Aging Without Apathy

A man sitting at a table by himself with a bowl of food.

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lex spends most of his time alone. His wife passed away several years ago and he lives alone in a three-story house. Family and friends stopped calling as often. Between his memory loss and trouble finding the right words, he thinks the people in his life must be frustrated. There’s no one to talk to about most things—let alone his mental health. When his children tell him he needs help, he resists. Alex knows he’s depressed, but hates the idea of losing independence and thinks this is just a part of getting older.

“Alex” isn’t an actual person, but that description fits many people, and caregiver Carolyn Callahan of Seniors Helping Seniors sees clients like Alex all the time. Callahan is a retired therapist, but she still experiences sleepless nights worrying about isolated older adults. A Mt. Lebanon-based homecare agency, Seniors Helping Seniors, hires active seniors to help older adults with a variety of services, from cooking to companionship.  Callahan actively listens while her clients “talk about losing their friends and spouses. They talk about what they used to do. They reminisce a lot.”

The National Council on Aging (NCOA) says on average, 7.7 percent of adults over the age of 50 report feeling depressed. About 20 percent of adults over 55 experience a mental health concern, which is comparable to the rates of mental illness across all age groups. It’s possible the figures are underestimated, since NCOA says older adults are more likely to discuss physical ailments than psychological concerns.

The mental health needs of older adults are expected to rise in coming years. In 2020, the worldwide population over 65 was 727 million. By 2050, that number is projected to be 1.5 billion. People are living longer, leading to greater need in all forms of healthcare, including mental health.

Depression in older adults is “eminently treatable,” says Richard Morycz, psychologist at UPMC. He is an expert in geriatric mental health and has lived in Mt. Lebanon for 46 years. “If you treat someone well for depression, it really improves their quality of life and their physical health. So, when people say, ‘Doesn’t everyone become depressed with age?’ the answer is no.”

Mental and physical health are inextricably bound

“A feature of late life is how mental and physical health problems are inextricably bound,”

says Morycz. The Centers for Disease Control and Prevention states 80 percent of older adults have at least one chronic health condition; subsequently, people with a chronic illness or limited functioning are more at risk of becoming depressed.

Taking steps to improve physical health by eating a balanced diet, managing chronic illnesses like diabetes and hypertension, maintaining a regular sleep schedule and exercising are all ways to boost mental health. “There’s this saying—what’s good for the heart in late life is good for the head. And that really does seem to be true,” Morycz said.

Other risk factors for mental health conditions later in life include social isolation, substance abuse, widowhood and cognitive impairment. In personal care homes, these problems are often amplified. Tammy McElhose, licensed practical nurse and executive operations officer of The Pines of Mount Lebanon, says loneliness and under-engagement are huge issues. “People in personal care homes are the forgotten ones. We try to meet residents where they are and listen to them. They see us more than their own families.”

Senior living facilities often schedule daily activities to enable social connection. Live entertainment, bingo, crafts, book clubs, exercise groups, music and field trips are all ways to engage residents. McElhose says “We’re big advocates of getting people out of their rooms. One of our goals for this year is to engage residents’ minds more.”

At Concordia of the South Hills, residents also enjoy spending time with therapy dogs. Maura Linehan, an activities director with a background in psychology, explains, “Some of our residents have to give up their animals when they move here. So they love the therapy dogs.”

Pets can improve mental health, regardless of living situation. Dogs, more so than other pets, help older adults exercise more, but all pets provide companionship and a sense of purpose. Plus, pet owners are more likely to connect with others. A recent study from Harvard University found pet owners were 60 percent more likely than non-pet owners to get to know people in their neighborhoods they hadn’t known before. For people who struggle with social connection, whether it’s because their loved ones have passed away or they just aren’t as active in their community as they once were, pets offer a gateway to new friendships.

