Mental Health Disorders Common in
Older Adult Population
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Gerontology
A Training Resource
By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T
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Introduction
Over 20% of adults ages 55 or older have had a mental health concern, but only about two out of three receive treatment (CDC, 2019). While mental illness in the elderly is often overlooked and challenging to diagnose, its effects can greatly diminish a senior’s health and well-being, complicate the treatment of other chronic diseases, and even lead to death (East, 2018)
Mental Health Statistics for Older Adults
- According to the World Health Organization, mental disorders affect approximately 15% of the population over the age of sixty, a number that is expected to increase substantially as the population ages. (WHO, 2017).- Anxiety disorders affect 3.8% of the older population (WHO, 2017).- The CDC reports that an estimated 20% of people fifty-five and older have some type of mental health concern (CDC, 2019).- Depression affects up to 5% of older adults, but that number jumps to around 13.5% for those requiring home healthcare (CDC, 2019).- Men ages seventy-five and older have a higher suicide rate than any other age group (38 per 100,000) (Tavernise, 2016).
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National Older Adult Mental Health Awareness Day 2019
On Monday, May 20, 2019, the Substance Abuse and Mental Health Services Administration (SAMHSA) hosted National Older Adult Mental Health Awareness Day 2019 at the U.S. Department of Health and Human Services’ Hubert H. Humphrey Building in Washington, DC. Along with SAMHSA, the Administration for Community Living served as a federal co-sponsor, with the National Coalition on Mental Health and Aging as a non-federal co-sponsor.
- The Assistant Secretary for Mental Health and Substance Use, Elinore McCance-Katz, MD, PhD and the Assistant Secretary for Aging, Lance Robertson, provided opening remarks followed by presentations on the focus areas. The event focused on prevention, treatment, and recovery services for older adults with serious mental illness and substance use the field of older adult mental health and substance use treatment;- Highlight effective suicide prevention and trauma-informed care practices for older adults; andShow how states can provide effective services for older adults, including the development of older adult peer support services.
- Watch the on-demand webcast of SAMHSA’s event to learn about prevention, treatment, and recovery supports for older adults: mental disorders; suicide prevention efforts with older adults; older adult peer support services; serving older veterans; and trauma-informed care for older adults. The event closed with a panel discussion with the speakers and National Alliance on Mental Illness (NAMI)-affiliate members offering personal stories and practical advice to assist older adults on a path to recovery.
The event was SAMHSA’s 2nd annual observance of Older Adult Mental Health Awareness Day.
The overall goals of this year’s observance were to:
- Highlight the need for prevention, treatment, and recovery practices for America’s growing older adult population, including older veterans;- Showcase evidence-based best practices in the field of older adult mental health and substance use treatment;- Highlight effective suicide prevention and trauma-informed care practices for older adults; andShow how states can provide effective services for older adults, including the development of older adult peer support services.
