The Double Distinction of Aging and Mental Health Problems

Mental health concerns in the elderly population are underrecognized and often untreated. This not only impacts one’s quality of life but can exacerbate other age-related disorders and vice versa (National Institutes of Health,1999; de Mendoca Lima & Ivbijaro, 2013).

Mental illness in the elderly community is a complex issue. Researchers and clinicians need to create awareness of the challenges this group faces and, likewise, bring about unique solutions for their overall well-being. Studies project that by 2050, more than 20% of individuals 55 or older will struggle with some form of mental health problem (de Mendonça & Ivbijaro, 2013).

The elderly struggle with mental health issues similar to those of younger adults—schizophrenia, bipolar disorder, and PTSD (National Council on Aging, 2023), with the most common issues being anxiety and depression. However, the elderly population’s experience with mental illness is different due to unique barriers to accessibility.

Barriers for the elderly include: a lack of awareness of their mental health, financial and physical constraints to accessing adequate care, and even societal and personal stigma attached to mental illness. Yet, once they do seek help for their mental health, their concerns are often normalized as part of old age. Despite being considered one of our most vulnerable populations, there is a tendency to devalue mental health, thereby further compounding the issue of accessibility of mental health services.

A major challenge the elderly face is their lack of awareness of mental health issues. They may struggle to identify symptoms accurately and to explain them to a qualified clinician. For many, mental health issues are viewed as something that can be managed without professional support. Such a perspective can extend the symptoms associated with mental illness further into old age and place a strain on the person’s daily life, family, and friends (Piper et al., 2018; Shankar & Muthuswamy, 2007; & Thompson et al., 2008).

Further, stigma may affect the accessibility of services. Society's negative perceptions about both aging and mental illness can create an overwhelming barrier. Reluctance to identify with a doubly stigmatized group, being elderly and having a mental illness, could deter acknowledging problems and seeking help for them (Farrer et al. 2008; Fisher & Goldney, 2003; & Reavley, Morgan, & Jorm 2013).

Also impacting the accessibility of mental health services is the perception of mental health by the medical community. Mental health issues like depression can go undiagnosed or misdiagnosed. This is especially so as some symptoms can resemble dementia or Alzheimer’s disease (Zenebe et al., 2021). In a 2011 study, researchers found that depression symptoms went undiagnosed by primary care providers almost 50% of the time (Mitchell, Rao, & Vaze, 2010; Park & Unützer, 2011). While it can be difficult for medical providers to assess which diagnosis takes precedence for treatment, more often than not, the medical diagnoses become the focus of treatment, and the mental health issue falls into the background (Batten, 2019).

Addressing awareness about mental health starts with increasing mental health literacy. Mental health literacy is the knowledge and beliefs about mental health conditions that aid in recognizing, managing, and preventing health concerns (Kim et al., 2017). By empowering elderly individuals with knowledge about their own mental health and its implications for their overall well-being, they can better advocate for their needs.

Increasing mental health literacy may require clinicians to change how we assess mental health in the elderly—separating out the mental health concern from any other pre-existing medical issues to understand the true implications of the mental health issue on its own. Increasing mental health literacy requires engaging in conversations about mental health as a routine aspect of overall wellness, similar to managing other chronic medical conditions. This parallel helps reframe treatment for mental health issues as a standard component of therapeutic services rather than a stigmatized separate entity.

Another way to increase accessibility of mental health services for the elderly is by increasing the visibility of mental health services in places the elderly often frequent, such as community centers, doctors’ offices, and retirement facilities. This not only makes mental health services more accessible but builds them into familiar systems, fostering trust. Along with creating convenient locations, we must establish an integrative model that connects the client with various medical, mental health, and social services to provide holistic care.

Mental Health Stigma Essential Reads

It’s Not Fair: Why Some People Don’t ‘Get’ Mental Health

The Human Behind the Athlete

Normalizing mental health issues as part of the aging process may not only reduce the likelihood that individuals will seek help for their mental health but shape their perspective that age and mental illness are limiting. If we could reimagine the aging process to be more of a healthy progression, as explained by Schaie (2016), in which a person's psychological functioning maintains consistency as the years progress or the individual experiences some decline in their physical or cognitive abilities but nothing drastic, the elderly might be more likely to seek professional intervention when significant changes do arise.

A further barrier is being part of another marginalized community that makes accessibility that much more challenging, as these intersecting identities often create compounded barriers to seeking and receiving appropriate mental healthcare. Aspects of one’s identity, such as race, ethnicity, sexual orientation, physical ability, etc., can add another element to the inaccessibility of mental health services. These individuals experience a “triple stigma” attached to their multiple identities and still need to access adequate mental healthcare (Jimenez et al., 2013).

Dismantling the paradigm that mental health should be seen as secondary to one’s physical health requires us to see just how bidirectional these issues are. As we work collaboratively with medical professionals, community agencies, and the elderly, we can envision a plan that educates about mental health, empowers individuals to advocate for holistic services, and champions emotional, physical, and psychological well-being. These are some of the steps to implement change in our current system.

Denise Williams, PhD

Source: AAMFT / Used with permission

Denise Williams, PhD, is an AAMFT Professional member and an associate professor of Marriage & Family Counseling/Therapy Counseling at Indiana Wesleyan University.