The World Health Organization (WHO) has updated its fact sheet on mental health of older adults today.

Background Information:

The world’s population is ageing rapidly. Between 2015 and 2050, the proportion of the world’s older adults is estimated to almost double from about 12% to 22%. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60.

 

Dementia:

Dementia is a syndrome, usually of a chronic or progressive nature, in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. It mainly affects older people, although it is not a normal part of ageing.

Key Messages:

Over 20% of adults aged 60 and over suffer from a mental or neurological disorder (excluding headache disorders) and 6.6% of all disability (disability adjusted life years-DALYs) among people over 60 years is attributed to mental and neurological disorders.

These disorders in older people account for 17.4% of Years Lived with Disability (YLDs).

Globally, the most common mental and neurological disorders in this age group are

• depression 7%
• dementia 5% 
• Anxiety disorders 3.8%
• substance use problems 1% and
• around a quarter of deaths from self-harm are among people aged 60 or above.

Substance abuse problems among older people are often overlooked or misdiagnosed.

It is estimated that 50 million people worldwide are living with dementia with nearly 60% living in low- and middle-income countries. The total number of people with dementia is projected to increase to 82 million in 2030 and 152 million in 2050.

Unipolar depression occurs in 7% of the general older population and it accounts for 5.7% of YLDs among those over 60 years old. Depression is both underdiagnosed and undertreated in primary care settings.

Older people with depressive symptoms have poorer functioning compared to those with chronic medical conditions such as lung disease, hypertension or diabetes.

Risk factors for mental health among older adults:

Older people may experience stressors that are more common in later life in addition to life stressors common to all people:

• a significant ongoing loss in capacities and
• a decline in functional ability.

For example, older adults may experience

• reduced mobility,
• chronic pain,
• frailty or
• other health problems, for which they require some form of long-term care.

In addition, older people are more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement.

All of these stressors can result in isolation, loneliness or psychological distress in older people, for which they may require long-term care.

Older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome.

Older adults are also vulnerable to

• elder abuse – including physical, verbal, psychological, financial and sexual abuse;
• abandonment;
• neglect; and
• serious losses of dignity and respect.

Current evidence suggests that 1 in 10 older people experience elder abuse. Elder abuse can lead not only to physical injuries, but also to serious, sometimes long-lasting psychological consequences, including depression and anxiety.

Treatment and care strategies:

Health Promotion

Promoting mental health depends largely on strategies to ensure that older people have the necessary resources to meet their needs, such as:

• providing security and freedom;
• adequate housing through supportive housing policy;
• social support for older people and their caregivers;
• health and social programmes targeted at vulnerable groups such as those who live alone and rural populations or who suffer from a chronic or relapsing mental or physical illness;
• programmes to prevent and deal with elder abuse; and
• community development programmes.

Interventions

There is no medication currently available to cure dementia but much can be done to support and improve the lives of people with dementia and their caregivers and families, such as:

• early diagnosis, in order to promote early and optimal management;
• optimizing physical and mental health, functional ability and well-being;
• identifying and treating accompanying physical illness;
• detecting and managing challenging behaviour; and
• providing information and long-term support to carers.

Useful Links:

Link to the updated fact sheet:

http://who.int/mediacentre/factsheets/fs381/en/

Link to WHO publication ‘Dementia: A Public Health Priority’:

http://who.int/mental_health/publications/dementia_report_2012/en/

Link to WHO’s mhGAP page on Dementia:

http://who.int/mental_health/mhgap/evidence/dementia/en/

Link to WHO’s mhGAP Mental Health Gap Action Programme:

http://who.int/mental_health/evidence/mhGAP/en/

Link to WHO’s Handouts on Depression:

http://who.int/campaigns/world-health-day/2017/handouts-depression/en/