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Older Adults and Mental Health

Why is it important to take care of our mental health as we age.

As people age, they may experience certain life changes that impact their mental health, such as coping with a serious illness or losing a loved one. Although many people will adjust to these life changes, some may experience feelings of grief, social isolation, or loneliness. When these feelings persist, they can lead to mental illnesses, such as depression and anxiety.

Mental health is important at every stage of life. Effective treatment options are available to help older adults manage their mental health and improve their quality of life. Recognizing the signs and seeing a health care provider are the first steps to getting treatment.

What are symptoms of mental disorders in older adults?

Noticeable changes in mood, energy level, or appetite
Feeling flat or having trouble feeling positive emotions
Difficulty sleeping or sleeping too much
Difficulty concentrating, feeling restless, or on edge
Increased worry or feeling stressed
Anger, irritability, or aggressiveness
Ongoing headaches, digestive issues, or pain
Misuse of alcohol or drugs
Sadness or hopelessness
Thoughts of death or suicide or suicide attempts
Engaging in high-risk activities
Obsessive thinking or compulsive behavior
Thoughts or behaviors that interfere with work, family, or social life
Engaging in thinking or behavior that is concerning to others
Seeing, hearing, and feeling things that other people do not see, hear, or feel

Mental disorders can be treated : A primary care provider is a good place to start if you're looking for help. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help you figure out next steps. Find tips for talking with a health care provider about your mental health.

You can learn more about getting help on the NIMH website. You can also learn about finding support and locating mental health services in your area on the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

Health hotlines

988 Suicide & Crisis Lifeline : The Lifeline provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week, across the United States. Call or text 988 to connect with a trained crisis counselor. Support is also available via live chat . Para ayuda en español, llame al 988 .
Veterans Crisis Line : This helpline is a free, confidential resource for veterans of all ages and circumstances. Call 988 then press 1; text 838255 ; or chat online to connect with 24/7 support.
Disaster Distress Hotline : This helpline from the Substance Abuse and Mental Health Services Administration provides immediate crisis counseling for people experiencing emotional distress related to any natural or human-caused disaster. The helpline is free, multilingual, confidential, and available 24 hours a day, 7 days a week. Call or text 1-800-985-5990 .
NIH Health Info Lines

Health topics and resources for older adults

Featured health topics.

Anxiety Disorders
Bipolar Disorder
Coping with Traumatic Events
Eating Disorders
Medications: Older Adults
Post-Traumatic Stress Disorder
Suicide Prevention

Featured brochures and fact sheets

Federal resources

Depression and Aging : This Centers for Disease Control and Prevention webpage describes signs of depression and how depression can be different for older adults.
Healthy Aging : This U.S. Department of Health and Human Services webpage lists links to health resources and services for older adults.
National Institute on Aging (NIA): Health Topics : NIA offers health information on various topics, including depression .
Older Adult Mental Health : The National Library of Medicine’s MedlinePlus offers resources on aging and mental health ( en español ).
Resources for Older Adults : The Substance Abuse and Mental Health Services Administration offers publications and digital products for and about older adults.
Mental Health and Older Adults Facebook Live Q&A : Learn about mental and emotional wellness in later life, signs and symptoms of depression, and ways to maintain and improve mental health.

Research resources

NIMH Geriatrics and Aging Processes Research Branch : This NIMH branch supports programs of research, research mid-career development, and resource development in the etiology, pathophysiology, and course of mental disorders of late life; the relationships between aging and mental disorders; the treatment and recovery of persons with aging-related disorders; and the prevention of these disorders and their consequences.

Why should older adults participate in clinical trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although people may benefit from being part of a clinical trial, they should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others can be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials have uncovered. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

NIMH’s Clinical Trials webpage: Information about participating in clinical trials

In addition, NIMH researchers are also studying mental disorders that affect older adults. To find studies being conducted at NIMH, visit Join a Study: Adults .

Our studies take place at the NIH Clinical Center in Bethesda, Maryland, and require regular visits. If you don’t live nearby, you can find a clinical trial near you .

It is important for clinical trials to have participants of different ages, sexes, races, and ethnicities. When research involves a group of people who are similar, the findings may not apply to or benefit everyone. When clinical trials include diverse participants, the study results may have a much wider applicability.

Researchers need the participation of older adults in their clinical trials so that they can learn more about how new drugs, therapies, medical devices, surgical procedures, or tests will work for all people. For more information, check out National Institute on Aging’s What Are Clinical Trials and Studies? tip sheet.

Last Reviewed: April 2024

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Mental Health In Older Adults: Common Conditions And How To Treat Them

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Mental Health In Older Adults: Common Conditions And How To Treat Them

Mental health as we age, common mental health conditions facing older adults, mental health warning signs, top tips to help prevent or alleviate mental health conditions.

At least one in four older adults experiences some sort of mental health condition, such as depression or anxiety , according to the Pan-American Health Organization [1] Seniors and Mental Health . Pan American Health Organization / World Health Organization. Accessed 9/28/2022. .

Mental health is closely linked to physical health , and the risk of experiencing complications with both mental and physical health at the same time can increase with age. For example, according to the World Health Organization, older adults with heart disease have higher rates of depression than those who don’t have heart disease. Unfortunately, mental health conditions in older adults are often under-identified by medical providers, and stigma associated with mental health conditions can prevent people from seeking help.

Given that the population of older adults is rapidly expanding worldwide, addressing the mental health of older adults is increasingly important.

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There are several physical and cognitive changes associated with aging that can have an impact on mental health.

Hearing and vision impairment , two common sensory changes associated with aging, can contribute to social withdrawal, isolation , anxiety and depression and may cause an older person to restrict activities like driving, reading or playing games. Isolation and anxiety can also exacerbate other chronic conditions, such as diabetes and heart disease, and decrease a person’s ability to perform activities of daily living (ADLs), which include getting dressed, eating and getting out of bed.

Physical changes to the brain can also lead to cognitive decline and increase the risk of a mental health disorder. Brain volume decreases with age, as well as specific areas of the brain responsible for cognitive functions, including memory, learning and emotional control. These cognitive functions are housed in areas of the brain that are prone to brain shrinkage, including the frontal lobe and the hippocampus. Some of these changes are age-normative but can nevertheless be frustrating to the individual when they can’t recall names and events as readily or learn new things with ease. However, when these changes are more severe and represent a form of dementia, that can increase the risk of other mental health concerns such as a diagnosable depression or anxiety disorder.

Sensory changes along with slowed cognitive processes may cause an older adult to feel a loss of control, which can lead to negative emotions such as sadness, loneliness and anxiety. There is some research to suggest that these natural aging changes may increase a person’s risk of chronic, persistent depression. Loss of prior physical function is another risk factor for mental health concerns. For example, there is an increased prevalence of suicidal thoughts among older adults who have feelings of hopelessness and isolation, particularly those with disabilities or who have very limited mobility.

Negative changes in sleeping patterns and sleep disruption can occur as we age and can lead to increased emotional distress, mood disorders and memory deficits. Almost half of older adults report poor sleep quality, according to a study in Sleep Medicine Clinics [2] Li J, Vitiello MV, Gooneratne NS. Sleep in Normal Aging . Sleep Med Clin.;13(1):1-11. . </em

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Feeling down or occasionally worried is a normal part of life. But if these feelings last more than a couple of weeks, or if they are severe enough to disrupt everyday tasks, it may be a sign of something more serious. It is important to keep an eye out for warning signs of depression and anxiety, as these are two of the most common mental health challenges facing older adults.

More than two million of the 34 million U.S. adults aged 65 and older have from some form of depression—which is a significant predictor of suicide among adults 65 and over in the U.S., who account for 20% of all suicide deaths, according to Mental Health America [3] Depression in Older Adults: More Facts . Mental Health America. Accessed 9/29/2022. . Symptoms of depression in older adults can include:

Persistent sad mood occurring most of the day, nearly every day
Loss of interest or pleasure in activities on used to enjoy
Feelings of hopelessness and/or pessimism that last for several weeks
Feelings of guilt, worthlessness and/or helplessness
Irritability, restlessness
Fatigue and decreased energy
Difficulty concentrating, remembering details and making decisions
Insomnia, early-morning wakefulness or excessive sleeping
Increased appetite—or loss of appetite
Thoughts of suicide, planning suicide, and/or suicide attempts
Persistent aches or pains, headaches, cramps or digestive problems that don’t improve over time, even after treatment

Older adults experience all the same stressors that other age groups experience, but additional stressors can mount in later life. These risk factors may include mobility challenges, chronic pain and loss of independence. Older adults may also experience more social isolation and loneliness, bereavement and a decline in financial status after retirement .

Nearly 14% of older adults meet the criteria for a diagnosable anxiety disorder, but many more may have symptoms of anxiety severe enough to affect their functioning, according to a study published in the International Journal of Geriatric Psychiatry [4] Anxiety in Older Adults . Mental Health America. Accessed 9/29/2022. . Symptoms of anxiety can include excessive nervousness, fear and worry that can sometimes lead to other physiological symptoms such as chest pains, headaches, sweating, gastrointestinal problems, insomnia, nightmares, dry mouth, nausea, shortness of breath and rapid heartbeat. Mental Health America and the National Council on Aging note that generalized anxiety disorder—the chronic, exaggerated worry about routine experiences that lasts longer than six months—is one of the most common anxiety disorders among older adults. Obsessive compulsive disorder, panic attacks and post-traumatic stress disorder are also forms of anxiety disorders but are less common among older adults.

Substance Use and Abuse

Nearly one million adults aged 65 and older are diagnosed with a substance use disorder, according to the National Institute on Drug Abuse, and about 65% of people 65 and older report high-risk drinking, which is defined as more than 14 drinks per week for men and 7 drinks per week for women [5] Drinking Levels Defined. U.S. Department of Health and Human Services . National Institute on Alcohol Abuse and Alcoholism. Accessed 9/29/2022. . Older adults typically metabolize substances at a slower rate than those under the age of 65, making them more sensitive to the effects of drugs and alcohol. These substances can also exacerbate existing physical conditions and impair coordination and judgment, increasing the risk of accidents and injuries.

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Warning signs of mental health conditions frequently seen in older adults include the following, according to the National Institute of Mental Health:

Noticeable changes in mood, energy level or appetite
Having trouble feeling positive emotions
Difficulty sleeping
Sleeping too much
Difficulty concentrating
Feelings of restlessness or being on edge
Feelings of increased worry or stress
Anger, irritability and/or aggressiveness
Ongoing headaches, digestive issues or pain
Misuse of alcohol or drugs
Sadness or hopelessness
Suicidal thoughts
Engaging in high-risk activities
Obsessive thinking or compulsive behavior
Thoughts or behaviors that interfere with work, family or social life
Engaging in thinking or behavior that is concerning to others
Seeing, hearing and feeling things that other people do not see, hear or feel

“There are behaviors and complaints that friends and family may dismiss at first as lazy or dramatic, things like hoarding and frequent somatic complaints,” says Lisa McLinden, a licensed clinical social worker in Maryland specializing in mental health and homelessness. “It’s important to dig a little deeper and see if anything else could be going on.”

Symptoms of mental illness may present differently among older adults and can be disguised as other conditions, McLinden notes. They also have a variety of causes. “Sometimes pain is related to sleeplessness, and depression is related to isolation and lack of stimulation,” she says. “Sometimes apathy is due to inadequate nutrition, dehydration or medication, and sometimes it’s related to progressive cognitive decline. Sometimes poor self-care is related to a physical condition and sometimes it’s due to paralyzing anxiety.”

Isolation is a leading cause of mental illness in older adults, according to Martha Pierce, M.D., a board-certified internist specializing in geriatrics and based in Maryland. “We really noticed an uptick in anxiety and depression in the elderly due to the isolation imposed by quarantines,” she says. “People really declined mentally and emotionally from the lack of contact with friends and family. That’s when it became obvious to me that social connection is vital to human mental health.” She adds that you should always speak to your doctor if you or a loved one is experiencing any symptoms of mental illness.

To proactively bolster and support mental health for older adults, McLinden says being supportive is a great start. “Provide a support system. Sometimes just having someone in your corner lowers stress and anxiety,” she says. “Older adults need to have a sense of security: financial, physical and emotional. Check in frequently, listen openly to concerns and complaints, and don’t dismiss symptoms just because they may seem baseless or inconsistent.”

Maintaining connections is crucial as well, according to Dr. Pierce. “Obviously good medical care is key, as well as exercise , diet and sound medication management, but the most important thing for older adults’ mental well-being is to have a close, personal connection with someone or something,” she adds. “If it can’t be another human, let it be a pet. A dog or cat is a wonderful way to feel connected and loved.”

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Forbes Health adheres to strict editorial integrity standards. To the best of our knowledge, all content is accurate as of the date posted, though offers contained herein may no longer be available. The opinions expressed are the author’s alone and have not been provided, approved or otherwise endorsed by our advertisers.

Sue Paul is an occupational therapist with more than 30 years of experience. After decades of work focused on bettering the lives of people with neurodegenerative conditions, Paul became a health coach and fitness trainer in order to design a more proactive, preventative approach to healthy aging. She's also an expert in environmental design and founded the non-profit SeniorScapes, whose mission is to build senior-centric, dementia-friendly public parks for older adults as a community design solution to a public health crisis. Paul is a passionate advocate for older adults—she spent many years as an ambassador for the Alzheimer’s Association and currently serves on a governor-appointed Alzheimer’s and dementia state council. When she isn't reading or writing at her desk, Paul can usually be found somewhere on a hiking trail in Maryland with her sporty husband and three reluctant kids.

Dr. Judy Ho is a triple board certified and licensed clinical and forensic neuropsychologist, a tenured associate professor at Pepperdine University and published author. Dr. Judy maintains a private practice in Manhattan Beach, California, where she specializes in comprehensive neuropsychological assessments and expert witness work. She regularly appears as an expert psychologist on television, podcasts and radio, and contributes to other media including print and electronic periodicals. She is a co-host on the syndicate daytime television talk show The Doctors, co-host of CBS’s Face the Truth and host of The SuperCharged Life podcast, which focuses on scientific, tangible tips for physical and mental wellness, and strategies for motivation and productivity.

Mental Health Concerns and Aging

Reviewed by Psychology Today Staff

The aging population may worry about replacing knees and encroaching memory loss, but emotional health is equally — and in some ways more — important. Good emotional health affects physical health, and vice versa. Depression, anxiety, and loneliness are not givens in this age group, yet older people are vulnerable to these and other mental health conditions. This is punctuated by the advancing age of Baby Boomers, who make up nearly one-quarter of the population. While mental health conditions are highly treatable, many older adults go undiagnosed and untreated. This equation may well impact the cost of healthcare in total, and it is no secret that the U.S. spends much more than other nations.

Loneliness has been a longstanding problem for people across many age brackets. In fact, more than a third of adults aged 45 and older feel lonely now and then; and some people, 15 to 30 percent, feel chronically lonely. The socially isolated are more likely to suffer anxiety, depression, stroke, heart disease, Type-2 diabetes, cognitive function, and other ailments. It can even increase the risk of dementia. Feeling socially isolated is acute for older adults, especially the elderly. A study from the University of California at San Francisco found that more than 40 percent of older people feel lonely regularly.

• Feeling negative

• Feeling that life is meaningless

• No self-worth

• Feeling left behind

• No real connection with others

• Interactions feel surface level

• Few or no close friends

• Reliance on family members

• Feeling lonely even when in the company of others

• Fatigue

• Poor sleep

• Poor diet

According to Pew Research, 27 percent of people age 60 and older live on their own--a group at high risk of isolation. It’s not a surprise that this age group feels the pain of disconnection; they are no longer working, their friends have moved away, their family members have died, and they contend with health issues. Mobility is just one problem among many, and if you cannot get around, people must come to you and that complicates matters even further.

