Mental Health Resources: How Older Adults and Their Loved Ones Can Get Support

Mental health is an important part of healthy aging. Seniors face many mental health challenges as they age, some unique to them and others common throughout the population.

The World Health Organization estimates that as many as 15% of seniors live with at least one mental health issue, while millions more go undiagnosed.

Some mental health conditions can be treated with medication and therapy, while others defy treatment. It often falls to caregivers and other loved ones to spot the signs of mental health conditions among the seniors they care for and to arrange help as early as possible in the disease process.

Fortunately, many resources are available – many at low or no cost – to help seniors manage a chronic mental health condition and carry on with as much dignity and independence as possible.

Major Mental Health Concerns for Seniors

Millions of American seniors live with at least one mental health condition that impairs their ability to live a productive and happy life.

Some of the mental health conditions seniors face are age-related and unique to their community, while others are widespread in the population.

Caregivers and others who look after seniors must know about the most common mental health issues among seniors, as well as what to do when a senior shows signs of them.

Depression

Depression is a very common mental health issue for adults in the United States. More than 7% of all Americans report having had at least one major episode of depression in their lives, and over 4% of seniors in the United States currently deal with this condition.

While episodes of depression are not rare, and a bout of sadness and emotional distress is common in response to major life stress or trauma, clinical depression is the result of a chemical imbalance in the brain. This imbalance can leave people with the disease exhausted, withdrawn, unmotivated and isolated.

Severe depression can cause thoughts of self-harm, and it is associated with negative health outcomes from almost every other condition a senior might have, including purely physical ailments.

Signs of depression include a withdrawal from community, family and friends, refusal to leave the home environment, increased or diminished appetite, sleep disturbances and a host of other troubling symptoms.

People who are suffering from suicidal thoughts or other disturbed behavior sometimes give away valued possessions or alienate friends.

Depression is serious, and any of the signs of the disease must be treated as an urgent mental health issue. This is especially so for seniors, who often lack the support network they need to identify depression on their own and to seek help.

Alzheimer’s Disease and Dementia

Alzheimer’s disease is the most common form of dementia, a progressive decay in a senior’s mental and cognitive abilities. Dementia is almost unique to seniors aged 65 and over, though early onset does sometimes occur among younger adults.

At least 5.5 million American adults have been diagnosed with Alzheimer’s disease, with an estimated 24 million more worldwide.

Alzheimer’s disease can begin slowly and take years to get noticed, or it can rapidly progress and change a senior’s life in just a few months. The disease is characterized by a loss of memory, verbal and sometimes physical abilities, and gradual decay in a senior’s ability to recognize the people they know and to perform basic tasks.

Much of the time, a senior with some form of dementia has needs that go beyond a family’s ability to provide for, and care has to be arranged in a special treatment unit specializing in memory care.

Anxiety

Anxiety is often overlooked among seniors, but the condition is as serious for them as it is for younger adults.

Serious anxiety affects 12.7% of adults aged 50 to 64, while 7.6% of seniors aged 65 and over report having an anxiety disorder. The condition ranges in severity from general unease and moderate difficulty in social settings, to serious symptoms, such as obsessive thoughts and panic attacks.

Seniors with anxiety are likely to have disturbed sleep and high blood pressure, as well as many of the conditions that go along with these health problems. Anxiety is also frequently found along with depression, which can make treating either condition more difficult.

The CDC speculates that many seniors hesitate to report the symptoms of anxiety, either because they are mistaken for physical ailments or dismissed as unimportant.

Bipolar Disorder

Bipolar disorder is a poorly understood condition that affects between 0.1% and 0.4% of all seniors in the United States. While the absolute numbers for bipolar disorder are low, relative to Alzheimer’s or depression, the manic swings this affective disorder causes can inflict severe distress on seniors and those who care for them.

A senior going through a manic episode might have forced speech, rapid movements and an agitated demeanor.

Manic periods often see wild ideas and delusional thinking go unchecked, which can lead to self-harm or reckless risk-seeking behavior. The National Institutes of Health estimates that between 5% and 10% of all senior hospitalizations for mental health issues are related to a manic episode.

After the manic phase has passed, it is not uncommon for seniors with bipolar disorder to suffer from severe depression. This comes with almost all of the symptoms of clinical depression, which frequently leads to its misdiagnosis and less effective treatment.

It is important to give a doctor a complete health history, including any recent bouts of disturbed behavior, to help develop an accurate diagnosis of bipolar disorder.

Schizophrenia

Schizophrenia is a very common mental health condition that can cause disturbed thinking, auditory and visual hallucinations, paranoia and even violent episodes. Even when medicated, schizophrenia can encourage inappropriate emotional outbursts and odd behavior.

While most new cases of schizophrenia are diagnosed among young adults in their late teens and early 20s, seniors aged 55 and over now make up 25% of all schizophrenia diagnoses, with the disorder ranked third among mental health concerns for senior patients.

