Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act as we cope with life. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, including as we age.

Many older adults are at risk for mental health problems. But this does not mean that mental health problems are a normal part of aging. Studies show that most older adults feel satisfied with their lives, even though they may have more illnesses or physical problems.

Sometimes, however, important life changes can make you feel uneasy, stressed, and sad. These changes could include the death of a loved one, retirement, or dealing with a serious illness. Many older adults will eventually adjust to the changes. But some people will have more trouble adjusting. This can put them at risk for mental disorders such as depression and anxiety.

It's important to recognize and treat mental disorders in older adults. These disorders don't just cause mental suffering. They can also make it harder for you to manage other health problems. This is especially true if those health problems are chronic.

Some of the warning signs of mental disorders in older adults include

• Changes in mood or energy level
• A change in your eating or sleeping habits
• Withdrawing from the people and activities you enjoy
• Feeling unusually confused, forgetful, angry, upset, worried, or scared
• Feeling numb or like nothing matters
• Having unexplained aches and pains
• Feeling sadness or hopelessness
• Smoking, drinking, or using drugs more than usual
• Anger, irritability, or aggressiveness
• Having thoughts and memories that you can't get out of your head
• Hearing voices or believing things that are not true
• Thinking of harming yourself or others

If you think that you may have a mental health problem, get help. Talk therapy and/or medicines can treat mental disorders. If you don't know where to start, contact your primary care provider.

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act, and helps determine how we handle stress, relate to others, and make choices.

Mental health is important at every stage of life, from childhood and adolescence through adulthood. Over the course of your life, if you experience mental health problems, your thinking, mood, and behavior could be affected.

Mental Health Conditions

Mental illnesses are disorders, ranging from mild to severe, that affect a person’s thinking, mood, and/or behavior. According to the National Institute of Mental Health, nearly one-in-five adults live with a mental illness.

Many factors contribute to mental health conditions, including:

• Biological factors, such as genes or brain chemistry
• Life experiences, such as trauma or abuse
• Family history of mental health problems

Some mental health topics include:

• Antisocial personality disorder
• Anxiety disorders (including generalized anxiety, panic disorders, obsessive-compulsive disorder (OCD), phobias, and social anxiety)
• Attention-deficit hyperactivity disorder (ADHD)
• Bipolar disorder
• Borderline Personality Disorder (BPD)
• Depression
• Eating disorders (including Anorexia Nervosa, binge eating Disorder, and Bulimia Nervosa)
• Post-traumatic Stress Disorder (PTSD)
• Schizophrenia
• Seasonal affective disorder (SAD)
• Self-harm
• Suicide and suicidal behavior

A Serious Mental Illness (SMI) is a mental illness that interferes with a person’s life and ability to function. Despite common misperceptions, having an SMI is not a choice, a weakness, or a character flaw. It is not something that just “passes” or can be “snapped out of” with willpower.

Early Warning Signs & Symptoms

Not sure if you or someone you know is living with mental health problems? Experiencing one or more of the following feelings or behaviors can be an early warning sign of a problem:

• Eating or sleeping too much or too little
• Pulling away from people and usual activities
• Having low or no energy
• Feeling numb or like nothing matters
• Having unexplained aches and pains
• Feeling helpless or hopeless
• Smoking, drinking, or using drugs more than usual
• Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared
• Yelling or fighting with family and friends
• Experiencing severe mood swings that cause problems in relationships
• Having persistent thoughts and memories you can't get out of your head
• Hearing voices or believing things that are not true
• Thinking of harming yourself or others
• Inability to perform daily tasks like taking care of your kids or getting to work or school

Do you think someone you know may have a mental health problem? Talking about mental health can be difficult. Learn about common mental health myths and facts and read about ways to help you get the conversation started.

Tips for Living Well with a Mental Health Condition

Having a mental health condition can make it a struggle to work, keep up with school, stick to a regular schedule, have healthy relationships, socialize, maintain hygiene, and more.

