How to Identify and Manage Mental Health Conditions in Seniors
With a global population that is rapidly aging, understanding the symptoms and risk factors of mental health for older adults is increasingly important. The number of people over 60 will increase by 10% from 2015 to 2050. The World Health Organization notes that mental health and well-being are just as important in older age as in any stage of life, and that nearly 15% of adults 60 or older suffer from a mental disorder.
Older adults contribute to society in a variety of forms, not only socially as family members and friends, but as a population that continues to participate in the workforce or as volunteers. This guide will present indicators, knowledge, and actionable steps to help seniors and family members seek treatments and mitigate the effects of mental illness.
Senior Mental Health Risk Factors
While mental health is a concern at any age, there are specific risk factors that are prevalent in older adults that can interlink and may increase the development of mental illness. This may include:
- Loss of physical capacity, mobility, and chronic pain that leads to physical disability.
- Alcohol and/or substance abuse.
- Malnutrition or poor diet.
- Chronic or long-term illnesses and medical interactions.
- Illnesses that may cause effects on memory, emotion, thoughts, and confusion.
- Feelings of social isolation and loneliness, and/or experiences of loss and bereavement.
- Feelings of abandonment, neglect, and loss of dignity and respect.
- Major life changes and experiencing a drop in socioeconomic status caused by retirement that can increase stress and psychological distress.
- Life-long feelings of depression and/or anxiety that are exacerbated by other factors and experiences of aging.
Most Common Mental Health Conditions in Seniors
Common mental health conditions found in senior populations include:
- Anxiety disorders affect 10-20% of the older population and may occur in differing types of anxiety disorders such as specific phobias, social phobias, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and panic disorder. Signs of anxiety disorders may include excessive worry or fear, refusal to do routine activities, avoidance of social situations, poor sleep, heightened concerns of safety, physical symptoms such as a racing heart, trembling, nausea, muscle weakness, and sweating, and self-medication with alcohol or other depressants.
- Bipolar disorder may onset with aging. Symptoms may include the classic signs of mania and feelings of elation or depression, but may also occur as agitation and irritability, distraction, confusion, hyperactivity, and psychosis.
- Personality disorders are estimated to affect 10% of the aging population. Observable behaviors may include emotional instability and impulsivity, aggression, suicidal self-injurious behaviors.
- Dementia, while not strictly considered a mental illness, is an abnormal degeneration of the brain. Dementia is essential to consider when assessing a senior's mental health and may manifest in four types, Alzheimer’s disease, vascular dementia, Lewy bodies, and frontotemporal lobe dementia. Symptoms of dementia include memory loss, loss of understanding or judgment, a decreased ability to make decisions, changes in expression, emotion, and personality, difficulty coping with daily life and activities, speech, understanding language, or socializing. Signs of dementia can include forgetting familiar names, appointments, or places, difficulty with finding the correct word, or using a word incorrectly, impaired judgment, loss of abstract thinking skills, misplacing or putting items away inappropriately, extreme changes in mood or personality, and loss of desire for daily activities.
- Depression is not a normal part of aging but may occur from important life changes or illnesses that can cause feelings of sadness, uneasiness, stress, and anxiety, or physical changes such as restricted blood flow. Symptoms may include sad, anxious, or “empty” moods, feelings of hopelessness, guilt, worthlessness, helplessness, irritability, restlessness, or trouble sitting still.
- Schizophrenia, or “late-life schizophrenia,” is not highly prevalent but is thought to increase as the population of older-aged adults increases. Symptoms may include delusions and hallucinations as well as social withdrawal, affective flattening, and avolition.
- Substance abuse, substance use disorder, and alcohol use disorder are expected to increase with the steadily aging population. Alcohol is the most commonly used substance among older adults, followed by tobacco use. Illicit substance use is more common among older adults in the U.S. than in any other country in the world. Triggers of substance abuse may include chronic pain, reduced mobility, transitions in living situations, poor health, history of alcohol or substance use issues, psychiatric and other mental illness, affluence, bereavement, and social isolation.
The Link Between Mental Health & Chronic Illness
Studies have shown that depression has an impact on chronic illness in older adults, such as contributing to higher risks for the development of diabetes, heart problems, and arthritis. A large study has also tied PTSD and acute stress to cardiovascular disease. Conversely, physical ailments, physical limitations, chronic pain, or chronic illness may also affect mental health.
