Mental health of older adults

Key facts

  • By 2030, one in six people in the world will be aged 60 years or over.
  • Loneliness and social isolation are key risk factors for mental health conditions in later life.
  • One in six older adults experience abuse, often by their own carers.
  • Approximately 14% of adults aged 60 and over live with a mental disorder.
  • Mental disorders among older adults account for 10.6% of the total years lived with disability for this age group.

 


Overview

The world’s population is ageing fast. In 2020, 1 billion people in the world were aged 60 years or over. That figure will rise to 1.4 billion by 2030, representing one in six people globally. By 2050, the number of people aged 60 years and over will have doubled to reach 2.1 billion. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million (1).

Older adults contribute to society as family and community members, and many are volunteers and workers. While most have good health, many are at risk of developing mental health conditions such as depression and anxiety disorders. Many may also experience reduced mobility, chronic pain, frailty, dementia or other health problems, for which they require some form of long-term care. As people age, they are more likely to experience several conditions at the same time.

Prevalence

Around 14% of adults aged 60 and over live with a mental disorder (2). According to the Global Health Estimates (GHE) 2019, these conditions account for 10.6% of the total disability (in disability adjusted life years, DALYs) among older adults. The most common mental health conditions for older adults are depression and anxiety. GHE 2019 shows that globally, around a quarter of deaths from suicide (27.2%) are among people aged 60 or over.

Mental health conditions among older people are often underrecognized and undertreated, and the stigma surrounding these conditions can make people reluctant to seek help.

Risk factors

At older ages, mental health is shaped not only by physical and social environments but also by the cumulative impacts of earlier life experiences and specific stressors related to ageing. Exposure to adversity, significant loss in intrinsic capacity and a decline in functional ability can all result in psychological distress.

Older adults are more likely to experience adverse events such as bereavement, or a drop in income or reduced sense of purpose with retirement. Despite their many contributions to society, many older adults are subject to ageism, which can seriously affect people’s mental health.

Social isolation and loneliness, which affect about a quarter of older people, are key risk factors for mental health conditions in later life (3). So too is abuse of older people, which includes any kind of physical, verbal, psychological, sexual or financial abuse, as well as neglect. One in six older adults experience abuse, often by their own carers (4). Abuse of older adults has serious consequences and can lead to depression and anxiety.

Many older people are carers of spouses with chronic health conditions, such as dementia. The responsibilities of such care can be overwhelming and can affect the carer’s mental health.

Some older adults are at greater risk of depression and anxiety, because of dire living conditions, poor physical health or lack of access to quality support and services. This includes older adults living in humanitarian settings and those living with chronic illnesses (such as heart disease, cancer or stroke), neurological conditions (such as dementia), or substance use problems.

Promotion and prevention

Mental health promotion and prevention strategies for older adults focus on supporting healthy ageing. That means creating physical and social environments that support well-being and enable people to do what is important to them, despite losses in capacity.

Key mental health promotion and prevention strategies for healthy ageing include:

  • measures to reduce financial insecurity and income inequality;
  • programmes to ensure safe and accessible housing, public buildings and transport;
  • social support for older adults and their carers;
  • support for healthy behaviours, especially to eat a balanced diet, be physically active, refrain from tobacco and reduce alcohol use; and
  • health and social programmes targeted at vulnerable groups such as those who live alone or in remote areas and those living with a chronic health condition.

For older adults, social connection is particularly important to reduce risk factors such as social isolation and loneliness. At this stage of life, meaningful social activities can significantly improve positive mental health, life satisfaction and quality of life; they can also reduce depressive symptoms. Example interventions include befriending initiatives, community and support groups, social skills training, creative arts groups, leisure and education services and volunteering programmes.

Protection from ageism and abuse is also critical. Key interventions include anti-discrimination policies and laws, educational interventions and intergenerational activities. A range of carer interventions – including respite care, advice, education, financial support and psychological interventions – can support carers to maintain a good and healthy caring relationship that avoids abuse of older people.

Treatment and care

Prompt recognition and treatment of mental health conditions (and associated neurological and substance use conditions) in older adults is essential. This should follow standards for integrated care for older people, which is community-based and focused on both the long-term care of older adults living with mental health conditions and declines in intrinsic capacity, as well as the education, training and support of carers. A mix of mental health interventions are usually recommended, alongside other supports to address the health, personal care and social needs of individuals.

Dementia is often an important concern. It affects people’s mental health (for example, sparking symptoms of psychosis and depression), and requires access to quality mental health care.

Responding to the abuse of older adults is also critical. Promising interventions include mandatory reporting of abuse, self-help groups, helplines and emergency shelters, psychological programmes for abusers, training of health care providers and other caregiver support interventions.

WHO response

WHO works with diverse partners on strategies, programmes and tools to support governments respond to the mental health needs of older adults.

For example, the Decade of Healthy Ageing (2021–2030) is a global collaboration led by WHO to improve the lives of older people, their families and the communities in which they live.

WHO Member States have also endorsed the Comprehensive mental health action plan 2013–2030, which supports improved mental health and mental health care for all populations, including older adults.

WHO’s Mental Health Gap Action Programme (mhGAP) provides evidence-based clinical protocols for assessing, managing and following up a set of priority mental, neurological and substance use conditions in non-specialized settings, including depression and dementia. The mhGAP intervention guide includes clinical tips for working with older adults.

During the COVID-19 pandemic, WHO and partners in the Inter-Agency-Standing Committee (IASC) developed the Living with the times toolkit of illustrated posters to help older adults maintain good mental health and well-being. Other WHO activities to support the mental health of older adults include the development of scalable psychological interventions to address depression and anxiety, research and guidance on interventions to reduce social isolation and loneliness, and cost–effective solutions to prevent abuse of older adults.

 

References

  1. World Population Prospect 2022: release note about major differences in total population estimates for mid-2021 between 2019 and 2022 revisions. New York: United Nations Department of Economic and Social Affairs, Population Division; 2022 (https://population.un.org/wpp/Publications/Files/WPP2022_Release-Note-rev1.pdf, accessed 12 September 2023).
  2. Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx).  https://vizhub.healthdata.org/gbd-results/, accessed 20 October 2023).
  3. Hong Teo R, Hui Cheng W, Jie Cheng L, Lau Y, Tiang Lau S. Global prevalence of social isolation among community-dwelling older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2023 Apr;107:104904. doi:10.1016/j.archger.2022.104904.
  4. Yon YY, Mikton CR, Gassoumis ZD, Wilber KH. Elder abuse prevalence in community settings: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(2):e147–e156. doi:10.1016/S2214-109X(17)30006-2.