Mental Health and Older Adults

As science and technology have advanced, the average lifespan has increased. Globally, the population is ageing rapidly. Between 2015 and 2050, the percentage of the world’s population over 60 years will nearly double, from 12 percent to 22 percent. Along with an increase in our elderly population and the fact that people are living longer lives, mental health and emotional well-being are as important in older age as at any other time of life.

Approximately 15 percent of adults aged 60 and over suffer from a mental disorder. Neuropsychiatric disorders, which can include; addictions, eating disorders, mood disorders, psychosis and sleep disorders, account for 6.6 percent of the total disability for older adults. Older adults, those aged 60 or above, make important contributions to society as family members, volunteers and as active participants in the workforce. While most have good mental health, many older adults are at risk of developing mental disorders, neurological disorders or substance use problems as well as other health conditions such as diabetes, hearing loss, and osteoarthritis. Furthermore, as people age, they are more likely to experience several conditions at the same time.

The problem

The World Health Organization informs us that the world’s population is ageing rapidly. The amount of people over the age of 60 is an expected increase from 900 million to 2 billion people over the next 35 years. Older people face special physical and mental health challenges, which need to be addressed.

In adults over 60, over 20 percent suffer from a mental or neurological disorder (excluding headache disorders). These disorders in the elderly population account for 17.4 percent of Years Lived with Disability. The most common neuropsychiatric disorders in this age group are dementia and depression. Anxiety disorders affect 3.8 percent of the elderly population, substance use problems affect almost one percent and around a quarter of deaths from self-harm are among those aged 60 or above. Substance abuse problems among the elderly are often overlooked or misdiagnosed.

Due to the stigma caused by mental illness, people are hesitant to reach out to a medical professional, especially the elderly. Because of this, mental health issues are widely un-diagnosed or incorrectly diagnosed

Risk factors for mental health problems among older adults

The type of mental health a person has at any point of their life can be due to many social, psychological, and biological factors. As a person ages they typically are unable to live independently due to either limited mobility, constant pain, weakness, or other body and/or mind issues. In addition, older people are more likely to experience events such as bereavement, a drop in socioeconomic status with retirement, or a disability. All of these factors can result in isolation, loss of independence, loneliness and psychological distress in older people.

Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are medically well. Conversely, untreated depression in an older person with heart disease can negatively affect the outcome of the physical disease.

Older adults are also vulnerable to elder abuse – including physical, sexual, psychological, emotional, financial and material abuse; abandonment; neglect; and serious losses of dignity and respect. Current evidence suggests that 1 in 10 older people experience elder abuse. Elder abuse can lead not only to physical injuries, but also to serious, sometimes long-lasting psychological consequences, including depression and anxiety.

Dementia

Dementia is a syndrome in which there is deterioration in memory, thinking, behavior and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing.

It is estimated that 47.5 million people worldwide are living with dementia. The total number of people with dementia is projected to increase to 75.6 million in 2030 and 135.5 million in 2050, with majority of sufferers living in low- and middle-income countries.

There are significant social and economic issues in terms of the direct costs of medical, social and informal care associated with dementia. Moreover, physical, emotional and economic pressures can cause great stress to families. Support is needed from the health, social, financial and legal systems for both people with dementia and their caregivers.

Depression

Depression can cause great suffering and leads to impaired functioning in daily life. Unipolar depression occurs in 7 percent of the general elderly population and it accounts for 5.7 percent of YLDs among over 60 year olds. Depression is both underdiagnosed and undertreated in primary care settings. Symptoms of depression in older adults are often overlooked and untreated because they coincide with other problems encountered by older adults.

Older adults with depressive symptoms have poorer functioning compared to those with chronic medical conditions such as lung disease, hypertension or diabetes. Depression also increases the perception of poor health, the utilization of medical services and health care costs.

Treatment and care strategies

It is important to prepare health providers and societies to meet the specific needs of older populations, including:

Training for health professionals in care for older persons;

Preventing and managing age-associated chronic diseases including mental, neurological and substance use disorders;

Designing sustainable policies on long-term and palliative care; and

Developing age-friendly services and settings.

Health promotion

The mental health of older adults can be improved through promoting Active and Healthy Ageing. Mental health-specific health promotion for older adults involves creating living conditions and environments that support wellbeing and allow people to lead healthy and integrated lifestyles. Promoting mental health depends largely on strategies which ensure the elderly have the necessary resources to meet their basic needs, such as:

Providing security and freedom;

Adequate housing through supportive housing policy;

Social support for older populations 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; and

Community development programs.

Interventions

Prompt recognition and treatment of mental, neurological and substance use disorders in older adults is essential. Both psychosocial interventions and medicines are recommended.

There is no medication currently available to cure dementia but much can be done to support and improve the lives of people with dementia and their caregivers and families, such as:

Early diagnosis, in order to promote early and optimal management;

Optimizing physical and psychological health and well-being;

Identifying and treating accompanying physical illness;

Detecting and managing challenging behavioral and psychological symptoms; and

Providing information and long-term support to caregivers.

Mental health care in the community

Good general health and social care is important for promoting older people’s health, preventing disease and managing chronic illnesses. Training all health providers in working with issues and disorders related to ageing is therefore important. Effective, community-level primary mental health care for older people is crucial. It is equally important to focus on the long-term care of older adults suffering from mental disorders, as well as to provide caregivers with education, training and support.

An appropriate and supportive legislative environment based on internationally accepted human rights standards is required to ensure the highest quality of services to people with mental illness and their caregivers.

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