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Aging, Mental Health and Caregiving (CA)

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By: Lakelyn Hogan, MA, MBA, Gerontologist and Caregiver Advocate, Home Instead

Often caregivers assume that mental health issues such as depression are a normal part of aging, but that assumption is wrong. Family caregivers supporting those living with emotional or mental health conditions face unique challenges that can cause a heavier burden of care and higher stress levels than that experienced by a typical family caregiver

Mental Health Across the Lifespan

While seniors can face unique mental health challenges, an American study shows that the percentage of adults experiencing frequent mental distress actually decreases as age increases. And older adults have the lowest rate of mental disorder of any age group, except for cognitive impairment.

  • 7.4% of adults ages 65-74
  • 6.3% of adults 65+

Age of onset varies by disorder, but 90% of lifetime cases of mental disorders start by age 42. The rate of mental disorders also varies by setting with higher rates of mental disorders in nursing home residents. Suicide rates are higher among older adults compared to the general population.

Research has identified three patterns of older individuals with mental disorders:

  • Those who had a mental disorder early in life and maintained the same disorder into later life.
  • Those who grew old and experienced mental disorder for the first time in later life.
  • Those who came to later life with a liability (genetic influence, life stress, etc.) that was exacerbated by the conditions of later life, producing mental disorder.

Mental Health Diagnosis

The combination of biological, social and psychological factors is thought to impact the manifestation and outcome of mental health disorders. Understanding the interaction between the older person and these elements are important for assessment and treatment of mental disorders.

Oftentimes, getting a diagnosis is challenging because distinguishing between/amongst neurocognitive disorders can be difficult. According to National Alliance for Family Caregiving research, it takes 11.8 years on average to arrive at an accurate diagnosis and 39% think the diagnosis may be incorrect.

Common stressors that can lead to or affect an older adult’s mental health include money, family members, personal health and wellbeing. This stress can be experienced physically through a quickened heartbeat, upset stomach, sweating or through a combination of feelings like worry, fear, apprehension and hopelessness. These stressors, combined with mental health and wellbeing contribute to older adults having a higher suicide rates at 24% higher than the national population.

Mood Disorders

Mood disorders can be broken down into two categories: Major Depressive Disorder and Bipolar Disorder. Of the two, major depressive disorder is more common among older adults. Bipolar Disorder is rare, only 0.6% of adult population is diagnosed.

Major Depressive Disorder

Depression is common among older adults but it is not a normal part of aging and is treatable. It can be easily confused with medical problems, cognitive impairment, variations of the grief process and normal ups and downs of later life. The prevalence of symptoms is higher among older adults than actual diagnosis.

Symptoms of Depression:

  • Cognitive symptoms: complaints about memory; executive functions deficits
  • Somatic symptoms: fatigue, sleep disruption
  • Loss of interest in activities and living

Lifelong depression will have more complicated treatment than an older adult who experiences depression for the first time in later life. Knowing past habits can help family caregivers understand current behaviour.

Medication and psychotherapy can be equally effective treatments. No one type of therapy is clearly superior to others but therapy is better than none at all or placebo.

Other Disorders

Other disorders can affect older adults, ultimately impacting family caregivers.


Anxiety is less common among older adults than younger adults, but still impacts seniors and, therefore, family caregivers. Symptoms can include: worry, fearfulness, low mood or irritability, racing heart, sweating, stomach distress, and distractibility.

Types of Anxiety:

  • Specific phobia: Fear or avoidance of a particular object or situation like heights or animals.
  • Social anxiety disorder: Characterized by excessive fear about social situations.
  • Generalized anxiety disorder (GAD): This is the descriptor of broader set of symptoms that includes excessive or unrealistic worry most days for 6 months or longer.
  • Panic disorder: Characterized by recurrent panic attacks which are abrupt surges of intense fear.
  • Agoraphobia: This is a distinct anxiety disorder causing the fear of leaving home.

Obsessive Compulsive and Related Disorders

  • Hoarding is characterized by chronic difficulty parting with possessions regardless of their actual value. Hoarding behaviours usually begin in early life and commonly span well into later life. The severity of hoarding usually increases with each decade of life.
  • Obsessive compulsive disorder (OCD) is a chronic disorder defined as recurring obsessions or compulsions. OCD affects about 1.2% of population. Onset occurs typically after age 35 but can span the lifespan especially if not treated.

Other disorders that can impact an older adult are included below. For more detailed information on each, watch this webinar.

  • Sleep disorders
  • Substance-Related disorders
  • Cognitive impairment and neurological disorders
  • Chronic pain
  • Post-Traumatic Stress Disorder
  • Sexual disorders
  • Personality disorders

Barriers to Mental Health Services Utilization

Accessing mental health services is an issue and older adults significantly under use services. The aging population is less likely to go to a mental health specialist than younger populations and tend to have an overreliance on nursing homes as a treatment setting. While stigma was at the bottom of list, paying for treatment, transportation and difficulty finding a provider were top barriers to older adults utilizing mental health services.

Challenges for Mental Health Caregivers

Caregivers to older adults with mental health issues face challenges not typically seen by other caregivers.

  • Care recipient is likely to be financially dependent on caregiver
  • Responsibility for oversight and care coordination falls to caregiver (including medication management)
  • Often there is no family to assist or provide care if caregiver is unable
  • Caregiver is an important advocate for care recipient
  • Caregiver has higher levels of stress and burden than average caregivers

The National Alliance for Caregiving published On Pins and Needles: Caregivers of Adults with Mental Illness, a report on mental health caregiving. The study found that the average mental health caregivers are women who are 54 years old, though most are ages 45 to 64(54%). They’re typically caring for a relative (88%) with one of the following conditions:

  • Bipolar disorder – 25%
  • Schizophrenia – 25%
  • Depression – 22%
  • Anxiety – 11%
  • Alcohol or drug abuse – 28%

When comparing mental health caregivers to all caregivers, they’re typically caring for longer durations – 8.7 years versus 4 years – and the intensity of care is higher too – 32 hours per week versus 24 hours per week. The other primary difference worth noting is that about half of caregivers report that their care recipient lives with them, in their household (45%), more so than the typical U.S. caregiver (34%).

Caring for a loved one with a mental health disorder can cause significant strain or stress on the caregiver. In fact, 72% of survey respondents said they were under high emotional stress and 62% said caregiving has had a negative effect on his or her health.

Help for Mental Health Caregivers

To help navigate the challenges of mental health caregiving, the National Alliance for Caregiving created Circle of Care, a free mental health guidebook that can help navigate system challenges and disorder specific symptoms. It also includes a four-part caregiver health self-assessment to assist caregivers in understanding their physical, spiritual, emotional and financial health.

Pie chart showing 12 areas of mental health caregiving called the Circle of Care.

Pie chart showing 12 areas of mental health caregiving called the Circle of Care.

If you are interested in a deeper dive on this topic, watch this webinar and even earn a free Continuing Education (CE) credit*.

*CE credits are only available for 60 days following the live webinar event.

Last revised: December 11, 2019

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