A Look Into Older Adults’ State of Mind

CONTRARY to conventional wisdom, an increase in age can lead to an increase in happiness. In fact, older adults tend to be more satisfied with their lives than their younger peers. But, for those who need it, limited supply of and access to proper geriatric psychiatric treatment leave many older adults' mental health issues under-diagnosed and thus under-treated.

One in four adults ages 65 and older experiences a mental health problem such as depression, anxiety, schizophrenia or dementia, according to the American Psychological Association. And people 85 and older have the highest suicide rate of any age group, especially among older white males who have a suicide rate almost six times that of the general population, according to the National Council on Aging.

The issue of access to mental health care treatment will be further compounded as baby boomers – who carry a higher predisposition to suicide than earlier generations – enter the older adult stage of life. The number of Americans between the ages of 65 and older is projected to double from 46 million to more than 98 million by 2060, according to the American Psychological Association.

But there's a positive side to this ledger.

More health systems across the country are merging mental health care into primary care visits, which older people are more likely to take advantage of, says Dr. Yeates Conwell, director of the geriatric psychiatry program at the University of Rochester.

"Older people ... are not going to go to a mental health center or a mental health provider, but they will more likely accept treatment from their primary care practitioner," Conwell says.

Yet access to proper mental health care for older adults is hindered by modern culture perpetuating the stigmas and misconceptions of ageism and mental health issues; social isolation; high health care costs; and a dwindling supply of geriatric caregivers for America's growing older population.

"The way we treat and take care of people, especially older people, with mental health illnesses is certainly an embarrassment and a shame to society," says Dr. Dilip Jeste, director of the Stein Institute for Research on Aging at University of California–San Diego School of Medicine. "This is one of the most disenfranchised segments of our society."

Addressing the Stigmas of Ageism and Mental Health

Modern culture in America values the new and, in the process, pushes the old aside.

"Ours is a culture that values innovation, which is new knowledge, and devalues wisdom, which is old knowledge or eternal knowledge – knowledge that doesn't change every five years when a new iPhone comes out," says Dr. Renee Garfinkel, a clinical psychologist, author and radio host.

"But something's lost and something's gained in every choice that society makes," Garfinkel adds. "When you're in a society where speed is highly valued, then an old person will not be."

By adapting this mindset, experts say society could be contributing to social isolation and misconceptions surrounding older adults' mental health.

"When older people incorporate the view that they are 'over the hill,' that they are a burden on their families or on their communities, then that's a very dangerous situation," Conwell says, as social isolation has been proven to be as bad for one's health as smoking or lack of exercise.

The stigma of ageism includes negative attitudes, stereotypes and behaviors directed toward older adults based solely on their perceived age. In other words, as people get older, others assume that they have or are increasingly susceptible to mental or physical impairments that make them no longer able to contribute in a way they once were, decreasing their value to the community.

"People with mental illnesses in general get really poor care. There is a considerable amount of stigma against mental illness, and when you talk about aging, there is considerable stigma against aging," Jeste says. "So older people with mental illness have this double whammy: They are stigmatized because of mental illness and stigmatized because they're older."

Further, mental health services may be underutilized by older patients as they may be in denial, may not have adequate insurance coverage, or their other physical chronic conditions may take precedence during a primary care visit, leaving their mental health unchecked.

"I think that time is an issue for practitioners," says Eric Weakly, chief of state and community programs for the western branch of Substance Abuse and Mental Health Services Administration, a division of the Department of Health and Human Services.

"If you're coming and you only have maybe 15 minutes, and you have a person who has multiple chronic conditions – they may be presented with cardiac conditions or diabetes or other things – of the list of conditions, depression, anxiety or another mental illness may not be first on the list when they're doing their screens," Weakly, a social worker, continues.

And, while the number of older adults with mental health disorders is expected to nearly double by 2030, the number of geriatric psychiatrists and psychologists is projected to continue its decline, resulting in less than one geriatric specialist per 6,000 patients with mental health and substance use disorders, according to a 2013 Dartmouth University study.

More than 20 percent of adults aged 60 and over suffer from a mental or neurological disorder, and the most common neuropsychiatric disorders in this age group are dementia and depression, according to the World Health Organization.

Dementia – including Alzheimer's disease, its most common form – affects about 5 percent of individuals between 71 and 79 and 37 percent of the population above the age of 90, according to the American Psychological Association.

But, as Garfinkel explains, growing older doesn't mean you will suffer from a mental health issue. Rather, a longer lifespan exposes a person more, both in terms of mental and physical conditions, which may affect a person's overall psyche.

"The longer you live, the more chance there is for illness to target you, and depression is a risk factor for people who have chronic illness, especially when it's chronic pain," Garfinkel says. "Pain and depression are very highly associated, and a lot of the disorders that strike more often in older age – but not exclusively in old age – are painful."

While depression is not a consequence of getting older, the misconception that it is – either due to bereavement over lost loved ones or the physical pains tied to aging – leads to underdiagnosis and undertreatment by health care professionals and older adults themselves who may not recognize the associated physical symptoms.

A combination of the individual and the people around him or her making incorrect assumptions about depression as a normal part of aging further complicates diagnoses, Conwell says.

"Older people tend in general to be more satisfied with their lives than middle-aged people, and have lower rates of syndromal depression, even though depressive symptoms may be present. But when they are, clinical depression is a syndrome that's made up of a bunch of different symptoms – sadness is only one of them," Conwell continues.

Senior patients may not bring up emotional symptoms, though, opting instead to describe physical ones such as loss of energy, poor sleeping habits, loss of appetite and trouble concentrating, Conwell says, all of which are common with other chronic medical conditions in later life.

Yet mental health correlates with physical health, according to the World Health Organization.