January 2014
Old Age Psychiatry


A Day to Reflect on the Mental Health and Well-Being of Older People Around the World

The mental health and well-being of older people was chosen by the World Federation for Mental Health as theme for the World Mental Health Day 2013. This is a very good occasion to reflect about the global situation of older people with mental disorders around the globe.

Mental health is essential to overall health and well-being, and should be recognized in all older persons with the same importance as physical health. By 2050, the world population over the age of 60 is estimated to be 2 billion. A rapid growth of older persons will occur in Low and Middle Income Countries (LMIC) with huge consequences for these vulnerable economies. Many people live a long and happy life without any mental health problem, and despite the all too prevalent image of elderly people being sad, slow, and forgetful, mental disorders are not an inevitable consequence of ageing. Nevertheless, one of the possible negative consequences of the rapid ageing of the global population is the increase in the number of people with mental disorders which will soon overwhelm the mental health system in all countries.

More than 20% of people aged 55 years or older may have some type of mental health problem. Biological changes may interfere with the brain’s functioning. Social changes can lead to isolation or worthlessness. Somatic diseases are often important contributory factors too. Mental disorders may exacerbate the symptoms and functional disabilities associated with medical illnesses and increase the use of healthcare resources, length of hospital stay and overall cost of care.

Mental health problems can have a high impact on an older person’s ability to carry out the basic activities of daily living, reducing their independency, autonomy, and quality of life. The first step to reduce these negative consequences is simply making a diagnosis. Unfortunately, too often mental health problems are undiagnosed and untreated and many older people struggle on without the proper help – or any help at all. 

Today’s older adult population has been less likely to acknowledge mental illness or access mental health services. Many stigmas exist regarding the meaning of mental illness. Several elders view mental illness as a sign of weakness and are unlikely to admit to problems, especially when they fear loss of independence. Too many persons consider that symptoms of dementia and depression are a normal part of aging. Many elders lack availability of and access to services.

Other difficulties concern the work force: few mental health providers have had specialized training in providing care for older adults, and many come with a set of societal-transmitted biases themselves. The therapeutic pessimism allows health professionals believe that older people cannot change and that it is too late for psychiatric care. In consequence, there are few investments in the development of policies, strategies, programs, and services for older persons with mental health problems.

Aging well in physical and mental health is a right of all persons. Such rights extend to enjoying active and satisfying social lives, participation, having equitable access to good quality health care and social systems, and providing adequate support to caregivers. 

The aging shift will have profound consequences for the workforce, healthcare systems, informal and formal caregiver capacity, and society. It will require more and better strategies to ensure good mental health and well-being in the growing older population. The negative stereotypes and negative attitudes against aging and older people must be stopped. The balance between vulnerability and resilience is central in mental health promotion and certain groups with specific burden face a higher risk of poorer mental health. Older women often face specific risks which increase their vulnerability both as sufferers of mental health problems and caregivers. Policies to support them and interventions to prevent mental health problems and isolation in older women must be strengthened.

Interventions to prevent social isolation and loneliness are effective measures. An increase in social inclusion and participation of older people must be a very high priority in order to promote active aging and quality of life in a holistic way by addressing:

- Life-long learning, training, and education of older people

- Psychological and behavioral determinants of health

- Socio-economic determinants of health

- Taking cultural and spiritual needs into account 

Mental health promotion research related to older people should be strengthened in order to improve scientific evidence and should concentrate on issues where the evidence base is weakest. The promotion of an appropriate use of medication is crucial for optimal mental health and functioning among older people.

In conclusion, the promotion of healthy aging in all its aspects is an important role for all societies. Early recognition, diagnosis, and treatment of mental disorders that are common in old age are important to prevent evitable suffering and disabilities. Care for older adults with mental illness requires sensitivity and observational and relational skills in order to help the older person achieve and maintain the highest possible level of function and well-being. Those who care for older persons should always be protected and supported in their tasks everywhere.

All these actions together can certainly contribute to a better mental health in old age.

Carlos Augusto de Mendonça Lima

Secretary, WPA Section on Old Age Psychiatry

Chair, European Psychiatric Association Section of Geriatric Psychiatry

Jacobo Mintzer

President, International Psychogeriatric Association

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