How to improve mental health in older adults: a caregiver's guide

Improving mental health in older adults starts with one fact many families don't know: depression and anxiety are not a normal part of getting older. About 14% of adults 60 and older live with a mental disorder, most often depression or anxiety, according to the World Health Organization. Many go undiagnosed, because the symptoms get blamed on age, illness or personality.

Depression in later life is treatable, and a family member or caregiver is often the first person to notice it and the one who gets a parent to the doctor.

The conditions to know

• Depression is more than sadness. It's a lasting change in mood, energy and interest that affects eating, sleep and health. In older adults it often comes with chronic illness, pain or loss.
• Anxiety can look like constant worry, restlessness, poor sleep, or physical symptoms like a racing heart or stomach trouble. Our guide to anxiety in older adults explains how to tell normal worry from a disorder.
• Grief after losing a spouse or friend is normal and comes in waves. When grief is unrelenting months later, or comes with hopelessness and inability to function, it may have become depression.
• Alcohol and medication misuse often hide in plain sight. Older bodies process alcohol more slowly, and alcohol interacts with many common medicines, so a nightly habit that was harmless at 50 may not be at 80.
• Dementia and delirium can cause mood and behavior changes that look like depression, and depression can cause memory problems that look like dementia. Sudden confusion is delirium until proven otherwise; see our guide to delirium and dementia.

Why it often goes unnoticed

Depression in older adults often doesn't look like the classic picture. Instead of saying they're sad, people describe being tired, achy, unable to sleep or "just not interested." Many grew up in a time when mental illness carried shame, and they'd rather talk about their back than their mood. Doctors' visits are short and crowded with physical problems. And families sometimes assume that slowing down and withdrawing is simply what happens at 85.

Warning signs caregivers can watch for

• Losing interest in hobbies, friends, church or family events
• Sleeping much more or much less, or waking very early
• Eating less, weight loss, or neglecting meals
• Fatigue, slowed movement, or staying in bed or the chair all day
• Irritability, tearfulness or new anxiety
• New trouble concentrating or remembering
• Aches, pains or stomach problems with no clear cause
• Letting hygiene, the house or medications slide
• Talk of being a burden, feeling worthless, or hopelessness

If several of these last two weeks or more, book a doctor's appointment and go along if you can.

When to act right away

Men 75 and older have the highest suicide rate of any age group in the United States, according to the CDC's National Center for Health Statistics. Take any talk of death, giving away belongings, stockpiling pills or saying goodbye seriously. Ask directly whether they're thinking of ending their life; asking doesn't put the idea in someone's head. Call or text 988, the Suicide and Crisis Lifeline, any time, or call 911 if someone is in immediate danger.

Daily habits that protect mental health

Move every day

Physical activity is one of the most reliable mood lifters at any age. The CDC notes that regular activity lowers the risk of depression and anxiety and helps people sleep better. It doesn't need to be strenuous: a daily walk, a chair exercise class, gardening or dancing to old records all count. Our guide to balance exercises has safe ways to start.

Keep a steady rhythm of sleep and daylight

Going to bed and getting up at the same times, getting outside or near a bright window in the morning, and keeping naps short all help mood. Poor sleep and depression feed each other, so treat both. Our guide to sleep in older adults explains what helps.

Eat regular meals and limit alcohol

Skipped meals, low protein and dehydration affect energy and mood, and depression in turn takes away appetite. Regular meals, ideally shared, break that cycle; our nutrition guide has a simple plan. Keep alcohol modest, and ask the pharmacist whether it interacts with any of your parent's medicines.

Stay connected

Regular contact with other people protects mental health, and isolation does the opposite. Standing commitments work best: a weekly lunch, a class, a faith community, a card game. Our guide to loneliness in older adults covers practical ways to rebuild a social life.

Keep a purpose

People do better when someone counts on them. Volunteering, caring for a pet or a garden, teaching a grandchild a skill, taking a class, painting, music or writing down family history give the week shape and meaning. Choose activities your parent enjoyed before; the familiar is easier to restart than the new.

Watch the news diet

Hours of cable news or crime shows can feed anxiety, especially for someone alone at home. Suggest turning the television off for set parts of the day, and filling that time with music, audiobooks, calls or outings.

Seasonal depression in older adults

Seasonal affective disorder is depression that returns at the same time each year, usually in late fall and winter. In New Jersey and Pennsylvania, short winter days and cold, icy weather keep many older adults indoors, and some get almost no daylight for weeks. According to the National Institute of Mental Health, treatments include light therapy, talk therapy and medication.

At home, help your parent get outside in the morning when it's safe, sit near the brightest window, keep up activity and social plans through the winter, and keep a regular sleep schedule. Light boxes can help, but ask the doctor first, especially if your parent has bipolar disorder or eye disease.

Treatment that works after 65

Talk therapy

Talk therapy works at any age. Cognitive behavioral therapy and problem-solving therapy, which focuses on tackling specific everyday problems one at a time, both have good evidence in late-life depression. Many therapists now see patients by video, which helps people who don't drive.

Medication, carefully

Antidepressants work in older adults, but doctors usually start with a low dose, raise it slowly, and watch for side effects and interactions, because older adults often take several medicines. Some drugs are best avoided; the American Geriatrics Society's Beers Criteria advise against benzodiazepines such as lorazepam and alprazolam for most older adults because of falls and confusion. It often takes several weeks to feel the benefit, so encourage your parent to keep going and report side effects rather than stop.

What Medicare covers

Medicare Part B covers a yearly depression screening at no cost when the provider accepts assignment, and outpatient mental health care such as therapy and medication management, usually with 20% coinsurance after the deductible. Since 2024 it also covers licensed marriage and family therapists and mental health counselors, which has widened the choice of therapists.

Where to find help

• Start with the primary care doctor, who can screen for depression, check for medical causes like thyroid problems, vitamin B12 deficiency or medication side effects, and refer to a specialist.
• Ask about a geriatric psychiatrist or a therapist who works with older adults, particularly when depression comes with memory problems or several medical conditions.
• In New Jersey, the state-funded NJ MentalHealthCares line, (866) 202-4357, offers information, emotional support and referrals to local services. It isn't a crisis line; for a crisis, call or text 988.

How caregivers make a difference

Family members and caregivers are often the first to notice that something has changed, and their encouragement is what gets many older adults to an appointment and keeps them on treatment. You can help by keeping a steady daily routine, getting your parent outside and moving, sharing meals, going with them to appointments, keeping track of medications, and listening without rushing to fix things.

Look after yourself too. Caring for someone who is depressed is draining, and caregivers have high rates of depression themselves. Our guide to caregiver burnout explains how to spot it, and respite care can give you regular time off.

Our caregivers help in the everyday ways that support mental health: company and conversation, walks, meals together, rides to appointments and activities, medication reminders, and a steady presence that notices when something changes. Our companion care is often where families start. If your parent has been pulling away from the things they used to enjoy, tell us what you're seeing.