Watch the on-demand webcast of SAMHSA’s event to learn about prevention, treatment, and recovery supports for older adults:
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SAMHSA/ACL National Older Adult Mental Health Awareness Day 2019 Part 1 at: https://www.youtube.com/watch?v=xshOjy5m3aU
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SAMHSA/ACL National Older Adult Mental Health Awareness Day 2019 Part 2 at: https://www.youtube.com/watch?v=mQp5RMwn_Dg
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Older Adult Behavioral Health Data Profiles by Regions and States
At the National Older Adult Mental Health Awareness Day 2019, the following resources were made available so that advocates in the USA could get accurate data on the state of the Behavioral Health of older adults in their states by regions:
Region 1: (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABHealth_Profiles_Region1.pdf
Region 2: (New Jersey, New York, Puerto Rico, U.S. Virgin Islands) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABH_Profiles_Region2.pdf
Region 3: (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABH_Profiles_Region3.pdf
Region 4: (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABH_Profiles_Region4.pdf
Region 5: (Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABH_Profiles_Region5.pdf
Region 6: (Arkansas, Louisiana, New Mexico, Oklahoma, Texas) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABH_Profiles_Region_6.pdf
Region 7: (Iowa, Kansas, Missouri, Nebraska) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABH_Profiles_Region_7.pdf
Region 8: (Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABH_Profile_Region_8.pdf
Region 9: (Arizona, California, Hawaii, Nevada, AS, FSM, CNMI, Guam, MI, RP) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABHprofile_Region_9.pdf
Region 10: (Alaska, Idaho, Oregon, Washington) Download at: https://acl.gov/sites/default/files/programs/2017-06/StateTA_OABHprofile_Region10.pdf
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Why Mental Health Issues Are Not Addressed for Older Adults
It can be difficult to pick up on mental health issues among aging adults because of the unique age-related health and life challenges they face. Sometimes symptoms can be very subtle or attributable to a variety of other health conditions or life changes. Aging adults are less likely to notify a health care provider of symptoms related to mental health problems than for physical symptoms they are experiencing. This can be due to the stigma attached to mental health problems, or because the individual may not be able to explain what he or she is experiencing (East, 2018). One major problem in diagnosing and treating seniors with mental illness is that elderly individuals are more likely to report physical issues than they are psychological issues (CDC, 2019b). But even the typical emotional and physical stresses associated with aging can lead to depression or anxiety (East, 2018).
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Possible Triggers for Mental Illness in Older Adults (LifeSpeak, 2017)
- Chronic pain
- Chronic disease
- Physical impairments like thyroid or adrenal disease that affect emotion, thought, or memory
- Physical disabilities
- Loneliness
- Major life changes
- Grief
- Widowhood
- Certain medications
- Heavy alcohol consumption or drug abuse
- Malnutrition/poor diet
- Dementia-causing illness
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Symptoms of Mental Illness in the Older Adults
As people grow older, it isn’t uncommon to see changes. General forgetfulness is normal, but persistent depression, anxiety, memory loss, or other cognitive issues can be signs of something more serious.
Here are some common warning signs to look for:
• A marked change in appetite, energy level, and/or mood
• Feeling emotionally “flat” or finding it difficult to experience positive emotions
• Trouble sleeping too much, or difficulty falling and staying asleep
• Persistent thoughts of hopelessness, sadness, or suicidal thoughts
• A desire or need for drugs or alcohol
• Feeling on edge, restless, or having trouble concentrating
• Increased feelings of stress or worry
• Short-term/recent memory loss
• Anger, agitation, or increased aggressiveness
• Obsessive-compulsive behavioral tendencies or thoughts
• Unusual behaviors or thoughts directed towards others
• Behaviors or thoughts that affect social opportunities, work, or family
• Persistent digestive issues, pain, or headaches not explained by other health problems
• Difficulty managing finances or tasks involving numbers
• Problems with grooming or household maintenance (NIH, 2019)
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African American Older Adults and COVID-19:
Addressing Mental Health Needs, Supporting Strengths
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Common Mental Health Disorders of Older Adults
Here are some of the most common mental health illnesses experienced by aging adults:
1. Depression
Depression is a type of mood disorder that ranks as the most pervasive mental health concern among older adults. If untreated, it can lead to physical and mental impairments and impede social functioning. Additionally, depression can interfere with the symptoms and treatment of other chronic health problems (NIH, 2019). Common symptoms of depression include ongoing sadness, problems sleeping, physical pain or discomfort, distancing from activities previously enjoyed, and a general “slowing down.” Aging Adults suffering from depression generally visit ERs and doctors more frequently, take more medications, and experience longer hospital stays than their same-age peers. Women are more likely to be affected than men (East, 2018).
