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Early Signs and Symptoms of Elderly Mental Health Issues

11 minute readLast updated April 10, 2024
fact checkedon April 10, 2024
Written by Marlena Gates, senior care writer and editor
Reviewed by Erin Martinez, Ph.D.Dr. Erin Martinez is an associate professor of gerontology and director of the Center on Aging at Kansas State University, where she focuses on promoting optimal aging.
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Mental health disorders affect about 20% of older adults in the U.S., according to the Centers for Disease Control and Prevention. Nearly one in three seniors don’t receive treatment because of shame or fear that it’ll be dismissed as part of the aging process. As your loved one ages, it’s natural for some mental and physical changes to occur. For example, occasional forgetfulness is normal. However, unexplained fatigue, persistent memory loss, extreme anxiety, and long-term depression are potentially serious signs of mental health issues that caregivers should look out for.

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Key Takeaways

  1. Watch closely for changes in a senior's routine, demeanor, and physical health. Remaining aware of early signs and symptoms of mental health issues is crucial for prevention.
  2. Seniors are less likely to report mental health symptoms. Common mental health disorders in seniors are depression, anxiety, substance use disorder (SUD), and dementia.
  3. Being proactive can lower the risk of mental disorders. Caregivers should monitor risk factors in their loved ones to prevent further decline in mental health.
  4. Mental health treatments should be tailored to a senior's needs. Consult with your loved one and their doctor regularly on their ideal care plan and treatment.

Emotional or mental warning signs

It’s important to keep a close eye on your aging loved one while visiting them to spot the signs they need help.

The following signs can point to a mental health issue in your loved one, especially if these issues interfere with quality of life:

  • Confusion, disorientation, or difficulty concentrating
  • Depressed mood lasting more than two weeks
  • Feelings of worthlessness, guilt, or helplessness
  • Thoughts of suicide or self-harm
  • Memory loss, especially recent or short-term memory problems
  • Social withdrawal, or loss of interest in hobbies
  • Trouble handling finances or working with numbers

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Physical warning signs

The following physical signs can also point to a mental health issue in your loved one:

  • Disheveled appearance and poor hygiene
  • Changes or fluctuations in weight and appetite
  • Difficulty maintaining the home or yard
  • Irregular or abnormal physical problems, such as aches, constipation, etc.
  • Unexplained fatigue, energy loss, or sleep changes

Do mental health issues get worse with age?

It’s possible. Studies suggest that untreated depression and bipolar disorder in middle-aged men and women can evolve into dementia in old age. However, mental health decline isn’t a natural part of aging. In fact, mental health disorders affect younger adults more often than the elderly.[01] But seniors are less likely to seek help or treatment.

Common mental health conditions in seniors

Depression and mood disorders, like bipolar disorder, affect up to 5% of seniors 65 and older. That number increases to 13.5% among seniors who require nursing care or are hospitalized.[02]

Anxiety disorders often coexist with depression or bipolar disorder. They include a range of issues, from hoarding syndrome and obsessive-compulsive disorder to phobias and post-traumatic stress disorder. Nearly 8% of adults older than 65 have been diagnosed with an anxiety disorder at some point in their lives.[02]

Dementia is not itself a mental illness, but a syndrome that involves progressive damage to the brain, causing cognitive impairment and a decline in mental health. About seven million adults age 65 and older — approximately 11% of seniors — have Alzheimer’s disease and dementia.[03,04]

Substance use disorder is another concerning mental health issue rising in seniors, which can lead to all of the mental disorders above. As reported in recent data by the National Institute on Drug Abuse, nearly one million (or about 2%) of adults over 65 live with a substance abuse disorder (or SUD).[05]

Oftentimes, these mental health issues go undiagnosed and untreated, leading to even more severe symptoms.

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Risk factors for mental health disorders in seniors

The normal emotional and physical stresses associated with aging can become risk factors for mental disorders. It’s important to pay close attention to your aging loved one’s mental health, especially if they’re living alone or aren’t able to socialize as often as they once did.

Risk factors for mental health decline in seniors can include the following:[04,06]

  • Alcohol or substance abuse
  • Social isolation and loneliness
  • Dementia-causing illnesses, such as Alzheimer’s disease
  • Grief and losing a loved one
  • Long-term illnesses, such as cancer or heart disease
  • Chronic pain
  • Medication interactions or side effects
  • Physical disability or loss of mobility
  • Physical illnesses that affect emotion, memory, and thought
  • Poor diet and malnutrition

How to assess the severity of mental illness in the elderly

One ongoing issue with diagnosing and treating mental disorders in seniors is the fact that older adults are more likely to report physical symptoms than emotional or psychological ones.

In fact, many seniors may not recognize their own mental health issues. That said, family members should help by assessing their loved one’s daily life to track any issues they may be experiencing. Consider keeping a log of how your family member is maintaining the following areas of their life:

  • Life tasks and self-care activities, such as dressing, preparing meals, or using the phone
  • Safety, including financial safety and driving
  • Physical health, including pain or uncomfortable symptoms, hospitalizations, or loss of appetite
  • Mood and brain health, such as feelings of hopelessness, loss of interest in activities they used to enjoy, or isolation
  • Medication safety, including skipping medications and worrisome side effects or symptoms related to medications

Identifying problems in the above areas can help your family determine whether a consultation with a doctor is warranted. Acknowledgment from a doctor of a mental disorder can pave the way for a calm and effective discussion with your loved one about their treatment options.

