By 2030, the number of Americans aged 65 and over is projected to be about 73.1 million (up from 56.1 million in 2020); of that group, nearly 10 million are projected to be at least 85. As the population ages, it will become increasingly important to promote healthy aging, as well as recognize and treat age-related conditions that affect mental and physical well-being.
Recent research has shown that older Americans today generally report better health than older cohorts did in the past. And thanks to advances in medicine, technology, and society at large, more people are living longer. This means that more individuals can expect to spend more time in retirement than those in previous generations did.
Yet even though older Americans tend to live longer and healthier lives than previous generations, many adults in midlife fail to commit to healthy routines that can bolster their well-being later in life. Research has established, for example, the physical and mental advantages of a consistent exercise regimen—but in 2018, less than 20 percent of U.S. adults ages 45 to 64 met the recommended guidelines for physical activity, according to the CDC. Nutrition also influences the progression of many diseases, and research has demonstrated that good nutrition habits can reduce the length of later hospital stays. Yet many older adults eat poorly, typically due to a lack of time, a lack of knowledge, or because they don’t have access to affordable, nutritious food.
Screening programs can lead to preventive measures and early treatment interventions, which can substantially reduce the later impact of illnesses. Other assessments of the quality of life of older individuals tend to focus on health and finance, but second and third careers, lifelong learning, leisure pursuits, voluntary work, and caregiving can also contribute, positively or negatively, to future quality of life.
To learn more about the biology of aging and how to age well, visit our Aging Center.
Although many people associate aging with physical and mental decline, poor health is not an inevitable consequence of aging. It is true, however, that many older adults struggle to stay mentally and physically healthy and maintain their quality of life. Common aging-related conditions include physical health concerns, mental health disorders such as depression, and Alzheimer's disease and other forms of cognitive decline.
Physical Health Concerns
Chronic health conditions such as heart disease, stroke, cancer, diabetes, and arthritis are the most common and costly health concerns for individuals later in life. They exact a particularly heavy health and economic burden due to associated long-term illness, diminished quality of life, and greatly increased healthcare costs.
Hearing and vision problems are often thought of as natural signs of aging. However, early detection and treatment can often prevent, postpone, or lessen some of the debilitating physical, social, and emotional effects that these impairments can have on the lives of older people.
Depression, Suicide, and Other Mental Health Challenges
Being "down in the dumps" over a long period of time is not a normal part of growing old. In fact, research has consistently shown that life satisfaction, after a dip in midlife, tends to increase with age. But depressive disorders are a common problem in the elderly, and medical help may be needed.
Unfortunately, depression in older people is often missed or untreated, for a wide variety of reasons. As a person ages, for one, the signs of depression are much more likely to be dismissed as crankiness, grumpiness, or a “normal” response to aging. Symptoms of depression may also manifest differently in older adults than they do in younger people. For example, an older person who is depressed may be more likely to report physical symptoms such as insomnia or aches and pains, rather than the feelings of sadness or worthlessness that commonly signal to a doctor that an individual is depressed.
Misdiagnosis is also a concern. Confusion or attention problems caused by depression can sometimes look like Alzheimer's disease or other brain disorders. Mood changes and signs of depression can also be caused by medicines older people may take for high blood pressure or heart disease. And depression can happen at the same time as other chronic diseases.
More broadly, mental disorders experienced by older adults may differ from those experienced by younger people, which can make accurate diagnosis and treatment difficult. Many physicians and other health professionals may not provide effective mental-health care because they often receive inadequate training in the diagnosis and treatment of mental disorders in older adults.
Though it can be hard for a doctor to diagnose depression, people who are depressed can get better with effective treatment. Talk therapies, drugs, or other methods of treatment can ease the pain of depression. (To learn more about signs of depression in older adults and approaches to treatment, visit our Depression Center.)
If left untreated, mental disorders such as depression can represent a grave threat to the health and well-being of older adults. Older adults—and especially older men—are at greater risk of dying by suicide than is commonly thought. In 2019, men over the age of 75 died by suicide at the highest rate of any cohort: 39.9 per 100,000. By comparison, young adult men between the ages of 15 and 24 died by suicide at a rate of 22 per 100,000. (To learn more about how age affects suicide risk and what can be done to help, visit our Suicide Center.)
Mental disorders can also negatively affect the ability of older people to recover from other health problems. Research has shown that people with depression are at greater risk of developing heart disease, for example. Furthermore, people with heart disease who are depressed have an increased risk of death after a heart attack compared with those who are not depressed.
The occurrence of Alzheimer's disease (AD) is not a normal development in the aging process. AD is characterized by a gradual loss of memory, decline in the ability to perform routine tasks, disorientation, difficulty in learning, loss of language skills, impaired judgment, an inability to plan, and personality changes. Over time, these changes become so severe that they interfere with an individual's daily functioning, resulting eventually in death. While the disease can last from three to 20 years after the onset of symptoms, the average duration is eight years.
