Mental Health Services

The most reliable studies suggest that when dementia is excluded from the mental health profile, the older population appears to fare slightly better, or at least no worse, than younger cohorts in the prevalence of mental disorders. In some sense this is remarkable, given that older adults are more vulnerable to known mental health risk factors, such as physical illness, poor nutrition, social isolation, bereavement, and financial insecurity. The U.S. Surgeon General reports that 21 percent of adults age eighteen to fifty-four and nearly 20 percent of older adults have a diagnosable mental disorder, excluding dementia, in any given one-year period. Age-associated dementia, such as Alzheimer's disease, is a significant threat to the quality of life of older adults, and although its manifestations may include depression, anxiety, paranoia, behavior problems, and even psychosis, dementia is more often studied and treated as a medical, not a mental, illness. Mental disorders conventionally addressed through mental health services include anxiety, depression, schizophrenia, and adjustment disorders.

Although the prevalence of mental disorders in the older population is similar to that in the younger adult population, the unique effects of these disorders on older adults represent correspondingly unique challenges for mental health treatment and services. Some of these challenges are closely associated with the epidemiological issues identified above. In general, older adults with mental disorders have high rates of coexisting and mutually complicating physical illnesses; are vulnerable to the complications of the use of multiple medications; are more likely to become malnourished; are at special risk of social isolation and loss of social supports; have significantly higher suicide rates; and are especially vulnerable to loss of autonomy.