Each May, Mental Health Awareness Month reminds us to reflect on the importance of our emotional well-being. Yet in all the discussion, one group is often left out—older adults. Mental health issues among adults over 65 are common, frequently misunderstood and too often go untreated.

As we age we encounter losses: the deaths of friends or a spouse, declining health, reduced independence or fewer opportunities for meaningful connection. These are difficult challenges, which can increase our risk for depression, anxiety and other mental health conditions. But many older adults are reluctant to ask for help, either because of stigma or because they’ve grown up believing emotional suffering is something to be endured quietly.

I’ve lived with depression for most of my life, though I haven’t always talked about it openly. Not long ago, at a breakfast meeting with a group of men I’ve known for years, the topic of depression came up. I chose not to mention my own experience, but I listened carefully. Several of the men, without hesitation, dismissed depression—calling it a passing mood, something people just need to “get over,” or even joking that they didn’t have time to be depressed. I wasn’t surprised, but I was struck once again by how difficult it can be for older men to acknowledge the reality of mental health challenges, especially their own. That kind of casual dismissal keeps too many of us suffering in silence. Therapy, medication, a wonderful support system of friends and family, and spending time giving back to my community have kept me fulfilled.

The Scope Of The Problem

According to the National Institute of Mental Health, about 20% of adults over 65 experience some form of mental illness. The most common are depression and anxiety disorders. And men over 75 have the highest suicide rates of any age group.

Symptoms of a mental health problem are often missed or misinterpreted. A withdrawn or irritable older adult may be labeled “grumpy,” “just slowing down” or “just getting old” when, in fact, they may be deeply depressed or anxious. Sleep changes, appetite loss or physical complaints may mask underlying emotional suffering.

We would never ignore a broken bone or a failing heart; we should not ignore symptoms of mental illness. All of us should expect the same level of care, compassion and scientific rigor for emotional health as we do for any other medical condition.

Depression Is Not A Normal Part Of Aging

Depression is a medical condition—not a character flaw or a sign of weakness. It is not the same as grief, although they can overlap. And it is not an inevitable part of aging.

In older adults, depression may look different than it does in younger people. Some may not express sadness, but instead show fatigue, lack of motivation or a loss of interest in activities they once enjoyed. Others may report vague physical symptoms with no clear medical cause.

Triggers vary. The death of a spouse, a major illness, financial stress, retirement or no longer being able to drive can all contribute. Yet even when there is a clear cause, depression should not be dismissed as “understandable.”

The Worry That Won’t Let Go

Persistent worry, trouble sleeping, restlessness or a general sense of unease are common symptoms of anxiety in older adults. In some cases, anxiety may follow health scares or a fall. In others, it may stem from broader fears about aging, dependence or the future.

Unfortunately, many older adults do not seek treatment for either depression or anxiety. They may minimize their symptoms or fear being a burden. And too often, these concerns are dismissed. Both depression and anxiety are treatable conditions. Therapy, medication and coping strategies can all help.

Dementia And Emotional Health

Dementia is not a mental illness, but it does affect mental health—both for the person living with the disease and for their caregivers. People in the early stages of Alzheimer’s or other dementias are at increased risk for depression and anxiety. Later, they may develop behavioral symptoms such as agitation, paranoia or withdrawal.

Barriers To Care

Older adults face several unique challenges when it comes to mental health care:

• Stigma remains powerful. Many older individuals who were raised in a time when emotional problems were kept private find that asking for help feels shameful or self-indulgent.

• Misdiagnosis is common. Some health care providers may attribute symptoms to aging or physical illness. This is a form of ageism, which can delay appropriate evaluation and treatment.

• Access is a serious problem. In many communities, including Falmouth, there is a shortage of mental health professionals trained in geriatric care. Lack of transportation, cost and insurance limitations also present obstacles.

What Helps

Treatment works—often remarkably well. Older adults respond just as positively to therapy and medication as younger people. Cognitive Behavioral Therapy (CBT), interpersonal therapy and mindfulness-based approaches have all been shown to reduce symptoms of depression and anxiety in older adults.

Medication, when carefully managed, can be effective, though it must be used with caution in older adults due to potential side effects, drug interactions and increased risk of falls.

But treatment is not only about professional intervention. Human connection—real, sustained connection—can be just as powerful as therapy or medication. Loneliness is strongly linked to poor mental and physical health outcomes. Staying socially active, maintaining friendships, participating in community- or faith-based programs and engaging in meaningful activities, such as volunteering, can all serve as protective factors.

Social engagement opportunities such as the Falmouth Senior Center and numerous volunteer programs are more than just “nice to have.” They are essential public health tools.

We must listen without judgment, speak up without shame and push for better, more-accessible care for ourselves and our peers. Mental health doesn’t age out. Neither should our compassion.

For more information about mental health issues in older adults, including resources for treatment, visit the Mental Health Resource section of the Neighborhood Falmouth website.