Highlights
- By 2030, one in six people in the world will be aged 60 or over.
- Loneliness and social isolation are key risk factors for mental health problems later in life.
- One in six older people are victims of abuse, often at the hands of their own caregivers.
- Approximately 14% of adults aged 60 and over live with a mental disorder.
- Mental disorders among older people represent 10.6% of the total years lived with disability for this age group.
Preview
The world’s population is aging rapidly. In 2020, 1 billion people worldwide were aged 60 or over. This figure will reach 1.4 billion by 2030, or one in six people in the world. By 2050, the number of people aged 60 and over will have doubled to 2.1 billion. The number of people aged 80 or over is expected to triple between 2020 and 2050 to reach 426 million. (1).
Older people contribute to society as members of their families and communities, and many are volunteers and workers. Although most are healthy, many are at risk of developing mental health problems such as depression and anxiety disorders. Many may also suffer from reduced mobility, chronic pain, frailty, dementia or other health conditions, for which they require some form of long-term care. As people age, they are more likely to suffer from multiple conditions at the same time.
Prevalence
About 14% of adults aged 60 and over live with a mental disorder (2). According to Global Health Estimates (GHE) 2019, these conditions represent 10.6% of total disability (in disability-adjusted life years, DALYs) among older people. The most common mental health problems among older adults are depression and anxiety. GHE 2019 shows that globally, about a quarter of suicide deaths (27.2%) occur in people aged 60 or older.
Mental health issues in older adults are often underestimated and undertreated, and the stigma surrounding these issues can make people reluctant to seek help.
Risk factors
At older ages, mental health is shaped not only by physical and social environments, but also by the cumulative impacts of prior life experiences and specific stressors related to aging. Exposure to adversity, significant loss of intrinsic capacity, and decline in functional capacity can all lead to psychological distress.
Older adults are more likely to experience adverse events such as bereavement, reduced income, or loss of sense of meaning in retirement. Despite their many contributions to society, many older people are subject to ageismwhich can seriously affect people’s mental health.
Social isolation and lonelinesswhich affect around a quarter of older people, are key risk factors for mental health problems later in life. (3). It is the same elder abuse, which includes any type of physical, verbal, psychological, sexual or financial abuse, as well as neglect. One in six older people are victims of abuse, often at the hands of their own caregivers. (4). Elder abuse has serious consequences and can lead to depression and anxiety.
Many older adults care for spouses with chronic health conditions, such as dementia. The responsibilities of such care can be overwhelming and affect the caregiver’s mental health.
Some older adults are at greater risk of depression and anxiety due to dire living conditions, poor physical health, or lack of access to quality support and services. This includes older people living in humanitarian settings and those living with chronic illnesses (such as heart disease, cancer or stroke), neurological problems (such as dementia) or substance use problems.
Promotion and prevention
Mental health promotion and prevention strategies among older people aim to support age healthily. This means creating physical and social environments that promote well-being and enable people to do what is important to them, despite loss of capabilities.
Key mental health promotion and prevention strategies for healthy aging include:
- measures to reduce financial insecurity and income inequality;
- programs to ensure safe and accessible housing, public buildings and transportation;
- social support for older people and their caregivers;
- supporting healthy behaviors, including eating a balanced diet, being physically active, abstaining from smoking and reducing alcohol consumption; And
- health and social programs aimed at vulnerable groups such as those living alone or in remote areas and those living with chronic illness.
For older adults, social connection is particularly important in reducing risk factors such as social isolation and loneliness. At this stage of life, meaningful social activities can significantly improve mental health, life satisfaction and quality of life; they can also reduce depressive symptoms. Examples of interventions include befriending initiatives, community and support groups, social skills training, creative arts groups, leisure and educational services, and volunteer programs.
Protection against ageism and abuse is also essential. Key interventions include anti-discrimination policies and laws, educational interventions and intergenerational activities. A range of carer interventions – including respite care, counselling, education, financial support and psychological interventions – can help carers maintain a good and healthy care relationship that prevents elder abuse .
Treatment and care
Prompt recognition and treatment of mental health problems (and neurological and substance use problems) in older adults is essential. This should follow the standards for integrated care for the elderly, which is community-based and focused on both the long-term care of older people living with mental health problems and a decline in their intrinsic abilities, as well as the education, training and support of caregivers . A combination of mental health interventions is typically recommended, along with other supports to meet individuals’ health, personal care, and social needs.
Dementia is often a significant concern. It affects people’s mental health (for example, by triggering symptoms of psychosis and depression) and requires access to quality mental health care.
It is also essential to respond to the mistreatment of older people. Promising interventions include mandatory reporting of abuse, support groups, hotlines and emergency shelters, psychological programs for abusers, training of health care providers, and other interventions. support for caregivers.
WHO response
WHO is working with various partners on strategies, programs and tools to help governments address the mental health needs of older people.
For example, the Decade of Healthy Aging (2021-2030) is a global collaboration led by WHO to improve the lives of older people, their families and the communities in which they live.
WHO Member States also approved the Global action plan for mental health 2013-2030which supports improved mental health and mental health care for all populations, including older adults.
WHO Mental Health Gap Action Program (mhGAP) provides evidence-based clinical protocols to assess, manage and monitor a range of priority mental, neurological and substance use problems in non-specialist settings, including depression and dementia. The mhGAP intervention guide includes clinical advice for working with older adults.
During the COVID-19 pandemic, WHO and its Inter-Agency Standing Committee (IASC) partners developed the Living with the times toolkit of illustrated posters to help older people maintain good mental health and well-being. Other WHO activities to support the mental health of older people include the development of scalable psychological interventions to combat depression and anxiety, research and advice on interventions to reduce social isolation and loneliness, and cost-effective solutions to prevent elder abuse.
The references
- World Population Prospects 2022: Issue note on the main differences in total population estimates for mid-2021 between the 2019 and 2022 revisions. New York: United Nations Department of Economic and Social Affairs, Division of population ; 2022 (https://population.un.org/wpp/Publications/Files/WPP2022_Release-Note-rev1.pdfaccessed September 12, 2023).
- Institute for Health Metrics and Evaluation. Global Health Data Exchange (GHDx). https://vizhub.healthdata.org/gbd-results/, accessed October 20, 2023).
- Hong Teo R, Hui Cheng W, Jie Cheng L, Lau Y, Tiang Lau S. Global prevalence of social isolation among community-dwelling older adults: a systematic review and meta-analysis. Arch Gerontol Geriatr. April 2023; 107:104904. doi:10.1016/j.archger.2022.104904.
- Yon YY, Mikton CR, Gassoumis ZD, Wilber KH. Prevalence of elder abuse in community settings: a systematic review and meta-analysis. Lancet Global Health. 2017;5(2):e147–e156. doi:10.1016/S2214-109X(17)30006-2.