Alzheimer's disease affects as many as 4 million Americans. The disease usually begins after the age of 60, and risk increases with age. Most people diagnosed with AD are older than 65. However, it is possible for the disease to occur in people in their 40s and 50s. (To learn more about symptoms, causes, and treatment of Alzheimer’s Disease, visit our Diagnosis Dictionary.)
No. Depression should not be considered a normal or inevitable part of aging. Recognizing symptoms of depression—such as withdrawal from normal activities, fatigue, restlessness, guilt, or excessive moodiness—as early as possible and seeking appropriate treatment can help improve the quality of life for elderly adults and their loved ones.
Most people's cognitive abilities decline with age to some degree. Usually, signs of normal age-related cognitive decline include slowed thinking, greater difficulty sustaining attention, and a reduced ability to hold information in the mind or recall it quickly. These changes should be fairly subtle and in most cases will not interfere with day-to-day functioning. They may, however, be frustrating for the person experiencing them, especially as they may continue to worsen with age.
It’s not always easy to tell when age-related cognitive decline should be seen as concerning, but there are some key signs to watch for that may help determine whether further action is needed. If the individual starts to demonstrate poor reasoning and judgment, struggles to make decisions that were once straightforward, or regularly forgets appointments, it may be time to seek a formal assessment from a medical professional. (To learn more about the different stages of cognitive impairment, visit our Aging Center.)
It can initially be difficult to discern whether an individual is experiencing depression or progressive cognitive decline, including Alzheimer's Disease. People with AD often exhibit a lack of confidence, tearfulness, and concentration and memory problems, all of which also manifest in depression. However, depressive episodes in individuals with Alzheimer's are shorter in duration and less intense than they are in individuals who experience primary depression.
Yes. Furthermore, depression itself inhibits cognitive function and, if untreated, can accelerate the progression of AD. To discern whether an individual with AD is clinically depressed, physicians look for signs of reduced interaction with others and loss of interest in daily routines, as well as signs of low mood. This can be challenging to diagnose as Alzheimer's Disease progressively erodes verbal ability. For those who are depressed in the early (still verbal) stages of Alzheimer's Disease, support groups and therapy are key interventions.
Aging is a natural process, and everyone will experience some changes with age—both mental and physical. What pushes someone over the line between “normal aging” and problematic age-related conditions isn’t always clear, but it’s likely that many factors—including genes, social and environmental factors, and lifestyle choices—play a role.
Depression in the elderly, for example, is often driven by a confluence of factors—including things like loneliness, declining physical health, frustration at decreasing independence, or an apparent lack of purpose. Certain people may also be genetically predisposed to depression and/or have dealt with depression in the past, potentially making a late-life recurrence more likely. Lifestyle factors, such as a lack of exercise or poor diet, may exacerbate low mood.
Aging itself is the strongest risk factor for Alzheimer’s disease. Beyond that, research has shown links between some genes and AD, and people who have a parent or sibling with AD are more likely to develop the condition themselves. When it comes to Alzheimer’s and other forms of dementia, early and careful evaluation is important—especially because many other conditions, including some that are treatable or reversible, may cause dementia-like symptoms. Examples of such treatable medical conditions are depression, nutritional deficiencies, adverse drug interactions, urinary tract infections, and metabolic changes.
As we age, our brains age too. Research suggests that natural decreases in hippocampal and frontal lobe size—areas of the brain involved in memory and higher-order thinking processes—contribute strongly to age-related cognitive decline. There is also evidence that white matter density tends to decrease with age, and the brain may generate fewer neurotransmitters—both of which may slow thinking and worsen memory.
What leads one person to develop Alzheimer’s over another is not fully understood. But many factors appear to increase risk, including familial history of the disease and gender. Women are significantly more likely than men to develop AD; there is emerging evidence that this is related to post-menopausal hormonal changes. Traumatic brain injury and vascular conditions such as high blood pressure or heart disease may also increase the risk of AD.
Many chronic conditions that come with age can be improved, if not cured, by treatment and/or medication, and so it is always worth seeking the advice of a doctor.
There are, however, some barriers to treatment-seeking that may need to be addressed. Many people, for example, mistakenly believe that mental disorders like depression or dementia are normal in older people and that no effective treatments are available. Another myth suggests that older people cannot change; therefore, efforts to enhance their mental health might be wrongly seen as futile. Some older people—or their friends or relatives—may feel that getting help is a sign of weakness, or may believe that a depressed person can quickly "snap out of it.” Refuting these myths with accurate information could motivate someone to seek treatment.
Once the decision is made to get medical advice, it’s often helpful to start with the family doctor. The doctor should check to see if there are medical or drug-related reasons for the depression, cognitive challenges, or other concerning symptoms. After a complete exam, the doctor may suggest talking to a mental health specialist or a neurologist.
Treating Mental Health Concerns in Older Adults
Some family doctors may not understand mental health challenges such as depression or anxiety, especially in the elderly, and may be dismissive or unsure of what to do. If a doctor is unable or unwilling to take a patient’s concerns seriously—whether about depression, cognitive decline, or anything else—it may be prudent to consult another health care provider.
