When it comes to our health, most of us will share freely about practically anything – except for mental health. For various reasons, discussing mental health problems is often taboo, whether the affected person is us or someone we love. Either we pretend the problems don’t exist, or we dismiss issues like depression, anxiety, even substance abuse as “just part of growing old.”

But that tendency to dismiss or ignore the very real cost of mental health problems means millions of seniors will fail to get the care they need. That was one of our big take-aways as we read this recent article from NextAvenue, written by freelance writer Elizabeth Hewitt. Hewitt writes that misconceptions about the prevalence of mental health issues among seniors and about the value of treatment leave too many seniors seeing life through what one researcher calls “charcoal-colored glasses.”

If you or a loved one is facing a mental health issue, it’s time to lay aside the stigma and get help. Maybe this NextAvenue piece is a good starting place.

The Challenges of Aging Can Impair Mental Health

Hewitt begins her article by highlighting the work of clinical psychologist and University of Washington School of Medicine professor Dr. Douglas Lane. In his practice he has worked with patients into their 90s, and has witnessed the way many of them grapple with deep and existential questions as they age. Many have even said, “I don’t even know who to be anymore.”

Lane says that aging comes with challenging transitions, and these transitions can have deep impacts on the mental health of older adults.

“We start developing as a child obviously, but we don’t stop developing,” Lane says. “Older age has its own unique developmental challenges and sometimes people have difficulty navigating those.”

Mental Health Conditions Affect One in Five Seniors

Hewitt writes, “According to the CDC, an estimated one in five adults over age 55 experience a mental health condition. Often needs go undetected or unaddressed, but there are effective treatment options.”

As with most problems in life, Hewitt adds that the first step to getting help is to recognize the signs of a shift in mental health, ranging from mood swings to physical symptoms.

According to the CDC report, “The most common conditions include anxiety, severe cognitive impairment, and mood disorders (such as depression or bipolar disorder). Mental health issues are often implicated as a factor in cases of suicide.” 

And, sadly, the emotional pain of many older people goes unreported. Dr. Regina Koepp, a clinical geropsychologist and founder of the Center for Mental Health and Aging, says, “Older adults are often overlooked, invisible, irrelevant, when it comes to mental health concerns and needs. That’s largely based on an ageist perspective that as we grow older, we lose value, which is really harmful and also inaccurate.”

Mental Health Challenges Are Not “Typical with Aging”

Aging comes with a lot of misconceptions, Koepp adds, because many people assume that it’s normal to experience depression or anxiety into old age, or they think that mental health treatment for older adults is pointless because “they won’t change.” But these beliefs are inaccurate, and harmful.

“In fact, depression is not normal, anxiety is not normal with aging, and older adults are just as capable of change as anybody else,” Koepp says.

Hewitt writes, “For people of older ages, certain life events can contribute to worsening mental health. Grief for a spouse or close loved one can be difficult to navigate. Diagnoses of a new medical condition can also be a risk factor. Another potential trigger is a big change, like retirement or moving out of a longtime home.”

One example from Lane’s practice was an older adult who had been central to developing a type of aircraft during their career. When that aircraft was taken out of use, it was an emotional blow. “When they retired the aircraft, this person grieved,” Lane says. “It was an important part of their life.”

When “Normal” Emotions Become Overwhelming

Hewitt reminds us that emotions are normal, and we all experience feelings like sadness, worry, and stress. It’s when those emotions linger, or become so severe that they run the risk of impairing daily functions, that they signal the possible onset of a mental health condition.

Moreover, getting help is paramount, according to experts, because when mental health issues go unaddressed, they can exacerbate other health problems. Hewitt writes, “In extreme cases, depression and other conditions can lead to suicidal thoughts. Over the last two decades, suicide rates have climbed among people over the age of 55. Men over age 85 have the highest rate of any age group. But treatment can help relieve suffering.”

Lane adds, “The bottom line is, you can’t take care of yourself holistically if you’re not taking care of the mental health pieces.”

Recognizing Mental Health Conditions in Those We Love

Depression is a common mental health concern among older adults, and often comes with an increasingly bleak view of the world, something Lane has dubbed “charcoal-colored glasses.”

He says, “These assumptions begin to develop, like ‘I’m worthless’, ‘I’m a burden on my family,’ ‘everything I do is wrong.’” These thought processes can lead to feeling blue, or experiencing increased pessimism. Eating habits could change, either undereating or overeating. And shifts in sleeping patterns, changes in attention span, or lapses in concentration and memory can all be signals of depression.

Similarly, anxiety is also common among older adults. Hewitt writes, “Someone experiencing anxiety may feel restless or fidgety. They might be more worried, and caught up with many questions of ‘what if.’ For many, anxiety can be a general sense of worry or fear. Koepp has also had many patients with agoraphobia, a fear of going out in public. That can lead to people becoming more isolated in their homes.”

