One area of mental health that at times might be overlooked is the mental health of the elderly. I am aware of this because my mother falls into the group of elderly with a mental health condition. She does not acknowledge that she has a mental health condition. Maybe it is because of the generation she grew up in. Maybe it is because she has Alzheimer’s. It could also just be her personality and personal beliefs. More than likely it is a combination of all three.
As I think about my mom, I am left wondering how many elderly people struggle with their mental health and what is the impact of mental illness on the elderly. Worldwide about 14% of elderly people live with a mental illness. Estimates for the Unites States indicate that 5-7 million elderly people live with mental illness. This includes disorders such as depression and anxiety. Other estimates indicates that 3-4 million of those elderly people with mental illness go untreated.
Let’s look at some reasons the elderly may not receive treatment for their mental illness.
· Symptoms get mistaken for normal aging
· The stigma surrounding mental health
· Limited access to geriatric mental health specialists
· Physical health issues overshadow mental health concerns
A simple Google search indicates that depression is the most common mental
health condition among the elderly. Approximately 15-20% of the elderly experience depression symptoms. There are even more who experience symptoms but do not meet the criteria of a diagnosis. It is estimated that about half of the elderly with depression do not receive treatment. This lack of treatment may be due to an overlap in symptoms of depression and the signs of aging or physical illness. These might include fatigue and sleep issues. Another issue is that the elderly often do not report mood changes.
Anxiety disorders are unrecognized in the elderly even more than depression. It is estimated that up to 70% of elderly with anxiety go untreated. Sometimes it is seen as a personality trait or lifelong worry. When I read about this I immediately thought about my grandmother. Everyone always said she was just a worrier. What if she really had an anxiety disorder that was left untreated? It pains me to look back and realize that maybe her life would have been easier with treatment. Another reason anxiety disorders are left untreated in the elderly is there is less screening for anxiety than depression.
When we look at the big picture, it is obvious that many of the elderly are living with untreated mental illness. I only looked at depression and anxiety. There are other mental illnesses that impact the elderly. We need to do a better job of recognizing and treating mental illness in the elderly. How do we do this?
First, we need to make it easier for the elderly to access care. Primary care specialists can increase screening efforts. Mental health care should be included in home health services and senior living centers, assisted living facilities, and nursing facilities. These actions can be as simple as a doctor or other physical health provider asking a few simple mental health questions and carefully listening to the answers. It is important to pay attention to what the person is not saying as well. In care facilities personnel should monitor the elderly’s participation in activities and whether they are being visited. Personnel should be aware of isolation. This could be a sign of depression. Having care providers who are aware of what is going on in the lives of the elderly is important.
If the person is not in a care facility, some of this responsibility lies in the hands of the person’s family. I get how hard this can be. Sometimes my work and life obligations make it difficult for me to monitor my mother’s mental health. I cannot allow that to be an excuse. At the same time, I need to recognize that I need to take care of my own mental health when I am with my mother. This has been a difficult task. My mother is in a care facility, but I cannot leave the task of monitoring her mental health to the facility staff. So, I understand how families can lose track of their elderly loved ones. This is where another strategy to increase mental health care for the elderly becomes apparent. We need to support caregivers and families. This can include teaching them early signs of depression and anxiety. Caregivers and families also need support navigating insurance services. This is an indirect support of the elderly but is vital.
Reducing stigma is another way to ensure that the elderly are receiving mental health care. This can begin with campaigns to normalize mental health as a part of overall health. We need trusted individuals to be a part of this campaign. Today awareness about mental health is increasing. That is a great, but we need to remember to include the elderly when we raise awareness. They are often forgotten or overlooked.
The elderly are often isolated whether by choice or circumstance. Isolation is a risk factor for mental illness. The elderly need to be encouraged to participate in family activities. At the same time families need to be encouraged to include their elderly loved ones. It is easy to overlook our elderly loved ones, but we need to recognize how important connection is for them. We can set up regular check-ins. To lessen the load on family members, they can set up a system where different people check in at different times. The check-ins can also be done by neighbors or friends. Encouraging the elderly to become involved in activities in senior centers, assisted living or care facilities is important. Just a little social interaction can go a long way.
I do not like to be political on this blog, but I will say that changes need to be made to Medicare. These changes need expand coverage for mental health services. We also need to fund community-based programs. This will provide more opportunities for the elderly to improve their mental health. It may also be necessary to provide incentives for mental health care professionals to work with the elderly.
As we look at improving mental health in the elderly we need to focus on identification of mental illness, providing easier access to care, and reducing isolation. These are simple actions that we can take as a society. We need to become advocates for mental health care for the elderly.
Another thing for many of us to consider is that if we have a mental illness now, we will still have that mental illness when we are elderly. We are going to want continued access to care. Our mental illness and our need for care is not going to disappear. If we work for increased mental health care for the elderly now, we are ensuring that those care practices will be in place as we age
I encourage you to check in on the elderly in your life. Even just friendly visits can make a difference. Be aware of the symptoms of mental illness:
Emotional and Mood Changes
· Persistent sadness, emptiness, and hopelessness
· Increased irritability or anger
· Loss of interest in hobbies or social activities
Physical Symptoms
· Unexplained aches and pains
· Fatigue or low energy
· Changes in sleep (too much or too little)
· Appetite or weight changes
Cognitive and Behavioral Changes
· Trouble concentrating or making decisions
· Withdrawing from family, friends, or usual routines
· Neglecting personal care (hygiene, medication, meals)
· Slower movement or speech
Anxiety-Related Signs
· Excessive worry or fear
· Restlessness or feeling “on edge”
· Avoiding certain places or activities
· Physical signs like rapid heartbeat or shortness of breath
Serious Warning Signs
· Thoughts of death or suicide
· Feeling like a burden or that life has no purpose
· Confusion that is new or sudden (check that this is not related to dementia)
These are basically the same signs of mental illness in anyone, which is why learning about mental illness is so important for all of us. As far as the elderly it is most important to notice changes in mood, behavior, energy levels, and social engagement. The mental health of the elderly is an important social issue. It is one that needs more attention. Share this post with anyone who might be in a position to help an elderly person with their mental health.
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