Older Adults

Background

The older adult population is rapidly increasing worldwide. By 2030, it is expected that one in six U.S. residents will be 60 years and older.1 In that decade, older adults as a population are projected to outnumber children for the first time in U.S. history.2 As of 2023, Texas alone has the third-largest older adult population in the nation at around 4 million people.3 As this population expands, so will their mental health and substance use service needs.

Older adults over the age of 65 often get grouped into one demographic category, but the aging population is not a monolithic group.4 Age ranges, race and ethnicity, gender identity, socioeconomic status, and many more demographic indicators can play into how older adults experience mental health and substance use conditions and access behavioral health care.

Age and Behavioral Health

Like youth and other adults, older adults can also experience mental health and substance use conditions. Older adults face numerous mental and neurological health challenges unique to their life stage and possible health conditions, including depression, late-life anxiety, substance use, bipolar disorder, and dementia.5 The leading mental and neurological health disorders among adults over 60 are dementia and depression, often co-occurring.6 Late-life anxiety is becoming increasingly more widespread, causing feelings of fear and vulnerability among older adults with decreased physical capabilities.7

Indicators of behavioral health needs among older adults are often misunderstood and undertreated. For instance, depression in older adults can be misdiagnosed as dementia due to overlapping symptoms.8 Misconceptions about aging can also lead providers to mistake characteristics of depression and anxiety for normal age-related changes.9 Furthermore, symptoms of dementia are frequently overlooked because cognitive decline is commonly believed to be a natural part of aging despite being a highly debilitating condition.10

Research indicates these are factors that increase the risk of experiencing mental health challenges among older adults:

  • Social isolation and loneliness
  • Elder abuse
  • Cumulative impacts of early life
  • Bereavement
  • Acting as the caretaker for their spouse
  • Living with chronic physical and neurological illnesses, such as heart disease, cancer, or dementia.11

Substance use is a growing mental health challenge among this population. The Substance Abuse and Mental Health Services Administration sponsors the annual National Survey on Drug Use and Health (NSDUH). A report based on 2021-2022 data that focused on substance abuse of older adults aged 60 or older in the U.S. found that:

  • 12.4 percent of older adults had smoked cigarettes in the past month;
  • 12.8 percent of older adults engaged in binge drinking in the past month;
  • 2.3 percent of older adults misused opioids in the past month;
  • 9.9 percent of older adults consumed marijuana in the past year;
  • 9.1 percent of older adults had a substance abuse disorder in the past year; and
  • Among older adults who needed substance abuse treatment in the past year, fewer than 1 in 3 received it.12

Challenges and Policy Improvement Efforts

There are various barriers to accessing services that have historically impacted this population. Older adults who grew up before the 1960s/1970s often face significant stigma around seeking mental health support.13 This can be linked to limited mental health awareness and the less advanced psychological practices that were prevalent in the past.14 Additionally, the geriatric mental health workforce is insufficient in numbers.15 As the population increases, so will this gap between older adults and licensed mental health and substance use professionals.

“While professionals working in the field of aging explain that successful adaptation to an aging society requires adjustments across the full spectrum of our national infrastructure, the public has largely not considered public policy as a solution.”16

In 2005, an executive order established the Texas Health and Human Services Commission’s (HHSC) Aging Texas Well initiative.17 The initiative’s purpose is to help Texans prepare for all aspects of aging at the individual, community, and state level.18 Through this program and others, HHSC oversees the behavioral health services that reach thousands of Texans, including treatment through Local Mental Health Authorities (LMHA), residential treatment centers, state-supported living centers, nursing facilities, etc.19 Furthermore, funding for these services is available through Medicaid and CHIP programs, including 764,080 older adults aged 50 and older who received health services under the Medicaid STAR+PLUS program.20

References

  1. World Health Organization. (2023). Mental health of older adults. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults  ↩︎
  2. Vespa, J. (2019, October). The U.S. Joins Other Countries With Large Aging Populations. The Graying of America: More Older Adults Than Kids by 2035. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html  ↩︎
  3. Administration for Community Living. (2024). (rep.). 2023 Profile of Older Americans. Retrieved from https://acl.gov/sites/default/files/Profile%20of%20OA/ACL_ProfileOlderAmericans2023_508.pdf. ↩︎
  4. Leavelle, J., Morrow-Howell, N., & York, K. (2022). Communication Best Practices: Reframing Aging Initiative Guide to Telling a More Complete Story of Aging. The National Center to Reframe Aging. https://www.reframingaging.org/Portals/0/pdfs/RAI-Communication-Best-Practices-Guide.pdf?ver=da8ZNWVPdW1cXco_VVokfg%3d%3d  ↩︎
  5. Adams, C. S., Merritt , P., & Panjwani, S. (n.d.). (issue brief). Behavioral and Mental Health Needs in Older Adults. Texas Health and Human Services. Retrieved from https://www.hhs.texas.gov/sites/default/files/documents/about-hhs/community-engagement/atw/atw-issue-brief-behavioral-health.pdf ↩︎
  6. Ibid. ↩︎
  7. Ibid. ↩︎
  8. Harvard Health Publishing. (2022). Is it dementia or depression? Harvard Health Medical School. https://www.health.harvard.edu/mind-and-mood/is-it-dementia-or-depression ↩︎
  9. Centers for Disease Control and Prevention. (September 2024). Depression and aging. https://www.cdc.gov/healthy-aging/about/depression-aging.html#print ↩︎
  10. Adams, C. S., Merritt , P., & Panjwani, S. (n.d.). (issue brief). Behavioral and Mental Health Needs in Older Adults. Texas Health and Human Services. Retrieved from https://www.hhs.texas.gov/sites/default/files/documents/about-hhs/community-engagement/atw/atw-issue-brief-behavioral-health.pdf ↩︎
  11. World Health Organization. (2023). Mental health of older adults. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults  ↩︎
  12. Substance Abuse and Mental Health Services Administration. (2024). Behavioral health among older adults: Results from the 2021 and 2022 National Surveys on Drug Use and Health (SAMHSA Publication No. PEP24-07-018). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/older-adult-behavioral-health-report-2021-2022  ↩︎
  13. Sewell, D. D. (n.d.). Older adults are being overlooked when it comes to mental health care. Care for Your Mind. https://careforyourmind.org/older-adults-are-being-overlooked-when-it-comes-to-mental-health-care/  ↩︎
  14. Ibid. ↩︎
  15. Reynolds, C. F., Jeste, D. V., Sachdev, P. S., & Blazer, D. G. (2022). Mental health care for older adults: Recent advances and New Directions in clinical practice and Research. World Psychiatry, 21(3), 336–363. https://doi.org/10.1002/wps.20996  ↩︎
  16. Leavelle, J., Morrow-Howell, N., & York, K. (2022). Communication Best Practices: Reframing Aging Initiative Guide to Telling a More Complete Story of Aging. The National Center to Reframe Aging. https://www.reframingaging.org/Portals/0/pdfs/RAI-Communication-Best-Practices-Guide.pdf?ver=da8ZNWVPdW1cXco_VVokfg%3d%3d ↩︎
  17. Texas Health and Human Services. (n.d.). Aging Texas well. https://www.hhs.texas.gov/about/community-engagement/age-well-live-well/aging-texas-well ↩︎
  18. Ibid. ↩︎
  19. Texas Health and Human Services. (2020). Aging Texas Well: Aging: By the Numbers. https://www.hhs.texas.gov/about/community-engagement/age-well-live-well/aging-texas-well  ↩︎
  20. Ibid. ↩︎

Updated on December 13th, 2024



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