Key Psychological Disorders Affecting Older Adults

Common Psychological Disorders in Older Adults

While some mental health conditions are more commonly diagnosed earlier in life, many can show up at any stage of life. Because the signals can be mistaken for typical symptoms of aging or personality changes in older adults, knowing what to look for ensures you can get an older person access to care and treatment as soon as possible. The earlier interventions are implemented, the more successful treatment outcomes can be.

1. Depression

Depression in older adults and seniors is often missed because the symptoms can closely align with normal aging or other physical health issues. It’s not something to overlook, though, since the prevalence of depression in this population is shockingly high — according to some studies, nearly half of older adults (44.4%) might be clinically depressed.

Depressive symptoms in older adults can manifest as:

• Persistent sadness
• Lack of motivation
• Change in appetite or sleep patterns
• Difficulty concentrating
• Physical pain without a clear medical cause

2. Anxiety disorders

Anxiety is a normal response to stress, but when it becomes so intense that it interferes with daily life and functioning, something more might be going on.

Research shows that anxiety is one of the most common mental health conditions among older adults — more than 27% experience symptoms. Conditions like generalized anxiety disorder (GAD), panic disorder, and some phobias can take a toll and significantly impact mental health and well-being. Understanding the factors that might contribute to anxiety in older adults can help avoid triggers.

Factors that might cause anxiety in older adults include:

• Failing health
• Financial stress
• Social isolation and lack of social participation
• Loss of hearing
• Visual impairments
• Poor sleep quality
• Medication side effects
• Falls

3. Late-onset bipolar disorder

The average age of onset for bipolar disorder is mid-20s, but this psychiatric mood disorder can emerge later in life and is sometimes misdiagnosed as depression or dementia. In one study on late-onset bipolar disorder — also known as geriatric bipolar or late‐onset bipolar illness (LOBI) — nearly 25% of the more than 65,000 people treated for symptoms were over the age of 60.

Late-onset bipolar disorder symptoms can include:

• Mood swings
• Impulsivity
• Manic episodes followed by deep depression
• Increased frequency of depressive episodes
• Cognitive and psychotic symptoms, like memory issues and problems with executive dysfunction

4. Psychotic disorders (schizophrenia and delusional disorder)

Schizophrenia typically begins in late adolescence or early adulthood, most often before age 40. Research suggests that around 1.1 million older adults in the U.S. are living with schizophrenia, reflecting an aging population with the condition. While rare, late-onset schizophrenia or delusional disorder can occur later in life, presenting with symptoms such as hallucinations or heightened paranoia.

Distinguishing between psychotic symptoms and dementia-related behaviors can be challenging in older adults, complicating diagnosis and treatment. Schizophrenia symptoms often overlap with age-related conditions, and research on schizophrenia in individuals over 65 is limited — with only 1% of all schizophrenia research focusing specifically on older adults.

Understanding how specific symptoms present is essential. For example:

• Delusions are often present in both, but with Alzheimer’s, they can look like theft or infidelity. In schizophrenia, they more commonly manifest as thought control.
• Hallucinations can be present as well, but when someone has Alzheimer’s disease, the hallucinations tend to be visual. In schizophrenia, it’s more likely they’re auditory.

5. Insomnia and nightmare disorder

Sleep issues are common among older adults, with many experiencing changes in their sleep patterns as they age. Seniors often find themselves sleeping less or at different hours due to changes in their circadian rhythm, medications, or physical conditions. While some seniors may sleep fewer hours, others may struggle with excessive daytime sleepiness or naps, both of which can disrupt nighttime sleep.

Two common sleep disorders that can affect older adults are insomnia and nightmare disorder.

• Insomnia, characterized by difficulty falling or staying asleep, is more prevalent in seniors due to factors like stress, pain, and underlying health conditions.
• Nightmare disorder, where disturbing dreams cause frequent awakenings, may also be more common as individuals age.

Lack of sleep can contribute to a host of physical, emotional, and mental health concerns for older adults. Poor sleep quality can exacerbate everything from anxiety to depression and can increase cognitive decline.

6. Substance use disorders

Substance misuse or abuse is growing in the older adult population, especially with alcohol and prescription medication. Experts believe there are a few common factors contributing.