Treatment of elderly mental health issues

For depression in seniors, the American Psychological Association (APA) treatment guidelines recommend various forms of psychotherapy and, in severe cases, second-generation antidepressants.[07]

For a dementia diagnosis, there is no known cure, but there are a wide variety of dementia treatment options that show promise in slowing the progression of the disease. These include lifestyle and behavior modifications as well as a variety of therapies.

Anxiety and substance use disorder can be mitigated and prevented in similar ways. Even depression is shown to respond positively to many of the approaches below.

Mental disorder prevention in seniors typically focuses on healthy aging practices and treatment approaches like the following:[06,08]

  • Cognitive stimulation
  • Lifestyle choices, like healthy sleep, diet, and exercise
  • Healthy socialization habits
  • Physical therapies, like yoga, Pilates, and dance
  • Behavioral, talk therapies, and mindfulness practices
  • Alternative therapies, like light and vitamin therapy
  • Music therapy
  • Certain medications

Treatment for caregivers

Heather Adams, a psychology professor at the University of Phoenix in Modesto, California, strongly advises caregivers of seniors with mental illnesses to seek out support for themselves as well.

“Managing an elderly parent with a mental disorder is emotionally taxing,” Adams says. “Sometimes speaking with a therapist can help adult children create a plan for addressing issues with an elderly parent.”

Additionally, caregiver support groups can help you connect with others in the same situation.

How to talk to an elder about their mental health

Some seniors who need help don’t seek treatment because they dismiss their mental changes as a natural part of aging, or are ashamed of talking about it. Another potential obstacle is that your loved one might resist the idea they even have a problem. Below we list some tips from Professor Adams on how to begin this conversation.

1. Focus on symptoms rather than the disorder itself

“If the elderly parent is unwilling to acknowledge their disorder, it may help to focus on symptoms rather than the disorder itself. This also works well for encouraging an elderly parent to schedule a doctor’s visit,” Adams explains.

2. Find a time to speak when you’re both calm

This will make it easier for you and your loved one to listen to each other and speak your minds. Then, explain your needs and stress the benefits of care, such as symptom relief. Be prepared to compromise with your loved one’s specific treatment or care preferences.

“For anxiety, obsessive-compulsive disorders, depressive, or bipolar disorders, it’s beneficial to delay discussion until the elderly parent has come out of an episode,” says Adams. “Manic or depressive episodes create a difficult environment for discussing sensitive topics.”

3. Take their resistance in stride

“When resistance occurs, shift the conversation to less inflammatory aspects of your concerns. Threats or emotional outbursts will only add anxiety and shut down communication,” Adams says. “Remember not to take outbursts personally and know that they often stem from fear of the unknown.”

4. Remain patient and empathetic

Your loved one may not want to discuss the topic when you bring it up. The Mayo Clinic advises trying again later. The same goes for conversations that may take a wrong turn and get off topic, turning too emotional.

“If you feel yourself becoming emotional, the best advice is to take a break from the conversation and choose another time to discuss the topic,” Adams says.

Next steps: Prepare necessary paperwork

“In cases where an elderly parent is a danger to themselves or others, adult children may want to acquire a medical power of attorney for their elderly parent so they can make medical decisions on their behalf,” explains Adams.

Many mental health disorders pose unique challenges to communication, so senior legal planning and gathering proper documents before they’re needed is essential.

Seek help if needed

If your parent’s mental illness is beyond your capacity to provide care for, don’t hesitate to seek assistance from a professional. Their family doctor or a geriatrician is a good resource to start with.

These professionals may recommend long-term senior care options, such as the following:

If you need to find long-term senior care options in your area, reach out to one of A Place for Mom’s Senior Living Advisors. Our advisors carefully tailor recommendations to your loved one’s needs and budget at no cost to you or your family, connecting you with a community or agency in your area.


  1. National Institute of Mental Health. (March 2023). Mental illness.

  2. Centers for Disease Control and Prevention. (September 2022). Depression is not a normal part of growing older.

  3. Alzheimer’s Association. (2024). Alzheimer’s disease facts and figures.

  4. World Health Organization. (March 2023). Dementia.

  5. National Institute on Drug Abuse. (July 2020). DrugFacts: Substance use in older adults.

  6. World Health Organization. (October 2023). Mental health of older adults.

  7. American Psychological Association: Clinical Practice Guidelines for the Treatment of Depression. (2024). Depression treatments for older adults.

  8. Subramanyam, A.A., Kedare, J., Singh, O.P., and Pinto, C. (February 2018). Clinical practice guidelines for Geriatric Anxiety Disorders. Indian Journal of Psychiatry. National Library of Medicine.

Meet the Author
Marlena Gates

Marlena Gates is a senior editor at A Place for Mom, where she's written or edited hundreds of articles covering senior care topics, including memory care, skilled nursing, and mental health. Earlier in her career, she worked as a nursing assistant in a residential care home for children suffering from severe traumatic brain injuries. Marlena holds a master's degree in nonfiction writing, plus a degree from the University of California, Davis, where she studied psychobiology and medical anthropology. While there, she worked as a research assistant in the psychobiology department.

Edited by

Merritt Whitley, senior living writer and editor

Reviewed by

Erin Martinez, Ph.D.

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