Everything You Need To Know About Older Adult Mental Health
Learn about common mental health issues that affect senior adults
December 27, 2022
The world is aging. According to the World Health Organization, we can expect the over-60 population to double worldwide between 2015 and 2050. Considering 15% of these individuals struggle with some form of mental health disorder, and that neurological and mental issues account for more than 6% of disability in this age group, we’re looking at a coming crisis.
One of the best ways we can address this crisis is by understanding what it entails and knowing what we can do to help. Whether you’re an older adult yourself, a family member with an elder loved one, a health care provider, or anyone else, it’s important to understand the challenges related to mental health in older adults and ways to manage them.
Keep Reading To Learn
- Which mental health conditions affect senior adults
- What normal aging looks like—and what you should discuss with a health professional
- The best ways to deal with specific mental health problems for older individuals
How Does the Brain Change as We Age?
The brain is not the same organ from birth to death. It goes through many changes throughout our lives, and continues to do so until the moment we pass away.
- The brain begins to shrink in your thirties and forties
- Some areas shrink more than others, such as the frontal lobe and hippocampus
- Changes in behavior and memory occur due to shrinking of the frontal lobe and hippocampus
- Thinning of the brain’s outer surface leads to fewer neural connections, slowing thinking
- Neurotransmitter production changes, also impacting cognitive and emotional function
These changes are natural and, for many people, they pose no issue at all.
However, changes in the brain can lead to serious mental health disorders that may take various forms.
It’s not possible to stop these changes: they are a normal part of aging and are irreversible once they occur. However, by practicing healthy lifestyles, it’s possible that older adults can minimize the effects that come with age.
This includes eating a healthy diet, sleeping enough, exercising moderately, and using the brain regularly—for instance, playing games, talking with friends, creating art, spending time with grandchildren, reading, and so on.
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Common Mental Health Conditions in Older Adults
There are several mental health issues that senior adults face. A few of the most common include:
- Memory issues
- Dementia, including Alzheimer’s disease
- Parkinson’s disease
- Bipolar disorder
It’s no secret that as we age, memory begins to slide. Older adults are known to misplace their car keys more often, become forgetful about dates, or need to search longer for a word than they used to.
As they advance in age, they may have a harder time recalling memories from long ago or pulling up information they learned recently. It’s easier to get lost and harder to form new connections—such as remembering where that new grocery store is located.
Whether you are an older adult or a caregiver, it’s critical to understand that these are all perfectly normal signs of aging. Taking a bit longer to express a thought or hunting a little harder for those medical forms they just saw is not necessarily a reason for concern. Given the changes the brain experiences with age, this is to be expected.
However, it can also make it hard to decide when memory problems are a normal sign of aging and when there is a more serious issue going on. If you or a loved one is showing the following signs, it might be time to talk to a doctor:
- Repeatedly asking the same questions, often in a short period of time
- Getting lost in places that are (or used to be) familiar
- Becoming easily confused about the date or time
- Failing to recognize or easily place people they know well or have met a number of times
- Having a harder time following instructions, or getting lost halfway through listening to or reading something
- Failing to provide proper self-care, such as eating, bathing, or picking up
- Behaving in ways that are uncharacteristic or unsafe
Sometimes these problems occur because of a condition like dementia or Alzheimer’s disease, a specific form of dementia. Other times, memory problems may stem from depression, which makes it harder to think and take action. In some cases, medications can affect memory as well.
If you see serious personality or physical changes (for example, changes in vision), it’s important to speak to a doctor right away. If the signs are mild, it may be a normal facet of aging. It could also be mild cognitive impairment.
Mild Cognitive Impairment
Mild cognitive impairment (MCI) is separate from normal memory problems that come with age, but is not nearly as serious as Alzheimer’s or other forms of dementia. MCI is not related to a mental health condition like depression or bipolar disorder. Rather, it is simply an advanced form of memory loss.
Although people with MCI have greater memory issues than peers of their age group, they can usually continue to care for themselves. They may need better systems in place to help them track objects, remember appointments, and communicate effectively, but they typically do not lose their ability to live independently.
