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Advocating for Older Adults


A Training Resource

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T

Mental Health Problems in Older Adults

It is estimated that 20% of people age 55 years or older experience some type of mental health concern (AAGP,2008). The most common conditions include anxiety, severe cognitive impairment, and mood disorders (such as depression or bipolar disorder) (AAGP,2008).

Mental health issues are often implicated as a factor in cases of suicide. Older men have the highest suicide rate of any age group (WISQARS, 2007). Men aged 85 years or older have a suicide rate of 45.23 per 100,000, compared to an overall rate of 11.01 per 100,000 for all ages (WISQARS, 2007).

Depression, a type of mood disorder, is the most prevalent mental health problem among older adults. It is associated with distress and suffering (DHHS, 2008). It also can lead to impairments in physical, mental, and social functioning (DHHS, 2008). The presence of depressive disorders often adversely affects the course and complicates the treatment of other chronic diseases (Chapman, et al., 2005). Older adults with depression visit the doctor and emergency room more often, use more medication, incur higher outpatient charges, and stay longer in the hospital (DHHS, 2008).  Although the rate of older adults with depressive symptoms tends to increase with age (DHHS, 2008),depression is not a normal part of growing older. Rather, in 80% of cases it is a treatable condition (Chapman, et al., 2005). Unfortunately, depressive disorders are a widely under-recognized condition and often are untreated or undertreated among older adults (DHHS, 2008).

The State of Social and Emotional Support of Seniors

CDC’s Behavioral Risk Factor Surveillance System (BRFSS) Question “How often do you get the social and emotional support you need?” The response options included:  “always”,  “usually”, “sometimes”, “rarely”, or “never.” (CDC, 2006)

  • Adequate social and emotional support is associated with reduced risk of mental illness, physical illness, and mortality.
  • The majority (nearly 90%) of adults age 50 or older indicated that they are receiving adequate amounts of support.
  • Adults age 65 or older were more likely than adults age 50–64 to report that they “rarely” or “never” received the social and emotional support they needed (12.2% compared to 8.1%, respectively).
  • Approximately one-fifth of Hispanic and other, non-Hispanic adults age 65 years or older reported that they were not receiving the support they need, compared to about one-tenth of older white adults.
  • Among adults age 50 or older, men were more likely than women to  report they “rarely” or “never” received the support they needed (11.39% compared to 8.49%) (Strine, et al, 2008).
The State of Life Satisfaction among Seniors

BRFSS question: In general, how satisfied are you with your life?” The response options included:  “very satisfied”, “satisfied”, “dissatisfied”, or “ very dissatisfied.” (CDC, 2006)

  • Life satisfaction is the self-evaluation of one’s life as a whole, and is  influenced by socioeconomic, health, and environmental factors (Strine, et al, 2008).
  • Life dissatisfaction is associated with obesity and risky health behaviors such as smoking, physical inactivity, and heavy drinking (Strine, et al, 2008).
  • Nearly 95% of adults age 50 or older reported being “satisfied” or “very satisfied” with their lives, with approximately 5% indicating that they were  “dissatisfied” or “very dissatisfied” with their lives.
  • Adults age 50–64 were more likely than adults age 65 or older to report that they were “dissatisfied” or “very dissatisfied” with their lives (5.8% compared to 3.5%, respectively).
  • Other, non-Hispanic adults age 50–64 were the group most likely to report that they were “dissatisfied” or “very dissatisfied” with their lives (9.7% compared to 7.0% of Hispanics, 7.2% of black, non-Hispanic adults, and 5.25% of white, non-Hispanic adults in the same age group).
  • Men and women age 50 or older reported similar rates of life satisfaction (4.7% to 5.0%, respectively).
The State of Frequent Mental Distress Among Seniors

 BRFSS Question: “Now thinking about your mental health, which includes stress, depression and problems with emotions, for how many days during the past 30 days was your mental health not good?” People who reported 14 or more days of poor mental health were defined as having frequent mental distress (FMD).

  • Frequent mental distress (FMD) may interfere with major life activities, such as eating well, maintaining a household, working, or sustaining personal relationships. 
  • FMD can also affect physical health. Older adults with FMD were more likely to engage in behaviors that can contribute to poor health, such as  smoking, not getting recommend amounts of exercise, or eating a diet with few fruits and vegetables (McGuire, et al., 2007).
  • The overwhelming majority of older adults did not experience FMD in fact, in 2006, the prevalence of FMD was only 9.2% among U.S. adults age 50 or older and 6.5% among those age 65 or older.
  • Hispanics had a higher prevalence of FMD (13.2%) compared to white, non-Hispanics (8.3%) or black, non-Hispanics (11.1%).
  • Women aged 50-64 and 65 or older reported more FMD than men in the same age groups (13.2% and 7.7% compared to 9.1% and 5.0%, respectively).
State of Current Depression

 BRFSS Question: Current Depression A PHQ-8 score of 10 or greater.

