16 August 2023

Misconceptions about mental health as we age

Australia, like most developed countries, has an ageing population. According to the Australian Institute of Health and Welfare (AIHW), 16.2% (or 4, 161, 780) of Australians were aged over 65 years in 2021. This is projected to increase to 17.9% (or approximately 5, 244, 700 people) by 2031.

Society has made improvements in recognition and acceptance of mental health in the past half century. Unfortunately, there continues to be several myths about ageing, and the mental health of older adults is often overlooked. This post aims to dispel some of these myths and raise awareness of peoples implicitly held beliefs about ageing.

1. Depression is inevitable.

It is a reasonable assumption to make that older people will more likely present with symptoms of depression as they experience psychosocial stressors including bereavement, loss, and changes to aspects of their life, leading to heightened feelings of sadness. However, research indicates that this is not the case. Most older adults can experience brief periods of low mood or sadness but are able to cope well after a short period of time.

Depression is a complex condition; it can present as a standalone diagnosis or occur secondary to other diagnoses. Approximately 1 in 5 older adults who live at home will develop clinical anxiety or depression, which is comparable to the adult population, albeit symptom severity can be greater (likely resultant latency in effective diagnosis and limited access to treatment). However, it is also important to note that the prevalence of depression and/or anxiety for older adults living in residential aged are facilities is as high as 50%. It is well established that diagnosis becomes more difficult with medical co-morbidities including dementia, making assessment and treatment by a psychologist or psychiatrist with specialist training in older adults integral. However, depression in older adults is treatable if diagnosed early and effectively.

2. Anxiety doesn’t impact older people.

People tend to think that the years spent as an older adult is associated with a time of well-earned rest and relaxation, free from any worries or strife. Whilst that can be the case, worry and anxiety can detrimentally impact anybody at any age, and older adults are no exception. Some of the common areas that older adults may worry about include retirement (due to lack of purpose in the day, or increased financial burdens with limited income), health (older people have higher risk of developing health-related concerns), and/or independence (how long will I stay at home, losing independence, becoming more reliant on others, increased need for care). Some older adults may also worry about being a burden on those they care about.

3. I will get Dementia.

This might be one of the most common health and insidious misconceptions about ageing to date. It is also one of the biggest barriers for both the older person, and/or their family, in seeking support. Everyone fears the older adult receiving this dreaded diagnosis. I want to make this clear: Dementia is not inevitable when you get older! Current research shows that only about 10% of older adults have a diagnosis of Dementia. Whilst this number is growing, it is attributed to the increasing number of the Baby Boomer Generation entering this age stage, rather than the inevitability to having dementia as people get older.

Additionally, memory deficits can be due to many things. Some factors are physical health concerns (e.g., stroke, ineffective thyroid function, delirium, Obstructive Sleep Apnea), and others mental health concerns (e.g., anxiety, sleep disturbance, low mood, bereavement). Leaving these unassessed and untreated can be seriously detrimental to the health of the older adult and can pose a serious life-threatening emergency. Some of these conditions can be treated through implementation of additional medications and/or therapy with a psychologist. Indeed, with treatment, the memory concerns are known to improve again.

Whilst there is no known cure for Dementia, earlier diagnosis is integral to improved outcomes. The progression of dementias is not linear; the earlier the diagnosis, the sooner strategies (medication and/or psychosocial) can be put in place to hinder its progression.

4. Older people aren’t engaged with society

There is a perception that older people have outlived their ability to be functional and productive members of society. This is a form of ageism, or discrimination against individuals based on their age. This links to why many older people are not provided with the opportunity to seek therapy (see below). This thinking is an error in judgement. Many older adults continue to be productive members of society well after they retire from the workforce. Some achieve this by being unpaid carers for loved ones, volunteering, or being an active member in community outreach programs.

Staying socially active is a known protective factor for developing depression. Even older adults with mobility concerns may not be as active as when they were younger, but activity within their level of functional ability is equally important.

5. Therapy is only for younger people

Who’s heard the adage of the ‘cranky senior’? what about the saying “you can’t teach an old dog new tricks”? How about when watching a movie, is the older character more often portrayed as cognitively rigid, set in their ways, and stubborn? In my clinical practice, people often say yes to at least one, but sometimes all three of these. Unfortunately, these ideas lead to the overarching implicit perception that older people will be unresponsive or resistant to change and, thus, unsuitable candidates for therapy. This results in many older adults suffering in silence.

It is true that some (especially the Silent Generation) do embody stoic values, which means asking for help is a sign of weakness; some people may know this as the “stiff upper lip” approach to life. These values are a carryover from their upbringing (i.e., WWI, Great Depression, and WWII all occurred during their formative years), which can get in the way of seeking help. It is important to know that if you hold this value, it’s commendable that you want to be independent for as long as possible, but not asking for help when you are suffering is known to prolong the suffering unnecessarily. Also, if your loved one has this outlook and you believe they could use additional support (even for a short time), encourage them to seek out that support.

However, older adults are more willing to try new things (e.g., technology) than people expect, including therapy. US statistics shows us that approximately 2/3 of seniors use the internet, at least sometimes – technology that was not available to them for most of their adult lives. This highlights just how adaptive older adults are to new experiences. Current literature indicates that, for the most part, older adults respond just as effectively to therapy as anyone else. Older adults should be provided with the option to seek help, and it is essential that they are supported to reach out for help, if you feel there is a need.

If you, or and older person you care for, is going through a difficult time seeking out help can be the first step in making improvements in your life, and so should be encouraged.

Written By Ryan Joffe, Clinical Psychologist