As your parents get older and you become their caregiver, you may be caught off guard by an unexpected health problem they develop: mental illness.
New cases of depression, anxiety or substance abuse can arise in seniors in response to physical, psychological and social issues.
If you have a parent with a chronic mental illness, such as bipolar disorder or schizophrenia, it may be getting harder to manage their condition as they age.
“The role of caregiver can be incredibly rewarding but also very challenging, especially with an aging loved one with mental illness,” says Kate Granigan, a geriatric social worker and fellow of the Leadership Academy of the Aging Life Care Association. “Although mental illness is a taboo topic for many older adults, symptoms are often very treatable and their quality of life can be vastly improved by treatment.”
Here’s what you can do to help your parent with mental illness live their best rest of their life.
[READ: What to Do During a Mental Health Crisis]
How Age Impacts Mental Illness
Becoming depressed, sad, anxious or “senile” aren’t normal parts of getting older, but your parent may believe this misconception.
“Sometimes, older people internalize ageist stereotypes and deploy them against themselves, so (they) may see no point in talking about feeling depressed because, ‘I’m just getting old,'” says Douglas W. Lane, a geriatric psychologist at the University of Washington School of Medicine. “These misconceptions can result in mental health issues in later life being under-identified and under-treated.”
Chronic mental health conditions
Serious mental health illnesses, such as bipolar disorder or schizophrenia, are usually diagnosed at younger ages, but they will likely still affect your aging parent.
“A person with a long-term diagnosis of schizophrenia or bipolar disorder may continue to experience symptoms into later life,” Lane says.
Seniors with these conditions should already be under treatment for them, but caregivers may need to communicate with their psychiatrist and make sure they stay on their medication.
New or worsening mental illness
In older generations, mental illnesses — such as depression, anxiety and substance use disorders — may have gone undiagnosed when they were younger, with symptoms becoming more prominent in their later years.
“Even those with a diagnosed and treated mental illness can have complications as they age,” Granigan says.
These mental conditions can also develop for the first time later in life.
“There are psychological and biological reasons why an adult may suffer depression, anxiety or substance use disorder as they age, even if they’ve never been prone to those psychiatric disorders before,” says Barry J. Jacobs, a Philadelphia-area clinical psychologist and co-author of “The AARP Caregiver Answer Book.”
Psychological factors include:
Loss of friends and family
As people age, they lose loved ones and may feel they don’t matter to anyone anymore.
“With such decreases in social supports, they may become more socially isolated,” Jacobs says.
Social isolation can lead to loneliness, a risk factor for depression in seniors.
Existential crises
At the end of life, people often ruminate on what they should have done differently.
“If they have regrets about things they did or opportunities they missed, then they may dwell on those,” Jacobs says. “They may then be prone to self-medicating with alcohol or drugs to relieve how they feel.”
Biological reasons include:
Chronic pain
Older people often suffer from painful medical conditions, such as arthritis or herniated discs, which can affect their mental health.
“Chronic pain has been found to be associated with depression and substance use disorder,” Jacobs says.
In a vicious cycle, mental illness can also make chronic conditions worse. For example, anxiety can worsen gastroesophageal reflux disease (GERD).
Brain changes
Cognitive conditions may affect how an older person handles emotions.
“One example might be deterioration in psychological coping abilities following a stroke, leading to anxiety the person previously might have been able to manage,” Lane says.
In addition, as the brain ages, it doesn’t regulate hormones that control mood as efficiently, Jacobs says.
[READ: Mental Health Resources for Seniors]
Signs of Mental Illness
Older people might not recognize or admit their mental illness, so be on the lookout for signs.
“It isn’t likely an older adult with a mental health disorder will ask other family members for help,” Jacobs says. “It is up to those family members to observe whether that older adult is displaying changes in functioning.”
Here’s what to watch for:
— Social withdrawal
— Lack of interest in previously enjoyed activities
— Nonverbal signs, such as sad facial expressions
— Irritability
— Excessive worrying
— Changes in eating or sleeping
— Less energy
— Not maintaining personal hygiene
— Cognition changes
Signs of crisis
It’s important to take a mental health crisis seriously.
Signs of a mental health crisis include:
— Hopelessness
— Worthlessness
— Burdensomeness
— Loss of meaning or purpose in life
— Substance abuse
— Self-harm or sabotaging their health
In addition to overt attempts, such as taking an overdose of pain medication, a senior may sabotage their health. For example, they may refuse to take blood pressure medication in order to cause a stroke or may fall intentionally to incur a life-ending injury.
“Older people do experience — and act on — suicidal or violent thoughts,” Lane says. “Data suggests older people who attempt suicide are significantly more likely to actually die than younger people.”
In the event of a mental health crisis:
— Call the 988 Suicide & Crisis Lifeline
— Go to the nearest emergency room
— Call 911
“A caregiver should never try to manage an urgent mental health situation without professional assistance,” Lane says.