However, MCI can be (but isn’t necessarily) a sign of the onset of dementia. For that reason, it is important not to completely dismiss seemingly harmless issues, like misplacing car keys. Rather, if such incidents start happening more often to you or your loved one, keep an eye out for other symptoms that might appear.
Make sure to keep your doctor updated on any changes in cognitive function.
Memory and Medical Conditions
Memory problems may also stem from medical conditions, especially if they seem to come on rather suddenly. Tumors, brain infections, or blood clots can bring about difficulty remembering or processing information. So can disorders of organs such as the kidneys, liver, or thyroid. Heavy alcohol use may also affect memory, though this is usually a slower effect that takes place over many years of heavy consumption.
If you or your loved one has recently suffered a head injury, it is critical you don’t wait to speak to a doctor. Memory loss can be a sign of concussion and should be treated immediately. Left untreated, concussions can lead to longer-lasting symptoms.
The same is true of starting new medications. If you immediately notice memory-related side effects, don’t wait to book your medical appointment. If you or your loved one seems to be aging well, but you see a few worrying signs of decreased emotional or cognitive functioning, you might consider neuropsychological and psychological testing.
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The differences between slow memory degradation, common to all aging individuals, and Alzheimer’s may at first be difficult to detect. It is a matter of both degree and frequency.
For instance, people aging normally may exhibit poor judgment on an occasion or two, but those with Alzheimer’s might do it often. People who don’t have dementia may occasionally misplace their car keys, miss a payment, or forget a word, whereas those with a disease may do the above several times a week or every day.
Although Alzheimer’s is not a normal part of aging, it is very common. In fact, it is the single most common cause of dementia, a group of conditions in which cognitive function, language skills, and memory degrade. While we don’t yet have all the answers about what causes this disease, scientists believe it results from a buildup of proteins in the brain.
Alzheimer’s can affect people younger than 65, but age is the greatest risk factor. The disease is progressive, starting with mild symptoms equivalent to MCI. By the end, most Alzheimer’s patients have lost the ability to speak with others, recognize their surroundings, and live a normal life.
The Alzheimer’s Association states that more than 6 million Americans have Alzheimer’s disease, a number that is projected to rise to 13 million by 2050.
According to the Alzheimer’s Association, the disease kills more individuals than prostate and breast cancer combined, and one out of every three older adults die with Alzheimer’s or another form of dementia.
Of dementia cases, 60 to 80% are suspected to be Alzheimer’s and, overall, about one in nine Americans 65 and older have the condition.
Alzheimer’s does not affect the population equally. Two-thirds of people who experience it are women, while Black and Latinx people are twice as likely as white people to have it.
While life expectancy after a diagnosis is usually around four to eight years, people can live with the disease for decades.
Signs of Alzheimer’s Disease
While some doctors are hesitant to diagnose Alzheimer’s specifically (as opposed to dementia in general), the condition does have some distinguishing characteristics.
One of the most important is the inability to remember new information. Signs such as confusion, dangerous behavior, odd decision-making, serious memory loss, and failing language skills are also red flags.
If you’re wondering whether you or a loved one is at risk, look for signs such as:
- Changes in mood and behavior that don’t reflect who the person used to be
- Disorientation and confusion, even in simple settings or familiar places
- A growing inability to track time and place
- Suspicions and withdrawal from family and friends, or an outright inability to recognize them
- Difficulty speaking or expressing ideas
- Difficulty eating and swallowing
- Reduced walking and other motor abilities
If you see any of the above, it’s time to speak with a doctor right away. They will try to rule out other potential causes. If they find medical conditions or other mental health issues (like depression), they will first try to address those and see if treatment resolves any of the issues.
If it does not, there’s a good chance Alzheimer’s is the culprit. In that case, the next step is to begin managing it right away.
While Alzheimer’s is a permanent and progressive condition, and can only worsen over time, that’s not the case with every dementia diagnosis. In fact, a significant proportion of dementia cases have treatable causes.
With the right help, the person may get better—either for a period of time or for the rest of their life.