If you have less than three people you can turn to for emotional support, you are twice as likely to die from all sorts of causes, including heart disease, cancer, diabetes, or other illnesses. This is true even when we take into account age, income, and whether or not you smoke. According to a Cigna Health report, loneliness is like smoking 15 cigarettes a day; it is more dangerous than being obese. And research from Brigham Young shows that loneliness hastens premature death in all age categories.

A study from Spain followed middle- and older-aged adults over a three-year period. They examined immediate recall, delayed recall, verbal fluency, among other cognitive tasks, and found that loneliness is indeed associated with a decrease in cognitive function.

An Austrian study published in the journal PLOS ONE examined the telomere length of the highly social African grey parrot, some parrots were isolated and others had partners. The telomere lengths of isolated parrots were shorter when compared with the parrots with companions. When telomeres, the ends of chromosomes, get too short, cells die off and hasten the aging process; the shortening of telomeres is also associated with the risk of death and disease, including dementia, heart disease, cancer, among others. While we need to focus on similar research concerning human isolation and telomere length, the work on grey parrots gives us a clue about the effects of loneliness.

People may think that depression is part of normal aging, but that is not true. Old age does not mean eventual clinical depression. Feeling depressed at older ages, for whatever reason, is common. And who wouldn’t feel down? At old age, you cannot move around easily, you have all sorts of aches and pains. Grandmas and grandpas do sit around and share their ailments; My knees give out. My lower back hurts. My fingers are stiff. I wheeze when I breathe. That’s depressing. Moreover, as mentioned, older adults are still standing, while others are gone. That’s also depressing. It is hard to stay emotionally healthy with these many obstacles of advanced age.

• Withdrawal from normal activities

• Sadness

• Anxiousness

• Guilt

• Frequent crying

• Moodiness

• Suicidal thoughts

• A feeling of worthlessness

• A feeling of helplessness

• Excessive worry

• Difficulty concentrating

• Restlessness

• Listlessness

• Oversleeping

• Undersleeping

• Weight gain

• Weight Loss

• Physical pain, such as headaches

• Gastrointestinal pain

The CDC reports that one-fifth of older adults have some type of mental health concern, whether it is depression or anxiety or another problem. However, only a third of those who suffer get treatment. Some 5 percent report feeling depressed, while more than 10 percent receive a diagnosis at some point in old age.

Grandma could be simply grumpy. But, yes, grumpiness and irritability can be a marker of a depressed granny. In fact, mood swings are common in older adults. She will sometimes change her mood instantaneously, and she won’t be happy with anything you may say or do for her.

Yes. If your loved one experienced depression in his younger years, he is more at risk for developing clinical depression at an older age. He may also suffer from dysthymia, which is a chronic form of depression. Chronic depression is more severe and intense than episodic depression, but not as severe as major depression.

A depressed mood in your loved one may be caused by restricted blood flow, called ischemia. The blood vessels get stiff and blood does not flow, especially to the brain, as it does in younger people. Vascular depression is also known as late-onset depression, and it affects 6 million Americans ages 65 and older.

We all feel anxious and stressed now and then. Butterflies over an upcoming job interview, for example, is garden-variety jitteriness. When stress does its job right, your vigilance pays off, you even ace the interview and nail the job. However, severe anxiety can have detrimental effects and interrupt daily living. And a third of us will feel the distress of unmitigated anxiety sometime in our lives.

The aging population is more vulnerable than many other age groups. Full-blown anxiety can have ill effects. For one, anxiety shortens the length of telomeres, the end caps of chromosomes; when these protective caps get shorter and shorter, cells die off and we age much faster.

When the mind shouts danger and fear sets in, anxiety can show itself in various forms. Sometimes it is mental, other times it is physical. Here are some emotional changes you may see in your loved one, many are similar to the signs of depression:

• Feeling scared

• Feeling restless

• Being irrational

• Being forgetful

• Feeling confused

• Being irritable or grumpy

• Obsessive thoughts

• Compulsive behavior

• Feeling panicked

• Substance abuse

• No interest in normal activities

• Will not leave home

• Withdrawal from life

When anxiety presents itself physically, it may come in the form of a headache or stomach ache, among many other symptoms:

• Difficulty breathing

• Dizziness or feeling lightheaded

• Sweating

• Nausea

• Headaches

• Chest pain

• Difficulty with vision

• Digestive problems

• Muscle tension

• Feeling achy and sore

• Weight loss

• Nightmares

• Under-sleeping

If your everyday life has been impacted by chronic and stifling angst and suffering, then you may have clinical anxiety. Some people are more predisposed to anxiety, for example, those who have suffered trauma in their past such as growing up in a household high in conflict. And some personalities are more prone as well. Perfectionists, for instance, who need control over their environment are also among the highly anxious.

The aging faces the end of life, and there is an experience of heightened anxiety . This is why some older people turn to religious activity; believing in a higher power as well as an afterlife is comforting and gives life more meaning. These older people seek connection with others and the universe on a spiritual level; having this shared belief eases the fear and dread.

When the world feels uncertain and insecure; people feel a collective unease. And according to the CDC, during COVID-19, two out of five people struggled with mental health problems , including anxiety depression, substance abuse, and others. The agency noted that there has been a marked elevation of mental health conditions during the pandemic.

how to deal with mental illness in elderly

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Geriatric Therapy: How to Help Older Adults With Depression

Fortunately, there are many effective therapeutic approaches and activities aimed at enhancing resilience among the elderly.

This article will describe geriatric therapy in general, applicable treatment options, the issue of depression among older people, helpful activities, and useful resources.

Consistent with the idea that “ aging is not lost youth but a new stage of opportunity and strength ” (Betty Friedan, n.d.), the information and tools provided herein will aid individuals in enjoying a high level of health and satisfaction throughout their lifespan.

Before you continue, we thought you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free . These science-based exercises will equip you and those you work with, with tools to manage stress better and find a healthier balance in your life.

This Article Contains:

What is geriatric therapy, how to help older adults with depression, 9 therapy intervention ideas, a look at geriatric group therapy, 11 helpful activities, positivepsychology.com’s relevant resources, a take-home message.

Geriatrics is “a branch of medicine that deals with the problems and diseases of old age and the medical care and treatment of aging” (Geriatric, n.d.).

Geriatric mental health therapy is focused on the psychological and emotional needs of individuals over the age of 60. Geriatric mental health is a burgeoning area in need of attention, as nearly one out of five elderly Americans experience at least one mental health disorder (Institute of Medicine, 2012).

According to the World Health Organization (WHO, 2017), around 15% of the geriatric population worldwide has a mental health disorder.

The high rates of psychological problems among older people are related to declining health and mobility, cognitive impairment, financial stress, chronic pain, elder abuse, and loneliness (WHO, 2017).

The outcomes of these risk mechanisms are disproportionate rates of depression, anxiety, and substance use issues among the elderly (WHO, 2017). And since adequate mental health treatment is less likely among older people with psychiatric problems (Bartels, 2002), accessing and treating mental health issues among geriatric populations is of immediate importance.

Fortunately, there are various effective approaches to treat mental health disorders among the elderly.

For example, in a study examining the prevalence of depression among seniors, Djernes (2006) reported the following:

In private households, rates of depression were between 0.9% and 9.4%
In institutional settings, rates of depression were between 14% and 42%

Predictors of geriatric depression included lack of social contacts, somatic illness, functional impairment, cognitive impairment, female gender, and history of depression (Djernes, 2006).

In a related study, significant risk factors for geriatric depression included poor self-rated health status and chronic disease (Chang-Quan et al., 2010).

Clearly, treatment approaches and lifestyle choices aimed at reducing depression among the elderly are needed.

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Empirical research supports the efficacy of multiple types of mental health therapy among older people. Here are nine examples:

1. Interpersonal Therapy (IPT)

This therapeutic approach is a short-term, structured process in which the practitioner and client work on identifying the client’s underlying problems and developing effective coping strategies.

Interpersonal Therapy , which has been found effective to treat depression, is implemented in the following three phases (Miller, 2008):

Exploration of the client’s difficulties and how they are affecting them
Identification of positive coping strategies and ongoing review of how they are working during treatment
Consolidation of the benefits of the client’s new coping strategies and preparation for the client to continue using them following treatment

Unfortunately, there is a lack of scientific studies specifically investigating the effects of IPT on older individuals, with most research only addressing IPT combined with medication (Mackin & Areán, 2005).

Of the few studies specifically addressing IPT, preliminary findings suggest that IPT may be a highly promising approach for older clients suffering from suicidal ideation and depression (Heisel, Duberstein, Talbot, King, & Tu, 2009).

Similarly, according to their extensive literature review, Bartels et al. (2004) found that IPT was effective specifically for the treatment of depression among older individuals.

Additionally, based on his comprehensive review, Miller (2008) posits that IPT is easily adaptable to older populations and may be especially useful for grief management and the development of coping skills for the transition to long-term care.

IPT also represents a potentially effective add-on treatment component for individuals receiving pharmaceutical therapy (Miller, 2008).

2. Cognitive-Behavioral Therapy (CBT)

CBT is based on the assumption that “emotional disorders are maintained by cognitive factors, and that psychological treatment leads to changes in these factors through cognitive and behavioral techniques” (Hofmann & Smits, 2008, p. 621).

This approach addresses both behavioral and cognitive influences on an individual’s emotions in a particular situation. Bartels et al. (2004) suggest that CBT represents an effective treatment for depression among older clients.

Likewise, Holland, Chong, Currier, O’Hara, and Gallagher-Thompson (2015) investigated CBT as a way of promoting meaning among individuals with geriatric depression. The researchers found that CBT was effective in fostering enhanced positive world views, values, and purpose in life among participants with higher education.

3. Exercise training

Staying physically active is essential for older populations, as it fosters emotional wellbeing, physical health, and longevity. Exercise training is also important for preventing injury.

Hauer et al. (2001) examined the impact of a three-month exercise program aimed at improving strength, mobility, and balance among geriatric participants with a history of falls.

The results showed that exercise was linked to increased functional motor performance, strength, and balance – effects that continued at three-month follow-up (Hauer et al., 2001).

Along these lines, in a literature review examining randomized controlled trials focused on exercise treatments among the elderly, exercise was found to represent a beneficial approach for treating depression among this population (Sjösten & Kivelä, 2006).

4. Occupational Therapy (OT)

OT is an approach that involves “the use of purposeful activity or intervention designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain or restore the highest possible level of independence” (Punwar & Peloquin, 2000, p. 5).

Research has supported the efficacy of OT among older individuals. For example, according to a systematic review of OT approaches among patients in acute geriatric wards, several studies reported higher degrees of functionality in terms of daily living skills (Cuevas-Lara et al., 2019).

5. Animal-Assisted Therapy

Pets have an amazing way of calming anxiety and promoting compassion and tenderness.

Many older people enjoy cats, dogs and other pets without realizing the many ways in which their non-human pals enhance emotional wellbeing. This idea is borne out in the substantive research.

For example, Vrbanac et al. (2013) examined the impact of dog companionship among geriatric nursing home residents. The authors found that participation in the program was associated with reductions in loneliness.

Overall, having a pet is a fun way for older individuals who are fond of animals to greatly improve their own quality of life , as well as that of their furry companion.

Read more about this in our article Pets & Wellbeing: 15 Benefits of Emotional Support Animals as well as this fascinating read on Animal Therapy .

6. Music Therapy (MT)

A person need not possess any musical talent to enjoy the benefits of music . For example, Okada et al. (2009) examined the impact of Music Therapy among elderly participants with dementia and cerebrovascular disease.

The treatment group received MT once a week over 10 times. Patients in the MT group experienced increased parasympathetic activity and reduced congestive heart failure events, which are the most common cause of death among seniors (Okada et al., 2009).

Similarly, in a randomized controlled trial, institutionalized geriatric patients with mild depression underwent a group singing intervention. Those who received the intervention showed significantly lower depression and loneliness than controls after three weeks (Mathew, Sundar, Subramaniam, & Parmar, 2016).

7. Laughter Therapy

Laughter is the sun that drives winter from the human face.

Victor Hugo

It is often said that laughter is the best medicine, a notion that is consistent with the research literature. For example, in a study by Lee, Seo, Lee, and Jung (2016), a laughter therapy program was implemented in order to promote healthy aging among the elderly.

Participants received 60 minutes of laughter therapy for 10 weeks. Those in the treatment group enjoyed reduced stress and more successful aging relative to the control group.

Another study looked at the impact of laughter on sleep, cognition, and depression among elderly individuals. The researchers found that participation in laughter therapy was associated with improvements in sleep quality and insomnia, as well as depression symptoms (Ko & Youn, 2011). Considering these findings, seeking out that which makes you laugh is not only fun, but healthy too.

For more in this, read this article about laughter yoga for a practical way to encourage laughter as a therapy.

8. Art Therapy

Being creative through art therapy is another great way to enhance healthy aging.

Research supports the benefits of art therapy among the elderly. For example, in a study examining the impact of art therapy among older Korean–Americans, the intervention was associated with improved self-esteem, reduced negative emotions, and lower anxiety (Kim, 2010).

Similarly, in their meta-analysis, Masika, Yu, and Li (2020) reported that visual art therapy was associated with improved cognitive function, and reduced depression and anxiety.

Lastly, in a study in which informal art therapy was implemented among low-income seniors, participation was linked to reduced resistance in terms of accessing and using important social services (Rodriguez, 2018).

9. Reminiscence Therapy (RT)

Reminiscence Therapy, also known as Life Review Therapy , involves having individuals discuss past experiences and events using various prompts (e.g., photos) as memory triggers (Subramaniam & Woods, 2012).

Although often used to improve memory among dementia patients, RT may also be helpful for enhancing mood among older people. RT is useful as both an individual or group therapy, and as a standalone or adjunct approach.

Research suggests that RT is a viable approach to treat depression among the aging. For example, among elderly depressed women in an assisted living facility, those who took part in RT experienced significantly lower depression symptoms after the three-week intervention (Jones, 2003).

RT has also been found to reduce depression among older people when combined with antidepressants (Lynch, Morse, Mendelson, & Robins, 2003).

Group therapy may also help to reduce social isolation. The limited research available suggests that group therapy is a good option for older people with depression (Agronin, 2009; Tavares & Barbosa, 2018).

Here are five examples of studies showing evidence for the benefits of group therapy among older people:

In their systematic review, Tavares and Barbosa (2018) reported that of nine identified studies, eight found significant reductions in depression among depressed seniors participating in group therapy. The authors further noted that group therapy was effective across participant qualities, protocols, and settings.
Husaini et al. (2005) examined the effect of group therapy among depressed elderly women in Tennessee. Participants underwent 12 group therapy sessions that included a range of components such as grief therapy , exercise, social skill development, and preventive health behaviors. They found significant reductions in depression symptoms among Caucasian participants with at least moderate depression.
Chiang, Lu, Chu, Chang, and Chou (2008) examined the impact of a life review group program on life satisfaction and self-esteem among the elderly. The program was intended to enhance self-integration and adaptation among older individuals. The study included elderly Taiwanese men from a veterans’ home. Participation in the group intervention was associated with significant improvements in both self-esteem and life satisfaction.
Nilsson and Nygård (2003) examined the effects of an occupational group therapy program among elderly individuals living in a pre-discharge community rehabilitation center. The group therapy comprised five sessions intended to promote mutual sharing and reflection. Participation in the group program was linked to increases in adaptation and reflection among elderly people awaiting hospital discharge.
Werner, Wosch, and Gold (2017) looked at the effects of group music therapy and recreational group singing among elderly nursing home residents in Germany. Participation in the group music therapy was associated with significant reductions in depressive symptoms, results that were still evident 12 weeks later.

Treatment of depression in older adults – SAMHSA

There are many things older individuals can do on their own to promote positive wellbeing.