A man sitting by a lake with a dog, you can see the reflection of the trees in the lakes water

The loneliness epidemic

Social connection is important, now more than ever. Loneliness is an international epidemic, so much so that in 2018 the United Kingdom created a new government position, Minister for Loneliness, to address the negative societal and health impacts. In Japan, there’s a term for death brought on by loneliness in elderly populations: Kodokushi. And last year, U.S. Surgeon General Vivek H. Murthy declared a national epidemic of loneliness. “It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety and premature death. The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day,” Murthy wrote.

McElhose says older generations “were raised in an era where you didn’t talk about mental illness. But it’s the silent killer. You hear about cancer and diabetes, but not mental illness.”

Part of the reason it may be a “silent killer” for older adults is the lack of treatment. NCOA states that fewer than 50 percent of older adults with a mental illness get treatment. This directly translates to more suicides in older adults. According to the CDC, older men have the highest suicide rate of any age group. To illustrate the disparity, men 85 years and older have a suicide rate of 45.23 per 100,000 people, versus the all-age average of 11.01. Additionally, suicide attempts are more deadly for older adults. Callahan explains, “About one in four seniors that try it will succeed. Seniors plan it out more seriously than younger people, and they have more lethal methods.” NCOA statistics support this statement, adding that the ratio of suicide completions versus attempts for young people is 1 in 200.

Mental health professionals agree that the older population needs more resources and help. Callahan notes that older generations  seem to be more open to discussing mental health in the past few years, which could help increase diagnosis and treatment rates.

Morycz adds,

“There is a lot of ageism, but there’s also a lot of stigma and prejudice against people with mental disorders. You end up with a double whammy.”

Ready for recovery

Healthy lifestyle changes, conveying mental health concerns to a provider and expanding your social network are all steps individuals can take to improve their mental wellbeing. Additionally, “having good psychotherapy and medication together gives you the best chance of getting better quickly and staying better longer,” said Morycz.

However, large-scale changes are needed to address the needs of older adults. Experts believe integrative care vastly improves the health of older adults. Morycz says family members, primary care physicians, psychiatrists and other doctors should coordinate care for each patient when possible. “Family members should become partners in care. It’s really important for me to hear a family member say ‘she’s not like herself anymore,’” said Morycz. Adding mental health therapists to primary care practices would also go a long way to identify and treat mental disorders in older adults, he says.

Integrative care is the core to many healthy aging programs, which improve senior well-being by combining chronic-disease management with mind-body interventions. Such programs could include cognitive behavior therapy, education on positive psychology, acceptance and commitment therapy, problem-solving and other forms of psychotherapy. Healthy aging also means creating environments where older adults can thrive, even if they’re dealing with illness or adversity. It is important to have access to transportation, financial security, housing, social support networks and more. Callahan believes the Allegheny County Department of Human Services needs more robust programs to help seniors with these issues.

Another key to recovery and wellbeing: giving back. As a therapist, Morycz says “a lot of people who are depressed fold into themselves and become apathetic.” To combat indifference, Morycz says older adults should look for ways help others, which he says is a depression-prevention activity.

Callahan would agree. It’s one of the reasons she started volunteering for Seniors Helping Seniors in the first place. “I had free time and saw the need out there. I know I’m giving something, but I also get something back. It makes you feel good that you’re adding some value to another person’s life. I’ll probably always do that, one way or another.”

Morycz offers words of hope: “Older people are people first. They are human beings who have compassion. They can grow, learn and feel life is worthwhile, in spite of having physical or mental health difficulties, in spite of having chronic conditions, and in spite of having pain.”

If you or someone you know is struggling with suicidal thoughts, call 988 to speak with a trained professional at the Suicide & Crisis Lifeline, available 24/7.

This is the final article in a three-part series on mental health in Mt. Lebanon. (See part 1 and part 2). Mental health issues have long been swept under the rug—but that is changing, especially in recent years. This series aims to uncover mental health concerns in our community, shed light on areas for improvement and provide support to those in need.