Old age: mental health in later life

Older adults have lived through a lot: changes, setbacks, losses and recoveries. That experience can be a real strength. Many people know themselves better, worry less about what others think, and can see the bigger picture.

Thinking back on how you got through hard times before can remind you that you have tools already. Maybe it was faith, friends, humor, work, nature or simply taking one day at a time.

Later life can bring several big changes close together: retiring, moving to a smaller home, losing a partner or friends, new health conditions, giving up driving. Each one can mean a loss of routine, independence or identity.

When changes pile up, it is normal to feel unsettled. It helps to name each change, give yourself time to adjust, and lean on others rather than carrying it all alone.

Some older adults think it is too late to change how they feel, or that therapy is for younger people. That is not true. Most older adults improve with treatment, and help is available.

A primary care provider is a good place to start. They can check your physical health and refer you to a psychologist, clinical social worker or counselor.

Someone might stop going to church, the club or family dinners. They may say they are “too tired” or “not bothered”. Over time, the world gets smaller.

Withdrawal can be a sign of low mood, but it can also make low mood worse. Less contact means fewer chances for comfort, laughter and help.

Mind and body are closely linked. Depression and anxiety can show up as headaches, stomach upsets, pain or exhaustion, especially in people who grew up being told not to talk about feelings.

Of course, physical symptoms should always be checked. But if tests come back clear and the person still feels unwell and low, it is worth asking about mood too.

Anxiety in later life often attaches to real concerns: health, money, safety, falling, or the future of a partner. The worry becomes a problem when it is constant, hard to control and starts to shrink your life.

For example, a fear of falling might stop someone going out at all. That reduces movement and contact, which can increase both the risk of falling and feeling low.

Trouble concentrating, remembering or deciding is a common sign of depression at any age. In older adults, this can be confused with dementia.

This is one reason a proper check-up matters. When low mood is treated, thinking often becomes clearer too. See “Memory changes: when to check” below.

Many older adults do not seek help. They may think their symptoms are a normal part of aging, feel stigma or shame, or not know that treatment can help. Cost, transport and a lack of local services can also get in the way.

Some people grew up in a time when mental health was rarely discussed, or was seen as weakness. Those messages can be hard to shake.

Talking therapies, also called psychotherapy, are an effective part of treatment for depression in older adults.

Approaches you might hear about

• Cognitive behavioral therapy (CBT): noticing unhelpful thought patterns and gently testing them
• Problem-solving therapy: breaking big worries into small, doable steps
• Behavioral activation: slowly adding back activities that bring meaning or pleasure
• Grief counseling: support to carry loss and find a way forward
• Life review or reminiscence: looking back on your life story to find meaning

Many therapists now offer sessions by phone or video, which can help if getting out is difficult. For anything medical, consult with your clinical provider.

• Sometimes misplacing your keys or glasses
• Struggling now and then to find the right word
• Forgetting the name of someone you met once
• Forgetting a recent event, then remembering later

With typical aging, old memories, life knowledge and language stay in place. These slips are annoying, but they do not stop you living your life.

• Getting lost in a familiar neighborhood
• Using unusual words for everyday objects
• Forgetting the name of a close family member or friend
• Losing older memories
• Not being able to do common tasks on your own

If you notice these in yourself or someone you love, please consult with your clinical provider. It does not automatically mean dementia.

Memory and thinking problems can be caused by a more treatable condition, so a check-up matters. Depression, poor sleep and other health problems can all affect memory.

If it is dementia, finding out early gives time to plan care, money and future wishes, and to get support in place.

Activity helps mood, sleep, balance and confidence. It does not have to be hard: a short walk, chair exercises, gardening, swimming or tai chi all count.

Exercising with others adds connection too. Many senior centers and community groups run gentle classes.

Pacing means spreading activity through the day instead of doing too much on good days and paying for it later. Relaxation and breathing can calm the body’s stress response, which often makes pain feel worse.

Talking therapies like CBT can help you cope with pain and the frustration it brings. For pain treatment, consult with your clinical provider.

Hearing loss is common, especially as we get older. People who cannot hear well may withdraw because they feel frustrated or embarrassed about not following what is said. They are sometimes wrongly thought to be confused or uncooperative.

What helps

• Get your hearing and eyes checked regularly
• Face people when they talk, so you can see their lips and expressions
• Move somewhere quieter, and ask people to speak slowly or write things down
• Ask about amplifiers for the phone and TV

In 2022, almost 52 million licensed drivers in the U.S. were 65 or older. Changes in vision, movement, memory and health can affect driving for some older adults.

Stopping driving is often a real loss of independence, and it is normal to grieve it. Planning other ways to get around before you need them helps you stay active and connected. Options include rides with friends, ride-share services and public transport. CDC’s MyMobility Plan can help you plan.

Safer driving while you still drive

• Drive in daylight and good weather
• Have your eyes checked every year
• Plan routes with good lighting and easy parking
• Never drink and drive

About 1 in 4 older adults report falling each year, and falls are the leading cause of injury for adults 65 and over.

