MENTAL HEALTH ISSUES

Most older adults enjoy good mental health, while some experience mental health issues that can adversely affect both physical health and ability to function. Besides cognitive impairment, common mental health issues among older adults include mood disorders such as depression and substance use. Mental health issues are often implicated as a factor in cases of suicide among this population.

Depression and Suicide

Depression is the most common mental health condition in adults age 65 and older (MHA, 2021). Negative effects of depression are far-reaching, further complicating existing conditions common among older adults.

Often depression in the older adult is confused with the effects of multiple illnesses and the medications used to treat them. Also, due to the belief that the older adult is expected to slow down, family and healthcare practitioners may miss signs of depression, and effective treatment is often delayed.

Suicide is the 17th leading cause of death among people age 65 and older. White males age 85 and older have the highest rate in the nation. Although older adults attempt suicide less often, they are more successful. Older adults should be screened for suicide risk using a tool such as the Patient Health Questionnaire (PHQ-2), a two-question depression screen (Wenker & Liebzeit, 2019).

Recognizing the symptoms and screening for depression and suicide in older people and referring them for appropriate diagnosis and treatment may greatly improve their quality of life and prevent suicide (NIA, 2017).

Management of depression includes antidepressants, psychotherapy, complementary therapies, electroconvulsive therapy, and stimulation techniques. Regular exercise may help prevent depression. Being fit and eating a balanced diet may help avoid illnesses that can increase the risk for disability or depression (NIMH, 2020).

Suicide protective factors include good physical and mental health, social relationships, and belief systems (CDC, 2019).

Substance Use in Older Adults

While illicit drug use typically is much lower in older adults than younger adults, it is currently increasing. Nearly 1 million older adults are living with a substance use disorder. Little is known about the effects of drugs and alcohol on the older brain, but older adults typically metabolize substances more slowly, and their brains can be more sensitive to drugs.

Alcohol is the most frequently used substance among older adults. Many older adults may use alcohol simply because it is a long-term habit that is part of their lifestyle. Some may use alcohol and other substances to cope with big life changes such as retirement, grief and loss, declining health, or a change in living situation.

Older adults may be more likely to experience mood disorders, lung and heart problems, or memory issues, and drug and alcohol use can worsen these conditions. Additionally, some drugs can impair judgment, coordination, or reaction, which can result in accidents, including falls and auto crashes (NIDA, 2020).

Despite the increasing prevalence of substance use among older adults, they are less likely to be screened compared to younger adults. Signs and symptoms of substance use may be mistaken for manifestations of chronic disease (Han & Moore, 2018). Several screening instruments for substance use are available for a range of substances (alcohol, tobacco, illicit drugs, and prescription drugs), but only a few are designed specifically for and validated in older adults.

One example of a validated screening tool that is commonly used with older adults in the primary care setting is the Substance Use Brief Screen (SUBS), a self-administered brief screen for tobacco, alcohol, and drug use (illegal and prescription). Screening positive with this tool would lead to further screening with longer, more reliable tools (Han & Moore, 2018).

The misuse and abuse of substances by the older adult presents unique challenges for recognizing the problem and determining the most appropriate treatment interventions. Misuse is the intentional use, for therapeutic purposes, of a drug by an individual in a way other than prescribed by the healthcare provider or for whom it was not prescribed. Abuse is the intentional nontherapeutic use of a drug, even once, for its desirable psychological or physiologic effects (U.S. FDA, 2019).

Treatment options specifically tailored for older adults are limited. The majority of older adults at risk for problem substance use do not need formal, specialized substance abuse treatment. However, many can benefit from prevention messages, screening, and brief interventions (Fulmer & Chernof, 2019).