Late-Onset Depression Risk Factors to Watch Out For
- Physical Illness
- Widowhood
- Lack of education (below high school level)
- Diminished functional status
- Heavy drinking
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Treatment for Depression available from Evidence Based Practices for Mental Health Professionals: An Online Book (Messina, 2014)
Chapter 6 Depressive Disorders
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2. Anxiety Disorders
Anxiety is a very common mood disorder among older aduts. In fact, these two problems often appear in tandem. Statistics from the CDC show that nearly half of older adults with anxiety also experience depression (CDC, 2019b). Anxiety in aging adults is thought to be underdiagnosed because older adults tend to emphasize physical problems and downplay psychiatric symptoms. Women in this age group are more likely to be diagnosed with an anxiety disorder than men (East, 2018)
Risk Factors for Anxiety Disorders in Older Adults
Anxiety in the elderly is linked to a number of risk factors, including but not limited to:
- General feelings of poor health
- Sleeping problems
- COPD, certain cardiovascular diseases, diabetes, thyroid disease, and related chronic conditions
- Side effects caused by certain medications
- The abuse/misuse of alcohol, street drugs, or prescription drugs
- Physical impairments limiting daily functioning
- Stressful events like the death of a spouse, serious medical condition, or other life-altering event
- Traumatic or difficult childhood
- Perseveration on physical symptoms (MHA, 2015).
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Types of Anxiety Disorders which older adults experience:
A. Generalized Anxiety Disorder: The effects of generalized anxiety include persistent worry or fear, which can get progressively worse with time.These symptoms eventually interfere with socialization, job performance, and day-to-day activities. Seniors with anxiety tend to become more withdrawn and reclusive.
Symptoms and Signs of Generalized Anxiety Disorders in Older Adults
Elderly individuals with generalized anxiety may experience the following symptoms: [x]
- Excessive, uncontrollable worry/anxiety
- Edginess, nervousness, or restlessness
- Chronic fatigue or tiring out easily
- Become irritable or agitated
- Poor quality of sleep or difficulty falling/staying asleep
- Tense muscles (NIH, 2019).
B. Phobia: An extreme, paralyzing fear of something that usually poses no threat, phobias can cause individuals to avoid certain things or situations due to irrational fears. Examples can include fear of social situations, flying, germs, driving, etc.
C. Panic disorder: This disorder is characterized by periods of sudden, intense fear that can be accompanied by heart palpitations or pounding, rapid heartbeat, shaking, sweating, difficulty breathing, or experiencing feelings of doom.
Symptoms of Panic Disorder
- Sudden, repeated bouts of intense fear
- Feeling powerless or out of control
- Persistent worry about the “next” attack
- Avoiding situations where past panic attacks have occurred
D. Social Anxiety Disorder: This social phobia causes individuals to fear being in certain social situations where they feel they might be judged, embarrassed, offensive to others, or rejected.
Social Phobia Symptoms
- Extreme anxiousness about being with others
- Difficulty talking to others in social situations
- Self-consciousness in social settings
- Fear of being judged, humiliated, or rejected
- Fear of offending others
- Worrying about attending social events long before they take place
- Avoiding social situations
- Difficulty with friendships
- Feeling queasy around other people
- Sweating, blushing or shaking around others
E. Post-Traumatic Stress Disorder: PTSD is a disorder that usually manifests following a traumatic event that threatens a person’s safety or survival, greatly impacting his or her quality of life.
Symptoms of PTSD
- Emotional numbness
- Flashbacks to the event
- Nightmares
- Depression
- Irritability
- Easily distracted or startled
- Anger
F. Obsessive-Compulsive Disorder: Those who suffer from OCD experience uncontrollable recurring thoughts (obsessions) or rituals (compulsions). Examples of rituals include washing hands, checking if appliances are on or off, counting, or other behaviors typically done to quell obsessive thoughts (e.g. washing hands repeatedly to remove germs and avoid getting sick).
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Treatment for Anxiety Disorders available from Evidence Based Practices for Mental Health Professionals: An Online Book (Messina, 2014)
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3. Bipolar Disorder
Bipolar disorder or manic-depressive illness is often marked by unusual mood shifts and are frequently misdiagnosed in senior citizens because the symptoms presented are typical with the aging process, especially related to dementia and Alzheimer’s. Bipolar disorder occurs equally among women and men in this age group.
While younger people in the manic phase of bipolar disorder will show classic signs like elation and risky behavior, seniors are likely to become more agitated or irritable (Bipolar Lives, 2019).
