Published June 26, 2020

Health is defined as “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity” (Centers for Disease Control and Prevention & National Association of Chronic Disease Directors, 2008). For many individuals it is easy to think of health as merely physical wellbeing. However, health is comprised of different facets of our lifestyles—and mental wellbeing is no exception to this. It is important that we treat mental illnesses with the same legitimacy and urgency as other disorders. Mental health is defined as “a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges” (U.S. Department of Health and Human Services, 2020). This term is not to be confused with mental illness, which are “health conditions involving changes in emotion, thinking or behavior“(Parekh, 2018). For the purposes of this fact sheet, “mental illness” will be used interchangeably with “mental health condition.”

Older Adults and Mental Health

Worldwide, mental health conditions are generally underreported and under-identified by health professionals and older adults themselves (World Health Organization, 2017). Due to the stigma around mental health, most individuals underreport the symptoms they may experience, or reattribute them to a less serious condition such as being tired. For many, it is easier to focus on their physical symptoms such as hunger or over- or under-sleeping, rather than determine the root cause to be mental or emotional. Mental health is a complex subject that cannot be simplified nor easy to treat. Our mental health affects our overall wellbeing as our body can react to chemicals that are released during sadness or stressful events, leading to some physical symptoms that we experience such as headaches or appetite changes (Lifespan Outpatient Psychiatry, n.d.). Susceptibility to mental illness increases even more for individuals who experience prolonged stress from their work life, home life, or being a caregiver (World Health Organization, 2017).

Diagnosing and treating these already underreported illnesses becomes more complicated with older adults due to the existence of multiple chronic conditions and lifestyle changes at that stage. They may be taking medications prescribed by multiple physicians who may not understand their medical history in its entirety. Limited mobility and social isolation can also multiply effects and detract from their mental wellness (Bursack, n.d.). Mental conditions—if left untreated—could potentially require the same amount of attention and long-term care as many chronic illnesses (World Health Organization, 2017).

According to the Administration on Aging, “there are over 46.2 million people (as of 2014) aged 65 years and older who reside in the United States, of which approximately 20%, or over 9 million [older adults], suffer with psychiatric symptoms,” such as an inability to concentrate, extreme mood swings from high to low, low energy, or changes in appetite (Klevins, 2018; Salters-Pedneault, 2019). In addition, “mental illness is a leading cause of disability worldwide” for the aging population (Klevins, 2018). However, taking this into account, “Asian Americans are [three] times less likely to seek mental health services than other Americans” (Anxiety and Depression Association of America, 2018)—that means of the over 19 million Americans who identify as Asian American or Pacific Islander (AAPI), there are plenty of individuals who are in serious need of care and are not receiving it (Mental Health America, n.d.).

An additional factor which makes it hard for AAPI to reach out for help is the belief that older generations experienced greater hardship, preventing people today from wanting to open up about their mental health difficulties. These individuals may hide their struggles “knowing their relatives faced something ‘more’ stressful just to survive” (2019).  For the Japanese American community, this could mean that many of us do not feel comfortable expressing issues with mental health as people close to our hearts may have experienced the concentration camps during World War II. An example of a Japanese cultural value that could prevent the community from seeking help would be haji or feeling ashamed or guilty in wanting to ask for help. We may not feel like we are able to express our feelings and struggles because our loved ones have gone through much worse. Although we may feel the need to keep such thoughts to ourselves, it is important to understand that mental illness is unique to every individual and should be treated with care regardless.

What Does Mental Illness Look Like?

Often, there is a misconception that mental illness is attributed to signs of weakness or lack of effort on the person’s behalf. Many people who have a mental illness do not want to talk about it (American Psychiatric Association, n.d.). There may be stigma surrounding mental illness, but mental illness is not something to be ashamed of. Mental illness can affect anyone regardless of age, gender, geographic location, income, race, ethnicity, religion, sexual orientation, or other aspect of cultural identity. Mental illness can take many forms and be diagnosed at any stage of life. Mental conditions develop as combinations of lifestyle choices, genetics, family history, and environmental factors interact with each other.

There is no exact medical test that can determine whether you have a certain mental illness or not (National Alliance on Mental Illness, n.d.). Speak with your primary care physician or consult with a mental health professional if you feel you are suffering from mood swings or personality changes, as these are symptoms of some mental illnesses. Health care professionals or other specialists take a number of tests and lab results into account to determine whether or not your feelings and symptoms are a result of underlying physical medical conditions. If no medical conditions are found to be the immediate cause of your symptoms, you will be referred to a mental health professional such as a psychiatrist who will use The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), which “lists criteria including feelings, symptoms, and behaviors over a period of time that a person must meet” to be diagnosed with a mental illness (National Alliance on Mental Illness, n.d.).

