7 Common Mental Health Issues Among Seniors

As many people live longer and healthier lives, the medical community is realizing that mental health is an important piece of the puzzle. Symptoms that are seen as natural consequences of getting older may actually be signs of a condition that requires treatment. A report from the National Academy of Medicine indicates that as many as 1 in 5 seniors has a mental health condition. To better understand the challenges facing older adults, and what can be done to recognize and address those conditions, we took a close look at the most common mental health issues among seniors.

Carol Povenmire, Ph.D., is a licensed psychologist with a practice in Pasadena, California.

Depressive disorders are estimated to affect 6.5 million people who are 65 or older, according to the National Alliance on Mental Illness. While the overall rate of depression is roughly 5 percent for all seniors, the rate of depressive symptoms rises dramatically for particular sub-groups. It is estimated at 13.5 percent of those requiring home health care, according to the Centers for Disease Control and Prevention, and between 18 percent to 30 percent for seniors living in nursing homes, according to Dr. Maria DiTomasso, who specializes in geriatric psychiatry.

Depression can manifest in seniors in profoundly different ways, according to the National Institute on Aging. In some cases, depressive symptoms include waking too early in the morning, an inability to experience pleasure or enjoyment, guilt and feelings of worthlessness, and slowed thinking, speech and movement. In other cases, depression appears as negative mood with restlessness, agitation, impulsivity, irritability and inability to fall asleep. Another version might be characterized as masked depression with flat or numbed feelings, oppositional behavior and a number of physical symptoms that don't respond to treatment. One of the most serious consequences of depression is suicide. According to the American Foundation for Suicide Prevention, adults 75 and older have a higher risk for suicide than almost any other age group. 

Related: How Seniors Can Save Money on Health Care 

There are an estimated 5 million adults over the age of 65 who have dementia in the United States, according to the Centers for Disease Control and Prevention. Like depression, dementia can result in cognitive impairment and memory problems. It is important to recognize that while these conditions may occur together, both require intervention and appropriate treatment. 

Warning signs and symptoms of dementia can vary from person to person, but some common signs include changes to cognitive function, including confusion, memory loss, disorientation, or loss of motor function. Signs might also include difficulty performing common tasks, such as reasoning, communicating, organizing, or planning. Interventions for Alzheimer's and other forms of dementia may include regular exercise, a diet low in saturated fats, and adequate sleep. Mental stimulation through socialization, activities, and memory prompts, such as calendars, photographs or music, are also important factors. 

Related: How Seniors Can Boost Memory and Help Ward Off Dementia

The capacity to feel grief in response to loss is a healthy psychological response, not a mental disorder. However, grief and depression share symptoms such as changes in appetite, low energy levels, and guilt. Yet they differ in some important ways. People who are grieving see their pain as a response to a specific absence or loss, whereas people who have depression can often identify other times in their lives when they experienced a similar low mood state. 

Grief can occur in response to death, but there is also grief when a loved one is physically present but now substantially altered as a result of stroke, dementia, or other neurological conditions. Grief can be prolonged in people with a history of early loss or a traumatic childhood, or due to the circumstances of the death. When the experience of grief produces symptoms of major depression, psychotherapy and medication may be indicated.

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Sleep disorders are common in seniors. Unfortunately, sleep issues are often minimized and not prioritized by treating professionals. There is the mistaken belief that seniors are less active, so they require less sleep. But during sleep, the brain performs essential maintenance and repair functions that protect cognitive performance. It also repairs organs and metabolic systems that regulate blood sugar, blood pressure, the digestive process, and cardiac functioning. The loss of restorative sleep is now known to be a causative factor in many physical conditions (hypertension, diabetes), cognitive disorders (dementia, Alzheimer's), and psychological conditions (depression, anxiety).

Treatment of sleep disorders often involves consulting with specialists in sleep disorders. These include a board-certified sleep medicine physician, or a psychotherapist specifically trained in cognitive-behavioral therapy for insomnia. Ongoing use of sleep medications is not recommended as medications do not provide the most restful levels of sleep and can produce a "rebound insomnia" once they are stopped.

Substance abuse is often perceived to be an issue for teens and younger adults but not seniors, which can cause serious abuse and addiction to be overlooked. An estimated 2.5 million Americans 65 and older have a substance abuse problem, according to the National Council on Alcoholism and Drug Dependence. As many seniors are admitted to hospitals for substance abuse as are admitted for heart attacks. 

