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Mental Illness in Older Adults ‘Very Common’–and Underdiagnosed

Mental Illness in Older Adults ‘Very Common’–and Underdiagnosed

May is Mental Health Month which is, according to Mental Health America, meant to ‘promote health and wellness in homes, communities, schools, and inform those who don’t believe it’s attainable.’ Depression has been called a ‘silent killer‘; anxiety disorders and other psychiatric disorders have been called ‘invisible as someone suffering from them may well have no obvious physical symptoms, even though that person may be experiencing deep pain within. Undiagnosed mental illness is said to be ‘highly prevalent‘ and, too, a cause of ‘needless morbidity.’

Further, even while rates of mood and anxiety disorders may seem to decline with age, a report in the May Archives of General Psychiatry has found that these conditions actually remain ‘very common’ in older adults, especially women. Researchers studied 2575 participants 55 years and older who were part of theNational Comorbidity Survey Replication NCS-R (43%, 55-64 years; 32%, 65-74 years; 20%, 75-84 years; 5%, 85 years). All were ‘noninstitutionalized’ and  resided in households within the community. The study concluded that:


Prevalence rates of DSM-IV mood and anxiety disorders in late life tend to decline with age, but remain very common, especially in women. These results highlight the need for intervention and prevention strategies.


I’ve had the under-diagnosis of mental illness in older adults—and the lack of adequate treatment, with potentially tragic results—on my mind much of late. 

My mother-in-law, Grace, died this past Mother’s Day. She was 81 years old and had long been in very poor health, physically (she struggled to walk and had had both knees replaced in 2006) and mentally, for many years. She suffered from depression and anxiety and had been hospitalized for these throughout her life. During her last years, she rarely left her house deep in the New Jersey suburbs; I can’t count how many times my husband Jim coaxed and cajoled her to come walk with him around the block—’I’ll be right beside you, Mom, holding your hand!”—or, when that seemed too daunting, up and down her long driveway. She was smart and curious and, when I first met her in 1994, loved to read five newspapers a day and send Jim a manila folder of clippings. Jim is a historian and his most recent book, On the Irish Waterfront: The Crusader, the Movie, and the Soul of the Port of New York, is rooted in Grace’s love of movies and stories, and her roots in Hudson County, in New Jersey.

On the Irish Waterfront was published in August of 2009 but Grace was not able to read it. Her eyesight was gone as the result of a stroke. But even more, what Jim refers to as the ‘depths of her emotional unease‘—sporadically treated and not talked about—had had their toll. Lying pale on her bed in the nursing home with the TV set droning on overhead, she did not respond when Jim read the chapter in the acknowledgments about his mother reading excerpts from Jimmy Breslin’s columns in the New York Herald Tribune out loud to her friends over the phone. 

And I’ll always wonder, how might Grace have smiled with that little pleased laugh to hear such stories of herself, had her mental illness been treated consistently and understood for what it is, rather than being explained away as this or that physical ailment, or as a personality trait, or just because ‘she was old and it must be Alzheimer’s’? 


As the study concludes:


‘The study of nationally representative samples provides evidence for research and policy planning that helps to define community-based priorities for future psychiatric research. The findings of this study emphasize the importance of individual and co-existing mood and anxiety disorders when studying older adults, even the oldest cohorts. Further study of risk factors, course and severity is needed to target intervention, prevention and health care needs.’


Yes, further study is needed.

‘Even among the oldest cohorts.’

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Photo from Military Health via Flickr.

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1:12AM PDT on Jun 18, 2010


11:03PM PDT on May 21, 2010

very good read,thanks

1:32AM PDT on May 19, 2010

thank you. very interesting.

11:51PM PDT on May 18, 2010

i work in a nursing home and the drs. see their pts. once a month. some of them don`t even go to their rooms and give them a check up. they go straight to the nurses notes and may or may not scribble out some orders. just because these people are older does not mean that they should be treated with any less care and dignity then those who are younger. in fact, alot of them need more care. more attention definitely needs to be paid to the mental health spectrum. if this were done, many of our seniors could go through their golden years not only healthier,but with peace and happiness in their hearts. and heaven knows they deserve it.

4:41PM PDT on May 18, 2010

Why is there so much mental disease today than there was before? Mind altering drugs aren't the solution but are often the problem. There used to be a time when people talked to one another if there was a problem but society has lost the ability to speak face-to-face. Families used to live in close proximity to one another so there was no time for depression but today families are fragmented thus leaving time for sadness and depression to manifest.

9:01AM PDT on May 18, 2010


10:54PM PDT on May 17, 2010

There is so much silent mental pain in the elderly, they are constantly thinking that 'this day might be my last' 'I hope I go quickly' and lots of layers in between, interspersed with some moments of deep appreciation of small events if they are lucky enough to have family around. If not there can be terrible lonlieness. Unable to talk out their anxieties. But medication is not the answer, INVOLVEMENT IS !! Please befriend and elderly person and bring them some contact and happiness, you may get to learn something from them with their acquired knowledge - age often brings wisdom - take a short cut with your life learning process, befriend and elderly person who has 'been there and done that' !

6:28PM PDT on May 17, 2010

Although human beings run the gamut of emotion and at times I think it's beneficial for the medicalcomunity to presribe pills for being sad, happy, depressed, hyper, there are serious mental illnesses which go untreated daily. Many people haven't a clue what their family's medical/mental history is.

4:16PM PDT on May 17, 2010

I haven't noticed attention drawn to the use of illegal drugs by people who are mentally ill. My son was diagnosed bi-polar as as a teenager. He exhibited typical symptoms, even had a couple psychotic breaks. He is now 38 and is doing better. He is still moody and gets depressed but it seems to be under control, even though he refuses to take medication (he won't even admit that he has a problem, even though he is on disability).

My 38 year old daughter is now in drug rehab. She was diagnosed bi-polar 2 years ago. She has been addicted to crack-cocaine for 5 years. Prior to that she was living with an multi-millionaire for 10 years and was on semester away from graduating from college with an English degree. Mental illness really snuck up from behind with her. She just started medication, though, so hopefully she will survive.

I really don't think many people understand how insidious mental illness can be. I also think that many of the drug addicts are mentally ill.

I am amazed at the number of people that I meet who have a grown child that is an addict. I just wonder if we just weren't aware of it years ago or if there is something in our society that is causing it. I know that it is genetic but it seems to be more prevelent that years ago.

2:52PM PDT on May 16, 2010

Thank you for posting.

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