Here are 11 examples:

Stay physically active. Maintaining an active lifestyle is essential for both physical and emotional health. Ideas for older folks include resistance or weight training to maintain lean muscle mass and joint stability, swimming, walking, yoga, and dancing. Also, by checking out a local senior center or joining a gym, seniors will find many options for staying active.
Stay mentally active. The importance of remaining sharp increases as we age. There are plenty of ways to stimulate the mind, such as puzzles, crosswords, books , and games.
Be social. Loneliness and isolation represent significant issues for the elderly. These problems may be diminished by getting involved in social activities, such as playing games (e.g., chess) or taking classes with other seniors. Joining community groups or book clubs also promotes social interaction.
Do gardening. For many, gardening is a relaxing and creative way to spend time outdoors. If you don’t have a yard, community or deck/patio gardens offer excellent alternatives.
Spend time with animals. Whether you prefer cats, dogs, rodents, or some other type of critter, they will improve your mood. Dog companionship brings the added benefits that come along with regular walks: exercise and social opportunities.
Live your passions. It is NEVER too late to do the things you love. Painter Grandma Moses didn’t begin her artistic career until the age of 78. So, find what you love and embrace it, no matter your age.
Be creative. Art represents another way for seniors to be both creative and social. There are endless ways for older people to be creative, such as drawing, painting, pottery, cooking, knitting, beading, sewing, and photography.
Enjoy music. Music has a way of inspiring and soothing the soul. It also brings wonderful memories to the forefront. So, turn the music up, and if you are a singer or musician, keep those gifts alive throughout your lifetime.
Help others. Altruism helps people think less of their own problems by focusing on the needs of others. There are endless ways to give to one’s community, many of which are doable for elderly individuals.
Get involved in local politics. Involvement in politics is a great way for older people to play a key role in personally meaningful causes. There are many ways to help, such as working with campaigns or polling centers.
Go on fun outings. Enjoying fun activities enhances happiness, intellectual growth, and social interaction. There are all sorts of outing possibilities for older folks, such as movies, museums, parks, comedy clubs, and shopping.

World’s Largest Positive Psychology Resource

The Positive Psychology Toolkit© is a groundbreaking practitioner resource containing over 500 science-based exercises , activities, interventions, questionnaires, and assessments created by experts using the latest positive psychology research.

Updated monthly. 100% Science-based.

“The best positive psychology resource out there!” — Emiliya Zhivotovskaya , Flourishing Center CEO

PositivePsychology.com boasts several excellent resources for enhancing wellbeing among older people. Here are four examples:

What Is Positive Aging? is a comprehensive article providing a ton of information aimed at ways to promote positive aging. It describes what positive aging looks like, relevant research findings, useful examples, positive aging theories and tips, helpful books, and so much more.

Realizing Your Meaning is an article containing examples of how individuals may better realize their meaning in life, along with inspiring quotes and useful tools. The article is particularly relevant to older individuals, as it contains a section specifically aimed at helping readers to find meaning as they age.

Our article on Savoring in Psychology is designed to help readers enhance savoring – attending, appreciating, and enhancing positive experiences that occur in one’s life (Bryant & Veroff, 2007).

Although not specifically aimed at older people, it contains tips and resources that nonetheless apply to this group. It includes a psychological description of savoring, numerous benefits, and useful exercises, interventions, books, quotes, and tools from PositivePsychology.com.

A note on savoring the past is also included, as recalling past events is a powerful way to re-experience positive emotions (Speer, Bhanji, & Delgado, 2014).

Positive Reminiscence is an exercise designed to promote the skills of savoring and building positive emotions. It contains the following three steps:

Think about a positive past event . Consider an event that brought great joy or a sense of accomplishment. Look at inspiring reminders, such as photos.
Savor . The next step involves taking a few moments to relive a moment from the above event, including event details and associated positive feelings.
Relive the experience . Last, relive the experience while avoiding analytical thoughts about the event.

Overall, this exercise supports individuals in enjoying greater positivity in life by savoring pleasant events from the past. You can access a pre-prepared version of the Positive Reminiscence exercise, together with over 450 more practitioner resources, with a subscription to the Positive Psychology Toolkit© .

17 Stress & Burnout Prevention Exercises

If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, this collection contains 17 validated stress management tools for practitioners. Use them to help others identify signs of burnout and create more balance in their lives.

There has never been a better time to age gracefully.

The tools and information provided here support older individuals in engaging in health-promoting activities, as well as research-guided treatment options.

It is essential to remember that:

“Age is inevitable. Aging isn’t.”

The sooner older individuals embrace the many resources and tips aimed at healthy aging, the more they will be able to make the most of their golden years.

We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free .

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Bartels, S., Dums, A., Oxman, T., Schneider, L., Areán, P., Alexopoulos, G., & Jeste, D. (2004). Evidence-based practices in geriatric mental health care. Focus , 2 , 268–281.
Bryant, F., & Veroff, J. (2007). Savoring: A new model of positive experience . Erlbaum Associates.
Chang-Quan, H., Xue-Mei, Z., Bi-Rong, D., Zhen-Chan, L., Ji-Rong, Y., & Qing-Xiu, L. (2010). Health status and risk for depression among the elderly: A meta-analysis of published literature. Age and Ageing , 39 , 23–30.
Chiang, K., Lu, R., Chu, H., Chang, Y., & Chou, K. (2008). Evaluation of the effect of a life review group program on self‐esteem and life satisfaction in the elderly. International Journal of Geriatric Psychiatry , 23 , 7–10.
Cuevas-Lara, C., Izquierdo, M., Gutiérrez-Valencia, M., Marín-Epelde, I., Zambom-Ferraresi, F., Contreras-Escámez, B., & Martínez-Velilla, N. (2019). Effectiveness of occupational therapy interventions in acute geriatric wards: A systematic review. Maturitas , 127 , 43–50.
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Heisel, M., Duberstein, P., Talbot, N., King, D., & Tu, X. (2009). Adapting interpersonal psychotherapy for older adults at risk for suicide: Preliminary findings. Professional Psychology: Research and Practice , 40 , 156–164.
Hofmann, S., & Smits, J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry , 69 , 621–632.
Holland, J., Chong, G., Currier, J., O’Hara, R., & Gallagher-Thompson, D. (2015). Does cognitive-behavioural therapy promote meaning making? A preliminary test in the context of geriatric depression. Psychology & Psychotherapy: Theory, Research & Practice , 88 , 120–124.
Husaini, B., Cummings, S., Kilbourne, B., Roback, H., Sherkat, D., Levine, R., & Cain, V. (2004). Group therapy for depressed elderly women. International Journal of Group Psychotherapy , 54 , 295–319.
Institute of Medicine. (2012). The mental health and substance use workforce for older adults: In whose hands? National Academies Press.
Jones, E. (2003). Reminiscence therapy for older women with depression. Effects of nursing intervention classification in assisted-living long-term care. Journal of Gerontological Nursing , 29 , 26–33.
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Ko, H., & Youn, K. (2011). Effects of laughter therapy on depression, cognition and sleep among the community-dwelling elderly. Geriatrics & Gerontology International , 11, 267-274.
Lee, D., Seo, H., Lee, B., & Jung, G. (2016). Development and effects of laughter therapy program in geriatric successful aging and stress in elderly. Journal of the Korea Convergence Society , 7 , 199–208.
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Mackin, R., & Areán, P. (2005). Evidence-based psychotherapeutic interventions for geriatric depression. Psychiatric Clinics of North America , 28 , 805–820.
Masika, G., Yu, D., & Li, P. (2020). Visual art therapy as a treatment option for cognitive decline among older adults. A systematic review and meta-analysis. Journal of Advanced Nursing , 76 , 1892–1910.
Mathew, D., Sundar, S., Subramaniam, E., & Parmar, P. (2017). Music therapy as group singing improves geriatric depression scale score and loneliness in institutionalized geriatric adults with mild depression: A randomized controlled study. International Journal of Educational & Psychological Researches , 3 , 6–10.
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Okada, K., Kurita, A., Takase, B., Otsuka, T., Kodani, E., Kusama, Y., … Mizuno, K. (2009). Effects of music therapy on autonomic nervous system activity, incidence of heart failure events, and plasma cytokine and catecholamine levels in elderly patients with cerebrovascular disease and dementia. International Heart Journal , 50 , 95–110.
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Vrbanac, Z., Zečević, I., Ljubić, M., Belić, M., Stanin, D., Brkljača Bottegaro, N., … Žubčić, D. (2013). Animal assisted therapy and perception of loneliness in geriatric nursing home residents. Collegium Antropologicum , 37 , 973–976.
Werner, J., Wosch, T., & Gold, C. (2017). Effectiveness of group music therapy versus recreational group singing for depressive symptoms of elderly nursing home residents: Pragmatic trial. Aging & Mental Health , 21 (2), 147–155.
World Health Organization. (2017, December 12). Mental health of older adults . Retrieved April 26, 2021, from https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

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Would love to locate an online support group for senior citizens.

Resentment stubbornness is key to unhappiness in individuals. Living in compassion and forgiveness is being willing to learn from the past and others.10-30% in older community dwelling adults are having minor depression. The high rates of psychological problems among older people are related to declining health and mobility, cognitive impairment, financial stress, chronic pain, elder abuse, and loneliness aged adults mental health should always be highly aware of，psychosocial depression intervention can be intervene in early stage. Advocate for older adult’s mental health is one of the key for their well being. The suggestion for therapy intervention is very helpful!

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Depression in Children
Depression in Teens
Depression in College
Depression in Women
Depression in Men

Depression in Older People

How Is Depression Diagnosed?
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What Are the Different Types of Depression?
Mild Depression
Major Depressive Disorder
Overview of Treatment
Psychotherapy
Complementary & Alternative Therapy
Overview of Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclic and Tetracyclic Antidepressants (TCAs)
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Treatment-Resistant Depression (TRD)
Family & Relationships
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View Full Guide

Clinical depression in older people is common. That doesn't mean it's normal. Late-life depression affects about 6 million Americans ages 65 and older. But only 10% get treatment. The likely reason is that older people often display symptoms of depression differently. Depression in older people is also frequently confused with the effects of multiple illnesses and the medicines used to treat them.

How Does Depression in Older People Differ From Depression in Younger Adults?

Depression affects older people differently than younger people. In older people, depression often goes along with other medical illnesses and disabilities and lasts longer.

Depression in older adults is tied to a higher risk of cardiac diseases and of death from illness. At the same time, depression reduces an older person's ability to rehabilitate. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increases the likelihood of death from those illnesses. Depression also has been linked with increased risk of death after a heart attack . For that reason, it’s important to make sure that an older adult you are concerned about is evaluated and treated, even if the depression is mild.

Older people may not have the obvious symptoms of depression. Instead, they may:

Have trouble sleeping
Be grumpy or irritable
Feel confused
Struggle to pay attention
Not enjoy activities they used to
Move more slowly
Have a change in weight or appetite
Feel hopeless, worthless, or guilty
Endure aches and pains
Have suicidal thoughts

Using a series of standard questions, a primary care doctor can check for depression, allowing for better diagnosis and treatment. Doctors are encouraged to routinely check for depression. This can happen during a visit for a chronic illness or at a wellness visit.

Depression also raises the risk of suicide, especially in older white men. The suicide rate in people ages 80 to 84 is more than twice that of the general population. The National Institute of Mental Health considers depression in people 65 and older to be a major public health problem.

In addition, advancing age often comes along with the loss of social support systems due to the death of a spouse or siblings, retirement, or relocation. Because of changes in an older person's circumstances and the fact that older people are expected to slow down, doctors and family may miss the signs of depression . As a result, effective treatment often gets delayed, forcing many older people to struggle unnecessarily with depression.

How Is Insomnia Related to Depression in Older Adults?

Insomnia is often a symptom of depression. Studies have found that insomnia is also a risk factor for new depression or depression that comes back, particularly in older adults.

To treat insomnia , experts sometimes recommend avoiding or minimizing benzodiazepines (such as Ativan , Klonopin , or Xanax ) or newer "hypnotic" drugs (such as Ambien or Lunesta ) that, according to the American Geriatric Society, may raise the risk of impaired alertness, respiratory depression, and falls.

Experts often favor treating insomnia in the elderly with the hormone melatonin, or a low-dose formulation of the tricyclic antidepressant doxepin (Silenor). Other potentially sedating antidepressants , such as Remeron or trazodone, are also sometimes prescribed for both purposes. The sleep aid Belsomra has also been found to be effective and safe in older adults. If there's no improvement in the sleep disorder or depression, a psychiatrist or psychopharmacologist may prescribe other medications , psychotherapy , or both.

What Are the Risk Factors for Depression in Older Adults?

Things that raise the risk of depression in older people include:

Being female
Being single, unmarried, divorced, or widowed
Lack of a supportive social network
Stressful life events

Physical conditions like stroke , hypertension , atrial fibrillation , diabetes , cancer , dementia , and chronic pain further increase the risk of depression. Additionally, these risk factors for depression are often seen in older adults:

Certain medicines or combination of medicines
Damage to body image (from amputation , cancer surgery, or heart attack )
Dependence, whether through being hospitalized or needing home health care
Family history of major depressive disorder
Fear of death
Living alone, social isolation
Other illnesses
Past suicide attempt(s)
Presence of chronic or severe pain
Previous history of depression
Recent loss of a loved one
Substance abuse

Brain scans of people who develop their first depression in old age often reveal spots in the brain that may not get enough blood flow, believed to result from years of high blood pressure . Chemical changes in these brain cells may enhance the likelihood of depression separate from any life stress.

What Treatments Are Available for Depression in Older Adults?

Treatments for depression include medicine, psychotherapy or counseling, or electroconvulsive therapy or other newer forms of brain stimulation (such as repetitive transcranial magnetic stimulation, or rTMS). Sometimes, a combination of these treatments may be used. The option a doctor might recommend depends on the type and severity of depression symptoms, past treatments, and overall health, among other factors.

How Do Antidepressants Relieve Depression in Older People?

Studies have found that while antidepressants can be helpful in older adults, they may not always be as effective as in younger patients. Also, the risk of side effects or potential reactions with other medicines must be carefully considered. For example, certain older antidepressants such as amitriptyline and imipramine can be sedating, may cause confusion, or might cause a sudden drop in blood pressure when a person stands up. That can lead to falls and fractures .

Medications you might get include:

Selective serotonin reuptake inhibitors (SSRIs) like citalopram ( Celexa ), escitalopram ( Lexapro ), fluoxetine ( Prozac ), paroxetine ( Paxil ), and sertraline ( Zoloft )
Serotonin and norepinephrine reuptake inhibitors (SNRIs) like desvenlafaxine ( Pristiq ), duloxetine ( Cymbalta ), and venlafaxine ( Effexor )
Serotonin modulators and stimulators (SMS) including vilazodone ( Viibryd ) and vortioxetine ( Trintellix )
Atypical antidepressants , such as bupropion ( Aplenzin , Wellbutrin ), mirtazapine ( Remeron ), and trazodone ( Oleptro ER )
Monamine oxidase inhibitors (MAOIs), like isocarboxazid ( Marplan ), phenelzine ( Nardil ), selegiline ( Eldepryl , Emsam , Zelapar ), and tranylcypromine ( Parnate )

Antidepressants may take longer to start working in older people than they do in younger people. Since older people are more sensitive to medicines, doctors may prescribe lower doses at first. In general, the length of treatment for depression in older adults is longer than it is in younger patients.

Can Psychotherapy Help Relieve Depression in Older Adults?

Most depressed people find that support from family and friends, involvement in self-help and support groups, and psychotherapy are helpful. Psychotherapy is especially beneficial for those who have gone through major life stresses (such as loss of friends and family, home relocations, and health problems) or who prefer not to take medicine and have only mild to moderate symptoms. It’s also helpful for people who can’t take drugs because of side effects, interactions with other medicines, or other medical illnesses.

Psychotherapy in older adults can address a broad range of functional and social consequences of depression. Many doctors recommend psychotherapy along with antidepressant medicines.

When Is Electroconvulsive therapy (ECT) Used?

ECT can play an important role in the treatment of depression in older adults. When older people can’t take traditional antidepressant medicines because of side effects or interactions with other medications, when depression is very severe and interferes with basic daily functioning (such as eating, bathing and grooming), or when risk for suicide is especially high, ECT is often a safe and effective treatment option.

What Problems Affect Treatment of Depression in Older Adults?

The stigma attached to mental illness and psychiatric treatment is even more powerful among older people. This stigma can keep older people from admitting that they are depressed, even to themselves. Older people and their families sometimes also may wrongly identify depression symptoms as "normal" reactions to life stresses, losses, or the aging process.

Also, depression may be expressed through physical complaints rather than traditional symptoms. This delays appropriate treatment. In addition, depressed older people may not report their depression because they wrongly believe there is no hope for help.

Older adults may also be unwilling to take their medicines because of side effects or cost. In addition, having certain other illnesses at the same time as depression can interfere with the effectiveness of antidepressant medicines. Alcoholism and abuse of other substances may cause or worsen depression and interfere with effective treatment. And unhappy life events including the death of family or friends, poverty, and isolation may also affect the person's motivation to continue with treatment.

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Amanda Lambert, MS, CMC, ALCP

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Learn what caring for aging parents with mental illness looks like with helpful tips and information.

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Caring for a parent with a mental illness is a special and unique kind of caregiving. Not only are you supporting and managing your parents' emotional and psychological state, but there are other physical changes associated with aging that can add to the strain.

Jump ahead to these sections:

Things to remember when caring for your aging parents with mental illness, how to discuss mental illnesses with aging parents, how to find assisted living or long-term care for aging parents with mental illness.

Mental illness is a term that has some negative connotations. This is why some prefer ‘mental health disorders’ or ‘mental health issues’ as the more politically correct terms. Still, the term ‘mental illness’ describes so many different conditions so it is valuable to know and understand what your parents are going through based on their diagnoses.

More common mental health disorders include depression, anxiety, and bipolar disorder. Others include schizophrenia and personality disorders, like narcissistic personality disorder or BPD. There is much that we don’t know about mental illness, but what we do know can help you support your parent regardless of their diagnosis.

First, there are things to remember when caring for your aging parents with mental illness that keep them stable and stress-free. The nature of mental health problems is that they fluctuate. They’re not always the same every day. For you as a caregiver, this can be highly stressful and time-consuming.

Our tips will help you build a foundation of support, develop a knowledge base, and maintain a flexible and accepting attitude. However, don’t forget to put your needs first when you feel the creeping presence of caregiver burnout.

1. Your parent is not his or her disorder

First, a mental illness is not a behavioral problem. It’s a brain disorder, and your parent can’t help what he or she feels and expresses. If your parent has depression or anxiety, he or she can’t simply ‘try harder’ or ‘pull themselves up by their bootstraps.’

It is heartbreaking to observe a parent suffering from a mental illness and not know how to respond, but do your best to show compassion. Remember that who your parent is not defined by their diagnosis.

2. You need to be your parent’s advocate

Everyone should discuss advance directives, go through the aging parent checklist , and assign powers of attorney for healthcare. It’s especially critical when you have a parent with a mental illness.

Some mental health disorders wax and wane or worsen through time. You need to have the legal authority to help manage their healthcare and finances when they can’t. It’s better to prepare today than to be underprepared tomorrow.

3. Understand their treatment options

Next, the more you know about your parent’s disease and treatment options, the better. You can better support your parent by recognizing symptoms, realizing when there might be an exacerbation of his or her illness, and knowing the treatment options.

As the saying goes, knowledge is power. Talk to their mental health provider, doctor, and online communities to find the right information.

4. Be there to provide support

Support can take many forms. You might help them find a therapist, a psychiatrist, or a support group, or simply be there for them. People with a mental illness often feel stigmatized and respond by becoming isolated and lonely.

Do what you can to facilitate social engagement, starting with immediate family and then putting together a health team that your parent can trust. Even consider a private caregiver who can offer companionship and monitor your parent’s health and well-being.

5. Ensure treatment compliance

Ensuring treatment compliance is easier said than done. Many medications used to treat mental illness can have unpleasant side effects, discouraging compliance. The other problem could be remembering to take medications.

By identifying what the challenge is, you can solve it. For side effects, ask the doctor for some alternatives. If your parent forgets to take medications, consider an automated system. The right treatment plan makes all the difference.

6. Accept instability

Some mental health disorders like depression and anxiety may respond better to treatment than psychotic disorders like schizophrenia. Similarly, psychotic disorders can result in hallucinations, delusions, and behavioral problems that are difficult to manage.

Your parent’s mental state may go through periods of stability and instability. If you accept that this is likely, you can stay calm and make better decisions about what they need when they are suffering. This is a reality of living with someone who has a mental illness, and it doesn’t have to disrupt your life.

7. There may be no ‘recovery’

For some mental health conditions, complete and long-lasting recovery may not be possible. As hard as this is to accept, it will take the pressure off of you and your parent to achieve something that may not happen.

Instead, think about managing the symptoms of mental illness and realize that there will be periods of remission and exacerbation of their condition. Strive for achievable short-term and long-term goals that set you both up for success.

8. Take care of yourself

Lastly, the stress of taking care of a parent with mental illness can be overwhelming, frustrating, and exhausting. Caregiving can take an enormous toll on you that can cause caregiver burnout and mental health problems for you as well.

Taking care of yourself may involve having your own mental health therapist to help you navigate care for your parent. A good place to get information is the National Alliance on Mental Illness (NAMI). Also, make sure you get enough sleep, eat well and engage in activities that bring you joy. Reach out to friends and stay connected with people who can support you. Caregiver burnout is real, and you need to protect your own wellness.

People can be sensitive and resistant when discussing mental illness. Your parents might be defensive or deny that they have a problem. If you anticipate either of these could happen, it will help you not to overreact. Here are some suggestions for discussing mental illness with your aging parents.

9. Pick a good time to talk

It might be a good idea to pick a time when you expect everyone to remain calm. Your parents might be more receptive in the morning or later in the day. Pre-schedule a time to discuss mental illness with your parent at a time you think they will be at their best.

10. Use respectful language

Additionally, your parents might be sensitive to certain terms like ‘mental illness,’ so consider using respectful and compassionate language. For example, you could begin by talking about behaviors and emotions that you observe that are causing discomfort or suffering.

Remember to focus on how these things affect you and your concern for them, not what they’re doing wrong. This is not the time to assign blame.

11. Have solutions and resources ready

If your parents are receptive to talking about mental illness, have some solutions ready to discuss. Some ideas include scheduling time to speak with a psychiatrist or therapist. Let your parents know you are there to support them and take whatever time is necessary to get treatment and help them feel better. Have some online or written resources available that talk about mental illness and treatment options.

12. Set healthy boundaries

In cases where you have tried to help your parents and haven’t had success, you may have to set boundaries . Angry or abusive behavior is not helpful, it’s harmful. Let your parents know that you won’t tolerate inappropriate behavior. If you don't feel comfortable, let them know you will come back another day to talk with them about mental illness.

13. Get support through this process

Consider bringing a sibling with you or a trusted friend like a chaplain to discuss mental illness with your parents. You will want to be sensitive to confidentiality issues, so plan the discussion taking into account your parent's privacy.

Finally, when the time comes to find assisted living or some other long-term care for a parent with mental illness, the decision depends on several factors. Before looking for any senior living option, including assisted living for someone with mental illness , these are some questions and suggestions on finding the best option.

How ill is your parent?

There is a difference between someone struggling with depression or anxiety and someone with a psychotic disorder. If your parent has angry outbursts, paranoia, or delusions, these behaviors could be upsetting and disruptive in a congregate senior living community. Before looking for assisted living, you may want to try and stabilize your parent first.

Is your parent compliant with treatment?

If your parent has difficulty with keeping appointments or taking their psychiatric medications, this could cause problems in assisted living. Even though assisted living communities dispense medications, anyone can refuse to take them.

Is your parent suicidal?

When someone voices that they no longer want to live, this situation needs immediate attention. Moving a parent under these circumstances could be risky. The change of a move could make things worse. With your parent’s permission, talk with your parent’s mental health provider about this issue.

Be honest about your parents’ struggles

Any assisted living community will have residents with mental health problems. Acknowledging that your parent struggles with mental illness is not necessarily a bad thing, but you will have to use your judgment as to how much information you are comfortable divulging.

On the one hand, it can help staff to be more supportive. On the other hand, it may create a stigma. If you can, talk with your parent about how they would like to handle communication with assisted living staff.

Consider all options

Try not to confine yourself to one idea of senior living for a parent with a mental illness. You could consider living with your aging parent but think through this option carefully and take an honest look at what you are taking on.

Would your parent prefer a larger community or something more intimate like a homier board and care situation with fewer residents? Perhaps a home share situation is a possibility where your parent shares housing with someone else. Or, the possibility of bringing home care caregivers to your parent’s home for additional support. Talk with your parent about what situation they feel most comfortable with.

Consider using a senior placement specialist

A senior living placement specialist is someone who knows the local senior living resources. You can be honest with a placement specialist about your parent’s situation and they may have experience working with communities that are accepting of residents with mental health issues. Ask your parent’s doctor for a referral or search online for one of these professionals.

Caring for Parents with Mental Illness

Caring for parents with mental illness can be a heartbreaking experience, but it can also bring a sense of responsibility and compassion for their suffering. If you can be prepared and informed, you can help your parent have a stable and worthwhile life.

Helping a family member navigate these end-of-life challenges as they age is also a reminder of your own future. Your health is the most important thing you have. Not only should you protect it today, but you should create a shareable plan for tomorrow.

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Mental health of older adults

By 2030, one in six people in the world will be aged 60 years or over.
Loneliness and social isolation are key risk factors for mental health conditions in later life.
One in six older adults experience abuse, often by their own carers.
Approximately 14% of adults aged 60 and over live with a mental disorder.
Mental disorders among older adults account for 10.6% of the total years lived with disability for this age group.

The world’s population is ageing fast. In 2020, 1 billion people in the world were aged 60 years or over. That figure will rise to 1.4 billion by 2030, representing one in six people globally. By 2050, the number of people aged 60 years and over will have doubled to reach 2.1 billion. The number of persons aged 80 years or older is expected to triple between 2020 and 2050 to reach 426 million (1) .

Older adults contribute to society as family and community members, and many are volunteers and workers. While most have good health, many are at risk of developing mental health conditions such as depression and anxiety disorders. Many may also experience reduced mobility, chronic pain, frailty, dementia or other health problems, for which they require some form of long-term care. As people age, they are more likely to experience several conditions at the same time.

Around 14% of adults aged 60 and over live with a mental disorder (2) . According to the Global Health Estimates (GHE) 2019 , these conditions account for 10.6% of the total disability (in disability adjusted life years, DALYs) among older adults. The most common mental health conditions for older adults are depression and anxiety. GHE 2019 shows that globally, around a quarter of deaths from suicide (27.2%) are among people aged 60 or over.

Mental health conditions among older people are often underrecognized and undertreated, and the stigma surrounding these conditions 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 earlier life experiences and specific stressors related to ageing. Exposure to adversity, significant loss in intrinsic capacity and a decline in functional ability can all result in psychological distress.

Older adults are more likely to experience adverse events such as bereavement, or a drop in income or reduced sense of purpose with retirement. Despite their many contributions to society, many older adults are subject to ageism , which can seriously affect people’s mental health.

Social isolation and loneliness , which affect about a quarter of older people, are key risk factors for mental health conditions in later life (3) . So too is abuse of older people , which includes any kind of physical, verbal, psychological, sexual or financial abuse, as well as neglect. One in six older adults experience abuse, often by their own carers (4) . Abuse of older adults has serious consequences and can lead to depression and anxiety.

Many older people are carers of spouses with chronic health conditions, such as dementia . The responsibilities of such care can be overwhelming and can affect the carer’s mental health.

Some older adults are at greater risk of depression and anxiety, because of dire living conditions, poor physical health or lack of access to quality support and services. This includes older adults living in humanitarian settings and those living with chronic illnesses (such as heart disease, cancer or stroke), neurological conditions (such as dementia), or substance use problems.

Promotion and prevention

Mental health promotion and prevention strategies for older adults focus on supporting healthy ageing . That means creating physical and social environments that support well-being and enable people to do what is important to them, despite losses in capacity.

Key mental health promotion and prevention strategies for healthy ageing include:

measures to reduce financial insecurity and income inequality;
programmes to ensure safe and accessible housing, public buildings and transport;
social support for older adults and their carers;
support for healthy behaviours, especially to eat a balanced diet, be physically active, refrain from tobacco and reduce alcohol use; and
health and social programmes targeted at vulnerable groups such as those who live alone or in remote areas and those living with a chronic health condition.

For older adults, social connection is particularly important to reduce risk factors such as social isolation and loneliness. At this stage of life, meaningful social activities can significantly improve positive mental health, life satisfaction and quality of life; they can also reduce depressive symptoms. Example interventions include befriending initiatives, community and support groups, social skills training, creative arts groups, leisure and education services and volunteering programmes.

Protection from ageism and abuse is also critical. Key interventions include anti-discrimination policies and laws, educational interventions and intergenerational activities. A range of carer interventions – including respite care, advice, education, financial support and psychological interventions – can support carers to maintain a good and healthy caring relationship that avoids abuse of older people.

Treatment and care

Prompt recognition and treatment of mental health conditions (and associated neurological and substance use conditions) in older adults is essential. This should follow standards for integrated care for older people , which is community-based and focused on both the long-term care of older adults living with mental health conditions and declines in intrinsic capacity, as well as the education, training and support of carers. A mix of mental health interventions are usually recommended, alongside other supports to address the health, personal care and social needs of individuals.

Dementia is often an important concern. It affects people’s mental health (for example, sparking symptoms of psychosis and depression), and requires access to quality mental health care.

Responding to the abuse of older adults is also critical. Promising interventions include mandatory reporting of abuse, self-help groups, helplines and emergency shelters, psychological programmes for abusers, training of health care providers and other caregiver support interventions.

WHO response

WHO works with diverse partners on strategies, programmes and tools to support governments respond to the mental health needs of older adults.

For example, the Decade of Healthy Ageing (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 have also endorsed the Comprehensive mental health action plan 2013–2030 , which supports improved mental health and mental health care for all populations, including older adults.

WHO’s Mental Health Gap Action Programme (mhGAP) provides evidence-based clinical protocols for assessing, managing and following up a set of priority mental, neurological and substance use conditions in non-specialized settings, including depression and dementia. The mhGAP intervention guide includes clinical tips for working with older adults.

During the COVID-19 pandemic, WHO and partners in the Inter-Agency-Standing Committee (IASC) developed the Living with the times toolkit of illustrated posters to help older adults maintain good mental health and well-being. Other WHO activities to support the mental health of older adults include the development of scalable psychological interventions to address depression and anxiety, research and guidance on interventions to reduce social isolation and loneliness, and cost–effective solutions to prevent abuse of older adults.

World Population Prospect 2022: release note about major differences in total population estimates for mid-2021 between 2019 and 2022 revisions. New York: United Nations Department of Economic and Social Affairs, Population Division; 2022 ( https://population.un.org/wpp/Publications/Files/WPP2022_Release-Note-rev1.pdf , accessed 12 September 2023).
Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx). https://vizhub.healthdata.org/gbd-results/ , accessed 20 October 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. 2023 Apr;107:104904. doi:10.1016/j.archger.2022.104904 .
Yon YY, Mikton CR, Gassoumis ZD, Wilber KH. Elder abuse prevalence in community settings: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(2):e147–e156. doi:10.1016/S2214-109X(17)30006-2 .
WHO's work on ageing
Global report on ageism
Integrated care for older people (ICOPE)
Scaling up care for mental, neurological and substance abuse disorders: mhGAP
WHO's work on mental health

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How to Approach Mental Illness in Seniors

2. Choose a time when both of you are calm.

According to the Mayo Clinic , “This will make it easier for you and your loved one to listen to each other and speak your minds.” Then, explain your needs, stress the benefits of care — and be prepared to compromise.

3. Take resistance in stride.

“When it occurs,” Professor Adams says, “shift the conversation to less inflammatory aspects of your concerns. Threats or emotional outbursts will only add anxiety and shut down communication. Remember not to take outbursts personally and know that they often stem from fear of the unknown.”

4. “If at first you don’t succeed, try again.”

Your loved one may not want to discuss the topic when you first bring it up, the Mayo Clinic advises trying again later. The same goes for conversations that go wrong. “If you feel yourself becoming emotional, the best advice is to take a break from the conversation and choose another time to discuss the topic,” says Professor Adams.

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Parenting and Family Mental Health

How to take care of elderly parents with mental illness.

Most seniors don’t seek treatment or even help because they view their mental changes as a natural part of aging or partly because they are ashamed of their condition. While it’s normal for elderly people to experience some level of forgetfulness, it’s important to seek professional help if they show obvious changes in behavior or mood.

A significant number of elderly people experience one or more mental health disorders, such as depression, anxiety, dementia, and bipolar disorder . This, together with the natural physical and cognitive impairments that occur in old age, can endanger their lives. Here’s how you can care for elderly parents with mental health issues:

Have a Conversation

Bringing up the topic of long-term senior care can be difficult. To mom or dad, accepting this type of care may seem like giving up their independence. The topic is even more fraught if they have a mental illness.

As a caregiver, you are worried about how to approach the subject without upsetting them, or worse, receiving an irrational or violent reaction. Here are a few tips to help you start such a tough discussion:

Choose a time when both of you are calm.
Expect some form of resistance and don’t take any outbursts personally. Remember, they are also afraid of the unknown and any threats or emotional outbursts from your side will only add anxiety and even cause them to shut down communication.
If you don’t succeed the first time, try again.

Schedule a Doctor’s Visit

The next step when caring for aging parents with mental illness is encouraging them to see a doctor. The doctor will give a diagnosis and prescribe medication that will help alleviate symptoms of the disorder. Remember to set up a therapist appointment as well. A good therapist will help your parents identify and learn how to cope with some of the underlying issues that may be causing their mental health issues.

Ensure Effective Communication

As a caregiver to aging parents with mental illness, you’ll have to communicate with many people, including their friends, other family members, healthcare professionals, etc.

Family members may want regular updates on a parent’s condition while the parent wants more privacy. It’s your job to manage these interactions effectively and keep them as stress-free as possible.

Gather As Much Information about the Illness as Possible

It’s important to do some research on the type of mental health problem an elderly parent is experiencing, not forgetting the different kinds of treatment available. Such information can be found on reputable websites such as health organizations or government sites .

You can also talk to the doctor and others who’ve cared for a loved one in a similar situation. In addition, find out about any online or local mental health assistance programs that can help you. All this information will help you figure out the types of emotional, practical, and financial support your parent might need.

Ensure They Take Their Medications as Prescribed

This will help treat the illness or alleviate symptoms. Be sure to know what medications have been prescribed, their potential side effects, as well as any interactions with other drugs the patient is taking, as well as food, supplements, and other substances.

Complete the Necessary Paperwork

Some mental health disorders, together with age-related illnesses, can pose unique challenges. They can cause aging parents to be of unsound mind, or be a danger to themselves or others. In such cases, you may need a power of attorney to make decisions, including medical ones, on their behalf.

Give Them Some Level of Control

Taking care of your parents when they are old is a great thing to do, but it can leave them feeling dependent and worthlessness. It’s important to keep them involved in their own care decisions, which in turn helps them feel more comfortable when it comes to taking a new step into their treatment.

Find Much Needed Support

Taking care of elderly parents can be overwhelming. Caregiver support is essential to anyone coping with the demands of taking care of aging parents. It’s also important for your parents to seek mental health support specifically intended for older people, as it will help them learn how to cope with their current condition.

If a parent’s mental health problems are proving beyond your capacity to provide home care, consider the option of assisted living for seniors. This may seem like a difficult decision to make, but it’s bound to improve his or her quality of life and reduce your stress.

Take Care of Yourself

Oftentimes, caregivers tend to overlook their own self-care when taking care of others. As a caregiver, your physical and emotional health is as important as the health of the one you’re taking care of.

Self-care can be achieved in many ways. For starters, general attention to daily activities such as exercising , sleeping, healthy eating , and socializing are all vital to your own overall well-being. Don’t forget to take breaks, as well as scheduling and keeping your own doctor appointments. And, be sure to ask for help from friends and family to help with different tasks.

If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.

About the Author:

Emily Lamp is a freelance writer, working closely with many aspiring thinkers and entrepreneurs from various companies including Open Minds , the organization that supports independent living and provides good care for elderly people, physically and mentally. Emily is also interested in self-care, mental health awareness and loves sharing her views through her writing.

The opinions and views expressed in this guest blog do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc. The author and www.rtor.org have no affiliations with any products or services mentioned in this article or linked to herein.

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21 thoughts on “ how to take care of elderly parents with mental illness ”.

I wanted to thank you for this advice for taking care of an elderly parent with a mental illness. You mentioned it could be good to consider if assisted living could be good for seniors. That said, it sounds important to maybe talk with the senior about it to figure out what kind of assisted living option they may like the best.

Great To Be Here. I am very much concerned about Senior Citizens mental health issues. I promote Meditation, which is necessary for them to control thoughts which makes them relaxed.

People tend to become weaker and less capable of doing many things as they age. Physical activities, particularly, begin to become exhausting as people reach past their mid-life age. This happens because, as people get older, their muscles tend to lose their size and strength, which can contribute so much to fatigue, weakness, and reduced tolerance to physical activities such as exercise. When an elderly family member reaches this stage, they may already need the complete assistance of a family caregiver.

Thank you for sharing this article. Self-care is so important – in many different ways. Check our self-care statistics if you are a fact oriented person. Especially during covid where we are inside all the time, self-care is everything.

My mom she has a mental illness and she is telling all her sisters on the phone that there is bugs and parasites in the house and there is not and she would come in my room and tell me that nonsense that there’s bugs and parasites in my room and there is not I would like her to make an appointment to see a therapist before her mental illness gets very bad. Want her no longer talking to me right now and stay out of my room.

We appreciate you sharing as this takes a lot of courage. I will contact you directly with some resources please check your email.

My mom has a history of paranoia schizophrenia and does not trust anyone including healthcare providers and pharmacists. My siblings and I are trying to be a support system. She was recently admitted for insulin overdose and when discharged refused to take the medication prescribed, wouldn’t listen to us and took more insulin. She has been admitted to behavioral units on separate occasions and the providers and nurses just dont seem compassionate enough, do not listen to her, pumps patients with psych meds and makes them institutionalized. There has been arrangements for nurses to come out but she wont let them in. We feel so out of control at this point.

Thank you for reading and commenting on this blog post. I am sorry to hear this, I can imagine this being a stressful experience for the family. I will email you directly with some resources.

What about an 89 year old parent who has always been abusive (physically and emotionally), has all the symptoms of Borderline Personality Disorder, is paranoid, and needs to be institutionalized? Are there still mental institutions in this country? I am terrified of him. I have had to go No Contact because of his horrible verbal abuse. He needs care, but he’s very combative and I cannot handle his out of control behavior. I am the oldest daughter.

Thank you for reading and commenting on the blog post. Caring for an elderly parent can be difficult and stressful for many especially if the elderly parent is struggling with mental health. There are alternative options for family members where all of the responsibilities of caring for the parent is not solely on them, such as a Visiting Nurse, a Social Worker or exploring assisted living options. I will email you directly to further discuss what you can consider.

My mother is getting worse by the day. She has no concept of finances anymore and has spent almost all my parents life savings on shopping networks within the last few months. My father went to the bank and they said bc there is no poa, there is nothing we can do. She refuses to see a mental health Dr. She tells people she has illnesses that she doesn’t have. She jumps from Dr to Dr bc they tell her things she disagrees with (like she hasn’t had a stroke)…. Just yesterday she had a blowout at my daughters and started crying that I yelled at her and that I’m mean when I’m mad at her (I wasn’t even anywhere around her. When my son tried to explain that to her, she accused him of pushing her. Then she continued sobbing and shaking for about 20 minutes. When we try and reason with her she just gets more dramatic. What should we do, she refuses to see a mental health provider and it’s getting bad

Thank you so much for reading and commenting on the blog post. I can imagine this being very stressful for the whole family. Dr. Amador, who is a psychologist, has a technique called LEAP (Listen, Empathize, Agree and Partner) that has been known to help with reaching someone who is unaware/unaccepting of their mental health conditions. I will follow up with you via email with helpful information.

My mother was just hospitalized then diagnosed with Bipolar mania. She is 70 years old. And up until about a month ago she was living a normal life but drinking heavily at night when she quit drinking cold turkey her mental Devine was rapid. I’m not sure if she is going to come out of the facility and be able to function. She lived on her own. Should I have a assisted living facility ready as a back up if at home health care doesn’t work out?

Thank you for reading and commenting on the blog post. I can imagine how stressful this can be as this is a major change for the family. You have asked a great question and it is important to be proactive and consider all options. You are doing a great job by looking for support, education and resources for your mother. I will email you directly with some resources.

My mom she has a mental illness she’s had it for a long time and it’s making her think she’s seeing bugs and parasites and she’s not seeing anything at all she’s not telling her doctor she has a mental illness and not making an appointment to see a therapist.

My mom has a mental illness believe she seeing bugs and parasites she is not her mental illness is affecting her brain.

My mother-in-law is experiencing paranoia, hallucinations and dementia like symptoms. She is 97 and refusing all outside help. She is a prisoner in her own mind. We don’t even know where to begin to help her and literally non of us r getting much sleep as a result of her confusion. It’s hard to watch and not know what to do to help. Any suggestions would be appreciated.

Thank you for reading our guest blog post, as this takes a lot of courage! I will contact you directly with some resources, please check your email.

I need assusrant to my mom who is 76yrs old. Is on amitrepline 25mg snce 1990 . Recently she is talking too much and hardly skeeping.

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Mental Health

Caring for Elderly Parents Suffering from Issues With Mental Health

Caring For Seniors With Mental Health Problems

As our parents age , it’s natural for us to worry about their health and well-being. And for those of us with parents who are suffering from mental health issues, that worry can become all-consuming. Whether it’s depression , anxiety , dementia, or other conditions, caring for elderly parents with mental health issues can be challenging, emotionally draining, and often overwhelming.

But it’s important to remember that you’re not alone in this. Many families are facing similar challenges, and there are resources and support available to help you navigate this difficult journey.

In this article, we’ll explore some of the key issues involved in caring for elderly parents with mental health issues and strategies for providing the best possible care and support. We hope that by sharing our insights and experiences, we can help make this journey a little easier for you and your family.

Growing Concern Of Mental Health Issues Among Elderly Parents

Mental health issues among elderly parents can have a profound impact on their children. As parents age, their children often become their primary caregivers, and the responsibilities of caring for an elderly parent can be challenging, especially when dealing with mental health issues. Children of elderly parents with mental health conditions may experience a range of emotions, such as guilt, anger, and sadness, as they navigate the complexities of caregiving.

They may also feel isolated and unsupported, especially if they do not have access to resources or support groups for caregivers. Additionally, children may feel like they are losing their parents, as the mental health condition can alter their loved one’s behavior and personality.

It is crucial to acknowledge and address the mental health concerns of elderly parents from the perspective of their children, and to provide the necessary support to ensure that both the elderly parent and their children receive the care they need.

Understanding Parents with Mental Illness

Knowing your feelings and emotions as a caregiver is an important first step in giving your loved ones high-quality care. It is also important to know how to take care of them and what tools or services are available.

Three useful launching points and recommendations for dealing with a mentally ill parent are given below:

Having a Talk With Your Parent

When you see symptoms of a mental illness in your parents, you should first talk to them.

Talking about mental illness may be a sensitive topic; thus, it is important to attempt to:

Keep your speech and tone calm.
Ask them about their health rather than pointing out what is wrong.
Choose a moment when everyone is calm.
Anticipate opposition and don’t take personal insults
Remain forgiving and patient
Anticipate opposition and do not take personal insults

Make Contact With a Medical Expert

While caring for an older parent with a mental illness, speaking with a medical expert might be useful. A doctor, psychologist, therapist, or a mix of these specialists might be among them. If you need help getting an older parent assessed, they can assist you.

Doctor of medicine

A doctor of medicine can explain how your parent’s physical body is acting. They can aid in recommending drugs or fostering an active lifestyle.

Psychologist

A psychologist can give your parents in-depth knowledge about the brain and behavioral changes. You can better understand what to anticipate from your parents mentally if you use psychology in senior care.

Consulting with a qualified therapist may benefit your parents or you. These can aid in understanding and stress management for caregivers . A therapist can help your parents adjust to these changes as well.

You and your parents can learn more about your parent’s condition and the care they require from any of these professionals. Another great option for having your parents hear about their illness from a trusted third party is connecting with a medical practitioner.

Residential Care

Older adults with mental illness might benefit greatly from in-home care services. These organizations provide temporary respite care options for family caregivers and reliable long-term care if your parents require round-the-clock assistance.

You might require a break from full-time caring if you are a family caregiver. You will get a few hours to concentrate on yourself and your tasks if you hire a respite caregiver . With respite care, carers will come to your house or your parent’s home to offer companionship or direct care.

Strategies For Providing Care And Support For Elderly Parents With Mental Health Issues

Providing care and support for elderly parents with mental health issues can be a challenging and complex task, but there are strategies that can help you provide effective care and support. Here are some tips to help you provide physical and emotional care to your elderly parents:

Managing medication: Elderly parents with mental health issues may require medication to manage their symptoms. It is important to ensure that medications are taken as prescribed and that any side effects are monitored. You can help your elderly parent by setting up a medication schedule and providing reminders if necessary.
Reducing stress: Stress can exacerbate symptoms of mental health conditions in elderly parents. Try to create a calm and supportive environment for your elderly parents, and help them avoid stressful situations whenever possible.
Promoting mental well-being: Encourage your elderly parent to engage in activities that promote mental well-being, such as socializing with friends, exercise, and hobbies they enjoy. These activities can help reduce symptoms of depression and anxiety.

In addition to providing physical care, it is also important to communicate effectively with elderly parents with mental health issues. Here are some tips to help you communicate effectively:

Dealing with difficult behavior: Elderly parents with mental health issues may display difficult behavior such as aggression or agitation. It is important to remain calm and patient when dealing with difficult behavior, and to try to understand the underlying causes of the behavior.
Setting boundaries: Setting clear boundaries can help you avoid conflicts with your elderly parents. Make sure that you communicate your expectations clearly and calmly, and try to find a compromise that works for both you and your elderly parent.

By following these strategies for providing care and support, you can help your elderly parent manage their mental health condition and maintain their overall well-being. Remember to seek professional help if you need additional support or guidance in caring for your elderly parent.

Resources And Support For Caregivers Of Elderly Parents With Mental Health Issues

Caring for an elderly parent with mental health issues can be a difficult and overwhelming task, but there are many resources and support available to help caregivers. Here are some of the resources and support options that you can consider:

Counseling services: Counseling services can be a valuable resource for caregivers who may be experiencing stress, anxiety, or depression as a result of their caregiving responsibilities. These services can provide emotional support and guidance to help caregivers cope with the challenges of caregiving.
Support groups: Support groups can be a helpful resource for caregivers to connect with others who are going through similar experiences. These groups can provide a safe space for caregivers to share their feelings, experiences, and challenges, and to receive support and encouragement from others.
Respite care: Respite care provides temporary relief for caregivers by allowing them to take a break from their caregiving responsibilities. Respite care can be provided in the home, in a facility, or through a caregiver agency.