Keep in mind that dementia is a general term for the pattern of cognitive changes that also characterize Alzheimer’s. This includes:
- Memory loss
- Loss of language abilities
- Trouble with problem solving
- Cognitive decline
However, these changes aren’t necessarily the result of brain degradation. Depression and bipolar disorder can also change the way the mind works, and can trigger changes that resemble Alzheimer’s.
Similarly, the side effects of medication (or self-medication) may appear to be dementia. Thyroid problems and vitamin deficiencies can cause similar symptoms too.
There are other non-Alzheimer’s causes of progressive dementia that are non-reversible, and whose prognosis and treatments differ from Alzheimer’s.
Three of the most common forms of dementia include frontotemporal disorder, Lewy body dementia, and vascular neurocognitive disorder.
It is critical that a doctor rule out these other possibilities before making a diagnosis of Alzheimer’s. If you are a caregiver, make sure your loved one has been adequately screened for these disorders described below before you accept an Alzheimer’s diagnosis.
Unlike Alzheimer’s disease, frontotemporal disorder (FTD) more commonly affects people under the age of 65.
While cognitive decline is less severe in this form of dementia, people with FTD may lose interest in life, engage in socially inappropriate behavior, and use poor judgment.
Other symptoms of this disorder include loss of empathy, changes in diet, and hyperorality—the practice of placing objects in the mouth.
FTD can affect language as well as behavior. People may have trouble talking and struggle to find and understand words.
FTD accounts for 5% of all dementia cases, with life expectancy of six to eleven years after symptoms appear.
Lewy Body Dementia
Lewy bodies are the abnormal build-up of protein that occur in the nerve cells of people with Lewy body dementia (LBD) and Parkinson’s disease. LBD includes symptoms of both Alzheimer’s and Parkinson’s disease.
The condition starts subtly but progresses into serious cognitive and physical decline over the course of five to seven years.
The severity of LBD symptoms can vary from day to day. A person’s ability to focus attention, plan, and remember tasks is particularly affected by the condition, and visual hallucinations frequently occur. After the onset of cognitive symptoms, motor symptoms such as tremor and trouble moving set in.
Quality of life is often more severely impacted than it is for those with Alzheimer’s disease.
Vascular Neurocognitive Disorder
Vascular neurocognitive disorder is the most common cause of dementia after Alzheimer’s with 16% of the U.S. population over age 80 estimated to have the condition.
The disorder is brought on by cerebrovascular disease, such as stroke. It develops when blood supply to brain tissue is cut off, leading to cognitive decline.
According to the American Psychiatric Association, 20-30% of people are diagnosed with the condition within three months following a stroke. Depression, instability, difficulty making decisions, and personality changes frequently appear as part of this vascular neurocognitive disorder.
Characterized by shaking, stiffness, difficulty moving and speaking, and cognitive decline, Parkinson’s is a disease that affects nearly a million people in the U.S. today.
The disorder stems from changes in the brain. Specifically, neurons in the area controlling movement start to malfunction or die.
The dopamine this area used to produce is reduced, which causes changes in speech and movement. Additionally, production of norepinephrine (which helps control nervous system functions) is also affected. Researchers still aren’t clear what causes these cells to die and, as such, available treatments are somewhat limited.
Like Alzheimer’s, Parkinson’s is a progressive disease related strongly to age, and most of the people it affects are over the age of 50. For those younger than 50, the disease is labeled “early-onset.” Symptoms start out mild and gradually get worse over time.
Changes in sleep, mood, memory, energy, and behavior often accompany the onset and progression of the disease. It affects more men than women by a factor of roughly 1.5.
Signs of Parkinson’s Disease
People with Parkinson’s may exhibit the following signs:
- Shakes and tremors in the arms or legs, head or jaw
- Stiffness and slowness of movement
- Difficulty walking and talking
- Difficulty with fine motor skills, such as grasping objects or writing
- Chronic fatigue
- Irregular blood pressure and sudden blood pressure drops
- Changes in digestion and sleep
- Skin problems
While there is no cure, doctors may prescribe certain surgeries, brain implants, and medications to help relieve some of the symptoms of Parkinson’s. It’s important to see a doctor right away if you see any of the above signs.