Increased risk of substance abuse can stem from:

• Social isolation that leads to loneliness in retirement
• Cognitive decline
• Chronic pain
• Widow grief from the loss of a spouse
• Loss of friends due to mobility issues, distance, or death

Increased risk of medication dependence or abuse can stem from:

• Sensitivity to drugs
• Slowed metabolism
• Interactions with other drugs
• Accidental over-use

7. Hoarding disorder

Hoarding disorder can develop and worsen as people age. As the condition progresses, it can increase safety risks and cause social withdrawal. Some research shows that older adults are three times more likely to have hoarding symptoms than younger adults. The study found that 15% of residents in nursing home environments and 25% of senior daycare participants exhibited symptoms.

It’s likely that emotional attachments to possessions are part of the reason older people might begin hoarding. This can be due to past trauma, loss, fear of forgetting people or memories, or anxiety about needs, now and in the future.

8. PTSD and trauma-related disorders

Trauma in early life — including things like wartime experiences or significant personal loss — can resurface or start to impact people in later years. An estimated 70 – 90% of senior adults over the age of 65 experienced at least one traumatic event in their life and the prevalence of PTSD in those over 60 ranges from 1.5% – 4%.

Post-traumatic stress disorder (PTSD) and other trauma disorders can cause debilitating symptoms, like frightening flashbacks, heightened anxiety, and severe depression. They can impact daily life, functioning, and relationships. There isn’t an abundance of research on PTSD in older adults, but some studies show that symptoms can increase with age for a variety of reasons.

PTSD in older adults can have a unique impact, as age-related factors may exacerbate symptoms and complicate recovery. It can:

• Be triggered by age-related life changes.
• Complicate the management of other health conditions.
• Make seeking help more difficult.
• Lead to functional loss, which can make coping with past trauma harder.
• Limit access to avoidance-coping mechanisms, like using alcohol, hyper-focusing on work, or socializing.

9. Social isolation and loneliness-induced psychological distress

Chronic loneliness is — not surprisingly — common in older populations (there’s evidence that up to one-third of older adults are lonely at the end of their lives). What might be surprising, though, is that loneliness is the most crucial factor when we look at anxiety in older adults.

Loneliness can also lead to severe emotional distress that causes depression, cognitive decline, and various other mental health conditions. Lack of social engagement and support can cause fear and feelings of helplessness.

Managing Psychological Disorders in Older Adults

Managing psychological disorders in older adults can feel daunting or challenging, but with the right tools and approaches, it’s possible to offer meaningful support.

• Therapy: Several therapeutic approaches, such as cognitive behavioral therapy (CBT) and interpersonal therapy, have been shown to be effective in treating psychiatric disorders in older populations. These evidence-based treatments can provide significant benefits for various mental health conditions.
• Medication management: Medication must be carefully monitored so that missed doses or unintentional overdoses don’t occur. A healthcare professional also must monitor age-related changes in metabolism and the potential for interaction with other medications.
• Lifestyle modifications: Small changes in lifestyle — like engaging in regular physical activity, maintaining social connections, participating in mentally stimulating activities, practicing healthy sleep habits, and eating a balanced diet — can have a significant positive impact on mental health.
• Support groups: Peer support can play a vital role in the well-being of older adults facing physical or mental health challenges. Connecting with others in similar situations can provide emotional comfort and practical insights.
• Caregiver and family involvement: Involving family members and caregivers in treatment plans is crucial. Educating loved ones is an important first step in creating a supportive environment for the individual.
• Regular and consistent healthcare checkups: Routine physical and mental health screenings should be part of an ongoing healthcare plan. This allows for the monitoring and management of underlying conditions that could affect mental health.
• Tailored treatment plans: Each individual has unique needs, so it’s essential to develop personalized treatment plans that incorporate the most effective strategies based on the person’s specific situation.

Supporting Mental Wellness in Aging Populations

Prioritizing mental healthcare allows you to identify and address psychological disorders in older people as soon as possible. A comprehensive approach can enhance quality of life and mental well-being. Encourage seeking professional support through therapy, social programs, and medical care — all of which will consider unique challenges and needs to create the best care plan possible.

Talkspace streamlines getting help, making mental healthcare easy, affordable, and convenient. Talkspace offers online therapy covered by Medicare, removing a common financial barrier that prevents many older adults from accessing care and the mental health support they need. If you’re looking for an online resource for an older person or a caretaker, contact Talkspace today to learn more about how therapy can change your life.