It can be hard to adapt to life changes from physical disability or illness such as loss of mobility, isolation, or dependency which in turn can exacerbate mental illness. Some chronic medical conditions such as Parkinson’s disease or stroke can cause physical changes in the brain that can trigger symptoms of depression or anxiety. Research suggests that those who suffer from both depression and physical ailments tend to show more severe symptoms of both, and have a more difficult time adapting to their situation.
Many forms of mental illness can be treated and chronic pain can be managed to alleviate the stresses and symptoms of extenuating medical conditions. It is important to be proactive in understanding and not dismissing important symptoms in order to seek treatment as early as possible for both mental and physical illnesses.
Tips to Improve Senior Mental Health
Mental health issues can be mitigated, alleviated, and made more manageable by following basic best practices and seeking treatments. These practices can be utilized by seniors as well as implemented by caretakers that are looking to provide more structure and actionable support in a senior’s life.
Stay Physically Active
There are many mental health benefits of staying active. Physical activity can relieve stress, improve memory and the ability to sleep, increase mood, and have an impact on depression, anxiety, ADHD, PTSD, and trauma. Physical activity does not have to be strenuous; in fact, moderate amounts of physical activity can make improvements in mental and emotional wellbeing. Tips for limited mobility senior exercise include:
- Check-in with a health provider and exercise at a slow pace and comfortable pace.
- Make exercising a regular occurrence, or a daily routine.
- Work on flexibility and stretching to increase movement and mobility.
- Including social activities with exercise can be encouraging and healthy.
- Be aware of any feelings of pain and consult a doctor immediately if there are any occurrences of dizziness, shortness of breath, or chest pain or pressure.
Have a Healthy Social Life by Cultivating Relationships
Feelings of loneliness and social isolation can cause risks to physical, mental, and emotional wellbeing. Loneliness or “reactive loneliness” is an emotional response that can be triggered by life changes such as the death of a loved one, moving, or general loss. Reactive loneliness can become chronic when individuals do not have the opportunity to satisfy their social needs and can result in negative health consequences. Loneliness can occur even when an individual is surrounded by others, as it is a result of feeling unsatisfied with their level of connectedness — their perceived social isolation. Feelings of social isolation and loneliness can result in stress, inability to sleep, harm to the body, depression, and anxiety.
Having a healthy social life and cultivating relationships is key to healthy aging. Research has found that engaging seniors and older adults in social and community groups can help reduce feelings of loneliness. It is important to pursue community and group activities that are meaningful to an individual after retirement, or when they enter retirement homes. Social relationships can calm the human stress-response system. It is important for seniors to continue cultivating new relationships by joining groups or participating in a community organized event, and to stay connected with meaningful relationships with friends and family. Senior activities could include:
- Physical activities and classes such as chair yoga, walking, or aquatic exercises.
- Seasonal arts and crafts.
- Trips to interesting local places.
- Organized card and board games.
- Visiting an animal shelter or zoo.
- Faith or book study groups.
- Volunteer activities.
- Political or social discourse groups.
- Hobby centric clubs or gatherings.
Maintain a Balanced Diet
Studies have found links between nutrition and psychiatry, naming ways that diet can affect brain function and mood. Eating a diet of high-quality foods that consist of vitamins, minerals, and antioxidants nourish the brain and can reduce oxidative stress. Conversely, eating a diet that is high in refined sugar can be harmful to the brain, impair brain function, and worsen the symptoms of mood disorders.
Serotonin is primarily produced in the gastrointestinal tract and is responsible for regulating sleep, appetite, mediating moods, and inhibiting pain. By eating a balanced diet that protects the lining of intestines and encourages “good” bacteria, inflammation can be regulated throughout the body, nutrients can be more readily absorbed, and neural pathways can be activated between the stomach and the brain. Healthy eating for seniors can also help control chronic conditions such as diabetes or heart disease. As metabolism slows down during the aging process and fewer calories are needed, it is important to ensure that the caloric intake is appropriate and nutritious.
Tips for curating a healthy diet as a senior include:
- Understanding the necessary building blocks of a healthy diet. This includes appropriate portion sizes, and caloric and nutritional value.
- Selecting appropriate foods such as lean proteins, fruits, and vegetables, whole grains, low-fat dairy, foods high in fiber and/or vitamins, or low in sugar, sodium, or salt.
- Learn how to read nutritional labels on packaged foods to find items that are low in fat, added sugars, or sodium.
