How Does Aging Affect Mental Health?

After losing her husband, my 71-year-old aunt’s world shrunk. Admittedly, she wasn’t in stellar physical health, but grief compounded by pre-existing symptoms of depression exacerbated the state of her mental and physical health.  

The loss of her husband kicked-off a destructive cycle: each new diagnosis driving her more deeply into despair and isolation. 

Ultimately, she passed away before her eightieth birthday.      

In contrast, a close friend and colleague who I’ll call Ann, recently celebrated becoming an octogenarian. A couple of years ago, she lost her husband to a longstanding illness, but she didn’t lose her lease on life. 

She has a thriving therapy practice, enjoys going to the theater, movies, and art exhibits with her posse of friends. She’s also looking for a new partner. Although she uses a hearing aid and is having cataract surgery, she addresses these ailments without dwelling on them—continuing to lead an enriching life. 

Why did aging have such a different effect on each of these women’s health? 

In this article, we’ll review what actually happens to the mind as we age, what mental health concerns to look out for, and how to get support for issues surrounding aging to make the last chapters of life as fulfilling as possible. 

At what age are we considered ‘elderly’?

Medically, the terms “geriatric” and “elderly” are used to describe people 65-years-old and above, which I find difficult to accept since my husband and I—at 52 and 61, respectively—are late bloomers who, in some ways, feel our lives are just beginning. 

In a 2020 article, Karl Pillemer, PhD, a professor of human development at Cornell University, told The Atlantic he prefers using the age range “over 75” to describe older adults because, “statistically, that’s the age when people become significantly more likely to develop a chronic disease.” 

The aging brain

The brain begins to shrink in a person’s thirties and forties, with the rate of decline accelerating at age 60. 

Getting older affects multiple areas of the brain, including: 

• The frontal lobes, which rule our behavior and emotions
  
• The hippocampus, which governs our memory and learning abilities
  
• The cortical density (the wrinkled outer layer of our brains) thins, affecting cognition
  
• The white matter connecting all four lobes of our brains decreases, slowing down our processing
  
• Chemicals from our aging bodies cause the neurotransmitter systems to break down, causing slower cognitive function 

All of this happens in a normal brain, so you can only imagine how quickly it manifests in a brain that is compromised by a disease like Alzheimer’s.

Mental health statistics in elders 

Learning about our shrinking brains can bring on feelings of grief and sadness. And, for those experiencing memory loss or dementia effects, these can cause depression. 

However, as bad as it seems, according to the Centers for Disease Control and Prevention (CDC), the percentage of older adults who are clinically depressed is relatively low, ranging from 1-5%, and increasing to 11-13% for adults who require hospitalization or home healthcare. 

 Psychologist Cecilia Dintino, PsyD, and works with middle-aged and older women in her practice and she interviews them in her podcast called Twisting the Plot. Speaking from her clinical experience with this age group, Dintino corroborates the CDC’s report of low depression rates in older people. 

“It is a myth that getting old comes with automatic depression or poor mental health,” Dintino says. “We have a bias in our culture that says aging brings inevitable decline, diminishment and, of course, depression.” 

However, according to Dintino, older people, like all people in the population, do have depression, anxiety, and grief, and  they also have the desire to grow in relationships, self, and in purpose.

Mental health challenges in elders

The bias Dintino refers to is found in the staggering amount of anti-aging products, supplements, and procedures designed to fend off the inevitable. 

Our culture’s negative attitudes toward aging are made even more obvious through the abundance of decrepit nursing homes where many elders are left to perish. 

Because ageism fosters shame around the open and honest discussion of aging, getting older can feel like impending doom rather than growing in wisdom and experience.  

Bouts of clinically minor depression are normal, as are temporary reactions to a variety of age-related factors, including grief from losing a loved one , depreciating bodily functions and abilities (such as memory and hearing loss), and feelings of purposelessness. 

However, when a low-grade depression sets in for two or more years, as it did in my aunt’s case, or erupts into a major depressive episode that impedes normal functioning, it needs professional attention. 

Loneliness and isolation in elders can lead to depression, faster decline, and even suicide. Older adults are also vulnerable to increased anxiety regarding financial stress, fear of one’s own or a loved one’s impending death, or of their painful deterioration due to limited functionality and sickness. Income levels are also a serious factor in elder vulnerability to anxiety and depression, with stress over affordable medical care being a definitive risk for mental health issues later in life. 

