Aging and mental health: What you need to know about mental health in older adults

Aging is a natural process that brings changes in health, relationships, work, family roles, independence and daily routines. Many older adults experience good mental health and live active, full lives. But there are situations that can impact emotional and psychological well-being later in life.

Mental health problems are not an inevitable aspect of aging. Older adults can suffer from depression, anxiety, substance-related problems and dementia, and they deserve the right attention and care. Spotting early changes can help link someone with the appropriate support.

The World Health Organization considers mental health an important part of healthy aging, and the National Institute of Mental Health notes that life changes such as serious illness, bereavement, loneliness and social isolation can affect the mental health of older adults.

What is Mental Health in Later Life?

Many factors related to mental health affect older adults. Psychological well-being can be affected by physical health, chronic medical conditions, medications, financial circumstances, relationships, living arrangements, social connections, mobility and experiences of loss.

For some people retirement means more freedom and chances for meaningful activities. For others it may involve changes in identity, income, routine or social interaction. Likewise, it can be difficult to become less physically independent, especially if a person has been used to doing everything by themselves.

These experiences don’t necessarily mean someone has a mental health disorder. But persistent or severe changes in mood, behavior, thinking, sleep or functioning deserve attention.

Common Mental Disorders in Older People

1. Depression

Depression is one of the most common mental health problems among older adults. It is more than just sadness and it is not a normal part of growing older. The CDC stresses that depression is a medical condition that can be treated.

Depression may involve:

• Constant feelings of sadness, emptiness or hopelessness.
• Loss of interest in activities that used to be enjoyable.
• Lack of energy or persistent tiredness.
• Weight or appetite changes.
• Trouble sleeping or sleeping too much.
• Feeling cranky or irritated.
• Trouble concentrating or making decisions.
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional).
• Social withdrawal from family and friends.
• Unexplained physical symptoms or chronic pain.

Depression in older adults is sometimes different. Instead of saying they are “sad”, a person might mostly say they feel tired, have trouble sleeping, have physical aches and pains, have a hard time remembering things, or have lost interest in normal daily activities.

It’s important to know these less obvious signs because depression can be missed when the symptoms are just seen as aging or physical illness.

2. Anxiety Disorders

Anxiety is a feeling of fear, worry or apprehension. It is natural to have some anxiety, but when it becomes constant or intense, it may interfere with daily activities and lower the quality of life.

Older adults may worry about:

• Medical and health conditions.
• Security of funds.
• Loss of self-government.
• Family ties.
• Living alone.
• Changes in normal routines.
• Needs for care in the future.
• Loss of a loved one or other major life changes.

Possible signs may include excessive worry, restlessness, feeling keyed up or on edge, trouble sleeping, irritability, trouble concentrating or physical symptoms associated with anxiety.

If anxiety is ongoing or begins to interfere with daily life, a professional assessment can help to clarify what is happening and what support may be helpful.

3. Dementia and Cognitive Change

Memory naturally alters somewhat with age. Forgetting a name once in a while or taking longer to recall information does not necessarily mean that a person has dementia.

But dementia is not an inevitable part of aging. Dementia is a change in memory, thinking, reasoning, communication or other cognitive abilities that interferes with everyday life.

Possible warning signs include:

• Difficulty remembering newly learned information.
• Confusion about familiar places or situations.
• Trouble completing familiar tasks.
• Difficulty with speech or word finding.
• Trouble making decisions or solving everyday problems.
• Major shifts in judgment or behavior.
• Increased dependence on others for daily activities.

Alzheimer’s disease is one form of dementia. Dementia can have other causes and types. If someone is having major changes in their thinking, they should be medically evaluated, not just diagnosed based on symptoms.

4. Substance and Medication Use Disorders

Older adults can also have substance-related problems. In some cases medications or alcohol are used as a means of coping with loneliness, anxiety, difficulties sleeping, chronic pain or other issues.

Older adults may also be more likely to have medication-related problems because they may be taking multiple medicines at the same time or have age-related changes in the way their bodies process medications.

Increased alcohol consumption, inappropriate use of prescription medication, unusual sedation, confusion, or changes in behavior should be discussed with a suitable healthcare professional.

A challenge for mental health in later life is that psychological symptoms may overlap with physical symptoms.

Why Mental Health Problems May Go Unnoticed in Older Adults

Fatigue, poor sleep, changes in appetite, difficulty concentrating and physical discomfort can all be symptoms of medical conditions as well as depression. Also, some medicines and medical conditions can have symptoms that look like depression. That’s why a professional evaluation is so important.

Another barrier is the belief that feeling depressed, lonely or constantly anxious is just part of getting older.

It’s not.

Growing old can be hard, but similar to physical symptoms, serious and persistent mental-health symptoms should not be ignored.

Warning Signs to Watch For

Family members, caregivers, friends and health care providers may be important in recognizing changes.

Warning signs could include:

Mood Changes

• Feeling sad or hopeless most of the day.
• Greater irritability or anger.
• Loss of interest or enjoyment.
• Intense fear or anxiety.