Suicide Prevention in Older Adults
In this talk, Yeates Conwell, MD, outlines aspects of suicide specific to older adults and the issues that make suicide in this population challenging to address.
We often think of depression as a disease that affects younger adults and teenagers, but in fact, it is common in older adults as well. However, clinical depression is not a normal facet of aging, and you should treat any depressive symptoms as serious and seek help right away.
Depression can stem from many causes, including:
- The death of friends and family
- Changes in living situation (especially unwanted ones)
- Medical conditions that limit quality of life or change brain chemistry
- Substance-induced mental health changes
- Medication side effects
Depression is characterized by a general listlessness, sadness, and disinterest in activities that used to bring joy, and it can come in different forms.
Major depressive disorder involves depression symptoms that last for at least 2 weeks, while persistent depressive disorder symptoms last more than 2 years. In severe cases, depression can cause suicidal thoughts and you should take immediate action.
Again, none of these are normal changes with age. If you or a loved one is experiencing any of them, you can do your research about depression and ask a doctor to help you find a solution.
It’s also important to know the signs and symptoms.
Signs of Depression
The common signs of depression include:
- Lack of interest in activities
- Being emotionally closed off
- Feelings of sadness or emptiness
- Oversleeping or under-sleeping
- Lack of interest in food
- Difficulty concentrating
Individuals may also experience anger, irritability, aggression, or belligerence or engage in risk-taking behaviors.
Note that depression is not the same as frailty, chronic illness, or disability. It is not an inevitable part of aging, nor is it limited to feelings of sadness. Depression may also be a sign that someone needs more social support, activities, and facilitation in their relationships.
Watch for any of the above symptoms and speak to a doctor about treatment such as therapy and medications.
Formerly called manic-depressive disorder, bipolar disorder is a condition in which the patient experiences alternating episodes of mania (high energy) and depression (low energy).
While it usually starts at a younger age, it is possible for bipolar disorder to go unrecognized for years or to come on later in life. Bipolar disorder is equally common in men and women of all ages, ethnicities, and social classes.
While the cause of bipolar disorder isn’t known for sure, it is likely a result of a combination of factors, including genes, background, brain chemistry, and the environment.
Those with bipolar disorder may swing from highs to lows in a matter of days or weeks.
The manic/depressive episodes may also last for months. Depressive episodes may result in suicidal thoughts.
Treatment for bipolar disorder involves medication and therapy. Look for signs of depression in the section above. Manic episodes usually present with the following symptoms.
Signs of Mania
- Jumpiness, jitteriness, or extreme cheerfulness
- Increased activity and ideas
- Faster talking and increased socializing
- Getting lots of things done at once
- Racing thoughts and distractibility
- Changes in sleeping patterns or reduced sleep
- Poor decision-making and unusual patterns of sexual activity, purchasing, eating, or other types of activity (though this may be less common in older adults)
Without care, bipolar disorder can result in serious degradation of quality of life, up to and including suicide. Don’t wait to speak to a medical professional.
We Are Here to Help
McLean offers world-class mental health care for older adults. Call us today at 877.866.5920 to learn more about treatment options for yourself of a loved one.
Obtaining Proper Mental Health Care For Older Adults
As you get older, your needs change—both physically and mentally. If you are an elder aging in place or looking at a change in location, it’s important to take your full mental health situation into account. The same is true if you are caring for an aging individual and want to ensure you make the right choices to support them. You need an accurate picture before you make decisions.
Barriers to Care
It’s important to understand the above conditions and seek treatment where appropriate. Granted, there can be roadblocks to obtaining proper mental health care for older adults. These can include:
- Resistance to treatment on a personal level
- Cultural barriers to seeking treatment
- General stigma around mental health conditions and treatment
- The senior lives in a “care desert,” where it’s hard to access appropriate treatments
- The senior does not have younger relatives or friends willing to take on their care
- Co-occurring physical and mental health conditions, making it hard to tell what’s going on
- Travel and change are difficult due to pain, frailty, confusion, frustration, low funds, or other barriers
- Feelings of fear and distress generated by hospitals/medical settings
These are all legitimate reasons for people to be wary of seeking treatment. However, it’s important that you press through and get help anyway. There are several types of treatment you can seek, depending on the mental health conditions involved.