Fear of falling can make people move less, which weakens muscles and balance. Activities that build strength and balance are recommended for older adults.

Adults 65 and over are advised to aim for about 150 minutes of moderate activity a week, such as brisk walking, plus muscle-strengthening on two days and activities that improve balance. If health makes that hard, be as active as you can.

Ideas

• Chair exercises while the kettle boils
• Dancing to music you love
• Gardening or yard work
• Swimming or water exercise
• Tai chi or a balance class
• Walking with a friend

Strong social connection is linked to better health and a lower risk of early death. Simple steps, like reaching out to someone, greeting neighbors or joining a local group, all help.

Taking a class or restarting an old hobby can be fun and help you meet people with similar interests. Libraries, senior centers and community colleges often run low-cost classes.

You are never too old to learn something new. People keep learning throughout life.

Hearing problems that are not treated can make people withdraw, because following conversation becomes tiring. Regular hearing and eye checks help you stay part of things.

Mention mood and sleep at check-ups too, not only your body. Both are part of your health.

• Get up and go to bed at similar times
• Get some daylight each morning, even by a window
• Keep regular mealtimes
• Plan one thing to look forward to each day

Ageism can be self-directed. If we grow up hearing that old age means decline and uselessness, we may start believing it about ourselves.

Thoughts like “I’m too old to learn”, “No one wants to hear from me” or “Feeling down is just my age” can stop us trying new things or seeking help.

How we see our own ageing matters. In a U.S. study of 660 people aged 50 and over, those with more positive views of ageing lived 7.5 years longer, on average, than those with more negative views.

Myth: Depression is a normal part of getting old. Fact: It is common, but it is not normal aging, and it can be treated.

Myth: Dementia is a normal part of aging. Fact: Some forgetfulness is typical, but dementia is not a normal part of aging.

Myth: Therapy does not work for older people. Fact: Most older adults improve with treatment.

Myth: Older people cannot learn new things. Fact: People keep learning throughout life. Classes, hobbies and technology are open to all ages.

WHO names three ways to reduce ageism: fair policies and laws, education that corrects myths and builds empathy, and activities that bring generations together.

In daily life, you can gently challenge jokes or comments that put people down because of age, and share stories of older people living full lives.

• Fear of pain, or of being a burden
• Worry about the people you will leave behind
• Regret about things left unsaid
• Spiritual questions
• Calm acceptance, even gratitude

All of these are normal. Talking about them with someone you trust often makes them lighter.

Advance care planning means talking about and preparing for future medical decisions, in case you cannot speak for yourself. Conversations with loved ones are the most important part. Many people also write advance directives, such as a living will or naming a health care proxy.

In one study, people guessed nearly one in three end-of-life decisions for their loved one wrongly. Planning makes it more likely you get the care you want, and may help loved ones grieve with less guilt and burden.

• Spend time on what matters most to you
• Make peace with people, or with yourself
• Faith, prayer or quiet reflection
• Time in nature
• Share your story with someone who wants to hear it

Chaplains, faith leaders and counselors can help with big questions, whatever you believe.

Pick a quiet time, perhaps during a walk or over tea. Share what you have noticed without judging: “You haven’t seemed yourself lately. How are you really doing?”

Some older adults may not use words like “depressed”. Ask about sleep, energy, enjoyment or worries instead. Then listen more than you talk.

Encourage your loved one to seek help, and offer to go with them to appointments. Doing activities together, like walking, can also help.

Practical help, like shopping, lifts or small jobs around the house, can ease stress and make it easier to stay connected.

Older adults want to stay in control of their own lives, just like anyone. Ask what help they want rather than deciding for them.

Speak to them, not about them, even at appointments. Treat them as the expert on their own life.

Thoughts of death or suicide are a serious sign. WHO estimates that about one in six suicide deaths worldwide are among people aged 70 and over.

If someone talks about being a burden, wanting to die, or starts giving belongings away, ask them directly and kindly if they are thinking about suicide. Asking does not put the idea in their head.

About one in six older adults experiences abuse, often from someone they know, including carers. It can be physical, emotional, financial, sexual or neglect. It is never the older person’s fault, and it can lead to depression and anxiety.

Helpful things to say

• “I’ve missed our chats. Tell me about your week.”
• “That sounds really hard. I’m glad you told me.”
• “What would make this week a bit easier?”
• “Would you show me how you make that? I’d love to learn.”

Try to avoid

• “That’s just old age.” Low mood and worry are not a normal part of ageing
• “At your age, what do you expect?”
• Talking down, using “baby talk”, or speaking to others as if they weren’t there
• Rushing to fix things before you’ve listened

Many adult children and partners juggle work, their own families and caregiving at the same time. It’s common to feel tired, guilty or resentful, and then guilty about feeling resentful. These feelings don’t make you a bad person. They are a sign you need support too.

What helps

• Share tasks with siblings, relatives or friends, and be specific about what you need
• Use local services. The Eldercare Locator can help you find support near your loved one
• Join a caregiver support group, in person or online
• Protect small breaks: a walk, a hobby, a coffee with a friend
• Talk to a counselor if you feel overwhelmed