What are the Common Concerns in Geriatric Mental Health?

Geriatric mental health refers to the mental health conditions or lack thereof that occur in the group of people identified as 65 years old and older. Many common concerns exist in this population group, and perhaps the largest concern is how frequently mental conditions in this population go unaddressed. Some of the most significant issues include the potential to develop conditions like depression, anxiety disorders, Alzheimer’s, and drug and alcohol addiction. Of additional concern is the high rate of suicide in the geriatric population.

Aging is a time of pronounced change and elders are adjusting to a general reduction in physical health and strength, reduced living circumstances, and deaths of family, spouses and close friends. Any of these concerns raises red flags in geriatric mental health and may cause depression or anxiety. When a number of these things occur together, risk of depression and anxiety disorders increases. For example, people who are living in nursing homes have a 37% incidence of depression. Even in other living arrangements, approximately one in five elders will develop a depressive disorder, and 10-20% may have an anxiety disorder.

Another equally important issue is the increased risk for disorders that can cause dementia, like Alzheimer’s. When people are 65, the risk of this is still relatively low, affecting about 7% of the population. Risk increases with age and roughly 30-50% of adults who are 85 and above will manifest some degree of Alzheimer’s.

Other concerns in geriatric mental health include abuse of alcohol and intentional or unintentional abuse of prescription drugs. Elders may take a wide variety of prescription medications. They may not always understand instructions on how to take them, and it’s quite possible for unintentional abuse to occur, causing physical symptoms or altered mental status.

Part of the problem with addressing geriatric mental health issues, especially those around conditions like depression or anxiety, is that this population is likely to assign more stigma to mental illness. They may view it as mental weakness and believe they can think their way out of mental disorders, so mainstream treatments like therapy or drug treatment are viewed with suspicion. Elders also may fail to report symptoms of mental illness to doctors, and even if they do, these symptoms aren’t always regarded with the respect they deserve. This can mean that treatment in the early stages of an illness is not initiated.

Geriatric mental health issues can create something of a domino effect. Undiagnosed and untreated depression and anxiety make people much more likely to abuse substances in order to self-medicate. They also greatly increase risk for suicide, as does unrecognized symptoms of Alzheimer’s. What this means is that mental health conditions may accrue, making diagnosis more difficult and causing more suffering.

There are several approaches to addressing common geriatric mental health problems. Medical doctors need to educate their elder patients about risk factors for mental issues and take seriously any reporting by patients of anxiety, sadness, or deficits in memory. Advocacy organizations should continue to work with this population, especially on elimination of stigma, education about substance abuse, and recognition of mental disorders. Continued research needs to be done on how elders respond to traditional treatment for mental illness, and research to treat or cure Alzheimer’s remains needed.