To access these resources and support options, caregivers can speak with their doctor or mental health provider, search online for local resources, or contact organizations such as the National Alliance on Mental Illness (NAMI) or the Alzheimer’s Association . It is important to do your research and find the resources and support options that work best for you and your elderly parents.

In addition to accessing these resources, it is important to make the most of them by staying engaged and involved. Attend support group meetings regularly, take advantage of respite care opportunities, and actively participate in counseling sessions. By making use of these resources and support options , caregivers can reduce their stress and improve their overall well-being.

Since they consider their mental changes a normal part of aging or in part because they are ashamed of their illness, most older persons do not seek therapy or aid. While some degree of forgetfulness in the elderly is common, it is crucial to receive expert assistance if there are clear behavioral or emotional abnormalities.

Many older persons suffer from one or more mental health conditions, such as bipolar disorder, dementia, anxiety, and depression. This might jeopardize their lives, along with the age-related normal physical and cognitive decline.

APA guidelines for psychological practice with older adults

therapist and older adult man during session

Approved by APA Council of Representatives February 2024

These guidelines help psychologists in evaluating their readiness for working with older adults, as well as seeking and using appropriate education and training in this area of practice.

Read the complete guidelines (PDF, 682KB) for more details, including the rationale behind each guideline and notes on application.

Introduction

Although “older adults” typically refers to persons 60–65 years of age and older, gerontological researchers and policy makers increasingly recognize that this demarcation is socially constructed, and is linked to many sociocultural referents, including family status, lived experience, and health conditions that vary widely across generational cohorts and socioeconomic and cultural groups. These guidelines draw on research which flexibly employs various age cutoffs consistent with this nuanced approach. We use “older adults” in this document since it is commonly used by geropsychologists and is the recommended term in APA publications and inclusive language guide .

The specific goals of these professional practice guidelines are to provide practitioners with a frame of reference for engaging in professional work with older adults and basic information and further references in the areas of attitudes, general aspects of aging and broad impacts of intersectionality, clinical issues, assessment, intervention, consultation, professional issues, and continuing education and training relevant to practice.

The term “guidelines” refers to pronouncements, statements, or declarations that suggest or recommend specific professional competencies, behavior, endeavors, or conduct for psychologists. Guidelines differ from standards in that standards are mandatory and may be accompanied by an enforcement mechanism. Thus, guidelines are aspirational and are intended to facilitate the continued systematic development of the profession and to help ensure a high level of professional practice by psychologists.

The guidelines should not be construed as definitive and are not intended to take precedence over the professional judgment of psychologists. Guidelines essentially involve recommendations regarding professional conduct and issues to be considered in particular areas of psychological practice.

Psychological science and practice in the area of geropsychology have evolved rapidly. Clinicians and researchers have made impressive strides toward identifying the unique aspects of knowledge that facilitate the accurate psychological assessment and effective treatment of older adults as the psychological literature in this area continues to burgeon.

Psychologists provide care to older adults in a wide range of settings from home and community-based clinics, to telehealth, integrated primary care, and long-term care settings. Nonetheless, older adults with mental disorders are less likely than younger and middle-aged adults to receive mental health services and, when they do, are less likely to receive care from a mental health specialist than younger persons.

The demand for psychologists with a substantial understanding of later life wellness, cultural, and clinical issues will expand as the older population grows and becomes more diverse, and as cohorts of younger individuals who are receptive to psychological services move into old age.

Compatibility

These guidelines build upon APA’s Ethics Code and are consistent with the Criteria for Practice Guideline Development and Evaluation and preexisting APA policy related to aging issues.

The guidelines are also consistent with the efforts that psychology has exerted over the past two decades to focus greater attention on the strengths and needs of older adults, and to develop workforce competency in working with older adults.

Development process

In 2021, the APA Policy and Planning Board, in accordance with Association Rule 30-8.4, provided notice that on December 31, 2023, the APA Guidelines for Psychological Practice with Older Adults would expire. The Board of Professional Affairs and the Committee on Professional Practice and Standards then conducted a review and recommended that the guidelines should not sunset, and that revision was appropriate.

Members of the Guidelines for Psychological Practice with Older Adults Revision Working Group considered the recent relevant background literature as well as the references contained in the initial guidelines for inclusion in the revision of the guidelines. They participated in formulating and/or reviewing all portions of the guidelines document and made suggestions about the inclusion of specific content and literature citations.

Reorganization of the guidelines was based upon consensus of workgroup members and informed by subject matter experts.

Guideline 1 Psychologists are encouraged to work with older adults within their scope of competence.

Guideline 2 Psychologists are encouraged to recognize ways in which their attitudes and beliefs about aging and about older adults may be relevant to their assessment and treatment of older adults, and to seek consultation or further education about these issues when indicated.

Guideline 3 Psychologists are encouraged to increase their knowledge, understanding, and skills with respect to working with older adults through training, supervision, consultation, and continuing education, and to apply their expertise in advocacy to support the psychological well-being of older adults.

General knowledge about adult development, aging, and the older adult population

Guideline 4 Psychologists strive to gain knowledge about theory and research in aging.

Guideline 5 Psychologists strive to be aware of the social and psychological dynamics of the aging process.

Guideline 6 Psychologists strive to understand diversity in the aging process, particularly how sociocultural factors such as sex, gender identity, race, ethnicity, socioeconomic status, immigration status, sexual orientation, disability status, religion, spirituality, employment status, and urban/rural residence may influence the experience and expression of health and of psychological problems in later life.

Guideline 7 Psychologists strive to be familiar with current information about biological and health-related aspects of aging.

Foundations of geropsychology practice

Guideline 8 Psychologists strive to be knowledgeable about psychopathology within the aging population and cognizant of the prevalence and nature of that psychopathology when providing services to older adults.

Guideline 9 Psychologists strive to be familiar with current knowledge about normal and disease-mediated cognitive changes in older adults.

Guideline 10 Psychologists strive to understand and address issues pertaining to the provision of services in the specific settings in which older adults are typically located or encountered.

Guideline 11 Psychologists strive to be familiar with the application of telehealth practices and policies in assessing and treating older adults across settings and living situations.

Guideline 12 In working with older adults, psychologists are encouraged to understand the importance of interfacing with other disciplines, and to make referrals to other disciplines and/or to work with them in collaborative teams and across a range of sites, as appropriate.

Guideline 13 Psychologists strive to understand the special ethical and/or legal issues entailed in providing services to older adults.

Guideline 14 Psychologists strive to be knowledgeable about public policy, state and federal laws, and regulations related to the provision of and reimbursement for psychological services to older adults and the business of practice.

Guideline 15 Psychologists strive to understand the functional capacity of older adults in their own social and physical environment.

Guideline 16 Psychologists strive to be familiar with the theory, research, and practice of various methods of assessment with older adults, and knowledgeable of assessment instruments that are culturally and psychometrically suitable for use with them.

Guideline 17 Psychologists strive to develop skill at conducting and interpreting cognitive and functional ability evaluations with older adults.

Intervention

Guideline 18 Psychologists strive to be familiar with the theory, research, and practice of various methods of intervention with older adults, particularly with current research evidence about their efficacy with this age group.

Guideline 19 Psychologists strive to develop skills in adapting psychotherapeutic interventions, including environmental modification, in a manner sensitive to cultural and other individual differences among older adults.

Consultation

Guideline 20 Psychologists strive to recognize and address issues related to the provision of prevention and health promotion services for older adults.

Guideline 21 Psychologists strive to understand issues pertaining to the provision of consultation services in assisting older adults.

Contact APA Practice Directorate

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Dealing With Aging Parents’ Depression: How To Help An Elderly Parent

Depression is not a normal part of aging. However, older adults are at increased risk for depression. There are many reasons for this. As people age, they often face losses – such as the death of spouses, friends, and pets.

They may also retire from jobs or suffer from medical conditions and/or un-diagnosed mental health problems.

All of these can affect one’s quality of life and lead to feelings of sadness, loneliness, and worthlessness.

Your elderly parents may become more depressed because they’re worried about their children and grandchildren. They may also be concerned about money and their ability to live independently.

Being a caregiver for someone with depression requires knowing how to provide both emotional and physical support. And if you’re new to the role, it can be overwhelming to know where to begin. parade.com

There are so many different factors that can contribute to someone’s depression.

If you have never been through it yourself, it’s difficult to comprehend. I never understood my husband’s depression fully until after he died which plunged me into a very deep depression. It truly does feel like a very dark, deep hole that you can never get out of.

Many adult children find themselves in the position of caring for their aging parents. This can be a difficult and emotional task, especially if one or both parents are dealing with depression. While it can be difficult to understand what your parent is going through, it is important to be sympathetic and supportive.

In this article we’ll talk a bit about some things that you can do to help your aging parent if they are suffering from depression.

Is It Depression Or Just Sadness?

I know quite a bit about depression, more than I ever wanted to know. My late husband suffered with it for many decades. Depression affects not only the person, but the entire family.

I also know that real depression is far different from just being “sad”. It’s a chemical imbalance in the brain that causes a person to lose interest in life, feel hopeless, and sometimes have thoughts of suicide.

Depression and sadness are linked but are not the same. Sadness is an emotion that everyone experiences, often after stressful or upsetting life events. Depression is an overpowering and ongoing mental health disorder that can drastically impact on daily living. medicalnewstoday.com

Depression is debilitating. It can make it hard to get out of bed, let alone take care of yourself or others. And, as we age, our risk for depression increases.

Regardless of what may be causing this serious illness, it’s important to recognize the signs and get help if necessary. There’s no single answer when it comes to the best way to deal with aging parents’ depression. But there are some general tips that can help.

If you suspect that your aging parent is suffering from depression, the first step is to get to a psychiatrist or health care provider like their doctor. Of course, let them know that you’re concerned and offer your support.

It seems to make sense that older people could easily become depressed. After all, they are getting older and most likely are starting to experience some medical problems. They may be less active than they used to be and their social circles may have shrunken.

It’s natural for anyone with these issues to feel overwhelmed and down. But for some people, these feelings don’t go away. They may be dealing with a common problem known as clinical depression.

Clinical depression is more than just feeling down or going through a tough time. It’s a serious illness that requires treatment.

What Is The Most Common Cause Of Depression In Older Adults?

There are many possible causes of depression in older adults, but the most common is loss. The death of a spouse, family, friends and even pets can be a very difficult event to deal with, and it can often lead to feelings of loneliness, sadness, and isolation.

My sweet mom-in-law is now 100 years old and she told me just the other day that the hardest part about growing older is losing loved ones.

Other common causes of depression in older adults include retirement, chronic illness, and financial problems.

If you are worried about an aging parent’s depression, it is important to talk to them about their symptoms and help them get the treatment they need.

What Are The Warning Signs Of Depression In Older Adults?

There are a number of warning signs that can indicate that an older adult is depressed. These include changes in sleeping patterns, eating habits, energy levels, and mood.

Studies by the Centers for Disease Control and Prevention (CDC)Trusted Source estimate that 7 million American adults over the age of 65 experience depression each year. The CDC also reports that adults over the age of 65 made up 16 percent of all suicide deaths in 2004. Healthline.com

Older adults who are depressed may also withdraw from social activities, have difficulty concentrating, and experience feelings of hopelessness.

Signs Of Depression In Elderly Adults

One of the most difficult things about dealing with aging parents is their depression. It can be hard to see them shutting down and giving up on life, especially when they’ve been such active, vibrant people in the past.

But depression is a real illness, and it’s important to understand that your parents are going through a tough time.

Depression is a thief. It steals your days, your sleep, your laughter, your memories, and your hope. Shane Koyczan

As our parents age, they may start to experience more health problems and emotional issues.

As a child or adult child of an aging parent, it’s important to be aware of the signs and symptoms of depression, as well as how you can help your parent if they are dealing with this condition.

Common Signs Of Depression

Persistent feelings of sadness, emptiness, or hopelessness
Loss of interest in activities that used to bring enjoyment
Withdrawal from friends and family
Changes in sleep patterns, such as difficulty falling asleep or staying asleep, or sleeping more than usual
They may have a change in appetite and either lose or gain weight.
Loss of energy or increased fatigue
Increased restlessness or irritability
Their mood may be off – they may seem more weepy or irritable than before.
Difficulty concentrating, remembering, or making decisions
Feelings of worthlessness or guilt
Thoughts of death or suicide

If you notice any of these signs or symptoms in your aging parent, it ‘s important to talk to them about it. Depression is a serious condition, but it’s also treatable. There are many options available, including therapy, medication, and support groups.

From 1980 to 1992, the suicide rate among persons age 65 and older increased nine percent, and most striking was a 35 percent rise in rates of suicide for men and women age 80 to 84. The suicide rate among males 85 years and older is six times the rate of the general population. National Alliance of Mental Illness

It’s clear to see that this age group is in need of intervention when it comes to depression.

Don’t hesitate to reach out for help if you’re worried about your aging parent’s mental health. You can contact the National Institute on Aging’s Eldercare Locator to find resources in your area.

You can also call the National Suicide Prevention Lifeline at 1-800-273-8255 if you or your parent are in crisis.

Who Is At Risk Of Depression?

There are many different risk factors for depression, and these can vary depending on a person’s age. For older adults, common risk factors include:

Having another medical condition (such as heart disease, cancer, or stroke)
Taking medication for another medical condition (such as high blood pressure or chronic pain)
Losing a loved one
Losing a pet
Losing the ability to perform daily activities
Having a chronic health condition that limits activity
Feeling isolated or lonely
Retiring from a job or no longer having a purpose in life
Having a history of depression

Any of these factors can contribute to a person’s risk of developing depression. And, as people age, they may be more likely to experience several of these risk factors at the same time.

The National Institute of Mental Health considers depression in people 65 and older to be a major public health problem. webmd.com

The good news is that depression is treatable. With treatment, most people with depression can improve their symptoms and live a full and happy life.

22 Tips For Taking Care Of A Depressed Elderly Parent

When it comes to providing help to someone who is depressed, it’s difficult for family caregivers to know what the best thing could be to do. Believe me, I know! Not only did I care for my husband through his depression, I myself became extremely depressed after he passed away.

Even some mental health professionals struggle with finding the right type of medical and therapy for these types of mental health conditions.

The important thing to remember when caring for a depressed parent is to not get too discouraged.

Here are some tips for dealing with your aging parents’ depression:

Understand the symptoms of depression.
Depression can manifest itself in a number of different ways, so it’s important to be aware of the signs and symptoms. We mentioned those above.
Be patient and acknowledge that their depression is real.
Be understanding if they don’t want to talk about their depression. It can be a difficult topic to discuss, and some people may feel embarrassed or ashamed to open up about it. Just let them know that you’re there for them if they need to talk.
Don’t try to fix their problems or tell them what to do – just listen.
Encourage them to see their doctor or a mental health professional.
Help them stick to their treatment plan, whether it includes medication, therapy, or both.
Help them to participate in physical activity and to stay active and connected to others, even if it’s just joining a senior center or taking walks together.
Make sure they’re eating healthy meals and getting enough sleep.
Be there for them when they need to talk, but respect their privacy when they want to be alone.
Keep an eye out for warning signs of suicide, such as talking about wanting to die or expressing feelings of hopelessness or spending a lot more time alone.
Be patient with them and understand that their depression may not go away overnight. It takes time to recover from depression, just like it does from any other illness.
Seek professional help if you’re struggling to cope with your own feelings or if you’re worried about your parent’s safety. Depression is a serious illness, and it’s important to get help if you’re feeling overwhelmed.
Help them find a support group or therapist to talk to. Sometimes it can be helpful to talk to someone who understands what they’re going through. You may even want to do a few therapy sessions yourself.
Encourage them to see their doctor regularly for checkups. Regular medical care can help identify any physical causes of depression and make sure they are getting the best possible treatment.
Make sure they are taking any medications prescribed by their doctor. Depression often requires medication to manage effectively.
Remind them that they are not alone and that you’re there for them. Let them know that you love them and support them through this difficult time.
Help them find an activity or hobby that brings them joy. Doing things that make us happy can help us to recover from depression. Maybe your parent used to enjoy painting but hasn’t picked up a brush in years. Encourage them to start again and offer to do it with them.
Depending on the severity of your parent’s depression, they may need help with day-to-day tasks. Offer to do things like run errands, cook meals, or help with housework. This can take some of the burden off of your parent and allow them to focus on getting better.
Encourage them to get outside and get some fresh air, even if it’s just for a short walk around the block. Getting some exercise and vitamin D from the sun can help improve mood.
Remind them that these feelings are temporary. That with help (medical and/or counseling) it will subside and get better.
Finally, don’t forget to take care of yourself. It can be emotionally draining to deal with a parent’s depression, so make sure you have a support system in place for yourself too. Talk to friends or family members about what you’re going through, and consider seeking professional help if you’re struggling to cope.