How To Find Help
For untreated depression, anxiety, or bipolar disorder, for instance, a mental health professional will likely prescribe therapy, medication, or a combination of both. Alzheimer’s and dementia patients, as well as those with MCI or slight memory loss, should be checked for complicating health conditions first.
If no complicating health conditions are present, you should at that time make a plan for helping the individual age in place safely or move to an assisted care facility. Speaking with a doctor is the best way to find out what the problem is and what is needed to fix it.
Also be aware that:
- Mental and physical health go hand in hand. If one suffers, so does the other. Don’t wait to get either checked out.
- Elders are at greater risk of physical, verbal, and financial abuse than younger, stronger adults. Make sure any living situation creates effective barriers to such abuse.
- Safety and freedom should be balanced to help the aging individual feel safe and happy in their living situation.
- Even if you have addressed a mental health condition, continued monitoring is critical. Plan to visit the doctor at least every 6-12 months—more if advised.
- Especially in situations where stigma is attached to the idea of mental health care, present doctor visits to friends and family using clear, understandable terms rather than using jargon. It can be helpful to equate mental health care to physical health care, i.e., a follow-up visit with a therapist is no different than getting your blood pressure checked.
Naturally, it may take time for you or your loved one to find the right care. Don’t stop looking. Many older adults fail to get the treatment they need simply because it is sometimes challenging to obtain.
Remember: everyone deserves a happy, healthy experience, even toward the end of life.
Want More Info?
Looking for even more information about older adult mental health? You may find these resources helpful.
Interesting Articles and More
Learn more about mental health in older adults and what you can do if you or a loved one is displaying signs they are struggling.
- Dementia: Addressing a Global Health Challenge
- Preventing Suicide in Older Adults – Mental Health America
- 10 Easy Ways Seniors Can Boost Their Mental Health and Well-Being – Everyday Health
- A Guide to Caring for a Loved One With Alzheimer’s Disease - Senior Living Specialists
- Falls Prevention for Older Adults – National Council on Aging
- Six Things Seniors Can Do to Improve Memory – Psychology Today
- Find all of McLean’s resources on older adult mental health
- Caregiver’s Guide to Understanding Dementia Behaviors – Caregiver.org
- Family Caregiver Alliance
- Senior Caregiver Alliance
A leading voluntary health organization focused on providing quality care and support, accelerating research, and educating and raising awareness about Alzheimer’s disease and all other dementia.
An online community that enables those affected by Alzheimer’s disease and related dementias to connect, advocate for change, and have access to up-to-date resources and expert information.
American Association for Geriatric Psychiatry
A membership association of geriatric psychiatrists and other health care professionals that is involved in professional education, advocacy, and career development for those in the field of geriatric psychiatry with the mission of promoting the mental health and well-being of older adults.
Depression and Bipolar Support Alliance
A nonprofit organization providing support groups for people with depression or bipolar disorder, as well as their friends and family. DBSA offers education, personal wellness tools, access to research studies, and assistance with finding the right treatment.
Depression and Bipolar Support Alliance Boston
A nonprofit, self-help support organization run by volunteers, for people who struggle with mood disorders, such as depression and bipolar disorder, and for family and friends.
National Council on Aging
An organization focused on delivering resources, tools, and advocacy for older adults, with a focus on health and financial security, to ensure that Americans age well, with dignity, purpose, and security.
National Institute on Aging
National Institutes of Health agency that leads the federal government in advancing and disseminating research and general health information on aging and the health and well-being of older adults.
Books About Older Adult Mental Health
Bipolar Disorder in Older Age Patients
by Susan W. Lehmann and Brent P. Forester, editors
Geriatric Forensic Psychiatry: Principles and Practice
by Jacob C. Holzer, Robert Kohn, James M. Ellison, Patricia R. Recupero, editors