People may be diagnosed with one or more mental conditions. What makes the situation more complicated is that some illnesses share symptoms, further confusing individuals, friends and family, and health care professionals. These professionals can help you understand what symptoms are normal and expected and explore possible treatment options for conditions that would benefit from more support. Here are some of the most common mental illnesses within the United States, ranked by prevalence (National Alliance on Mental Illness, 2019):

Recognizing Warning Signs of Mental Illness in Older Adults

Symptoms of mental illness are not a normal part of the aging process and should not simply be dismissed as commonplace. Many older adults however believe that it is part of growing old, and continue to underreport their experiences (The Pavilion at Williamsburg Place, 2019). Although there are a number of symptoms that can lead to different conditions, and the potential that these may be shared with other diseases, it is important to recognize some early warning signs that could help detect mental illness in both yourself and your loved ones (CMSS, 2015):

1. Memory issues – Memory issues are commonly viewed as an almost guaranteed aspect of aging. However, this is simply not true. Our mental acuity is thought to be in a “use-it-or-lose-it” fashion—if we do not challenge our brain daily, we lose our sharpness regardless of age.
2. Changes in personal care – Sometimes inability to perform activities of daily living (ADLs), may indicate a person is experiencing challenges with mental health issues.
3. Social withdrawal – The emotional toll on someone experiencing mental illness can sometimes force them to become socially withdrawn from others. This can be seen in people losing interest in their usual hobbies, seeming “off” in social gatherings, or avoiding social interactions as a whole.
4. Changes in mood – If you find that someone’s mood switches quickly from one to another, there may be an issue underneath that is affecting their temperament. Emotional irregularity is a common symptom of various mental illnesses.

This is not a fully comprehensive list of signs of mental conditions. However, if you find that you or someone you know are experiencing any of these risk factors, speak to your physician to learn more about what you can do to find proper care. In addition, these signs may be similar to warning signs of Alzheimer’s disease or other cognitive impairment. Again, speak to your loved one’s physician to determine what may be causing these signs and symptoms.

How to Help Older Adults Cope with Mental Illness

It is not always easy to help others suffering from mental illness. However, we can still do the best we can to support them in other ways aside from purely emotional support. Here are some tips on how to help an older adult that is battling mental illness (Bursack, n.d.):

• Ask your loved one how you can best support them in their times of need. What are certain things that you should do/not do? What would they like their personal space to look like?
• Keep a neatly organized medical file that includes their basic information, a list of current medical conditions, a list of current medications with their dosages, a list of supplements, and a list of all physicians and specialists with their addresses and contact numbers. It is important to have two copies, one as back-up and one that you bring to your loved one’s appointments.
• Ask their physician if there are any lifestyle changes that need to be made with each new medication that is prescribed.
• Encourage exercise when possible. As Carol Bursack (d.) of AgingCare says, “physical activity is an effective, drug-free and low-cost treatment for depression and other mental disorders.”
• Keep a dated list of your loved one’s reported physical, emotional, and mental complaints. This may be good to bring up with his/her physician when you next see them.
• In addition to recording complaints, make note of your loved one’s overall mood—what are they feeling and how long do they feel this way before experiencing another mood? Sometimes mood switches, if too drastic or rapid, can indicate a serious issue underlying an individual’s mental wellbeing. In addition, prolonged experiences of one state, such as lack of interest in things or high levels of anxiety or excitement can indicate changes in mental wellbeing.

How to Cope with Mental Illness

If you are living with a mental illness, there are several different ways to support your needs through techniques known as “self-care” or “self-help.” There are some common self-care techniques such as meditation or leaving your room to spend time with friends and family even though you may not feel like interacting with others mentally or emotionally. Here is a list of other techniques you can utilize if you suffer from mental illness:

• Opposite-to-emotion thinking – Acting in the opposite way your emotions are making you feel. For example, “say you’re feeling upset and you have the urge to isolate. Opposite-to-emotion tells you to go out and be around people—the opposite action of isolation” (Pombo, 2019).
• Mental reframing – Thinking of an event or situation that stresses you out and looking at it from a different perspective. Often times you can think of reframing as putting a positive twist on something (Pombo, 2019).
• Keep up with your physical health – The burden of mental illness can bring down individuals to the point that maintaining daily routines can be difficult. Remember to eat nutritious meals, stay hydrated, exercise “which [can help] decrease depression and anxiety and improve moods,” avoid alcohol and tobacco, and get at least eight hours of sleep (University Health Service, n.d.).
• Seeking treatment when you need it – As previously mentioned, seeking help for mental illness is often viewed as a sign of weakness. Rather than a sign of weakness, it is actually quite the opposite due to the stigma that is placed around mental illness. Mental illness can be treated a number of ways. Speak with a physician to get started.

Keiro’s Call to Action

Mental disorders are something that only the sufferer can experience. Although we can never quite tell if and when mental illness will affect our lives, it is still important for us to familiarize ourselves on the topic. The reality is that there are many individuals suffering from mental illness who are not getting the necessary services and treatment they deserve. Although this is something that cannot change overnight, the more we strive to educate ourselves and advocate for mental wellness, the more we can help the people around us. If you know someone who is struggling with mental illness, take the time today to learn more about it and how you can support them.

Mental Health Organizations

For more information on mental health, visit these resources: