Every year in the month of May, mental health advocates around the U.S. collaborate to sponsor Mental Health Awareness Month (MHAM). In 2023, the lead organizer – Mental Health America (MHA) – chose to focus their advocacy efforts for MHAM around the theme Look Around, Look Within. MHAM advocates mental health awareness for all people and all age groups, including older adults and seniors.
Here’s how the people at MHA they describe the theme for 2023:
“From your neighborhood to genetics, many factors come into play when it comes to mental health conditions. We encourage everyone to consider how the world around you affects your mental health: look around, look within.”
We’ve also published two additional articles that address mental health in the U.S. in 2023, as part of our mental health advocacy efforts. You can read these articles here:
Mental Health Awareness Month: Did Anxiety and Depression Increase in Children and Teens During COVID-19
This article is also part of our MHAM advocacy efforts. We realized we needed to write this article when we read a recent CDC report that indicated that between 2020 and 2021, drug overdose deaths among seniors increased more than in any other age group. The connection between substance use and mental health is undeniable. In fact, the disordered use of substances itself is classified as a mental health disorder, called substance use disorder (SUD).
To help raise awareness about mental health and substance use among seniors, we’ll offer the latest prevalence rates of mental illness and substance use among seniors, share the latest statistics on mental health and substance use treatment among seniors, and close by describing two important national programs currently in place, which are designed to support seniors with mental illness.
Mental Illness, Alcohol and Substance Use, and Treatment Among Older Adults and Seniors: Facts and Figures
We’ll start with big-picture information provided by The World Health Organization (WHO). The WHO offers these insights on the mental health of older adults and seniors worldwide:
- Between now and 2050, the proportion of adults age 60+ years will increase from 12% to 22%
- Mental health disorders – alongside neurological conditions – account for 6.6% of disability among adults 60+
- 15% of adults age 60+ have a mental health disorder
- Dementia affects 50 million older adults worldwide
Next, we’ll offer the latest prevalence rates of mental health disorders in the United States, as reported by the 2021 National Survey on Drug Use and Health (2021 NSDUH).
We’ll begin with older adults diagnosed with a mental illness or a serious mental illness. We include the prevalence rates among other age groups for comparison and perspective.
Mental Illness Among Older Adults
Any Mental Illness (AMI):
- 18-25: 33.7% (11.3 million)
- 26-49: 28.1% (28.8 million)
- 65+: 11.9% (698,000)
Serious Mental Illness (SMI):
- 18-25: 11.4% (3.8 million)
- 26-49: 7.1% (7.3 million)
- 50+: 2.5% (3.0 million)
- Received treatment: 71% (2 million)
- 61% received medication (1.8 million)
Now we’ll look at rates of major depressive episode (MDE) and MDE with severe impairment among adults. In the NSDUH, the categories MDE and MDE with severe impairment serve as proxy metric for diagnosis of major depressive disorder (MDD) and severe MDD. Again, we include data on other age groups for purposes of comparison and perspective.
Depression Among Adults
Major Depressive Episode (MDE):
- 18-25: 18.6% (6.2 million)
- 26-49: 9.3% (9.5 million)
- 50+: 4.5% (5.3 million)
- 65+: 2.8% (1.5 million)
MDE With Severe Impairment:
- 18-25: 13.3% (4.4 million)
- 26-49: 6.5% (6.6 million)
- 50+: 2.9% (3.4 million)
- 65+: 1.3% (739,000)
Next, we’ll look at the rates of treatment for depression among older adults, with other age groups included.
Depression Treatment Among Adults
- Adults 18+ with MDE:
- 18-25: 51.1% received treatment (3.1 million)
- 26-49: 63.5% received treatment (5.9 million)
- 50+: 68.2% (3.5 million)
- Adults 18+ with MDE with severe impairment:
- 64.8% received treatment (9.1 million)
- 18-25: 56.7% received treatment (2.4 million)
- 26-49: 66.6% received treatment (4.3 million)
- 50+: 71.8% received treatment (2.3 million)
When we read this last set of statistics, our reactions are mixed. We’re encouraged that rates of treatment are relatively high, especially among people over age fifty. However, the fact that we’re encouraged reveals something that’s definitely not encouraging. We accept treatment rates in the 50-70 percent range as good – but when we think about it, that’s not good enough. We would not accept those treatment rates for people with chronic physical conditions such as hypertension and diabetes, and we should not accept them for mental health disorder such as depression.
That’s another reason for the existence of MHAM. Despite significant progress over the past 20 years, our ideas about mental health disorders and treatment are still skewed. We can work to recalibrate our perceptions, and normalize treatment, so that we can expect – and deliver – treatment rates that are higher than the current data reveal.
We’ll shift gears now, and report on prevalence rates of alcohol and drug use among adults, followed by prevalence rates of people diagnosed with a mental health disorder and alcohol/substance use disorder AUD/SUD) at the same time. When this happens, an individual receives a dual diagnosis and has what clinicians call co-occurring disorders.
Alcohol, Drug Use, and Co-Occurring Disorders Among Older Adults
We’ll define the two terms you’ll find in the following data in case you’ve never seen them. Binge alcohol use refers to drinking five or more alcoholic beverages in under two hours for males, and four or more alcoholic beverages in under two hours for females. Heavy alcohol use refers to five or more binge drinking episodes in a one-month period, for males or females.
Here’s the data:
Alcohol and Drug Use Among Older Adults
- Past Month Alcohol Use:
- 50-64: 47.1%
- 65+: 42.2
- Binge Alcohol Use:
- 50-64: 16.4%
- 65+: 42.2%
- Heavy Alcohol Use:
- 50-64: 6.7%
- 65+: 2.8%
- Any illicit drug use:
- 50-64: 47.1%
- 65+: 38%
- Marijuana use:
- 50-64: 44.0%
- 65+: 38%
- Illicit drug other than marijuana:
- 50-64: 4.8%
- 65+: 7.3%
Those are the rates of drug and alcohol use among older adults. We include this information because any level of alcohol and drug use increases the risk of developing an alcohol or substance use disorder (AUD/SUD), which in turn is associated with increased risk of developing a mental health disorder. We report rates of AUD/SUD among older adults below.
Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD) Among Older Adults
- Alcohol Use Disorder (AUD)
- 50-64: 7.6%
- Received treatment: 0.6%
- 65+: 5.3%%
- Received treatment: 0.4%
- 50-64: 7.6%
- Substance Use Disorder:
- 50-64: 11.3%
- Received treatment: 0.5%
- 65+: 7.8%
- Received treatment: 0.3%
- 50-64: 11.3%
In contrast to treatment for major depressive disorder, we can see that rates of treatment for AUD and SUD among older adults is very low: in both age groups above, for both SUD and AUD, this data tells us that 99 percent of older adults who needed treatment for AUD/SUD did not get the treatment they need.
That’s something we need to fix – sooner rather than later. This treatment gap is related to the next set of data we share. The longer a person with AUD or SUD goes without treatment, the greater their chance of developing a mental health disorder, and vice-versa. That means that those low treatment rates likely contribute to the phenomenon of co-occurring disorders.
Co-Occurring Disorders Among Older Adults and Seniors
To meet criteria for a co-occurring disorder, a person must receive a diagnosis of a mental health disorder and an alcohol and/or substance use disorder. Here’s the latest prevalence data from the 2021 NSDUH:
- Adults 18 to 25: 45.8% (15.3 million) had either SUD or AMI
- Among adults 26-49: 39.5% (40.4 million) had either SUD or AMI
- Adults 50+: 22.6% (26.7 million) had either SUD or AMI
- Adults with AMI and SUD:
- 50+: 3.7% (4.4 million people)
- Adults with SMI and SUD:
- 18+: 2.5% (6.4 million people)
- 50+: 1.0%
Now we’ve finally arrived at the dataset that prompted us to write this article: the increase in overdose deaths among older adults and seniors between 2020 and 2021. In a surprise to public health officials, addiction treatment experts, and other, this data shows that Seniors age 65+ showed the largest increase among all age groups. This foreground the need for everything we’ve mentioned to this point in this article: awareness, advocacy, and treatment for mental health disorders and substance use disorders among older adults and seniors.
Overdose Deaths Among Older Adults Seniors 2020-2021 (Rate per 100,00 people)
- 2020: 37.3
- 2021: 45.3
- 21% increase
- 2020: 9.4
- 2021: 12.0
- 27% increase
Those are the latest facts and figures – and that’s a lot of data to digest. If you’re curious about the sources and learning more details about these various disorders and how they manifest in the general public, we encourage you to click the links and explore the data firsthand. However, the summaries we offer above can give you a solid working idea of the current state of mental health among people over age 50 in the U.S.
Next, let’s learn about how we can recognize the presence of a mental health disorder among older adults and seniors.
Older Adult and Senior Mental Health: Warning Signs and Risk Factors
The peer-reviewed journal article “Prevalence, Structure, and Risk Factors for Mental Disorders in Older People” identifies the risk factors for mental health disorders among older adults:
- Being female
- Alcohol abuse
- Lack of education
- Financial shortage
- A family history of mental diseases
- Severe physical disease
The symptoms of mental health disorders among older adults include:
- Extreme changes in mood, energy level, or appetite
- Feeling flat or emotionless
- Persistent sadness
- Problems experiencing or feeling positive emotions
- Sleep problems: too much or too little
- Problems with concentration
- Restlessness/feeling edgy
- Anxiety/feeling stressed
- Uncharacteristic aggression
- Headaches, stomachaches, nausea
- Increased or new use of alcohol and/or drugs
- Suicidality: thinking about, talking about, or planning suicide
- Risky behavior
- Uncharacteristic compulsive/impulsive behavior
- Uncomfortable emotions that disrupt typical behavior associated with work or family life
- Hallucinations, i.e., seeing, hearing, and feeling things that others don’t see/hear/feel
If an older person in your life – a family member, a friend, a coworker – shows any of these signs or symptoms and is considered at-risk, we encourage you to help them find professional treatment and support. That’s an essential step, and treatment can help an older person manage their emotions and life a full and fulfilling life.
We’ll close this article by discussing two programs currently in place that do exactly that: they support the mental health of older adults and seniors, and promote overall health, happiness, and wellbeing.
Special Programs Target Older Adult and Senior Mental Health
Between 2005 and 2010, the Centers for Disease Control (CDC) published two helpful resources on mental health among seniors: The State of Mental Health and Aging in America: Brief #1 and Brief #2. In Brief #2, they describe two programs that help seniors with mental health issues: Project IMPACT and Project PEARLS.
- We’ll describe those programs now, starting with Project IMPACT.
Program 1: Project IMPACT
IMPACT is a program for older adults who have major depressive disorder or a related mood disorder. Here’s how it works:
- A nurse, social worker, or psychologist works with the primary care provider to develop a course of treatment.
- During the initial visit, the depression care manager (DCM):
- Assesses the patient
- Provides information and about depression and depression treatment
- Discusses treatment options and preferences with the patient
- DCMs encourage all older and senior patients to:
- Stay physically active
- Schedule and participate in pleasurable events
- Studies show that patients who participate in IMPACT care were twice as likely as usual care patients to experience a 50% or greater reduction in symptoms of depression.
Next, we’ll describe the PEARLS program.
Program 2: PEARLS (Program to Encourage Active Rewarding Lives for Seniors)
PEARLS is a short, patient-directed, patient-centered program. The goal of PEARLS is to teach practical, effective depression management techniques to older adults diagnosed with a depressive disorder. The program is for older adults who receive home-based social services from local community social support programs.
The program is designed to:
- Reduce depressive symptoms
- improve quality of life.
- Depression care managers (DCM) use three depression management techniques:
- Problem solving. DCMs teach participants to recognize depressive symptoms, identify problems that exacerbate depression, and take steps to resolve those problems
- Social and physical activity planning. In some cases, seniors with depression need coaching to plan the social and physical activities that improve their quality of life
- Pleasant event planning and scheduling. This is similar to social and physical activity planning: pleasant events improve quality of life, and many seniors with depression need hep planning these types of events.
- DCMs meet with seniors according the following schedule:
- (8) 50-minute in-home counseling sessions over two months
- 3-6 maintenance session contacts conducted over the telephone
- Studies show that participants who received the PEARLS intervention were three times more likely than those receiving usual care to reduce symptoms of depression.
Those two programs, which began close to twenty years ago, have helped improve life for seniors around the country. Here’s something you may not know: you can help improve life for older adults and seniors, too.
Mental Health Awareness Month: How We Can Help Seniors
This year, during MHAM, we can all help older adults and seniors improve their mental health. We can start with the people in our families: reach out to older relatives and check in. If you see any warning signs of mental health or alcohol/drug issues, try to learn more about what’s going on. If possible, help them arrange a full mental health assessment: if they need treatment, the sooner they get it, the better the outcome.
The same is true for older adults and seniors who aren’t direct family members. Talk to them, ask questions, and find out how they’re doing. If you think they need help with mental health issues, you can find a local IMPACT or PEARLS program and connect them. If they don’t need professional mental health support, we encourage you to maintain a friendly relationship with them. A positive social network is a protective factor against mental illness for people of any age – and for older adults and seniors, it can make all the difference.