There’s an assumption that mental health problems are a 'normal' aspect of ageing. This is not true. Most older people do not develop mental health problems, and they can be helped if they do.
However a significant number of people do develop dementia or depression in old age.
Between 10–16% of people over 65 have depression. An estimated 2–4% have severe depression.
Older people living alone or in residential/nursing care and those with physical illnesses and/or disabilities are more at risk, with some 40% affected by depression.
An estimated 4–23% of older adults seen by medical staff have an alcohol problem.
Fewer than 1.6% of men and 0.5% of women aged 60–65 have dementia, but this increases with age to over 32% of men and women aged 90+.
Many older people experience psychological or emotional distress associated with factors linked to old age, including isolation, loss of independence, loneliness and losses of many kinds, including bereavements.
Depression in old age
Depression describes a range of moods, from feeling a bit low in mood to feeling unable to cope with everyday life. People with severe depression experience a range of symptoms including low mood, loss of interest and pleasure and feelings of worthlessness or guilt.
Depression can affect anyone, of any culture, age or background. It affects more older people than any other age group. Some 10–16% of elderly people in the community have depression, rising to some 40% of older people in residential and nursing care homes. This is because older people are much more vulnerable to factors that lead to depression.
That said, depression is not an automatic feature of getting older; it can be prevented, and older people respond just as well to the drug and psychological treatments available to working age adults – although they are not always offered them.
What causes depression?
Older people are more vulnerable to many of the factors that are known to cause depression, including:
- being widowed or divorced
- being retired/unemployed
- physical disability or illness
- loneliness and isolation.
In addition, older people may develop depression because of:
- neurobiological changes associated with ageing
- prescribed medication for other conditions
- genetic susceptibility, which increases with age.
Can depression be prevented?
Depression in later life is a widely under-recognised and under-treated medical condition. Up until recently many health professionals – including GPs – failed to identify depression, seeing it as an inevitable feature of aging and so have not offered the treatments and support available to other age groups. Most forms of depression can be treated, regardless of the person’s age, using medication, talking treatments or other interventions.
It is can be difficult to diagnose depression in older people because it often occurs alongside other mental and physical illnesses, such as dementia and chronic illnesses such as stroke, diabetes and cancer. In addition many older people do not seek help from their GP. It is important to seek help as early as possible.
Self-help strategies that can help reduce the risk of depression include:
- taking regular exercise
- planning for major life transitions such as retirement or moving home
- seeking support from family and friends following the death of a long-term partner
- maintaining interests, activities and social involvement, including learning.
Please visit our dementia page.
Alcohol abuse in old age
An estimated 4%–23% of older adults seen by medical staff have an alcohol problem. Alcohol problems are more common in older men: around one in six older men and one in 15 older women are drinking alcohol at levels that could harm their health.
Although alcohol abuse is a problem for people of all ages, it is more likely to go unrecognised among older people. About one in three older people with alcohol problems only start drinking excessively in later life.
Reasons for alcohol abuse in older age include bereavement and other losses, loneliness, physical ill health, disability and pain, loss of independence, boredom and depression, which is also linked to the other factors. Retirement may also provide more opportunities for drinking too much. Approximately 10–30% of older people who abuse alcohol become depressed. They are also at greater risk of suicide.
Mental health problems associated with alcohol abuse include:
- hearing voices
Prescribed medications can cause symptoms associated with mental illness in older people. Most older people are taking some kind of medication, and many are taking several at the same time. There are risks associated with taking multiple medications, including confusion.
Other mental health problems
There are a number of rarer mental health problems that affect older people, including delirium, anxiety and late-onset schizophrenia. The prevalence, nature, and course of these illnesses are different in older people, as are the treatments that may be offered.
Mental capacity and older people with mental illness
People with dementia or severe mental illness may be unable to make and communicate decisions. Very few people are completely incapable of making any choices or decisions, but some older people may have partial or fluctuating mental capacity and may need help. People with dementia often need special support – they may take longer to make decisions, may need an advocate to speak on their behalf and their mental functioning may also vary by day, and time of day. Family members or carers are often useful sources of information but it is important to take account of the views of the person with dementia alongside those of their carer.
The Mental Capacity Act 2005 is the main law covering the rights and decision-making for people who lack mental capacity, including older people with dementia and other organic brain disorders.
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