  • Depression is more than just a passing mood.  Rather, it is a condition in which one may experience persistent sadness, withdrawal from previously enjoyed activities, difficulty sleeping, physical discomforts, and feeling “slowed down” (McGuire, et al., 2007).
  • Risk factors for late-onset depression included widowhood, physical illness, low educational attainment (less than high school), impaired functional status, and heavy alcohol consumption (UDH, 1999).
  • Depression is one of the most successfully treated illnesses. There are highly effective treatments for depression in late life, and most depressed older adults can improve dramatically from treatment (McGuire, et al., 2007).
  • Contrary to popular belief, most adults age 50 or older were not currently depressed      only 7.7% in this age group reported current depression, and 15.7% reported a lifetime diagnosis of depression.
Lifetime Diagnosis of Depression of Aging Seniors

BRFSS Question: Lifetime Diagnosis of Depression “Has a doctor or other healthcare provider EVER told you that you have a depressive disorder (including depression, major depression, dysthymia, or minor depression)?”

  • In 2006, adults age 50–64 reported more current depression and lifetime diagnosis of depression than adults age 65 or older (9.4% compared with 5.0% for current depressive symptoms and 19.3% compared with 10.5% for lifetime diagnosis of depression, respectively).
  • Hispanic adults age 50 or older reported more  current depression than white, non-Hispanic, black, non-Hispanic adults, or other, non-Hispanic adults (11.4% compared to 6.8%, 9.0%, and 11%, respectively). 
  • Women age 50 or older reported more current and lifetime diagnosis of depression than men (8.9% compared to 6.2% for current depressive symptoms; 19.1% compared to 11.7% for lifetime diagnosis).
Lifetime Diagnosis of Anxiety Disorder

BRFSS Question “Has a doctor or other healthcare provider EVER told you that you have an anxiety disorder (including acute stress disorder, anxiety, generalized anxiety disorder, obsessive-compulsive disorder, panic attacks, panic disorder, phobia, posttraumatic stress disorder, or social anxiety disorder)?”

  • Anxiety, like depression, is among the most prevalent mental health problems among older adults (6).  The two conditions often go hand in hand, with almost half of older adults who are diagnosed with a major depression also meeting the criteria for anxiety (ADDA,2008). 
  • Late-life anxiety is not well understood but is believed to be as common in older adults as in younger age groups (although how and when it appears is distinctly different in older adults). Anxiety in this age group may be underestimated because older adults are less likely to report psychiatric symptoms and more likely to emphasize physical complaints (ADDA,2008).
  • More than 90% of adults age 50 or older did not report a lifetime diagnosis of anxiety.  
  • Adults age 50–64 reported a lifetime diagnosis of an existing anxiety disorder more than adults age 65 or older (12.7% compared to 7.6%).
  • Hispanic adults age 50 or older were slightly more likely to report a lifetime diagnosis of an anxiety disorder compared to white, non-Hispanic, black, non-Hispanic, or other, non-Hispanic adults (14.5%compared to 12.6%, 11% and 14.2%, respectively).
  • Women age 50–64 years report a lifetime diagnosis of an anxiety disorder more often than men in this age group (16.1% compared to 9.2%, respectively.)
References on BRFSS Findings

American Association of Geriatric Psychiatry (AAGP) (2008). Geriatrics and mental health—the facts.  Available at:  (accessed June 23, 2008).

Anxiety Disorders Association of America (ADDA) (2008). New thinking on anxiety and aging: Anxiety disorders common in the elderly. Available at:  (accessed June 23, 2008).

CDC, (2006). Behavioral Risk Factor Surveillance System (BRFSS)

Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. (2008)  The State of Mental Health and Aging in America, Issue Brief 1: What Do the Data Tell Us?  Atlanta, GA: National Association of Chronic Disease Directors.

Chapman, D.P., Perry, G.S., Strine, T.W. (2005). The vital link between chronic disease and depressive disorders. Preventing Chronic Disease (PCD), 2(1):A14.

