By Melissa Chalos Riddle

Americans are getting older. They’re working longer. They’re staying active and making the most of their senior years. With activity and more medical advances, life expectancy flourishes. So, it comes as no surprise when projections indicate the number of Americans 65 and older is likely to double from 46 million to more than 98 million by 2060.1

Elderly people laughingBut growing older comes with more than its share of complications. Whether it’s the death of a spouse, the loss of mobility, financial stress, family neglect or anxiety, societal isolation or the approaching need for long-term care, seniors deal with myriad mental and behavioral health challenges. In fact, according to the American Psychological Association (APA), “20 percent of people over 55 suffer from a mental disorder, and two-thirds of nursing home residents exhibit mental and behavioral problems. Yet, less than 3 percent of older adults report seeing a mental health professional for their problems.”2

“The answer to old age,” Leon Edel, Pulitzer-winning biographer once wrote, “is to keep one’s mind busy and to go on with one’s life as if it were interminable.”3 Keeping one’s mind busy may be the beginning, but keeping one’s mind healthy is what makes everything else possible.

In short, health and wellness — especially for seniors — simply cannot exist without proper mental health care.

The Complexities of Growing Old

What, then, are the common mental health issues seniors face and how do those impact overall health and wellness? These are just the beginning:

Chronic Illness

It’s important to understand that 85 percent of seniors have at least one, if not many chronic conditions. Arthritis, hypertension, diabetes, heart disease, hearing loss, cataracts, strokes — these are all serious health issues that impact their quality of life. Inactivity, poor nutrition, smoking or excessive drinking contribute to these conditions. But more often than not, seniors seek primary medical care due to anxiety, panic, stress or depression associated with these physical limitations, not for the issues themselves. In fact, according to the APA, 70 percent of all primary care visits are motivated by psychological factors.1,2

Seniors go see the doctor, riddled with anxiety related to their chronic illness, and they leave the doctor’s office or emergency clinic without their mental health issues being addressed.

Alzheimer’s Disease and Dementia

Defined as “the irreversible deterioration of intellectual ability,” dementia affects about five percent of individuals between 71 and 79 as well as 37 percent of the population above the age of 90, according to the APA.2 It’s most commonly known form, Alzheimer’s disease, affects 12 million people worldwide, and the number of cases doubles every five years between ages 65 and 85.2

The Alzheimer’s Association says early signs of Alzheimer’s disease may include the following (among others): memory loss that disrupts daily life; difficulty planning or solving problems; difficulty completing familiar tasks; confusion with time or place; new problems with words in speaking or writing; misplacing things and being unable to retrace steps to find them, among others.4  Early diagnosis is more and more possible, with the diagnostic tools and advancements of the modern age, but without attentive family, loved ones or primary care physicians to notice and pursue diagnosis when signs emerge, it will not matter.2

Depression and Suicide

Depression is all too common in seniors, and yet is one of the most often overlooked mental health issues they face. Signs of depression include: little interest or pleasure in doing things, feeling down or hopeless, feeling tired or having little energy, sleeplessness or sleeping too much, poor appetite, self-criticism, trouble concentrating.5

But it doesn’t always look the same in senior adults. “Depression is experienced, witnessed, and treated differently in older adults,” writes Dr. Daniel D. Sewell, Director of Senior Behavioral Health at UC San Diego Medical Center. “In this population, depression symptoms can present as physical complaints, irritability, and/or cognitive impairment rather than overt signs of sadness such as crying.”6

And sadly, according to the National Council on Aging, “people 85 and older have the highest suicide rate of any age group, especially among older white males who have a suicide rate almost six times that of the general population.”1

Substance Abuse

The APA estimates that 17 percent of senior adults misuse and abuse alcohol and medications. But this statistic rarely comes to light because although the majority of older adults regularly see a doctor, 40 percent of those at risk for substance abuse do not self-identify or seek services that could help them.2

Why Don’t They Seek Help?

