- Globally, the population is ageing rapidly. It is projected that the number of persons aged 60 or over is expected to more than triple by 2100.
- Mental health and emotional well-being are as important in older age as at any other time of life.
- Neuropsychiatric disorders among the older adults account for 6.6% of the total disability (DALYs) for this age group.1
- Approximately 15% of adults aged 60 and over suffer from a mental disorder.1
Older adults, those aged 60 or above, make important contributions to society as family members, volunteers and as active participants in the workforce. While most have good mental health, many older adults are at risk of developing mental disorders, neurological disorders or substance use problems as well as physical illness or disability.
The world’s population is ageing rapidly. Between 2000 and 2050, the proportion of the world’s older adults is estimated to double from about 11% to 22%. In absolute terms, this is an expected increase from 605 million to 2 billion people over the age of 60. Older people face special physical and mental health challenges which need to be recognized.
Over 20% of adults aged 60 and over suffer from a mental or neurological disorder (excluding headache disorders) and 6.6% of all disability (disability adjusted life years-DALYs) among over 60s is attributed to neurological and mental disorders.1The most common neuropsychiatric disorders in this age group are dementia and depression. Anxiety disorders affect 3.8% of the elderly population, substance use problems affect almost 1% and around a quarter of deaths from self-harm are among those aged 60 or above.1 Substance abuse problems among the elderly are often overlooked or misdiagnosed.
Mental health problems are under-identified by health-care professionals and older people themselves, and the stigma surrounding mental illness makes people reluctant to seek help.
Risk factors for mental health problems among the older adults
Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. As well as the typical life stressors common to all people, many older adults lose their ability to live independently because of limited mobility, chronic pain, frailty or other mental or physical problems, and require some form of long-term care. In addition, older people are more likely to experience events such as bereavement, a drop in socioeconomic status with retirement, or a disability. All of these factors can result in isolation, loss of independence, loneliness and psychological distress in older people.
Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are medically well. Conversely, untreated depression in an older person with heart disease can negatively affect the outcome of the physical disease.
Older adults are also vulnerable to physical neglect and maltreatment. Elder maltreatment can lead not only to physical injuries; but also to serious, sometimes long-lasting psychological consequences, including depression and anxiety.
Dementia and depression among the elderly as public health issues
Dementia is a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing.
It is estimated that 35.6 million people worldwide are living with dementia. The total number of people with dementia is projected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050, with majority of sufferers living in low- and middle-income countries.
There are significant social and economic issues in terms of the direct costs of medical, social and informal care associated with dementia. Moreover, physical, emotional and economic pressures can cause great stress to families. Support is needed from the health, social, financial and legal systems for both people with dementia and their caregivers.
Depression can cause great suffering and leads to impaired functioning in daily life. Unipolar depression occurs in 7% of the general elderly population and it accounts for 1.6% of total disability (DALYs) among over 60 year olds.1 Depression is both under diagnosed and undertreated in primary care settings. Symptoms of depression in older adults are often overlooked and untreated because they coincide with other late life problems.
Older adults with depressive symptoms have poorer functioning compared to those with chronic medical conditions such as lung disease, hypertension or diabetes. Depression also increases the perception of poor health, the utilization of medical services and health care costs.
Treatment and care strategies
It is important to prepare health providers and societies to meet the specific needs of older populations, including:
- training for health professionals in old-age care;
- preventing and managing age-associated chronic diseases including mental, neurological and substance use disorders;
- designing sustainable policies on long-term and palliative care; and
- developing age-friendly services and settings.
Mental health of older adults can be improved through promoting active and healthy ageing. Mental health-specific health promotion for the older adults involves creating living conditions and environments that support wellbeing and allow people to lead healthy and integrated lifestyles. Promoting mental health depends largely on strategies which ensure the elderly have the necessary resources to meet their basic needs, such as:
- providing security and freedom;
- adequate housing through supportive housing policy;
- social support for elderly populations and their caregivers;
- health and social programmes targeted at vulnerable groups such as those who live alone, rural populations or who suffer from a chronic or relapsing mental or physical illness;
- violence or older adults maltreatment prevention programmes; and
- community development programmes.
Prompt recognition and treatment of mental, neurological and substance use disorders in older adults is essential. Both psychosocial interventions and medicines are recommended.
There is no medication currently available to cure dementia but much can be done to support and improve the lives of people with dementia and their caregivers and families, such as:
- early diagnosis, in order to promote early and optimal management;
- optimizing physical and psychological health, including identifying and treating; accompanying physical illness, increasing physical and cognitive activity and optimizing well-being;
- detecting and managing challenging behavioural and psychological symptoms;
- providing information and long-term support to caregivers.
Mental health care in the community
Good general health and social care is important for promoting older people’s health, preventing disease and managing chronic illnesses. Training all health providers in working with issues and disorders related to ageing is therefore important. Effective, community-level primary mental health care for older people is crucial. It is equally important to focus on the long-term care of older adults suffering from mental disorders, as well as to provide caregivers with education, training and support.
An appropriate and supportive legislative environment based on internationally accepted human rights standards is required to ensure the highest quality of services to people with mental illness and their caregivers.
WHO’s programmes for active and healthy ageing have created a global framework for action at the country level.
WHO supports governments in the goal of strengthening and promoting mental health in older adults and to integrate the effective strategies into policies and plans.
WHO recognizes dementia as a public health priority. The WHO report “Dementia: a public health priority”, published in 2012, aims to provide information and raise awareness about dementia. It also aims to strengthen public and private efforts to improve care and support for people with dementia and for their caregivers.
Dementia, along with depression and other priority mental disorders are included in the WHO Mental Health Gap Action Programme (mhGAP). This programme aims to improve care for mental, neurological and substance use disorders through providing guidance and tools to develop health services in resource poor areas.