There is no obvious trigger for schizophrenia, which can come on suddenly or gradually.

Early signs of the disorder can be very subtle, such as an odd word or idea expressed at an inappropriate time. There could also be a sudden and severe psychotic break, in which the senior with schizophrenia becomes very difficult to reason with or to prevent from engaging in self-harm.

Seniors suffering from a bout of schizophrenia, or of symptoms that resemble the disorder, must be seen by a psychiatrist as soon as possible.

Because of the sudden nature of some episodes, the condition has to be treated as a mental health emergency in need of immediate intervention, which can include inpatient admission to a specialized psychiatric hospital.

Symptoms of Mental Health Disorders and Signs of a Crisis

Mental health issues can often be identified by specific symptoms that are indicators of a known condition. Often, however, a senior with a mental health issue shows only vague symptoms or a general range of signs that are consistent with many mental health disorders.

Caregivers and loved ones should learn to spot some of the most common signs of a mental health issue, especially symptoms that could indicate an emergency that calls for immediate intervention.

Depression Symptoms

Common signs of depression include:

• Sadness that is seemingly unconnected with sad events, such as a death or other loss
• Social withdrawal
• Moodiness and sometimes hostility to visitors and loved ones
• Insomnia or daytime sleeping
• Nightmares
• Alcohol or drug consumption, especially as an attempt to regulate mood
• Suicidal thoughts or statements
• Periods of inactivity and seeming apathy

The symptoms of depression can be a sign of any number of conditions operating underneath the surface. Symptoms of depression often occur as a result of anxiety, psychosis, epilepsy and physical ailments.

Depression is also common among seniors dealing with short-term emotional stress or as a reaction to seasonal changes. The symptoms may even be uncaused, last for only a short time and clear up on their own.

The signs of depression could still be caused by a serious underlying condition, which is best identified and treated if necessary by a psychiatric professional.

Anxiety Symptoms

Like depression, anxiety is also a common symptom of mental health issues, in addition to being a condition on its own.

Many physical ailments can induce a feeling of acute anxiety, such as a heart attack or stroke.

Mental health issues also often present the symptoms of anxiety, such as a rapid heart rate, sweating, labored breathing and feelings of pain or pressure in the chest. Acute anxiety attacks can be part of an anxiety disorder, a psychotic episode caused by schizophrenia or another, unrelated cause.

Because of the wide range of conditions associated with anxiety, and the potentially life-threatening nature of a few of the less common conditions that cause it, it is important to quickly seek medical help for persistent symptoms of anxiety.

Seek out psychiatric or medical help if the symptoms of anxiety persist, or if there are other symptoms present, such as depression or hallucinations.

Changes in Appearance or Housekeeping

Not all mental health issues show up in behavior changes or during a visit. Many can leave their mark on the way a senior maintains personal hygiene and housekeeping standards.

A usually fastidious person who suddenly becomes unkempt, or whose home condition begins to deteriorate, might be experiencing a loss of mental or emotional control associated with a developing mental health condition.

This can also rarely happen in reverse, when a senior who keeps a usually cluttered home suddenly organizes everything and compulsively cleans.

While there are less than ominous reasons for this to happen, it can also be a sign of mania or compulsive behavior.

Confusion, Poor Concentration and Unsafe Decisions

Many of the progressive diseases associated with age come on gradually.

The progress of a disease like Alzheimer’s can be slow and uneven, with plenty of time for loved ones to adjust to the “new normal” of behavior, which can seriously delay the point where help is sought. Sometimes, however, caregivers and loved ones can observe a dramatic shift in ability or behavior over a very short span of time.

Many seniors with Alzheimer’s disease, Huntington’s chorea or another form of dementia start to show noticeable confusion about where they are, who they are and what date or year it is. Some of this can be normal forgetfulness, but a consistent pattern of this behavior merits an examination.

Changes to Appetite or Weight

Depression, anxiety and several other conditions can manifest themselves as an increased or diminished appetite. Seniors with any number of underlying conditions may swiftly gain or lose weight, and either can be a serious sign to watch for.

Overeating or loss of ability to exercise often cause a rapid increase in weight, which can bring health consequences of its own. Rapid weight loss can be caused by all of the same disorders, but it can also be a sign of elder abuse, neglect or a serious physical ailment that has not been diagnosed.

If a senior you care for has gained or lost a significant fraction of body weight in a relatively short time, a physical and mental health evaluation could identify the issue and get treatment started early enough to make a difference.

Memory or Language Loss

Alzheimer’s disease is not the only memory disorder seniors can face. Apart from the diseases of aging, including almost all forms of dementia, certain psychotic illnesses and even manic episodes can be accompanied by a loss of memory.

The inability to recall long-remembered facts and events, or to identify the face or voice of a loved one, is a very troubling sign that should be investigated at once. While ordinary forgetfulness is a normal part of growing older, a consistent pattern of memory impairment is almost always cause for a memory care evaluation.