For individuals experiencing dementia, confusion is common, and this can be as disorienting for elders as it is for their caregivers. 

How to age gracefully and increase resilience

When I think of the difference between Ann and my aunt, both white women of reasonable financial security who had friends and family, it appears the difference in their approaches to aging lies in their resilience. 

According to the American Psychological Association (APA), “resilience is the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands.” 

My aunt, for a number of reasons, based on her genetics and her life story, did not develop this skill, whereas Ann, through her therapy training and spiritual practice, did. 

While there’s not much we can do to prevent dementia or the physical ailments of aging, here are some ways to increase resilience and stave off mental illness as we age:

1. Stay connected 

Loneliness is one of the biggest threats to wellbeing for elderly people.

 If possible, stay connected with family members, reaching out regularly to check in. While you get to know their stories and keep up with their lives, be sure to share your experiences and wisdom as well. 

If you don’t have family you keep in contact with, connect with communities that focus on topics that are important to you or activities you love. Through hobbies, religious or spiritual groups, and music or craft making endeavors, you can seek community and foster connection. Ann often talks about her book club, and how much fun it is to get into rich discussions about the stories that move her. 

2. Be aware of the mental health warning signs to look for 

Alert your loved ones or community members about how to keep an eye on you.
According to the National Institute of Mental Health (NIMH), here are the signs of mental distress to look out for in older adults:

• Persistent sad, anxious, or depleted mood
  
• Loss of interest or pleasure in hobbies and activities
  
• Feelings of hopelessness and pessimism
  
• Feelings of guilt, worthlessness, helplessness
  
• Decreased energy, fatigue, feeling sluggish
• Difficulty concentrating, remembering, making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or unintended weight changes
• Thoughts of death or suicide, suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease, even with treatment
• Restlessness, irritability

Should you recognize these prolonged symptoms in yourself, talk to your doctor and if you can, bring along a spouse, child, friend, or all of the above. 

As noted above, elders need community to thrive and face the challenges and losses associated with growing older. 

3. Get the right help

Depression and anxiety can be treated with therapy and/or medication. 

However, Dintino warns against falling for “the biomedicalization of aging,” in which people are defined by their declining physique and psychiatric treatment of older people is relegated to a pill. 

Sadly, when this happens, according to Dintino, there is a missed opportunity. She points out that the risk is that the elder individual with ongoing vitality, growth and introspection can get lost.
Furthermore, Medicare pays less for psychological treatment than other insurance plans, barring psychologists and psychotherapists from taking on older clients.

4. Foster resilience through therapies

Resilience may come to some organically, as a native inner resource, however with the right therapeutic intervention, resilience can also be developed. 

Physical therapy not only reduces joint and muscle pain, but it also does wonders for mental strength, resilience, and self-esteem. 

Learning a new language, skill, or physical activity can build strength and resilience as well. 

Despite the fact that Sigmund Freud dismissed elders as unsuited for psychotherapy due to what he called, “mental rigidity,” aging pioneers and authors of seminal books in the field—Tracey Gendron, PhD, (Ageism Unmasked) and Becca Levy, PhD,(Breaking the Age Code)—view elders as ripe candidates for psychotherapy. 

According to Dintino, Older adults have greater emotional intelligence, greater capacity for the meta understanding of patterns, capacity and willingness for life review and life processing. “Late life therapy could be the deepest and most life changing work in a lifetime,” she says. 

5. Discuss ‘the big D’

According to Jon Underwood, founder of Death Cafes, a safe space for discussions around dying, talking about death helps people see their lives more clearly, build community, and make the most out of the time they have left. 

Holding space for important conversations about the logistics and deep feelings around death removes the secrecy and shame often surrounding aging and dying. 

Invite your friends and family into frank discussions about your vision for your death and other end-of-life concerns. 

While they may resist at first, they will be grateful to you for your courage and grace in bringing up a discussion about one of life’s most important events. 

A life well-lived

Richard Nodell, a 70-year-old psychotherapist, leadership consultant, and a mentor of mine, rocked my world when years ago he told me “a life well grieved is a life well lived.” 

The more open we can be to experience life’s losses, the more available we are to cherish all the beauty life has to offer. If you can allow yourself to face the inevitable losses, both personal and bodily, that come with getting older, this will unburden you to experience the best this stage of your life has to offer. It is in our willingness to grieve that we keep hope alive as we grow closer to death.

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