McGuire, L.C., Strine, T.W., Okoro, C.A., Ahluwalia, I.B., & Ford, E.S. (2007).  Modifiable Characteristics of a Healthy Lifestyle in U.S. Older Adults with or without Frequent Mental Distress, 2003 Behavioral Risk Factor Surveillance System.  American Journal of Geriatric Psychiatry, 15(9):754-761.

Strine, T.W., Chapman D.P., Balluz, L., Mokdad, A.H. (2008). Health-related quality of life and health behaviors by social and emotional support: Their relevance to psychiatry and medicine. Social Psychiatry and Psychiatric Epidemiology 43:151-159.

U.S. Department of Health and Human Services (1999). Older Adults and Mental Health. In: Mental Health: A Report of the Surgeon General. Available at: (Accessed June 10, 2008).

Web-based Injury Statistics and Query Reporting System (WISQARS) (Online). National  Center for Injury Prevention and Control, Centers for Disease Control and Prevention  (producer). Available at:  (accessed June 10, 2008).

Aging Seniors Beliefs About Themselves Which Need Our Continuous Advocacy

  • I was and still am abandoned
  • I am all alone
  • I am worthless
  • No One Care about me
  • I am forgotten
  • I am useless
  • I would be better off dead
  • I am a burden on my family
  • I have nothing to offer anybody to keep me relevant
  • I should have died years ago
  • I should have done a better retirement plan
  • I should still be working fulltime
  • My life is meaningless
  • I should get out of here and live on my own
  • I should not put up with the caregiving I am being given
  • I should run away
  • I should escape this life
  • I should not allow these people to help me
  • I should not
  • Why Try? Just Give Up!
  • I am ignored by family, friends, and staff here
Why Advocate for Aging Seniors?

 Aging Seniors need to: 
  • find their own voices of self-affirmation
  • squash their irrational beliefs that keep them silent and afraid
  • learn how to turn their irrational thinking into rational calming thinking
  • find new supportive companions on their life’s journey
  • understand that it is not unusual to have fears and dread as one grows old
  • accept that you are an advocate for them
  • recognize that their negative beliefs are just that negative and need to be changed
What are some outcomes which can come from our Advocacy for Aging Seniors?

 Aging Seniors can:
  • Turn their negative beliefs around to be more positive
  • Develop new supportive relationships with others in their current circumstances
  • Learn to trust their caregivers in their current living settings
  • Grow in self-esteem and lessen their loneliness
  • Believe in their worth and value and learn to express them in more positive ways
  • Accept life on life’s terms
  • Accept that their life today does not need to be dictated by their life being raised in their families of origin
  • Forgive those who have failed them and let go of their resentment towards them
Why do Aging Seniors Need our Advocacy?
 Aging Seniors need our advocacy because they are often:
  • not listened to or ignored
  • afraid to speak up for their rights and needs
  • not treated adultlike but rather childlike
  • forgotten and invisible to people who need to see and hear them
  • feeling all alone out there in the world with no advocates working with and for them
  • treated just like “money makers” or “products” for professionals who work with them
  • not respected as human beings deserving respect, honesty and generosity
  • continuously reminded that they need to be silent and let others do their talking for them
Organizations Advocating for Seniors 

 AARP a nonprofit, nonpartisan organization that empowers people to choose how they live as they age.  at:
Administration on Aging (AoA) at:
Alzheimer’s Association at:
American Society on Aging at:
Agewell Foundation-Self-respect in Old Age at:

CARIE (Center for Advocacy for the Rights and Interests of Elders) at:

engAGED The National Resource Center for Engaging Older Adults at:

Justice in Aging Fighting Senior Poverty Through Law at:
KFF Health News at:

Legal Advocates for Seniors and People with Disabilities at:

National Aging and Disability Transportation Center at:

National Center on Elder Abuse at At:
National Consumer Voice for Quality Long-Term Care  at:
National Council on Aging at:

NHCOA - National Hispanic Council on Aging at:

NICOA – National Indian Council on Aging at:
National Institute on Aging at:
Pension Rights Center at:
Sage-  Advocacy & Services for LGBTQ+Elders at:
Senior Medicare Patrol –Preventing Medicare Fraud at:

USAging - Leaders in Aging Well at Home at:
 Organizations Advocating for the Aging Seniors’ Mental Health

Alliance for Aging Research at:

American Association for Geriatric Psychiatry (AAGP) at:

Geriatric Mental Health Alliance at:

NAMI (National Alliance on Mental Health) at: