 10, Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340.
[12] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop, p. 20, Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340.
[13] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop, p. 42, Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340. (“The ‘supply side’ of the workforce (i.e., number of care providers specializing in geriatric mental health) is ‘past the critical tipping point.’ . . . While the aging of the population is increasing, the number of psychiatrists participating in Medicare is decreasing, the majority of rural health service areas have no psychiatrists at all, and geriatricians are experiencing a massive shortfall where half of training fellowships go unfilled.”)
[14] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the rising mental health needs of an aging population: Proceedings of a workshop, p. 39, Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340.
[15] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop, p. 18, Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340.
[16] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop, p. 51, Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340.
[17] National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the Rising Mental Health Needs of an Aging Population: Proceedings of a Workshop, p. 64, Washington, DC: The National Academies Press (internal citations omitted). https://doi.org/10.17226/27340
[18] Addressing the Rising Mental Health Needs of an Aging Population: A Workshop (May 15 – 16, 2023)
PWDF Profile
Who We Are
People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.
Services
Advocacy: PWDF advocates for Social Security claimant’s disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney’s fees.
Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF’s educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.
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