Good care for a depressed elderly parent means being understanding and patient. It’s important to be there for them, to listen to them, and to help them find ways to cope with their depression. There is no one-size-fits-all solution, but with love and support, your parent can get the treatment they need and start feeling better.

Depression is a real and serious problem that can affect anyone at any age. But it’s especially difficult to deal with when it’s your own parent who is affected.

Remember, they may not be ready to talk about it, so don’t force the issue. Just let them know that you are there for them if they need to talk.

Younger people may not have as much experience dealing with depression, so it can be difficult to know how to help a parent who is affected by this condition. It’s important to be patient and understanding, and to provide support however you can.

Seek professional help if you feel like you’re struggling to cope, and remember that you are absolutely not alone.

About the Author: Esther C. Kane, CAPS, C.D.S.

Esther C. Kane, CAPS, C.D.S. is a retired occupational therapist, a CAPS certified specialist. a certified Senior Home Safety Specialist and a CARES® Dementia Specialist (C.D.S.). She graduated from Florida International University and practiced OT in Florida, Georgia and North Carolina for 10 years. She specialized in working with neurological impairments in the senior adult population. Her expertise in home assessments and home safety issues for seniors will help you to make the best possible decisions for yourself or your elderly parent.

View all post by Esther C. Kane, CAPS, C.D.S. | Website

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Diseases & Conditions
Depression (major depressive disorder)
What is depression? A Mayo Clinic expert explains.

Learn more about depression from Craig Sawchuk, Ph.D., L.P., clinical psychologist at Mayo Clinic.

Hi, I'm Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I'm here to talk with you about depression. Whether you're looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.

Depression is a mood disorder that causes feelings of sadness that won't go away. Unfortunately, there's a lot of stigma around depression. Depression isn't a weakness or a character flaw. It's not about being in a bad mood, and people who experience depression can't just snap out of it. Depression is a common, serious, and treatable condition. If you're experiencing depression, you're not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It's really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That's why it's important to get an accurate diagnosis.

While there's no single cause of depression, most experts believe there's a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.

The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.

To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.

Help is available. You don't have to deal with depression by yourself. Take the next step and reach out. If you're hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn't easy and you're not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Depression care at Mayo Clinic

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Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, tearfulness, emptiness or hopelessness
Angry outbursts, irritability or frustration, even over small matters
Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
Sleep disturbances, including insomnia or sleeping too much
Tiredness and lack of energy, so even small tasks take extra effort
Reduced appetite and weight loss or increased cravings for food and weight gain
Anxiety, agitation or restlessness
Slowed thinking, speaking or body movements
Feelings of worthlessness or guilt, fixating on past failures or self-blame
Trouble thinking, concentrating, making decisions and remembering things
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

Memory difficulties or personality changes
Physical aches or pain
Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
Often wanting to stay at home, rather than going out to socialize or doing new things
Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

Call your doctor or mental health professional.
Contact a suicide hotline.
In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.
U.S. veterans or service members who are in crisis can call 988 and then press “1” for the Veterans Crisis Line . Or text 838255. Or chat online .
The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
Reach out to a close friend or loved one.
Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

More Information

Depression (major depressive disorder) care at Mayo Clinic

Male depression: Understanding the issues
Nervous breakdown: What does it mean?
Pain and depression: Is there a link?

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It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.
Marijuana and depression
Vitamin B-12 and depression

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation
History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
Abuse of alcohol or recreational drugs
Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

Excess weight or obesity, which can lead to heart disease and diabetes
Pain or physical illness
Alcohol or drug misuse
Anxiety, panic disorder or social phobia
Family conflicts, relationship difficulties, and work or school problems
Social isolation
Suicidal feelings, suicide attempts or suicide
Self-mutilation, such as cutting
Premature death from medical conditions
Depression and anxiety: Can I have both?

There's no sure way to prevent depression. However, these strategies may help.

Take steps to control stress, to increase your resilience and boost your self-esteem.
Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
Get treatment at the earliest sign of a problem to help prevent depression from worsening.
Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.
Brown AY. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Nov. 17, 2016.
Research report: Psychiatry and psychology, 2016-2017. Mayo Clinic. http://www.mayo.edu/research/departments-divisions/department-psychiatry-psychology/overview?_ga=1.199925222.939187614.1464371889. Accessed Jan. 23, 2017.
Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Jan. 23, 2017.
Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed Jan. 23, 2017.
Depression. National Alliance on Mental Illness. http://www.nami.org/Learn-More/Mental-Health-Conditions/Depression/Overview. Accessed Jan. 23, 2017.
Depression: What you need to know. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml. Accessed Jan. 23, 2017.
What is depression? American Psychiatric Association. https://www.psychiatry.org/patients-families/depression/what-is-depression. Accessed Jan. 23, 2017.
Depression. NIH Senior Health. https://nihseniorhealth.gov/depression/aboutdepression/01.html. Accessed Jan. 23, 2017.
Children’s mental health: Anxiety and depression. Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/depression.html#depression. Accessed. Jan. 23, 2017.
Depression and complementary health approaches: What the science says. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/providers/digest/depression-science. Accessed Jan. 23, 2017.
Depression. Natural Medicines. https://naturalmedicines.therapeuticresearch.com/databases/medical-conditions/d/depression.aspx. Accessed Jan. 23, 2017.
Natural medicines in the clinical management of depression. Natural Medicines. http://naturaldatabase.therapeuticresearch.com/ce/CECourse.aspx?cs=naturalstandard&s=ND&pm=5&pc=15-111. Accessed Jan. 23, 2017.
The road to resilience. American Psychological Association. http://www.apa.org/helpcenter/road-resilience.aspx. Accessed Jan. 23, 2017.
Simon G, et al. Unipolar depression in adults: Choosing initial treatment. http://www.uptodate.com/home. Accessed Jan. 23, 2017.
Stewart D, et al. Risks of antidepressants during pregnancy: Selective serotonin reuptake inhibitors (SSRIs). http://www.uptodate.com/home. Accessed Jan. 23, 2017.
Kimmel MC, et al. Safety of infant exposure to antidepressants and benzodiazepines through breastfeeding. http://www.uptodate.com/home. Accessed Jan. 23, 2017.
Bipolar and related disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Jan. 23, 2017.
Hirsch M, et al. Monoamine oxidase inhibitors (MAOIs) for treating depressed adults. http://www.uptodate.com/home. Accessed Jan. 24, 2017.
Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 31, 2017.
Krieger CA (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 2, 2017.
Antidepressant withdrawal: Is there such a thing?
Antidepressants and alcohol: What's the concern?
Antidepressants and weight gain: What causes it?
Antidepressants: Can they stop working?
Antidepressants: Selecting one that's right for you
Antidepressants: Side effects
Antidepressants: Which cause the fewest sexual side effects?
Atypical antidepressants
Clinical depression: What does that mean?
Depression in women: Understanding the gender gap
Depression, anxiety and exercise
Depression: Supporting a family member or friend
MAOIs and diet: Is it necessary to restrict tyramine?
Monoamine oxidase inhibitors (MAOIs)
Natural remedies for depression: Are they effective?
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Treatment-resistant depression
Tricyclic antidepressants and tetracyclic antidepressants

Associated Procedures

Complete blood count (CBC)
Electroconvulsive therapy (ECT)
Psychotherapy
Transcranial magnetic stimulation
Vagus nerve stimulation

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In families affected by individuals with serious mental illness (SMI), caregiving often falls primarily to the parents. As the individual with SMI ages, so do his or her parents. Although accustomed to the challenges of caring for a child with SMI, aging parents face additional difficulties, especially if they have not had social work interventions.

“Aging parents are a hidden population in the mental health arena. They are unpaid and uncelebrated,” says Allan V. Kaufman, PhD, MSW, professor emeritus at the University of Alabama School of Social Work and lead author of a study published last year in the on a home-delivered social work intervention for aging parental caregivers of adult children with schizophrenia. The amount of care provided to adults with SMI by their aging parents is so substantial that if parental caregivers suddenly stopped providing care, public programs could never handle the large population of adults with SMI, he says.

Aging parental caregivers are the backbone of long-term support for adult children with SMI. Kelly Aschbrenner, PhD, a research assistant professor in the departments of psychiatry and community and family medicine at Dartmouth Medical School and an investigator at the Dartmouth Institute’s Center for Aging Research, says, “Aging parents provide years of ongoing support for an adult child with a severe and persistent mental illness, such as schizophrenia, bipolar disorder, and major depression, when debilitating symptoms and illness behaviors produce obstacles to social and occupational functioning and independent living.”

Aschbrenner and colleagues recently authored a study published in on the stress burden vs. personal gain for older parents who care for their adult child with SMI.

One of the biggest problems for aging caregivers is dealing with symptoms associated with discontinuing medications for SMI. “Coming off medications really exacerbates SMI symptoms,” Kaufman says.

In addition to lack of compliance, which is a common issue for adults with SMI, medications may be discontinued due to side effects, forgetting to refill prescriptions, financial hardship, and/or denial of insurance coverage. This increase in symptom severity adds to the high level of stress already experienced by aging caregivers. Additionally, the current economy creates an even greater burden.

Susan Gingerich, MSW, who works in private practice and as a trainer and consultant in suburban Philadelphia, says, “When a person develops SMI, the whole family, including parents, grandparents, siblings, and other relatives who have regular contact with the person, benefits from receiving basic information about the illness and the principles of its treatment, strategies for reducing stress, skills for increasing positive communication, practice in using a step-by-step family problem-solving method, and support for establishing household rules and sharing responsibilities.” These interventions are especially beneficial when the individual with SMI lives with his or her family.

While some older parental caregivers do access support services, many, if not most, deal with care challenges themselves, possibly due to the societal stigma associated with SMI, says Kaufman. New research is focused on better understanding the dynamics of relationships between aging caregivers and their adult children and improving the nature of social work support services for these families.

“Most research to date has focused on care recipients and family counseling rather than caregivers,” Kaufman notes.

While many studies have examined family counseling and interventions, very little is known about what types of interventions might be most effective in assisting aging parental caregivers. Kaufman and colleagues conducted a pilot study of a unique home-based intervention for aging parents and their adult children with schizophrenia. The goal of this new intervention is to increase the emotional well-being and lower the stress burden for aging parents, Kaufman explains.

“We know from other research that parents and family members who are asked to come to a facility for counseling or other social services are not likely to come. The home is a more effective setting for families with adult children with SMI, and the pilot study was designed to see if our intervention could be successfully delivered at home in 10 sessions by an MSW-level social worker,” he explains.

According to Kaufman, this home-based intervention is much different from current and past interventions, which tend to focus on families in general, not on older parents as caregivers, and primarily use psychoeducation. “Our intervention goes far beyond psychoeducation and includes a cognitive therapy component,” he explains.

In the pilot study, families received instruction on problem-solving techniques and education and information about schizophrenia, followed by sessions that included cognitive therapy, stress management, behavioral management, and future planning.

For instance, cognitive therapy delivered by a social worker helped aging parents learn to deal with behavioral management issues and helped the adult child with schizophrenia learn about appropriate roles in the family setting. Behavioral management sessions helped parents in identifying and dealing with problem behaviors, such as substance abuse, hostility, and interpersonal relationship difficulties, and assisted parents in averting potential crises or emergencies involving their adult child. The pilot study yielded positive and promising results, including greater life satisfaction and less emotional stress reported by aging caregivers.

Findings from research by Aschbrenner and colleagues suggest that recovery-oriented approaches that strive to improve self-esteem and self-efficacy for the adult child with SMI may also benefit the aging parental caregiver.

“Since there already exists a plethora of studies documenting the toll of coping with an adult child’s mental illness, we wanted to also examine the potential positive side of caregiving to inform a strengths-based approach to working with older parents of adults with SMI,” Aschbrenner says.

An analysis of the stressors and resources associated with caring for adult children with SMI found that the adult child’s contributions to the household had a significant and positive association with the parent’s experience of personal gains related to caregiving. Participation in support groups and having confidantes were also associated with positive feelings toward caregiving.

“The amount of help a parent provided to the child was related to the amount of assistance the child provided to the parent, indicating a positive, reciprocal relationship,” Aschbrenner says.

Research by Kaufman, Aschbrenner, and others suggests that social work support for aging parental caregivers may need to include interventions and resources that specifically help the adult with SMI assume a more positive role in the family home and help the aging parent recognize successful ways to cope with caregiving challenges.

One challenge aging parental caregivers often do not address is planning for their adult child with SMI’s future care.

“In my work with aging caregivers, I’ve found that most do not think, or want to think, about what happens to their adult child when they die,” says Kaufman.

Because it may be painful for aging parents to think about what will happen to their adult child when the they die, parents often avoid planning for the adult child’s continuing care. The complicated nature of estate planning for an adult child with SMI, which can involve government benefits and financial management, also contributes to avoidance.

“Whether parents and their adult children develop plans for the future has important consequences for the entire family,” Aschbrenner says.

Aging parents often assume siblings or other family members will take on the role of caregiver after their death. According to Kaufman and Aschbrenner, among the most critical issues for parents to consider are residential and financial planning as well as the future involvement of other family members in caregiving. Establishing legal documentation and plans for continuing care can ensure the adult child with SMI is properly cared for and alleviate worries for aging parents later in life when their own health may be declining.

As parents age, they confront the stress of coping with the challenges of having an adult child with SMI while dealing with their own aging-related changes in health, such as physical disability and greater vulnerability to illness.

“Consequently, parents’ ability to provide the support and care needed by an adult child with SMI may become compromised. Making plans for the future is especially crucial when adult children are living with their aging parents,” Aschbrenner emphasizes.

While many parents hope that siblings will care for a brother or sister with mental illness, families may put off discussing the future caregiving involvement of siblings. Early discussions between aging parents and their children without disabilities to clarify what roles siblings will play can help families avoid having to make future caregiving decisions in the midst of a family crisis, when the aging parent is incapacitated or dies, says Aschbrenner.

Parents may need considerable help with learning about available residential and financial planning resources and with involving siblings and other family members in future care, she says. The home-based intervention under investigation by Kaufman and his colleagues includes two sessions with a social worker to help aging parents develop a concrete plan for the continuing care of their adult child after a caregiver’s death.

Data from the pilot study by Kaufman and colleagues will form the basis for an application to the National Institute on Aging for funding of a larger and more rigorous study of the home-based intervention.

In today’s economic climate of uncertainty for funding of social services, family support is essential for adults with SMI. There is a clear need for evidence-based social work interventions to enable aging parents to more effectively handle the variety of emotional, financial, familial, and continuing care challenges they experience every day in caring for an adult child with SMI.

Handling the holiday season can create additional stress for families with adult children with serious mental illness (SMI). Despite the added stress, Susan Gingerich, MSW, cautions against abandoning family get-togethers and holiday celebrations. To manage holiday gatherings, she suggests the following:

• Continue to follow the holiday traditions that are most important to the family, adapting them as needed.

• Involve the person with SMI in the planning of events and allow them to do what they can to assist with meal preparation, decorating, gift wrapping, etc.