Late-Onset Bipolar Disorder Symptoms
- Confusion
- Agitation
- Irritability
- Hyperactivity
- Psychosis
- Cognitive issues including memory problems, trouble problem solving, loss of judgment, and loss of perception
Effects of certain medication and some types of illnesses show similar symptoms of bipolar disorder. The individual should be seen and diagnosed by a medical professional to determine the root cause of any symptoms as well as the best options for treatment (East, 2018).
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Treatment for Bipolar Disorder available from Evidence Based Practices for Mental Health Professionals: An Online Book (Messina, 2014)
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4. Eating Disorders
Eating disorders like bulimia and anorexia nervosa are becoming increasingly prevalent among the elderly. Underlying behavioral or psychological issues that cause and exacerbate eating disorders can go undetected for quite a while before an eating disorder can be identified and treated, making it especially dangerous (NIH, 2019).
Underlying Factors for Eating Disorders in the Elderly
- Changes in taste and smell (often due to medications)
- Persistent, untreated psychological issues from youth
- Memory/cognitive impairment
- Loss of a loved one
- Attention-seeking behavior
- Depression
- Other physical ailments
Eating Disorders – Signs to Watch For
- Unexplained weight fluctuations (especially weight loss)
- Anemia and muscle weakness/wasting
- Increase in falls
- Memory deficits
- Cognitive decline
- Depression
- Loss of appetite
- Slow healing
- Chronic dizziness
- Unopened or uneaten food in the fridge or cupboards
- Decrease in food intake or rejection of meals
- Use of laxatives (for purging)
Because elderly individuals face many unique challenges like loose dentures, digestive issues, medications, or other health problems that affect appetite and eating, it’s important not to make assumptions as to whether he or she has an eating disorder (EatingDisorders.com, 2019). Instead, alert the aging adult’s family and care team to make sure they get the care needed for proper diagnosis and treatment.
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Treatment for Eating Disorders available from Evidence Based Practices for Mental Health Professionals: An Online Book (Messina, 2014)
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References
Bipolar Lives (2019). Bipolar disorder: How common is it in seniors? Retrieved at:
https://www.bipolar-lives.com/bipolar-disorder-and-seniors.html
Center for Disease Control and Prevention (CDC) (2019a). Alzheimer’s disease and
healthy aging-Depression is not a normal part of growing old retrieved at: https://www.cdc.gov/aging/mentalhealth/depression.htm
Center for Disease Control and Prevention (CDC), (2019b). The state of mental health
and aging in America. Retrieved at: https://www.cdc.gov/aging/pdf/mental_health.pdf
East, A. (2018). Four common mental health illness in the elderly: Learn the risk factors
and Symptoms. Caring People, March 27, 2018 retrieved at: https://caringpeopleinc.com/blog/mental-illnesses-in-the-elderly/
EatingDisorders.com (2019). Eating disorders in elderly patients. Retrieved at:
https://eatingdisorders.com/articles/general/eating-disorders-in-elderly-patients
LifeSpeak Blog (2017). How can aging affect mental health? The LifeSpeak Blog, May
1, 2017, Retrieved at: https://lifespeak.com/can-aging-affect-mental-health/
Mental Health America (MHA) (2015). Anxiety in Older Adults-Mental Health in Older
Adults. Retrieved at: http://www.mentalhealthamerica.net/anxiety-older-adults
Messina, J.J. (2014). Evidence Based Practices for Mental Health Professionals – An
Online Book. Retrieved from: http://coping.us/evidencebasedpractices.html
National Institute of Mental Health (NIH). (2019). Older adults and mental health.
Retrieved at: https://www.nimh.nih.gov/health/topics/older-adults-and-mental-health/index.shtml
Tavernise, S. (2016). U.S. suicide rate surges to a 30-year high. The New York Times,
April 22, 2016. Retrieved at: https://www.nytimes.com/2016/04/22/health/us-suicide-rate-surges-to-a-30-year-high.html
World Health Organization (WHO). (2017). Mental health of older adults. Retrieved at:
https://www.who.int/en/news-room/fact-sheets/detail/mental-health-of-older-adults
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