- Drink water and liquids that hydrate. Hydration is important in a balanced diet. Drinking small amounts of liquids throughout the day can be a manageable way to ensure hydration.
- Use vitamins and supplements when necessary to ensure you are meeting your nutritional needs.
- Budget appropriately while shopping to make smarter choices at the grocery store.
Explore Vitamins and Supplements
The National Institute on Aging discusses dietary supplements alongside a nutritious diet that can aid the intake of necessary vitamins and minerals. Before taking vitamins and supplements it is important to consult healthcare providers or doctors as some supplements can change, interact with, or negatively impact medications.
Dietary supplements may include vitamins, minerals, fiber, amino acids, herbs, and plants, or enzymes, and can supplement nutrition that may be missing or difficult to absorb. Supplements for aging adults may include:
- Vitamin C;
- Vitamin E;
- Vitamin D;
- Vitamin B6
- Vitamin B12;
- Omega-3 fatty acids;
The use of CBD has become more popular in age-related health problems. The National Council for Aging Care discusses the use of medical cannabis and CBD in the treatment of common physical and mental health ailments in the aging population. Therapeutic benefits CBD use for mental health include:
- Stress relief;
- Reduced anxiety;
- Improved sleeping habits;
- Enhanced cognitive functions;
- Alleviating depression;
- Regulating appetite;
- Chronic pain management.
Elderly patients considering CBD for its therapeutic benefits should consider speaking with their health care provider or doctor to discover clinical effects and safety concerns associated with its use. Some clinical trials have indicated CBD treatments for depression, pain, inflammation, anxiety, insomnia, and neurodegenerative disorders. Clinical trials with younger patients have also reported positive outcomes for patients with anxiety, bipolar disorder, epilepsy, insomnia, and schizophrenia.
There is limited evidence of adverse effects of CBD in elderly patients, but some potential adverse effects may include sedation, psychomotor slowing, orthostatic hypotension, and lightheadedness that could increase fall risks. Selecting the right CBD product may include understanding terpene content and application or delivery, such as ingestible oils and edibles, or topical products that can target specific areas on the body for pain, inflammation, soreness, or arthritis.
Long-Term Treatments and Therapies for Mental Illness
In addition to the actionable practices previously outlined, there are also long-term treatments and lifestyle choices that can improve senior comfort, independence, and the ability to live life to the fullest. Seeking and planning for long-term treatments, therapies, and living situations as early as possible allows for changes in knowledgable, incremental, manageable, and more comfortable ways.
What to Look for in Assisted Living Options for Seniors With Mental Illness
While aging in place and home renovation for seniors can work for some, it is important to recognize the value of assisted living options for seniors with depression or mental illness. Residential and long term care facilities can provide help with:
- Administering medication;
- Food preparation and dietary needs;
- Building maintenance and accommodations;
- Supervision and assistance for health needs;
- Health services;
- Counseling services;
- Physical activities;
- Social activities.
For elderly adults with mental health conditions, selecting a facility may include ensuring that mental, social, physical, and dietary needs are met. It can be valuable to consider facilities that include counseling services with specialized caregivers, or an aging-in-place community to reduce life changes.
Cognitive Behavioral Therapy and Talk Therapy
Cognitive-behavioral therapy addresses changing thinking patterns in an effort to change behavioral patterns to learn better ways of coping with and relieving symptoms of poor mental health. Cognitive-behavioral therapy with older adults may be adapted to focus on specific cognitive changes with aging, personality, and emotional development. Applications can be targeted to specific late-life problems such as chronic illness, disability, depression, alcoholism, and insomnia.
Talk therapy occurs as a collaborative treatment between a patient and a counselor or therapist to discuss thoughts, challenges, and mood regulation. Talk therapy can help identify obstacles and goals, overcome fears and insecurities, and provide tools to cope with stress and process past traumatic experiences.
It is important to ensure that any mental health provider is licensed and in good standing. Check for certifications, and ask healthcare providers to help you find a mental health professional. Tips for selecting a mental health professional include:
- Considering the type of mental health specialist and treatment needed.
- Asking for referrals from insurance and health care providers.
- Call to inquire for appointment availability, some mental health care professionals can be booked months in advance.
- Consider the following questions after the first session:
- Is this person comfortable to be around?
- Does this person have the required education or personal experience?
- How will the mental health care provider support and evaluate goals and progress?
- Does the provider understand and respect your cultural background?