Likewise, language loss is often a sign of cognitive decline that may be caused by advancing Alzheimer’s disease, or it could be a sign of something else serious. Seniors sometimes fall and suffer trauma, which can cause difficulty understanding or responding to speech.

Trauma or a stroke on the left side of the brain can cause weakness on the right side of the body, slurred or disconnected speech and potentially a dilated pupil in one eye.

If any of these symptoms are observed, get immediate medical attention at the nearest emergency department.

Improving Seniors’ Mental Health

It isn’t always possible to improve a mental health condition. This is especially true for seniors with certain irreversible disorders.

Part of the challenge of helping a senior manage a mental health issue for family and other loved ones is coming to terms with the progressive nature of many disorders and adapting to diminished capacity.

That does not mean seniors and families are helpless, however. Many conditions do show improvement with regular therapy and proper medication.

Prevention may also be possible, or at least the onset of serious symptoms may be delayed, with a host of practices aimed at keeping seniors alert and oriented during the day. Even incurable mental health conditions can be managed with effort and attention.

For seniors with a progressive mental or cognitive decline, ongoing treatment is often aimed toward maintaining the highest quality of life possible for several years, rather than a reversal of symptoms that may never occur.

In general, senior interventions can be grouped into three categories: Prevention, treatment and ongoing therapy to maintain quality of life.

Many of the activities in each category overlap with others, and most seniors with mental health issues could benefit from more than one approach to managing their conditions.

Prevention

Much of the science on senior mental health is inconclusive about the causes of cognitive decline with age. There doesn’t seem to be one single cause for many of the most common age-related mental health issues.

Despite the mystery of some illness’ origins, seniors can take steps early on to prevent or to slow the appearance of age-related decline.

Positive social interactions are both mentally stimulating and refreshing for many seniors, who are more likely than younger adults to report loneliness and isolation. Regular card games, sporting events, social dinners and other events with peers provide much of the attention and interaction seniors need to stay engaged.

Volunteer service is popular with active seniors, not just to give back to their community but to stay busy and engaged. While heavy lifting might be difficult for aging citizens, many seniors keep active volunteering at food banks, hospitals and homeless shelters.

Several nonprofit organizations, such as the Salvation Army, depend on seniors to keep running, and the opportunity to volunteer doubles as a source for new friends and the social interactions that help fight depression.

Treatment

Once a mental or cognitive issue has surfaced, it doesn’t automatically proceed unchecked. Many seniors are able to live for many years with minimal or limited impairment, often with the aid of mentally stimulating exercises they do each day. These can be games and other events at an assisted living community or care home, or they can be regular activities with family and friends.

Learning new games and taking up hobbies are two outstanding ways to keep seniors’ minds active. Board games, such as backgammon or chess, can help sharpen the minds of seniors with limited mobility, while gardening and supervised walks can be positive exercise for seniors with more advanced dementia.

Some hobbies are social, such as collecting and trading stamps with people all over the world. These activities can also help fight off feelings of isolation and depression.

Therapy

Despite the effort of caregivers and loved ones, many seniors’ mental health conditions eventually progress to the point where normal activities have become difficult or impossible.

When a senior you care for has advanced to this point, there are still numerous options open for healthy activities to keep them engaged and preserve a high quality of life.

With a doctor’s approval and close supervision, seniors with almost all stages of Alzheimer’s disease can enjoy walks outdoors, group swim activities in a pool, or simple and unchallenging ball games.

Many adult day programs offer these types of activities, as well as painting, music and other art programs. Some facilities also keep pets, which are often some of the best companions seniors with mental health conditions can have.

Medicare and Medicaid Assistance for Mental Health Issues

Medicare and Medicaid both offer extensive services for seniors with all stages of mental health or cognitive decline.

Medicare is the most common health insurance program for seniors in the United States, covering over 60 million seniors.

Seniors are often enrolled in Medicare Part A automatically when they reach age 65. They can also call 1-800-MEDICARE for information or for a phone application.

Medicaid provides basic health insurance for many seniors with low or fixed incomes. Preventive care, hospitalization, prescription drugs and many mental health conditions are covered by Medicaid in every state.

National Senior Mental Health Resources

MentalHealth.gov – Provides comprehensive advice and referrals for seniors who need help with a mental health issue.

Suicide Prevention Lifeline – A 24-hour helpline for mental health emergencies, especially involving self-harm. Can be reached by calling: 1-800-273-TALK (8255).

SAMHSA’s National Helpline – Provides confidential and free drug, alcohol and mental health referrals by phone. Call 1-800-662-HELP (4357) to speak with a volunteer.

Veteran's Crisis Line – Volunteer phone responders who work for the VA, many of whom are also veterans, who can intervene during a mental health crisis and refer family members to VA-approved mental health resources.

Geriatric Mental Health Foundation – Acts as an online compendium of information about mental health providers, institutional supports for seniors and various community resources for family members.