Aging and mental health
About 20% of older people have mental health challenges. Challenges in the mental health of the elderly often remain unrecognized by the system, as well as by the elderly themselves and their families, which negatively affects their well-being, health and quality of life. As the global population ages, timely development of responses to the mental health challenges of the elderly is increasingly important.
Namely, with sterilization, people can experience various changes, both biological and social, which have a negative impact on their mental health. Aging often leads to limitations in the participation of older people in social activities and activities that were important to them, as well as to the loss of close people, a reduction in the social network and loneliness. In the same way, elderly people often face a decline in physical abilities, an increase in the degree of dependence on others in performing daily activities, stigmatization and discrimination, all of which can lead to social isolation and exclusion. With aging, chronic diseases appear, which are sometimes accompanied by chronic pain, as well as biological changes that can interfere with a person’s cognitive abilities. Taking large amounts of drugs and higher doses of drugs in the elderly can also cause side effects such as dizziness, loss of appetite, general weakness, lethargy and confusion, which make functioning difficult and can look like mental disorders.
Depression occurs most often in the elderly, which affects 7% of the elderly. About 4% of older people face anxiety disorders, and about 1% deal with substance abuse. Likewise, about 6% of the elderly, or 55 million, live with dementia. Elderly people also have the highest suicide rate compared to other age groups, especially those over 85 years old. However, mental disorders in the elderly are most often not treated, so two thirds of the elderly with mental disorders have no therapy or support.
If we look at the prevalence of depression based on self-assessment scales, research indicates an even greater number of elderly people with depressive symptoms of varying intensity. Thus, the frequency of depressive symptoms in people ranges from 18% in Denmark to 37% in Spain. When we talk about the availability of health care for people with depressive symptoms, research from the UK indicates that as many as 85% of people with depressive symptoms have not had contact with health services.
Challenges in the mental health of the elderly have a negative effect on the elderly themselves, but also on society. In addition to having a negative impact on the quality of life of the elderly, mental disorders also reduce the elderly’s ability to perform daily activities and accelerate the progression of other diseases. In this way, apart from physical health having an impact on mental health, mental disorders also have an additional negative impact on physical health. Therefore, untreated mental disorders in the elderly increase the use of health care system resources, the length of hospitalization of the elderly as well as the recovery period and the costs of treatment and care. For example, an estimate of the costs of dementia carried out in the UK in 2014 indicates that on an annual level dementia costs £32,250 per person, ie £26.3 billion, which is about 0.8% of GDP.
How many elderly people in Serbia have mental health challenges?
By analyzing publications related to the mental health of the elderly in the last ten years, two studies were identified that were conducted on a sufficiently large sample and with an adequate methodology. Data from 2013, obtained through the EHIS (European Health Intervention Survey) on a sample of 3,540 elderly respondents, with the application of the PHQ-8 scale, implemented by the Institute for Public Health, indicates that 34% of the elderly had symptoms of depression, of which a depressive episode was identified in 13%. IDEAS research, based on a sample of 800 elderly respondents, from 2021 indicates that 38% of the elderly have mental health challenges based on the MHI-5 scale. Within the same research, based on the application of the DASS-21 scale, it was identified that depressive symptoms are present in 41% of the elderly, while 50% of the elderly face increased anxiety. Serious and very serious depression was also identified in 13% of the elderly. Although the data are not directly comparable, they indicate a stable estimate of 13% of seniors experiencing depression, as well as a possible increase in depressive symptoms among seniors due to the COVID-19 pandemic. These data indicate a very high exposure of the elderly to depression and anxiety, which makes Serbia one of the nations with the highest assessment of depression among the elderly in Europe.
Although there is no data on access to health care for people with mental health challenges, the available data indicate that the health system is difficult to access for the elderly. While before the COVID-19 pandemic, a total of 19% of the elderly had challenges using health care services, during the pandemic this percentage increased to 33%. The available data also indicate a significant influence of the state of health on the participation of the elderly in the community. Introspection data conducted by UNFPA in Serbia in 2021 indicates that 42% have challenges participating in community life due to challenges in mental and physical health, of which almost a quarter often or all the time (23%).
Directions of developing responses to challenges in the mental health of the elderly
In order to improve the response to the challenges in the mental health of the elderly, it is necessary to first address the challenge of the low rate of identification of mental disorders in the elderly. In this sense, it is necessary to invest efforts in the development of the system of early recognition and diagnosis of mental disorders. This includes both working with the community and families of the elderly, with the aim of reducing stereotypes and improving the recognition of symptoms of mental disorders, since the symptoms of depression are often perceived as a normal course of aging, and with health workers on the development of competencies. Trainings should also be organized for social welfare service providers, as well as all other persons who provide support to the elderly. As the biggest burden of care falls on informal caregivers, it is necessary to establish support mechanisms for informal caregivers. Namely, in as many as 80% of elderly people, the symptoms of depression can be successfully treated. Likewise, it is necessary to work on raising the awareness of the elderly themselves, who often avoid reporting problems, especially if they fear that they will lose their independence because of it. Likewise, it is necessary to work on the development of the prevention of mental disorders and isolation, that is, the creation of conditions for healthy aging.