Medication management is an important topic for aging adults and seniors. Physician and patient dialogues about prescription medication and nonadherence may include talking with all prescribing physicians about the different medications they take, as well as reporting skipping doses or stopping medication during treatment. Without medication management, the effects of nonadherence may include an increased risk of falls, addiction, depression, and isolation.
While prescriptions and taking medications can be an important aspect to senior health, it is also important to continue an ongoing dialog with your doctor, be a self-advocate, or to take and advocate with you. When taking a new medication it is important to be watchful for side effects and to contact your doctor if you experience any. In preparation for the appointment, make a list of concerns and be prepared to have the areas of concern examined. It can also be helpful to have a friend or advocate attend the appointment to ensure that the information and diagnosis are completely understood.
When prescribed new medications, it is important to ask how this medication works, what to expect, and if there is a need for a follow-up plan. It is also acceptable to question the diagnosis and consider alternatives, including alternative treatment plans.
Resources to Help Seniors Struggling With Mental Health
There are a variety of resources available for the elderly and their caretakers for times of crisis, and for general mental health support to live life to the fullest.
- National Suicide Prevention Lifeline: The National Suicide Prevention Lifeline is a national network of crisis centers that offer free and confidential emotional support for those in emotional distress or in a suicide crisis. Crisis services are available 24 hours a day, and seven days a week. The National Suicide Prevention Lifeline is 1-800-273-8255.
- SAMHSA’s National Helpline: The Substance Abuse and Mental Health Services Administration offers a helpline that is available 24 hours a day, every day of the year. The helpline offers information and services such as local treatment facilities, contact information for support groups, community-based organizations, free publications, and other supportive documents for those facing mental health or substance abuse disorders. Services are offered in Spanish and English.
- ElderCare Locator: Eldercare Locator is a service provided by the U.S Administration of Aging to connect seniors and caretakers with the support and services they need. This can include support services for the elderly as well as caretakers, housing information, elderly rights, insurance and benefits information, health guides, and access to transportation. Utilize their services through their website, or call 1-800-677-1116.
- National Association of Area Agencies on Aging: The National Association of Area Agencies on Aging provides advocacy resources and aging services. The mission of the agency is to help older adults and people with disabilities live with dignity and choices in their own homes and communities for as long as possible. Aging services include services for caretakers, health insurance assistance, healthy aging information, elder justice, care transitions, home, and community-based services, and more.
- MyHealthfinder: MyHealthfinder is run by the U.S. Department of Health and Human Services and provides information, resources, and support for health conditions, doctor visits, and everyday healthy living.
- Mental Health America - Take a Mental Health Test: Mental Health America offers online screening to determine if you are experiencing symptoms of specific mental health conditions. The site offers insight on which screening test to take and includes tests for depression, anxiety, psychosis, bipolar disorder, eating disorders, PTSD, addiction tests, and caregiver surveys.
- National Council on Aging; The National Council on Aging is an organization that is partnered with nonprofits, the government, and businesses to provide community programs, services, online help, and advocacy for people 60 and over. The mission of the organization is to improve the lives of older adults, by improving health and economic security.
- My Medical Matters: A partnership between Mental Health America and the National Council on Aging provides medicare enrollment support, advice on comparing plans, and assistance in comparing costs and looking for plan qualifications,
- AARP Foundation - Connect2Affect: AARP Foundation Connect 2 Affect offers support and social services to combat loneliness and isolation in older adults. The site offers an assessment to determine if an individual is at risk for social isolation, as well as resources to find community help and to rebuild social ties.
- APA - African American Older Adults and Race-Related Stress: The American Psychological Association offers resources for older African American adults that are dealing with race-related stress. Resources include support, education, and opportunities for access to safe spaces, mental health services, culture celebration, and advocacy.
- SAGE Advocacy & Services for LGBT Elders: Sage Advocacy and Services for LGBT Elders offers information on rights and resources for the aging LGBT community. The organization focuses on building welcoming communities and advocating for aging members of the LGBT community. The organization has a hotline, centers, and spaces for resources and housing initiatives.
- U.S. Department of Veterans Affairs - Geriatrics and Extended Care: The U.S. The Department of Veteran Affairs offers extended care for elderly adults that are veterans, or family members of veterans. Resources are offered for home and community services, residential and nursing homes, paying for long-term care, advanced care planning, memory loss and brain help, and overall health and wellness.