There are many reasons why older people find it difficult to seek and get the mental health treatment they need. For starters, the stigma and shame associated their generation associates with mental illness keeps them from getting help. “Due to historical shame and ignorance surrounding mental illnesses and psychological problems,” Dr. Sewell says, “stigma tends to be more powerful among those who came of age before the 1960s.”6

That stigma is a two-edged sword for the elderly. “People with mental illnesses in general get really poor care. There is a considerable amount of stigma against mental illness, and when you talk about aging, there is considerable stigma against aging,” says Dr. Dilip Jeste, director of the Stein Institute for Research on Aging at University of California–San Diego School of Medicine according to US News & World Report. “So older people with mental illness have this double whammy: They are stigmatized because of mental illness and stigmatized because they’re older.”1

Isolation and Misconceptions Impede Care

Because we live in a society that only values what is new and fast, seniors’ mental health issues are often overlooked, misdiagnosed or dismissed. Ageism assumes that the older our society gets, the more prone to physical and mental problems, the less useful the elderly become.1 In other words, the elderly aren’t viewed as valuable to society, but as social and economic burdens, not worth the effort. And when older people begin to believe this societal perception, the isolation they feel is emotionally paralyzing.

Insurance Issues

A big deterrent for seniors is the lack of insurance coverage for mental health. Despite the 21st Century Cures Act, which included the first major mental health care and substance-abuse legislation to be passed in 20 years, private insurance companies go to great lengths not to cover mental illness. Medicaid or Medicare insurance patients face restrictions that make it unaffordable as well. US News & World Report says, “Because of this restrictive coverage, physicians may not prescribe a patient the psychotherapy they need because it does not come with the same reimbursement as prescription drugs.”1

Also, dramatic reductions in the amount of time physicians spend with patients — due to insurance costs and restrictions —impacts seniors’ mental health. Doctors simply don’t have time to assess and address potential mental and behavioral issues that arise during a medical visit.

Too Many Patients, Not Enough Geriatric Practitioners

Despite the rise in elderly population predicted by 2030, the number of geriatric psychiatrists and psychologists continues to decline. According to one Dartmouth University study, there is currently one geriatric specialist per 6,000 patients with mental health and substance use disorders, which doesn’t bode well for seniors who need specialized care.1

Integrated Care Is the First Solution

The above issues speak to the “serious gap” between physical and mental health care for the elderly. The answer, many mental health experts agree, is integrated care.For older adults in particular, receiving mental health help at their primary care provider’s office makes the process easier,” Dr. Sewell says. “This kind of care lessens stigma, makes transportation easier, and helps them feel more comfortable. The whole system works better when primary care providers and mental health providers can work side by side and collaborate on providing care that addresses patient needs and preferences.”4

While this kind of integrated care is not widely available for our most vulnerable and growing population, efforts at collaborative care are gaining momentum. According to Eric Weakly of the Substance Abuse and Mental Health Services Administration (SAMHSA), they and the US Department of Health and Human Services are “working to bring mental health care information into the primary care setting.”1

“People like to go to where they are comfortable, and they’re comfortable in primary care,” says Dr. Brenda Reiss-Brennan, head of the mental health integration program at Utah’s Intermountain Healthcare in an interview with US World & World Report. “Mental health is normalized as a routine part of care, so the staff’s more comfortable and confident in dealing with mental health.”1

Our Seniors Deserve More

Truth be told, our seniors deserve affordable, accessible health services that meet both their physical and mental health needs. The golden years shouldn’t be a season of anxiety and decline.

If your senior loved one is struggling with any of the above issues, there is help. Here at Holly Hill, our medical psychology geriatric program offers specialized medical evaluation, an assessment of daily living skills and a full psychological assessment and intervention. Call our toll-free number 1-800-447-1800 today and help your loved one.


1 Newman, Katelyn. “A Look Into Older Adults’ State of Mind.” US News & World Report, October 11, 2017.

2Growing Mental and Behavioral Health Concerns Facing Older Americans.” American Psychological Association, Accessed October 29, 2017.

3 Demakis, Joseph. The Ultimate Book of Quotations. Amazon Digital Services. 2014. Web. Accessed 29 October 2017.

410 Early Signs and Symptoms of Alzheimer’s.” Alzheimer’s Association, Accessed October 29, 2017.

5 Huysman, James D. “Older Adults and Mental Health.” Psychology Today, May 9, 2017.

6 Sewell, Daniel D. “Older Adults are Being Overlooked When It Comes to Mental Health Care.” Care for Your Mind, November 15, 2016.