Mental Health challenges are a hidden issue in America that impact 20% of older adults and 1/3 of all older people in nursing homes.  Some notice their mental illness in earlier years while others encounter mental difficulties through chronic physical illness or experiences of aging. Less then 3% will consult a mental health professional and a disturbing number will elect suicide. How is mental illness defined in aging? What are the triggers in older adults?  Why is it important to learn about mental illness in older adults? How might a mentally ill older adult impact you?

Mental Illness in older adults has unique features. By definition it includes familiar conditions like depression, anxiety, and substance abuse but also encompasses dementia, symptoms of chronic illness, adjustment disorders and behavioral health concerns like insomnia and incontinence. Why are incontinence and insomnia under the mental illness umbrella? Because incontinence can trigger depression or be a consequence of mental illness while insomnia can cause memory problems and is linked with Post Traumatic Stress Disorder, Obsessive Compulsive Disorder, depression, anxiety and stress.

Potential triggers of mental illness in older adults abound: death of friends and family, stress/anxiety, major relocation, long term illness, lack of social supports, hospitalization, and medication conflicts or adverse drug reactions (ADR). Anxiety is a trigger impacting many older adults. Coined "The Silent Geriatric Giant," numbers of older adults with anxiety rival incidences of depression and dementia. Medscape notes, anxiety can go unnoticed because older adults often express it as a physical manifestation (such as gastrointestinal pain) or report multiple medical problems managed by multiple medications which obscures their degree of anxiety.  Post operative Cognitive Decline (POCD) and delirium is also a concern for older adults. According to a 2015 study as many a 15% of patients over 60 experienced a degree of cognitive decline following non-cardiac major surgery. Surgeons still debate the phenomenon and cite lack of research but cardiologists have known this effect for years. Is it because of anesthesia? Is it inflammation in the body from incisions?  The physiology of aging and the unique experiences of later years put older adults at greater risk of encountering mental illness through any one of the triggers listed above.

Why is it important to learn about mental illness in older adults? In many cases mental illness can be prevented, treated, or managed but only if it's recognized. Without awareness, mental illness can hide or be denied thereby going untreated. Depression, for instance, impacts 6 million older Americans and co-occurs with some age related illnesses. Despite high treatment success rates just 10% of elders sought professional help for the condition.  Similarly, of the 1 in 5 older adults with mental illness, only 22% sought help through inpatient psychiatric, community health care, or private psychiatry. Complicating matters, doctors don't always detect mental illness. In one study of older adults who committed suicide; 20% had seen a doctor within 24 hours of their suicide, 41% saw a doctor 7 days before and 84% saw their doctor within one month of taking their life. According to "Overlooked and Underserved: Elders in Need of Mental Health Care" every day 17 older adults take their life- that's the highest rate of suicide among all age groups. We need to turn this around by valuing older Americans more, lifting awareness of mental illness in elders, and educating ourselves about the unique risks for mental illness after 55.

How does mental illness impact you? Perhaps you're one of the 43 million people providing care for someone over the age of 50. When we offer to caregive we step into the vulnerable, intimate and often unresolved or still unknown issues of another person's life. If mental illness was never diagnosed or treated during younger years then illness and aging can aggravate the condition and complicate diagnostics or challenge your caregiving relationship.  If you're one of nearly 9 million people caring for someone with dementia I don't need to tell you how challenging and complicated that can become. Dementia or cognitive decline can make it difficult to interpret signs of illness. In addition medication side effects have to be closely monitored. High agitation and confusion in people with dementia, for instance, is too often treated with antipsychotic drugs which, the FDA warns, can cause stroke, fractures, and death in older adults. It's often up to the patient advocate to read about medications and any known impacts. Mental illness can interfere with treatment and cognitive decline can result from a treatment. Did you know that providing care for people experiencing mental illness can trigger stress, anxiety, and cognitive decline in oneself? Some studies show 40-70% of caregivers develop clinically significant depression. Please, if you're a caregiver cultivate well being and support and if you're the friend or employer of a family caregiver offer your listening ear.

As older adults we experience unique and sometimes powerful life events that put us at higher risk of mental health challenges. Learn about the spectrum of triggers that increase your risk and take steps to build support as you encounter those circumstances. Seek treatment help if you find yourself struggling with or questioning your mental stability.  Age brings us greater comfort with so many aspects of our lives let it also bring us comfort in seeking help. Through awareness and the willingness to seek treatment we can fight the depression and anxiety that marks later years and bring older adult suicides to a stop.