[READ: Does Medicare Cover Mental Health Treatment?]
How to Find Help
Even without a crisis, caregivers benefit from reaching out to health care professionals.
“Mental health conditions, like any health issue, are best managed with professional assistance,” Lane says. “You do not have to do it alone. It’s always better to ask for help than not to ask.”
Involve their medical doctor
Reach out to your parent’s trusted general practitioner, who can:
— Screen for depression, anxiety and substance use
— Make sure their symptoms don’t have a medical cause
— Prescribe medications
— Refer them to mental health services
“The first line of help is the older adult’s primary care provider, especially if that provider has been working with that older adult for years,” Jacobs says.
Tell the doctor your concerns before the appointment. Sometimes health information is better received from a professional.
Seek out a specialist
Few mental health providers have special training or experience working with older adults, but a geriatric psychiatrist or geropsychologist can be “game-changing,” Granigan says.
“Ideally, referrals should be made to a mental health clinician who understands the psychological and biological factors that impact an older adult’s mental health,” Jacobs says.
In addition to individual counseling, other mental health resources for seniors include group therapies and outpatient programs.
Look at the whole person
Addressing seemingly unrelated aspects of your parent’s physical or social situation may relieve mental illness triggers.
“Mental health intervention may include engaging other members of the professional care team one would not expect,” Lane says. “For example, enabling a person to have better mobility with physical therapy can be critical to treating depression, via facilitating their re-engagement in meaningful activities.”
Enlist family and friends
Join with concerned others such as their spouse, family members, faith leaders or good friends to create a supportive environment both for you and your parent.
“A team-based approach usually works better than trying to do it alone,” Lane says.
Consider a care facility
For intensive, short-term mental health care, a specialized mental health hospital may be required.
“In extreme cases when the older adult is in danger of hurting themselves or someone else, in-patient treatment may be necessary to stabilize and create a safe plan,” Granigan says.
However, if your parent needs more daily support than you can provide or can no longer live safely on their own, it may be time to consider moving them to a long-term care facility.
If their mental health condition isn’t severe, an assisted living, continuing care retirement community (CCRC) or nursing home might be right for them.
“These types of facilities will accept individuals with mild to moderate depression and anxiety,” Jacobs says.
They aren’t good options, though, for someone with more serious depression, anxiety or substance use disorder, or a long-standing serious condition such as schizophrenia and bipolar disorder.
“These facilities generally will not admit them because they do not have the staff with the training to support such individuals,” Jacobs says.
Instead, consider specialized residential facilities such as personal care homes.
For help finding a proper facility in your state, visit the Eldercare Locator website or call 800-677-1116, or consult with an aging life care professional.
[READ: What Not to Say to Someone With Depression.]
How to Discuss Mental Health With Your Aging Parent
Bringing up mental health can be difficult because of lingering stigma in older generations who grew up with outdated ideas.
“A sense of shame in acknowledging a mental health concern can leave the person fearful their legacy will be stained,” Lane says. “Normalize the fact that all people have emotions and sometimes we need help with those.”
In addition, mental health conditions are more accepted and treatable now than in the past.
Here are some approaches to use:
Be patient
If they’re not experiencing a mental health crisis, gently addressing mental health may require a series of conversations.
“Create an environment in which the person does not feel judged, burdensome or a loss of dignity because of their mental health concerns,” Lane says.
Acknowledge this is hard to talk about
Validating another’s feelings always goes a long way to putting them at ease.
Start the conversation positively, such as, “Mom, I love you and I want to help you” and end with appreciation, such as, “Thank you for talking with me about this, Mom,” Lane says.
Don’t patronize
Your parent will feel humiliated if you treat them like a child, or defensive if you’re heavy-handed about taking charge of their care.
“Make clear they are still respected as your parent by saying something like, ‘You know, Dad, I’ve always looked up to you and I still do,'” Lane says. “Also, avoid infantilizing or disempowering the older person in their own health care. Instead, partner with them by adopting a stance of, ‘We’ll figure this out together.'”
Be specific
Engage your parent by asking them about certain instances of concerning behavior. Posing questions instead of insisting you know what’s going on gives them a chance to voice their own thoughts.
“For example, ‘Mom, I notice you’ve been crying pretty much every day. Have you noticed it? What do you think it means?’ versus, ‘Mom, you’re depressed,'” Lane says.
Bottom Line
Caring for an aging parent with a mental illness is not easy, but taking the right approach with your loved one and their care team can make it easier.
In addition, safeguard your own mental health.
“Ensuring that you have support and opportunities to take time to care for yourself is paramount to avoiding burnout or your own crisis,” Granigan says.
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How to Care for an Aging Parent With a Mental Illness originally appeared on usnews.com
Update 03/27/26: This story was published at an earlier date and has been updated with new information.
