Mentally Healthy Aging A Report on Overcoming Stigma for Older Americans

Research Findings on Older Adults and Mental Health

Demographic trends tell us that the number of older adults with mental illnesses will climb in the next 15 years, but research shows that the stigma of having a mental illness is getting worse, not better. The Indiana Consortium for Mental Health Services Research project (Pescosolido et al., 2000) found that over the past 40 years, Americans have acquired a greater and more sophisticated knowledge of mental illnesses. Americans are able to identify different types of mental illness, and many believe that treatment works. In that time, however, the stigma has intensified in some ways, the researchers found. About three-quarters of Americans do not want to work alongside someone with a mental illness nor do they wish such a person to marry into their family (Pescosolido et al., 2000). More people today believe that someone with a mental illness is dangerous to himself or herself and to others than they did in the 1950s, the research found (Pescosolido et al., 2000).

Manifestations of Stigma and Discrimination

Roundtable participants identified three types of stigma and discrimination:

self-stigma—older adults may be fearful of acknowledging their own mental illnesses;

public stigma—providers, employers, and the general public view older adults with mental illnesses as people who will not get better with treatment, or worse, people who are not worth treating;

institutional stigma—assumptions about older adults with mental illnesses are translated into public policy and funding decisions that stigmatize and discriminate against these individuals.

Barriers to Eliminating Stigma

Next, the participants concluded that the barriers to reducing stigma and deterring discrimination were lack of information, resources, understanding, interest, and knowledgeable and experienced health care professionals. These barriers perpetuate the misconceptions about older adults with mental illnesses and continue the cycle of stigma and discrimination.

Strategies to Overcome the Barriers

Finally, two strategies were selected as most promising to effect change. These strategies are summarized below.

• Empower and educate older adults with mental illnesses. Undertake efforts to reach older adults in our communities who are isolated, who do not know much about aging and mental health, or who may fear identifying themselves as possibly suffering a mental illness. Older adults in general should learn about aging well in terms of their mental health. In addition, an empowerment and education campaign should reach the people who work with older adults, volunteer to help them, or those who provide them physical and mental health care. The roundtable participants decided on the messages that such a campaign should encompass, who should be targeted, the strategies of such a campaign, and the resources for funding it.

• Educate the public on mental health and aging. Deliver positive messages about mental health and aging. Advertising experts should develop these messages for all forms of media—print, radio, and television. The campaign should target older adults, their children, and the general population. Strategies for developing and focusing the message, as well as the resources for creating such a campaign, were identified.

Both roundtables ended on the upbeat note of reaffirming that action must be taken quickly, with many of the stakeholders agreeing to continue to work on these two initiatives in their own communities. Participants also agreed to communicate periodically to determine the next best steps to implementing the plans made at the roundtables to stop stigma against older adults experiencing mental illnesses.

Research Findings on Older Adults and Mental Health

The roundtables reviewed the research findings on older adults and mental health. Many facts were found that must be taken into account when developing action plans for the future of mental health care for older adults (adults age 65 and older). Some of the trends for older adults and mental illnesses are illustrated here.

Mental Illnesses in Older Adults

It is estimated that by 2030, more than 15 million older adults will experience a mental illness. That is nearly double the current number (Jeste et al., 1999). These projections are largely based on the aging of the “baby boomer” cohort and greater longevity.

Prevalence of Mental Disorders at Age 65+

One-quarter of today’s older adults experience some mental disorder, including dementia. About 16 percent have psychiatric disorders, and about 10 percent have dementia. A third of those with dementia exhibit psychosis and/or depression, and they represent about 3 percent of the total elderly population (Jeste et al., 1999).

Depression Is Associated with Worse Health Outcomes

Depression can strike an older adult after he or she has suffered a hip fracture or heart attack or has been diagnosed with cancer; as a result of these co-occurring illnesses, older adults are at increased risk of poor recovery (Mossey et al., 1990; Penninx et al., 2001; Evans et al., 1999). Mortality rates also increase for those with depression and myocardial infarction (Frasure-Smith et al., 1993, 1995) and those with depression who are long-term care residents (Katz et al., 1989; Rovner et al., 1991; Parmelee et al., 1992). In general, older adults with mental illnesses experience high medical comorbidity (Vieweg et al., 1995; Goldman 1999).

Depression in Older Adults and Health Care Costs

Older adults with significant depression have total health care costs that are roughly 50 percent higher than those without depression. They have a higher use of services in all categories of medical care, including inpatient admissions, outpatient visits, laboratory tests, emergency department visits, the number of prescriptions, and ancillary and optometry visits (Unützer et al., 1997).

Suicide in Older Adults

Compared to other age categories, older adults have the highest suicide rate in the country. For women, the suicide rate peaks at midlife, then declines. For men, the suicide rate continuously goes up. One-third of older men saw their primary care physician in the week before completing suicide. Seventy percent saw their physician within the prior month (Hoyert et al., 1999).