• Adjust the location, length of time, and intensity of holiday events to make everyone comfortable. For example, the person with SMI may prefer to attend a few hours of Thanksgiving dinner rather than make a whole day of it.

• Expect that the adult with SMI may need breaks during the holiday event and identify a place where he or she can spend some time alone.

• When travel is involved, prepare the adult with SMI in advance for logistics, such as security rules at the airport or taking rest stops during car trips.

• If some family members have not seen the adult with SMI in a long time, it may be helpful to prepare them in advance about the person’s mental condition.

Social Work Today magazine

How to Sleep Better: Tips to Improve Sleep Quality
Can’t Sleep? Insomnia Causes, Symptoms & What You Can Do About it

Sleep Therapy: Treating Sleep Problems with CBT

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Aging and sleep

How does aging affect sleep, causes of insomnia in the elderly, tips to improve sleep habits as you age, tip 1: improve your sleep environment, tip 3: keep a regular bedtime routine, tip 3: learn the best ways to nap, tip 4: use diet to improve sleep as you age, tip 5: exercise for overcoming sleep problems in older adults, tip 6: reduce mental stress, when to talk to a doctor about sleep problems, sleep aids for the elderly vs. therapy, sleep and aging: sleep tips for older adults.

Are you a senior having trouble sleeping? These tips can help you treat insomnia, overcome age-related sleep problems, and get a good night’s rest.

As we age, we often experience normal changes in our sleeping patterns, such as becoming sleepy earlier, waking up earlier, or not sleeping as deeply. However, disturbed sleep, waking up tired every day, and other symptoms of insomnia are NOT a normal part of aging.

Sleep is just as important to your physical and emotional health as it was when you were younger. A good night’s sleep helps improve concentration and memory formation, allows your body to repair any cell damage that occurred during the day, and refreshes your immune system, which in turn helps to prevent disease.

Older people who don’t sleep well are more likely to suffer from depression, attention and memory problems, excessive daytime sleepiness, and experience more nighttime falls. Insufficient sleep can also lead to serious health problems, including an increased risk of cardiovascular disease, diabetes, weight problems, and breast cancer in women.

To improve your quality of sleep it’s important to understand the underlying causes of your sleep problems. The following tips can help you identify and overcome age-related sleep problems, get a good night’s rest, and improve the quality of your waking life.

How much sleep do older adults need?

While sleep requirements vary from person to person, most healthy adults require seven to nine hours of sleep per night. However, how you feel in the morning is more important than a specific number of hours. Frequently waking up not feeling rested or feeling tired during the day are the best indications that you’re not getting enough sleep.

As you age your body produces lower levels of growth hormone, so you’ll likely experience a decrease in slow wave or deep sleep (an especially refreshing part of the sleep cycle). When this happens you produce less melatonin, meaning you’ll often experience more fragmented sleep and wake up more often during the night. That’s why many of us consider ourselves “light sleepers” as we age. You may also:

Want to go to sleep earlier in the evening and wake up earlier in the morning.
Have to spend longer in bed at night to get the hours of sleep you need, or make up the shortfall by taking a nap during the day.

In most cases, such sleep changes are normal and don’t indicate a sleep problem.

Sleep problems not related to age

At any age, it’s common to experience occasional sleep problems. However, if you experience any of the following symptoms on a regular basis, you may be dealing with a sleep disorder :

Have trouble falling asleep even though you feel tired.
Have trouble getting back to sleep when awakened.
Don’t feel refreshed after a night’s sleep.
Feel irritable or sleepy during the day.
Have difficulty staying awake when sitting still, watching television, or driving.
Have difficulty concentrating during the day.
Rely on sleeping pills or alcohol to fall asleep.
Have trouble controlling your emotions.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

Many cases of insomnia or sleep difficulties are caused by underlying but very treatable causes. By identifying all possible causes, you can tailor treatment accordingly.

Are you under a lot of stress ?
Are you depressed ? Do you feel emotionally flat or hopeless?
Do you struggle with chronic anxiety or worry ?
Have you recently gone through a traumatic experience?
Are you taking any medications that might be affecting your sleep?
Do you have any health problems that may interfere with sleep?

Common causes of insomnia and sleep problems in older adults

Poor sleep habits and sleep environment. These include irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on. Make sure your room is comfortable, dark and quiet, and your bedtime rituals are conducive to sleep.

Pain or medical conditions. Health conditions such as a frequent need to urinate, pain , arthritis, asthma, diabetes, osteoporosis, nighttime heartburn, and Alzheimer’s disease can interfere with sleep. Talk to your doctor to address any medical issues.

Menopause and post menopause. During menopause, many women find that hot flashes and night sweats can interrupt sleep. Even post menopause, sleep problems can continue. Improving your daytime habits, especially diet and exercise, can help.

Medications. Older adults tend to take more medications than younger people, and the combination of drugs, as well as their side effects, can impair sleep. Your doctor may be able to make changes to your medications to improve sleep.

Lack of exercise. If you are too sedentary, you may never feel sleepy or feel sleepy all the time. Regular aerobic exercise during the day can promote good sleep.

Stress. Significant life changes like retirement , the death of a loved one, or moving from a family home can cause stress. Nothing improves your mood better than finding someone you can talk to face-to-face.

Lack of social engagement. Social activities, family, and work can keep your activity level up and prepare your body for a good night’s sleep. If you’re retired, try volunteering , joining a seniors’ group, or taking an adult education class.

Sleep disorders. Restless Legs Syndrome (RLS) and sleep-disordered breathing—such as snoring and sleep apnea —occur more frequently in older adults.

Lack of sunlight. Bright sunlight helps regulate melatonin and your sleep-wake cycles . Try to get at least two hours of sunlight a day. Keep shades open during the day or use a light therapy box.

In many cases, you can improve your sleep by addressing emotional issues, improving your sleep environment, and choosing healthier daytime habits.

Since everyone is different, though, it may take some experimentation to find the specific changes that work best to improve your sleep.

Naturally boost your melatonin levels. Artificial lights at night can suppress your body’s production of melatonin, the hormone that makes you sleepy. Use low-wattage bulbs where safe to do so, and turn off the TV and computer at least one hour before bed.

Don’t read from a backlit device at night (such as an iPad). If like to read from a tablet or other electronic device, switch to an eReader that requires an additional light source.

Make sure your bedroom is quiet, dark, and cool . We often become more sensitive to noise as we age, and light and heat can also cause sleep problems. Using a sound machine, ear plugs, or a sleep mask can help.

Ensure your bed is comfortable . Try out different pillows and toppers, or consider a new mattress that better suits your sleeping position. Using an adjustable base can benefit both your upper and lower body, provide sleep apnea relief, and reduce back pain as you age.

Use your bedroom only for sleep and sex. By not working, watching TV, or using your computer in bed, your brain will associate the bedroom with just sleep and sex.

Move bedroom clocks out of view. The light can disrupt your sleep and anxiously watching the minutes tick by is a surefire recipe for insomnia.

Maintain a consistent sleep schedule. Go to bed and wake up at the same times every day, even on weekends.

Block out snoring. If snoring is keeping you up, try earplugs, a white-noise machine, or separate bedrooms.

Go to bed earlier. Adjust your bedtime to match when you feel like going to bed, even if that’s earlier than it used to be.

Develop soothing bedtime rituals. Taking a bath, playing music, or practicing a relaxation technique such as progressive muscle relaxation, mindfulness meditation, or deep breathing can help you wind down before bed.

Limit sleep aids and sleeping pills. Many sleep aids have side effects and are not meant for long-term use. Sleeping pills don’t address the causes of insomnia and can even make it worse in the long run.

Combine sex and sleep. Sex and physical intimacy, such as hugging, can lead to restful sleep.

If you don’t feel fully alert during the day, a nap may provide the energy you need to perform fully for the rest of the day. Experiment to see if it helps you.

Some tips for napping:

Keep it short. Naps as short as five minutes can improve alertness and certain memory processes. Most people benefit from limiting naps to 15-45 minutes. You may feel groggy and unable to concentrate after a longer nap.
Nap early. Nap early in the afternoon. Napping too late in the day may disrupt your nighttime sleep.
Be comfortable. Try to nap in a comfortable environment preferably with limited light and noise.

As well as eating a sleep-friendly diet during the day, it’s particularly important to watch what you put in your body in the hours before bedtime.

Limit caffeine late in the day. Avoid coffee, tea, soda, and chocolate late in the day.

Avoid alcohol before bedtime. It might seem that alcohol makes you sleepy, but it will actually disrupt your sleep.

Satisfy your hunger prior to bed. Have a light snack such as low-sugar cereal, yogurt, or warm milk.

Cut down on sugary foods. Eating a diet high in sugar and refined carbs such as white bread, white rice, pasta, and French fries can cause wakefulness at night and pull you out of the deep, restorative stages of sleep.

Avoid big meals or spicy foods just before bedtime. Large or spicy meals may lead to indigestion or discomfort. Try to eat a modest-size dinner at least 3 hours before bedtime.

Minimize liquid intake before sleep. Limit what you drink within the hour and a half before bedtime to limit how often you wake up to use the bathroom at night.

Exercise—especially aerobic activity—releases chemicals in your body that promote more restful sleep. Even if you have mobility issues , there are countless activities you can do to prepare yourself for a good night’s sleep. But always consult your doctor before embarking on any new fitness program.

Swimming/water exercises. Swimming laps is a gentle way to build up fitness and is great for sore joints or weak muscles. Many community and YMCA pools have swim programs just for older adults, as well as water-based exercise classes.

Dancing. If you love to move to music, go dancing or take a dance class. Dance classes are also a great way to extend your social network.

Lawn bowling, bocce, or pétanque. These ball games are gentle ways to exercise. The more you walk, and the brisker the pace, the more aerobic benefit you’ll experience.

Golfing. Golf is another exercise that doesn’t require vigorous movement. Walking adds an aerobic bonus and spending time on the course with friends can improve your mood.

Cycling or running. If you are in good shape, you can run and cycle until late in life. Both can be done outdoors or on a stationary bike or treadmill.

Aerobic exercise helps seniors sleep better

A study at Northwestern University found that aerobic exercise resulted in the most dramatic improvement in quality of sleep, including sleep duration, for middle-aged and older adults with a diagnosis of insomnia.

The participants exercised for two 20-minute sessions or one 30-to-40-minute session four times per week.
They worked at 75 percent of their maximum heart rate on at least two activities including walking or using a stationary bicycle or treadmill.
Their sleep quality improved from a diagnosis of poor sleeper to good sleeper.
They reported fewer depressive symptoms, more vitality, and less daytime sleepiness.

Source: National Sleep Foundation

Stress and anxiety built up during the day can also interfere with sleep at night. It’s important to learn how to let go of thoughts and worries when it’s time to sleep.

Keep a journal to record worries before you retire.
On your to-do list, check off tasks completed, list your goals for tomorrow, and then let them go.
Listen to calming music.
Read a book that makes you feel relaxed.
Get a massage from a friend or partner.
Use a relaxation technique to prepare your body for sleep.
Seek opportunities during the day to talk about what’s troubling you with a friend, family member, or therapist .

Getting back to sleep when you wake up at night

As you get older, it’s normal to wake up more often during the night. However, if you’re having trouble falling back asleep , the following tips may help:

Don’t stress. Stressing over the fact that you can’t get back to sleep only encourages your body to stay awake. Try to stay out of your head and focus on the feelings and sensations in your body instead.

Make relaxation your goal, not sleep. Try a relaxation technique such as deep breathing or meditation, without getting out of bed. Although not a replacement for sleep, relaxation can still help rejuvenate your body.

Do a quiet, non-stimulating activity. If you’ve been awake for more than 20 minutes, get out of bed and do a non-stimulating activity, such as reading a book. But keep the lights dim and avoid screens.

Postpone worrying. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when it will be easier to resolve.

If your own attempts to solve your sleep problems are unsuccessful, keep a sleep diary and take it to your doctor. Write down when you use alcohol, caffeine, and nicotine, and keep track of your medications, exercise, lifestyle changes, and recent stresses. Your doctor may then refer you to a sleep specialist or cognitive behavioral therapist for further treatment, especially if insomnia is taking a heavy toll on your mood and health.

There are many different prescription sleeping pills, over-the-counter sleep aids, and herbal sleep supplements that are available for older adults. In many cases they can be effective when used sparingly for short-term situations, such as recovery from a medical procedure or jet lag. However, it’s important to weigh the benefits against the risks that can come with some sleeping pills and sleep aids.

Sleeping pills and sleep aids won’t cure your insomnia. In fact, they can actually make insomnia worse in the long term. To permanently address your sleep issues, you may want to consider cognitive-behavioral therapy (CBT) .

This form of psychotherapy treats sleep problems by addressing the negative thoughts, worries, and behavior that prevent you from sleeping well at night. A study at Harvard Medical School found that CBT was more effective at treating chronic insomnia than prescription sleep medication—but without the risks or side effects. CBT can be conducted individually, in a group, or even online .

More Information

Improving Sleep - A guide to a good night’s rest. (Harvard Medical School Special Health Report)
A Good Night's Sleep - How sleep changes in older adults, common problems, and steps you can take to alleviate sleep problems. (National Institute on Aging)
Cognitive Behavioral Therapy for Insomnia - How CBT works treating insomnia. (National Sleep Foundation)
Insomnia Treatment: Cognitive Behavioral Therapy Instead of Sleeping Pills - Your attitudes about sleep and certain behaviors are often the root cause of insomnia. (The Mayo Clinic)
Diet, Exercise, and Sleep - Describes the interrelationships between sleep, nutrition, and exercise. (National Sleep Foundation)
Stress Less, Sleep More - Tips for reducing stress to promote better sleep, including the use of acupressure. (UCLA)
Sleep-Wake Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link
Allen, R. P., Walters, A. S., Montplaisir, J., Hening, W., Myers, A., Bell, T. J., & Ferini-Strambi, L. (2005). Restless Legs Syndrome Prevalence and Impact: REST General Population Study. Archives of Internal Medicine , 165(11), 1286. Link
CDC – Sleep Hygiene Tips—Sleep and Sleep Disorders . (n.d.). Retrieved May 13, 2022, from Link
Chattu, V., Manzar, Md., Kumary, S., Burman, D., Spence, D., & Pandi-Perumal, S. (2018). The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare , 7(1), 1. Link
Effects of Light on Circadian Rhythms | NIOSH | CDC . (n.d.). Retrieved May 13, 2022, from Link
Growth Hormone in Aging—Endotext—NCBI Bookshelf . (n.d.). Retrieved May 13, 2022, from Link
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., & Adams Hillard, P. J. (2015). National Sleep Foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health , 1(1), 40–43. Link
Jacobs, G. D., Pace-Schott, E. F., Stickgold, R., & Otto, M. W. (2004). Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison. Archives of Internal Medicine , 164(17), 1888. Link
Reid, K. J., Baron, K. G., Lu, B., Naylor, E., Wolfe, L., & Zee, P. C. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Medicine , 11(9), 934–940. Link
Sleep Disorders | MedlinePlus . (n.d.). Retrieved May 13, 2022, from Link
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of Internal Medicine , 163(3), 191–204. Link

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How to Care for Aging Parents With Mental Illness: 13 Tips

Amanda Lambert, MS, CMC, ALCP

Jump ahead to these sections:

1. Your parent is not his or her disorder

2. You need to be your parent’s advocate

3. Understand their treatment options

4. Be there to provide support

5. Ensure treatment compliance

6. Accept instability

7. There may be no ‘recovery’

8. Take care of yourself

9. Pick a good time to talk

10. Use respectful language

11. Have solutions and resources ready

12. Set healthy boundaries

13. Get support through this process

How ill is your parent?

Is your parent compliant with treatment?

Is your parent suicidal?

Be honest about your parents’ struggles

Consider all options

Consider using a senior placement specialist

Caring for Parents with Mental Illness

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