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.’