If an older person is experiencing concerning symptoms but won't go to a doctor for treatment, relatives or friends can help by explaining how treatment may help the person feel better, engage in cherished activities again, and generally become more active. In some cases, when an older person can't or won't go to the doctor, the doctor or mental health specialist can start by participating in a phone call. The telephone can't take the place of the personal contact needed for a complete medical checkup, but it can break the ice. Sometimes a home visit can be made.
Some older people avoid seeking psychological treatment because they are afraid of how much treatment might cost. However, short-term psychotherapy, with or without medication, will be beneficial in many cases and is often covered by insurance, and community mental health centers may offer treatment based on a person's ability to pay. (For more about treating depression, visit our Depression Center.)
Treating Alzheimer’s Disease in Older Adults
There is no known cure for Alzheimer's disease. However, scientists have found some medications that may help control some symptoms. People with AD must work closely with their doctor to determine which drugs and activities are best for them, because reaction to medications varies for each person. Organizations such as the Alzheimer's Disease Education and Referral Center (ADEAR) and the Alzheimer's Association can provide up-to-date information, support, and advice. (For more about treating Alzheimer’s disease, visit our Diagnosis Dictionary.)
Research has shown that a healthy lifestyle tends to be more influential than genetic factors in helping older people avoid the deterioration often associated with aging. People who are physically active, maintain a healthy diet, do not use tobacco or drink to excess, and practice other healthy behaviors reduce their risk of suffering from chronic disease and have half the rate of disability compared with those who do not. Screening to detect chronic diseases (such as diabetes or cancers of the breast, cervix, and colon) early in their course can save many lives.
Immunizations against influenza and pneumococcal disease will also reduce a person's risk for hospitalization and death from these diseases. Other preventative measures include removing tripping hazards in the home and installing grab bars, which can greatly reduce the risk of falls and fractures.
Regular exercise is a preventative measure that will enhance quality of life. Research has shown that even among frail and very old adults, mobility and functioning can be improved through physical activity. However, anyone at risk for any chronic diseases, such as heart disease or diabetes, or who smokes or is overweight, should first check with their doctor before becoming more physically active. Older adults also have special considerations:
- Exercise can help older people feel better and enjoy life more, even those who think they're too old or too out of shape.
- Most older adults don't get enough physical activity.
- Regular exercise can improve symptoms of some diseases and disabilities in older people who already have them. It can improve mood and relieve depression, too.
- Staying physically active on a regular, permanent basis can help prevent or delay certain diseases (like some types of cancer, heart disease, or diabetes) and disabilities.
Plan on making physical activity a part of your everyday life. Do things you enjoy. Go for brisk walks. Ride a bike. Dance. And don't stop doing physical tasks around the house and in the yard. Trim your hedges without a power tool. Climb stairs. Rake leaves.
Make sure you are exercising safely:
- Start slowly. Build up your activities and your level of effort gradually. Doing too much too soon can hurt you, especially if you have been inactive.
- Avoid holding your breath when exerting yourself. It may seem strange at first, but the rule is to exhale during muscle exertion and inhale during relaxation. For example, if you are lifting something, breathe out on the lift; breathe in on the release. If you have high blood pressure, pay special attention to this tip.
- If you are on medications or have any conditions that change your natural heart rate, don't use your pulse rate as a way of judging how hard you should exercise. "Beta-blockers," a type of blood pressure drug, are an example of this kind of medicine.
- Use safety equipment, such as helmets, knee and elbow pads, and eye protection.
- Unless your doctor has asked you to limit fluids, be sure to drink plenty when you are doing endurance activities that make you sweat. Many older people do not drink enough fluids, even when not exercising.
- When you bend forward, bend from the hips, not the waist. If you keep your back straight, you're probably bending correctly. If you let your back "hump," you're probably bending from the waist.
- Make sure your muscles are warmed up before you stretch. For example, you can do a little easy biking, or walking, and light arm pumping first.
Physical activity and exercise should generally make you feel better. None of the exercises you do should hurt or make you feel really tired. You might feel soreness, a slight discomfort, or a little weariness, but you should not feel pain.
Finally, exercising the mind is as important as keeping physically active. Recent research suggests that people who regularly engage in mentally stimulating activities such as reading, playing games, doing puzzles, listening to the radio, and visiting museums have a decreased risk of developing Alzheimer's disease. Thus the Japanese proverb "We begin aging when we stop learning" may well be accurate.
The special nature of mental health disorders in older people has led to the creation of a new medical specialty, known as geriatric psychiatry. Geriatric psychiatrists help older adults navigate the challenges of aging, such as coping with chronic health conditions or grappling with an increasing dependence on others. They also work to recognize and treat psychiatric disorders such as depression or anxiety.
To find a therapist who specializes in treating adults 65 and older, visit the Psychology Today Therapy Directory.