Substance abuse late in life can result from the same conditions and risk factors that produce late-life depression. Social isolation, treatment of chronic pain, boredom, lack of purpose, sleep disorders, and other factors can result in misuse or dependence on alcohol, opiates, or sedatives. Risks from substance abuse include falls and other accidents, drug interactions, increased depression, and overdose.

An estimated 3.8 percent of seniors have an anxiety disorder, according to the World Health Organization. Anxiety, like depression, can manifest differently in seniors than in younger age groups. Seniors might have a specific fear of falling due to poor balance and reduced mobility, or more general safety concerns. They might worry more about health issues than interpersonal or work issues.

Anxiety is associated with medical conditions such as cardiovascular disease, COPD, vestibular disorders, diabetes and thyroid disorders. It can also lead to depression and increased risk for substance abuse since alcohol and other sedatives may be used to calm anxiety. The particular forms of anxiety that tend to appear for the first time in older adults are generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD) and various phobias, particularly agoraphobia. Possible treatments include increased exercise, reduced caffeine, psychotherapy and medications.

Older adults often have multiple prescriptions for multiple medical conditions, and some have powerful mood-related side effects that can be missed. Seniors also often see more than one medical provider, and the risk of complications and unforeseen interactions increases with the number of prescribers. In addition, dosage recommendations are often based on healthy adults, and the needs of older patients with more compromised livers and kidneys may be overlooked.

There are a number of misconceptions with regard to senior mental health issues. Some of the prevalent ones are: 

• Depression and sleep disorders are mistakenly perceived to be natural consequences of getting older as opposed to symptoms that require treatment.
• Dementia is often seen as an issue arising from Alzheimer's disease, but experts note that vascular (circulation) problems may be significant causative factors for dementia.
• Substance abuse is perceived to be an issue for teens and adults, but not seniors, which often cause serious issues of abuse and addiction to be overlooked.
• Seniors are often not referred for psychological treatment due to the belief that they are unlikely to benefit. In reality, they have the same response rate as any other age group.

In addition to the myths about that persist around senior mental health, there can also be obstacles to obtaining care for those who need it. One notable factor is that most care for senior citizens is provided by primary care physicians. Physicians who have limited time to address multiple patient concerns may prioritize medical rather than psychological issues. Seniors may also describe distress in more physical rather than psychological terms, such complaining of low energy, loss of appetite, sleep challenges, trouble concentrating, or persistent aches, rather than sadness or depression.

Symptoms of psychological disorders and medical conditions can also exist independently and concurrently with each other (also known as comorbidity). For example, the effects of depression can result in reduced immune system function, increased pain perception, and poor recovery from strokes. Alzheimer's, Parkinson's disease, macular degeneration, arthritis, and diabetes are conditions that have comorbid depression risks.

While emotional well-being and cognitive functioning are not always easy to quantify, here are some clear indications that some form of support or intervention is needed.

• Changes in Mood: depressed mood for more than two weeks; agitated mood or increased impulsivity; feelings of worthlessness; suicidality.
• Changes in Personal Care: poor hygiene or grooming; dirty clothing or clothing inappropriate to weather or social situation; problems maintaining home or yard.
• Social Isolation: withdrawal from relationships or usual social activities; lack of interest in formerly important events or hobbies.
• Cognitive Issues: confusion; disorientation; memory loss, especially short-term memory loss; problems with decision-making or concentration; misplacing belongings; repetitive questions.
• Physical Issues: unusual fatigue or energy loss; sleep changes; changes in appetite; weight loss or gain; recent aches or stomach problems with no clear origin.

While mental health issues among seniors can be often be overlooked or misunderstood, an increased focus on addressing the issues, including new research, technology and public awareness, holds promise. Here are just some of the hopeful trends taking place:

• The role of exercise in maintaining and improving physical and mental health for seniors is clear. The benefits of remaining physically active include reduced pain, increased blood circulation, improved muscle strength, and better balance and stability.
• Current research is focusing on areas directly relevant to seniors. Some research is on senolytics, the cells within our body that promote aging, and other research is exploring the benefits of irisin, a substance released during exercise.
• Seniors are staying more engaged. More baby boomers are planning to work past age 65, and employers are increasingly appreciating the value of their senior employees. Volunteering is another avenue for seniors to remain engaged, have a sense of purpose, learn new skills, and interact with others.
• New technologies and modes of transportation benefit seniors and maintain their mobility. Smart home features (such as Siri or Alexa), the availability of on-demand home care services, the potential for remote access to physicians and specialists to help seniors in rural areas or those with transportation challenges, the current availability of services such as Lyft and Uber, and the future availability of driverless cars, will allow seniors to remain in their homes, access necessary resources, and stay connected to important activities and communities.