“…adults over the age of 65 are the least likely to utilize mental health services compared to any other adult group.” 6,8

As people age they face new milestones, opportunities and challenges. Addressing mental health needs is an essential part of the aging process, yet one that has been historically neglected. This has begun to change, as people recognize that the health and well-being of aging people includes both their mental and physical health.2,3

Mental health is an essential and vital part of overall health for all people of all ages. As with other life stages, aging brings about a unique set of developmental changes that affects mental health.4

Older adults are less likely to seek treatment for mental health problems than younger adults. In fact, adults over the age of 65 are the least likely to utilize mental health services compared to any other adult group.3,5

It is important to recognize that many adults make the transitions associated with aging without encountering mental health problems. These individuals tend to have supportive networks of family, friends and health care providers, as well as access to high quality physical and mental health care.6,7

The most common disorders for people 55 years and older, in order of prevalence are:

• anxiety disorders (e.g., phobias)

• severe cognitive impairment (e.g., dementia*)

• mood disorders (e.g., depression)9,10

Schizophrenia and substance abuse are also common disorders affecting older Americans.10
*Dementia includes Alzheimer's Disease, but may also be the result of undetected strokes.

When individuals have an existing mental illness, the changes and challenges associated with growing older can exacerbate that illness.4

As with all age groups, the severity of mental health problems in older people covers the entire range from mildly problematic to disabling or fatal.1,8

“Successful" or "vital" aging is characterized by engagement with life, a low risk of disease, and high levels of physical and cognitive functioning. Factors associated with vital aging include good nutrition and physical exercise, contribution through work, learning new skills, volunteer activities including care giving, socialization with friends or relatives, and positive mental attitude.6

Many professionals fail to identify the signs and symptoms of mental health problems in older adults.

Mental health services are significantly under-utilized by the aging population for a variety of reasons:

• Stigma. There are several beliefs regarding mental health and aging that are inaccurate, yet widely held. These contribute to ageism and include: 1) mental health problems naturally occur with aging; 2) people with mental health problems or disorders are weak or inferior; and 3) mental health problems in older individuals do not require treatment (since these problems are a "natural part of aging").3,8,9
  

• Lack of recognition or denial of problems. Older adults may not recognize the symptoms of poor mental health or may deny that the symptoms are problematic. They also may believe that nothing can be done to alleviate the symptoms associated with poor mental health.3,8,9
  

• Under-recognition by professionals. Many professionals, such as primary care physicians, fail to identify the signs and symptoms of mental health problems in older adults. They may hold the same inaccurate beliefs and misunderstandings as the general population about mental health care and aging.8,9
  

• Lack of access to mental health services and insurance benefits. Managed care organizations typically restrict use of mental health services. Insurance benefits almost always cover physical health care more thoroughly than mental health care. When it is covered, it is often fragmented and inadequate. Medicare pays for only 50% of the cost of outpatient mental health services, leaving the remainder of the cost to the patient, regardless of the ability to pay. Lack of transportation to services also may be an issue.1,8,9
  

• Shortage of mental health professionals. There is a serious shortage of trained mental health professionals in most communities, and those trained in geriatrics and mental health are almost non-existent. The problem is greatest for people of color who are unable to find a geriatric mental health professional who is culturally competent.1,9
  

• Symptoms can prohibit seeking help. The very nature of certain mental illnesses such as depression often leaves individuals without the interest or energy to seek the help they need.1,4,10
  

• Older adults may be caregivers. Caring for family members who are also aging, or disabled or chronically ill, can be overwhelming. Seeking and obtaining mental health care in addition to other daily duties may not be possible.8,10

It is estimated that by the year 2030,
15 million people
65 years and older will be affected
by psychiatric disorders.10

Overall, individuals are living longer than in the past. Currently, there are approximately 35 million people in the United States over the age of 64, comprising 13% of the population. It is estimated that by the year 2030, 20% of the nation’s population will be 65 years or older.9,11

Additionally, it is estimated that by the year 2030, 15 million people 65 years and older will be affected by psychiatric disorders.1

Adults aged 65 and older have the highest rates of suicide of any age group in the U.S. For those 85 and older, the suicide rate is twice the national average.1

Mental health disorders, such as paranoia, depression, and dementia, are among the most debilitating illnesses affecting older adults. Yet, many older adults may not recognize mental health disorders as such, or be aware that they are treatable.3

Older adults who suffer from mental health disorders may depend upon their children, caretakers, or friends for financial, physical, and emotional care. This often leaves "younger" adults (even those who are in their sixties and seventies) feeling weighed down and overwhelmed.3

Untreated mental disorders can significantly burden society. Higher levels of depressive symptoms are associated with higher rates of physical illness, greater functional disability, and higher health care utilization.12

The early detection and treatment of mental disorders in older adults is far more economical than waiting until a mental illness becomes debilitating.1

A comprehensive mental health policy agenda for aging Americans will come about only if policy makers, service providers, researchers, consumers, family members, and advocacy groups work together to shape, fund and implement one.

Credible, research-based expertise exists both in the mental health and the aging disciplines to address public policy issues. A comprehensive mental health policy agenda for aging Americans will come about only if policy makers, service providers, researchers, consumers, family members, and advocacy groups work together to shape, fund and implement one. Research suggests this agenda should include:

• Education initiatives to teach Americans about the aging process and the relevance of mental health.1 Similarly, activities to engage older adults socially, physically, and cognitively need to be promoted. Research reveals that decline is not inevitable and adults continue to grow new brain cells throughout their lifetime.7

• Policies to eliminate the inequities in insurance coverage for mental health services, so that mental health care has parity with physical health care.2 Require Medicare to cover mental health care to the same degree that it covers other medical care conditions.1

• Policies to remove the restrictions on insurance reimbursement for mental health services, both in the public and private sectors. Improved prescription drug coverage for those on a fixed income.1,3

• Geriatric mental health research to explore the treatment of mental illnesses in older adults. Research to date has demonstrated the effectiveness of treatment is similar to that in younger people.1,3

• The availability of mental health services in non-hospital based, outpatient settings, including community centers. This is especially critical to the detection and treatment of mental health disorders in the aging population.1

• Financing to develop and implement community-based mental health services for older adults.4 Currently, older adults receive less than 1.5% of all community-based mental health care.3

• Expanded interdisciplinary research to explore the biological, behavioral, social, and cultural factors that may prevent or contribute to mental health disorders.3,9

• Transfer of skills, resources and needs across the generations. Support for inter-generational programming and services is needed, so that younger and older generations can support and contribute to one another's lives.

• Mental health screening as a preventive measure during routine health care visits.1

• Training of health care professionals in geriatric mental health and the care of older adults with mental illnesses.1 Older adults with mental health problems frequently seek services in primary care settings, indicating a need to optimize the detection and management of mental health disorders.3

• Increased time that health care professionals are able to spend with patients so screening and identification of physical and mental health problems can take place.2

• Culturally competent service providers to address the needs of the diverse aging population.2

• Providing treatment to people in nursing homes who need services. Despite the high prevalence of people with mental disorders in nursing homes, these settings are typically ill equipped to meet the mental health needs of their residents.4,9

• Peer counseling, which is a cost-effective, informal model of providing mental health support. Further exploration on the efficacy of this model is needed.9