Physical Symptoms of Mental Health Issues Often Appear First

For older people—especially in contrast to their younger counterparts—physical symptoms may be easier to recognize than emotional ones. Hewitt explains, “Symptoms like gastro-intestinal distress, headaches and general pain can be associated with a mental health condition. Often, older people are more focused on their physical health, and their symptoms could be linked to pre-existing health issues. Because of social norms when they were younger, mental health can also be harder to discuss.”

Koepp agrees, saying, “There’s more stigma toward mental health concerns and mental health care. It’s easier to talk about a physical complaint.”

Addiction is another issue increasingly faced by the older generations. Hewitt explains, “The use of substances like drugs and alcohol is a growing mental health concern. Studies find that older adults are drinking more. As people age, alcohol is metabolized more slowly, so it has a stronger impact. There’s also the risk of potential interactions with prescription medications.”

What to look out for? Lane says that people with a substance use disorder may appear to be “impaired or loopy,” or may slip up in their day-to-day activities, like personal hygiene or staying on top of their finances. 

Help for Mental Health Conditions: Start With Your Physician

The spectrum of mental health issues that can impact older people is pretty broad, and experts encourage paying attention to symptoms in order to catch issues as early as possible.

“The good news is that mental health conditions are highly treatable among older adults,” says Koepp.

Hewitt adds, “Checking in with a primary care provider is a good first step if someone is experiencing signs of depression, anxiety or other mental health issues. Some mental symptoms could be an indication of a physical health problem. Thyroid issues, for instance, can be associated with low energy and appear like depression. Medications can also have side effects that impact mental health. Primary care providers can look at symptoms in broader health context, and refer people to next steps that work for them.”

Therapy, Medications Address Mental Health Concerns

Treatment options are, thankfully, equally as broad as the range of problems. Some people may find solace in therapy—either individual or in a group setting—while others may require medications, such as anti-depressants. But the bottom line, and Hewitt’s conclusion: it is possible to get better.

“As we age, we become more resilient,” Koepp says, explaining that resilience is built by overcoming hardship through life. That has a positive impact on mental wellbeing. “The full picture is actually that older adults are incredibly resilient.”

Facing a Mental Health Crisis: the Suicide & Crisis Lifeline (988)

If you or someone you know needs help, take them to an emergency room, or call/text 988 to reach the Suicide & Crisis Lifeline. The 988 Lifeline provides free and confidential mental health crisis services 24 hours a day, seven days a week.

Rajiv Adds: Consider a Mental Health Advance Directive

Rajiv Nagaich has seen this scenario play out in hundreds of families. In his experience, especially when a loved one is facing a diagnosis such as dementia, schizophrenia, or bi-polar disorder, a Mental Health Advance Directive is an essential document to have.

“As Americans live longer into old age, seniors are going to face a growing list of mental health problems,” Rajiv says. “In order to make sure caregivers have the power to make critical care decisions, they need the tools as part of a Durable Power of Attorney. A Mental Health Advance Directive gives a designated agent the authority to commit a loved one to a mental health facility for a maximum of 14 days. That gives the doctors time to observe the patient and prescribe medications or treatments to stabilize their mental condition.”

Rajiv stresses that a properly-executed MHAD has plenty of safeguards to protect patient rights. For example, the directive only empowers the agent to refer the loved one to a mental health facility for a maximum of 14 days. “If the agent then has to take the ultimate next step and seek guardianship, or subject the patient to involuntary civil commitment proceedings, that’s another process entirely,” Rajiv states, “and the standard of proof is extremely high.”

We urge you to contact us for further information about a Mental Health Advance Directive, to see if such a document is appropriate for you and those you love.

Breaking News: Rajiv’s New Book is Here!

We have big news! The long-awaited book by Rajiv Nagaich, called Your Retirement: Dream or Disaster, has been released and is now available to the public.  As a friend of AgingOptions, we know you’ll want to get your copy and spread the word.

You’ve heard Rajiv say it repeatedly: 70 percent of retirement plans will fail. If you know someone whose retirement turned into a nightmare when they were forced into a nursing home, went broke paying for care, or became a burden to their families – and you want to make sure it doesn’t happen to you – then this book is must-read.

Through stories, examples, and personal insights, Rajiv takes us along on his journey of expanding awareness about a problem that few are willing to talk about, yet it’s one that results in millions of Americans sleepwalking their way into their worst nightmares about aging. Rajiv lays bare the shortcomings of traditional retirement planning advice, exposes the biases many professionals have about what is best for older adults, and much more.

Rajiv then offers a solution: LifePlanning, his groundbreaking approach to retirement planning. Rajiv explains the essential planning steps and, most importantly, how to develop the framework for these elements to work in concert toward your most deeply held retirement goals.

Your retirement can be the exciting and fulfilling life you’ve always wanted it to be. Start by reading and sharing Rajiv’s important new book. And remember, Age On, everyone!

(originally reported at www.nextavenue.org)