Behavioral Changes

• Withdrawing from family and friends.
• Lack of interest in hobbies.
• Stopping things that the person liked to do.
• Significant change in personality or daily routine.

Changes in Thinking

• Increased forgetfulness.
• Confusion or disorientation.
• Trouble concentrating.
• Trouble making decisions.
• Struggles with routine activities.

Changes in Physical Health

• Chronic fatigue.
• Bodily complaints or aches with no explanation.
• Significant changes in appetite or weight.
• Significant alterations in sleep.

These signs don’t necessarily indicate that someone has a mental health disorder. They suggest that something may have changed and it might be appropriate to discuss further with a healthcare professional. NIMH notes that symptoms that may need attention in older adults include noticeable changes in mood, energy, appetite, sleep, concentration, behavior, and substance use.

Aging, Social Isolation and Loneliness

Later in life, social connectedness is particularly important.

Opportunities for social interaction can be diminished by reduced mobility, illness or loss of friends and family members, retirement, bereavement, relocation. Loneliness and social isolation can be long-lasting and affect mental health, and may play a role in depression and anxiety.

Thus, maintaining good relationships can be an important part of healthy aging.

Simple activities can make a difference, such as:

• Frequent contact with family and friends.
• Engaging in community activities.
• Becoming a member of clubs or interest groups.
• Volunteering when you can.
• Staying physically active.
• Having hobbies and interests.
• Attending religious, cultural, or community events that are important to the person.
• Maintaining meaningful connections can also involve using technology intentionally to stay connected while making time for real-world relationships and activities.”

It’s not about keeping someone busy all the time. It is to help keep meaningful connection, purpose, autonomy and joy alive.

Supporting Mental Health For Older Adults

Worried about an aging parent, relative, friend or neighbor? It begins with a caring conversation.

Rather than saying:

“You’re getting on in years. This is the standard.”

Try: the following

“I’ve noticed something different about you lately. How have you been feeling?”»

Let the man speak. Listen without judging, and don’t try to fix the problem immediately.

You may also:

Encourage them to talk to a doctor about any symptoms.

Offer to go with them to an appointment.

Help them to stay socially connected.

Promote fun and meaningful activities.

Promote healthy sleep, nutrition and physical activity as appropriate. Respect their independence and their choices.

Do not ignore marked changes in mood, thinking, or behavior.

Family and friends are supposed to support and encourage, not diagnose.

When You Need Professional Help

When symptoms When to think about professional help

Persist or escalate.

Disrupt everyday life.

impact relationships.

Create great distress.- Cause withdrawal from normal activities.

Involve major changes in memory or thinking.

Include problematic use of alcohol or medications.- Accompanied by thoughts of death or suicide.

“The first step might be to become a primary-care health care professional. They may recommend that you seek additional evaluation from a psychologist, psychiatrist, neurologist, geriatrician or other qualified professional, depending on the circumstances. Older adults with mental health conditions can be treated with psychotherapy, medication, lifestyle approaches, social support, or a combination of approaches.

Promoting Healthy Aging and Mental Well-Being

We should look at mental well-being not as separate from physical health, but as one thing in terms of healthy aging.

Helpful foundations include:

Regular physical activity appropriate to the person’s condition.

Regular sleeping hours.- Good nutrition and adequate fluid intake.

Meaningful social connections.- Entertaining activities and educational opportunities.

Maintaining your independence where you can.

managing long-term health problems.- Routine medical examinations.

Asking for help when emotional or cognitive changes begin to become concerning.

These measures do not guaranty that a person won’t develop mental illness or dementia. They are just parts of a larger plan for physical, emotional, cognitive and social wellbeing.

Busting the myth: mental health problems are not ‘just old age’

And one of the most important messages about aging and mental health is this:

Mental health issues should not automatically be dismissed as a normal part of getting older.

Depression is not part of normal aging. Dementia is not part of normal aging.

And at the same time, not every change in memory, mood, sleep or behavior is a sign of disorder. The right answer is not to ignore the symptoms that are of concern, and not to assume a diagnosis. Significant changes should be discussed with an appropriate healthcare professional.

Conclusion

Aging is a stage of life in which opportunities and challenges are present. Knowing the difference between normal changes and symptoms that may need attention is part of preventing mental health problems in later life.

Depression, anxiety, dementia, substance-related problems, loneliness and other mental health concerns can affect older adults, but help and treatment are available.

Families and communities can make a real difference by noticing changes, staying connected, reducing stigma, and encouraging older adults to seek professional help when needed.

Mental health is important at every age. Getting on in years doesn’t have to mean suffering from constant emotional upset, serious anxiety or major mental changes as something you have to accept.

This article is solely for educational purposes and is not a substitute for medical diagnosis or treatment. If you or an older adult you know notices persistent or concerning changes in mood, behavior, memory or functioning, seek advice from a qualified healthcare professional. If you think you might be in immediate danger of harming yourself or someone else, get emergency help in your area. Our professional team in OBHI is always ready to assist you and your loved once with necessary clinical evaluations and treatments