Mental Health of Older Adults: an Agenda for Action

The world’s population is ageing rapidly. Estimates by the United Nations (UN) and World Health Organization (WHO) suggest that between 2015 and 2050, the proportion of the world's older adults will almost double from about 12% to 22% [1]. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60. Older people face unique physical and mental health challenges that need to be recognized. Mental health and well-being are particularly important in older age. While most have good mental health, many older adults are at high risk of developing mental and neurological disorders, as well as other medical conditions. Similarly, as people age, they are more likely to experience a number of conditions at the same time [2]. Besides, there are numerous social, psychological, and ecological factors that can impact the mental wellbeing of older people.

The world’s population is ageing rapidly. Estimates by the United Nations (UN) and World Health Organization (WHO) suggest that between 2015 and 2050, the proportion of the world's older adults will almost double from about 12% to 22% [1]. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60. Older people face unique physical and mental health challenges that need to be recognized. Mental health and well-being are particularly important in older age. While most have good mental health, many older adults are at high risk of developing mental and neurological disorders, as well as other medical conditions. Similarly, as people age, they are more likely to experience a number of conditions at the same time [2]. Besides, there are numerous social, psychological, and ecological factors that can impact the mental wellbeing of older people.

There are multiple prejudices about the meaning of mental illness in old age. Many older adults today still see mental illness as a sign of weakness and are unlikely to admit their difficulties. In addition, symptoms of dementia and depression are too often considered a part of normal aging. Older people may be vulnerable to multiple risk factors for mental health problems and, like adults, older people may experience life stressors common to all people in addition to the challenges that are more common in later life, like a significant ongoing loss in capacities and a decline in functional ability. Additionally, older people are more likely to experience events such as bereavement, or a drop in finances with retirement. Limitations in mobility, frailty, and other medical health problems may require additional and long-term care. All these factors can result in isolation, loneliness, or psychological distress amongst older people, for which they may require specialized care. Likewise, mental health conditions can have a significant impact on an older adults’ ability to carry out the basic activities of everyday life, leading to reductions in their independence, autonomy, and quality of life. Unfortunately, mental health conditions are not often diagnosed and treated. Many older adults struggle without proper help, or simply without any help at all. Besides, ageism and age-based discrimination, which are prevalent globally, threaten the human rights and dignity of older people, enhancing the risks of elder abuse, limited help-seeking, and loneliness. The ongoing Coronavirus Disease 2019 (COVID-19) pandemic has further widened the gaps inherent to later-life health inequalities, leading to marginalization and human rights crises in this age group [3]. Hence, additional focus on research related to the mental health conditions of older people is warranted to improve service and policy interventions.

The World Psychiatric Association (WPA) recognizes old age mental health problems as a public health challenge and calls for global action to ensure a better understanding of care for elderly people [4, 5]. The WPA’s Section of Old Age Psychiatry (WPA-SOAP) has been extremely active in improving the knowledge in this area and in advocating a better mental health for older adults around the world. The WPA thus strongly supports the International Psychogeriatric Association (IPA) and joins their efforts to ensure that older persons with mental health conditions and psychosocial disabilities are not discriminated against on the basis of their age, their mental health, or psychosocial disability status, and are treated as full citizens enjoying all rights on an equal basis with other citizens. The Joint Statement of WPA-IPA is a step forward in empowering our psychogeriatric colleagues’ efforts to raise awareness among mental health professionals regarding the human rights of older persons [6]. Collaborating on dialog- and evidence-based practices on mental health challenges among older adults thus represents an urgent need.

Mental health care has undergone a paradigm shift in recent years to a rights-based approach and the same applies to all ages. The UN Decade of Healthy Ageing (2021–2030) calls for advocacy, an age-friendly environment, combatting ageism, and integrated care among older people [7]. It is a global collaboration in line with the last decade of Sustainable Developmental Goals (SDG) that serve as a framework for professionals, academics, civil societies, governments, and international agencies to “improve the lives of older people, their families, and the communities they live in”. A vital decade-enabler of this global initiative is “strengthening research, data, and innovation.”

Against this backdrop, the publication of a thematic issue on old age psychiatry by Consortium Psychiatricum is indeed a great initiative and I hope this issue will generate increased attention amongst the scientific community to the problem of delivering mental health care for the old age population. This issue caters to various dimensions related to mental health care among older adults: human rights advocacy, psychosexual health, loneliness, technology-based interventions, and COVID-19-related neurobiological changes, to name but a few.

This thematic issue may have the potential to sensitize mental health professionals across the globe towards the mental health needs of, and challenges faced by older people. It may also serve as a resource for researchers and academicians in the field of geriatric psychiatry.

1. United Nations, Department of Economic and Social Affairs, Population Division [Internet]. World Population Ageing 2019 (ST/ESA/SER.A/444), 2020 [cited 2022 Mar 12]. Available from: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
2. World Health Organization Geneva [Internet].The World Health Report 1998 Life in the 21st century — A vision for all Report of the Director General [cited 2022 Mar 12]. Available from: https://www.who.int/whr/1998/en/whr98_en.pdf
3. D'cruz M, Banerjee D. ‘An invisible human rights crisis’: The marginalization of older adults during the COVID-19 pandemic — An advocacy review. Psychiatry research. 2020 Oct 1;292:113369.
4. World Psychiatric Association [Internet]. Position Statement on the Rights of Persons with Disabilities, 2017 [cited 2022 Mar 12]. Available from: https://www.wpanet.org/_files/ugd/e172f3_869fbde423a44e7ca9d18b97030eb31c.pdf
5. World Psychiatric Association [Internet]. Bill of Rights for Persons with Mental Illness, 2017 [cited 2022 Mar 12]. Available from: https://psikiyatri.org.tr/userfiles/file/WPA6.pdf
6. Peisah C, de Mendonça Lima C, Verbeek H, Rabheru K. IPA and WPA-SOAP joint statement on the rights of older persons with mental health conditions and psychosocial disabilities. International Psychogeriatrics. 2021:1–5. doi: 10.1017/s1041610221000454.
7. World Health Organization [Internet]. UN Decade of Healthy Aging. 2021–2030 [cited 2022 Mar 12]. Available from: https://www.who.int/initiatives/decade-of-healthy-ageing