Helping Older Loved Ones Face Changes in Mental Health

What is mental illness?

Mental illness represents a wide array of conditions that affect a person’s thinking, feelings, or mood. Mental illness may affect one’s ability to think rationally and exercise control, which makes it challenging to care for oneself on a daily basis.

For older adults, mental illness is a conversation made difficult by stereotypes. Assumptions like “Old people are just stubborn” or “He’s become mean as he’s aged” cause many to dismiss mental illness in older adults. For caregivers, messages like these can make it difficult to differentiate mental illness from what are considered “normal parts of aging.” It’s important to recognize that mental illness does not naturally come with aging, and to recognize the signs and symptoms so we know when a loved one needs help coping with their challenges.

How does mental illness present in older adults?

How mental illness presents varies from person to person. However, there are some common symptoms often found in older adults. These include:

• Changes in personal hygiene or standards of living
• Confusion, poor concentration, trouble making decisions
• Changes in appetite or weight
• Feelings of worthlessness, guilt and helplessness
• Short-term memory loss
• Unexplained fatigue, oversleeping or insomnia
• Social withdrawal
• Loss of interest in activities

According to the National Alliance on Mental Illness (NAMI) Mental Health Facts in America report, about 1 in 5 adults experience mental illness in any given year. Two common forms of mental illness older adults face are generalized anxiety disorder and depression.

Generalized anxiety disorder is marked by severe, ongoing anxiety that interferes with daily activities. It can cause older loved ones to feel apprehensive, restless, tense and full of dread, and lead to headaches, fatigue, insomnia, heart palpitations and stomach problems.

Meanwhile, depression is marked by persistent feelings of sadness and loss of interest that can interfere with daily life. Depression can be triggered by stressful life events and change, and may be worsened in older adults by social isolation, the death of peers and loved ones, and experiencing chronic pain.

Both depression and generalized anxiety disorder can mimic symptoms of dementia, so it’s important to consult with a physician to get an accurate diagnosis.

Dos and Don’ts of responding to a loved one’s mental health as a caregiver

Mental illness is a sensitive topic, and we may worry about saying or doing the wrong thing when trying to support a loved one. The trap here is that many avoid having the conversation and stepping in out of fear of making a mistake. As caregivers, we are an important source of support and validation to our loved ones, so it’s important to face these challenges head on and with confidence.

Here are some tips to keep in mind:

• DO be respectful and listen 
• DO offer support and let your loved one know you will be there to help them
• DO recognize fears, anxieties, feelings of despair, and even hallucinations and/or delusions are real to the person, even if you do not understand or relate
• DO establish a trusting relationship so your loved one feels comfortable turning to you in times of need
• DO keep calm—if your loved one sees you are distressed, it may heighten their own distress
• DO sincerely express your own concerns
• DO leave medical and treatment advice to psychological or medical experts

Here are some “don’ts” to avoid:

• DON’T use aggressive body language
• DON’T assume that your loved one has cognitive impairment
• DON’T tell your loved one that their mental health is their fault or imply that it is entirely theirs to control. Even well-intentioned advice like “just think positively” can come across as telling them they aren’t trying hard enough.
• DON’T assume that they are under the influence of alcohol or recreational drugs
• DON’T drastically change how you behave around your loved one because of their mental illness

Mental health resources

In the case of a mental health emergency, don’t hesitate to get your loved one the help they need right away. If the situation is life-threatening, call 911, and if your loved one is suicidal, contact the National Suicide Prevention Lifeline at 1-800-273-8255 to involve the help of trained crisis workers. 

In less severe situations, you can contact the SAMHSA Treatment Referral Helpline at 1-877-726-4727 to discuss available mental health services in your area. If your loved one needs ongoing support, consider looking into mental and behavioral health services that offer counseling and treatment, like Benjamin Rose Institute on Aging’s Behavioral Health Services.