Is old age a mental illness?

Introduction:

The theme of World Mental Health Day in 2013 was older adults, that of 2012 was depression, and 2014’s was schizophrenia. Given that the term ‘mental health’ is commonly (mis)used or (mis)interpreted as referring to mental illness, together with negative connotations associated with health and old age, later life may well seem to be synonymous with mental health problems.

Although defining the parameters of later life can be difficult, we do know that
 the populations of most European countries and North America are ageing… Longevity should be a cause for celebration and the majority of people have mentally healthy later lives… Yet society often appears ambivalent in its views about older people, ignoring, criticising or demeaning them, and for many older people later life can be a time of poor mental health and cognitive decline.

What is ageing?

There are different definitions of age…from ‘chronological’ age (the number of years we have lived since birth), ‘biological’ age (wear and tear on the body occurs at different rates for different people), to ‘psychological’ and ‘social’ age (one is ‘as old as one feels’ or how old society perceives you to be).

…Dynamic theories of ageing recognise that life events, social, economic factors, and the ability of the individual to effect change in themselves have… an effect. A concise summary of definitions of age and theories of ageing is contained in McCulloch (2009).

…The age of 50 is…a rough benchmark for the start of later life, but respecting self-definitions of age is important. People in their 50s may look to retire… if they have children they are usually grown up and events linked with later life are becoming more commonplace. Yet…increasing numbers of people in their 50s also have parents still alive, so one might argue that there are two generations
 of older people….

Despite the changing demographics, later life is often portrayed in negative terms, with a sense of being a ‘burden on society’, something to be feared, and…a combination of problems…

Ageing in the UK:

• A third of the UK population (21 million people) is over the age of 50. Ten million are over 65.
• For the first time in UK history there are more people aged over 60 than under the age of 18.
• The fastest population increase has been in the number of people age 85 and over.
• However, a man born 
in central Glasgow can expect to live almost 14 years less than a man born in Kensington and Chelsea. 
(Age UK, 2014)

Mental health in later life:

Evidence indicates that the majority of older people experience good mental health in later life… Five key factors are particularly important:

• Adequate income
• Being treated with respect
• Reasonably good physical health
• Positive social relationships
• Opportunities for meaningful activity and participation in community (Mental Health Foundation & Age Concern, 2006)

… Older people tend to be reluctant to acknowledge difficulties with mental health (Williamson, 2010)… Furthermore, doctors may be reluctant to diagnose because problems such as depression are viewed as an inevitable part of ageing. As a result, diagnosis rates for dementia are as low as 40% (Alzheimer’s Society, 2014). Most people over the age of 65 have two or more long-term health conditions (Barnett et al, 2012).

Mental health services in later life:

Until recently, older people’s mental health was treated separately from
 adults of ‘working age’ based on the argument that there were differences
 in…mental health problems in later life… Dementia largely…appears in later life, which provided a strong justification. Social care provided… by local authorities for older people was separate… and, for older adults with mental health problems or dementia, it tended to be dominated by traditional services such as residential care.

 

Mental Health Today…and Tomorrow: Exploring current and future trends in mental health care is a forward-thinking, multi-author handbook that marks a turning point in UK mental health theory, policy and practice. The book explores a wide range of current and future trends in mental health care, looking at the whole lifespan from approaches to children and young people and well-being within school settings to mental health in later life and ageing.

Recent blogs by Toby Williamson

• The critical issues affecting deprivation of liberty safeguards (DoLS) - 16 July 2015
• Less Grouchy, More Grim: Suicide Rates are Rising in Middle Aged Men - 12 March 2015
• Life expectancy and loneliness in later life - visually challenged policy making? - 5 March 2014
• Some thoughts on stigma - 6 December 2013
• Debating dementia diagnosis – detecting differences - 22 November 2013