However, with early and consistent treatment—often a combination of medication and psychotherapy—it is possible to manage these conditions, overcome challenges, and lead a meaningful, productive life.

Today, there are new tools, evidence-based treatments, and social support systems that help people feel better and pursue their goals. Some of these tips, tools and strategies include:

• Stick to a treatment plan. Even if you feel better, don’t stop going to therapy or taking medication without a doctor’s guidance. Work with a doctor to safely adjust doses or medication if needed to continue a treatment plan.
• Keep your primary care physician updated. Primary care physicians are an important part of long-term management, even if you also see a psychiatrist.
• Learn about the condition. Being educated can help you stick to your treatment plan. Education can also help your loved ones be more supportive and compassionate.
• Practice good self-care. Control stress with activities such as meditation or tai-chi; eat healthy and exercise; and get enough sleep.
• Reach out to family and friends. Maintaining relationships with others is important. In times of crisis or rough spells, reach out to them for support and help.
• Develop coping skills. Establishing healthy coping skills can help people deal with stress easier.
• Get enough sleep. Good sleep improves your brain performance, mood and overall health. Consistently poor sleep is associated with anxiety, depression, and other mental health conditions.

Need Help?

• If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org.
• To learn how to get support for mental health, drug, and alcohol issues, visit FindSupport.gov.
• To locate treatment facilities or providers, visit FindTreatment.gov or call SAMHSA’s National Helpline at 800-662-HELP (4357).

Why is it important to take care of our mental health as we age?

As people age, they may experience certain life changes that impact their mental health, such as coping with a serious illness or losing a loved one. Although many people will adjust to these life changes, some may experience feelings of grief, social isolation, or loneliness. When these feelings persist, they can lead to mental illnesses, such as depression and anxiety.

Mental health is important at every stage of life. Effective treatment options are available to help older adults manage their mental health and improve their quality of life. Recognizing the signs and seeing a health care provider are the first steps to getting treatment.

Mental health includes emotional, psychological, and social well-being. Learn more about taking care of your mental health.

What are symptoms of mental disorders in older adults?

• Noticeable changes in mood, energy level, or appetite
• Feeling flat or having trouble feeling positive emotions
• Difficulty sleeping or sleeping too much
• Difficulty concentrating, feeling restless, or on edge
• Increased worry or feeling stressed
• Anger, irritability, or aggressiveness
• Ongoing headaches, digestive issues, or pain
• Misuse of alcohol or drugs
• Sadness or hopelessness
• Thoughts of death or suicide or suicide attempts
• Engaging in high-risk activities
• Obsessive thinking or compulsive behavior
• Thoughts or behaviors that interfere with work, family, or social life
• Engaging in thinking or behavior that is concerning to others
• Seeing, hearing, and feeling things that other people do not see, hear, or feel

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In life-threatening situations, call 911.

Depression is a true and treatable medical condition, not a normal part of aging. However older adults are at an increased risk for experiencing depression. If you are concerned about a loved one, offer to go with him or her to see a health care provider to be diagnosed and treated.

Depression is not just having “the blues” or the emotions we feel when grieving the loss of a loved one. It is a true medical condition that is treatable, like diabetes or hypertension.

How Do I Know if it’s Depression

Someone who is depressed has feelings of sadness or anxiety that last for weeks at a time. He or she may also experience–

• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Insomnia, early–morning wakefulness, or excessive sleeping
• Overeating or appetite loss
• Thoughts of suicide, suicide attempts
• Persistent aches or pains, headaches, cramps, or digestive problems that do not get better, even with treatment

How is Depression Different for Older Adults

• Older adults are at increased risk. We know that about 80% of older adults have at least one chronic health condition, and 50% have two or more. Depression is more common in people who also have other illnesses (such as heart disease or cancer) or whose function becomes limited.
• Older adults are often misdiagnosed and undertreated. Healthcare providers may mistake an older adult’s symptoms of depression as just a natural reaction to illness or the life changes that may occur as we age, and therefore not see the depression as something to be treated. Older adults themselves often share this belief and do not seek help because they don’t understand that they could feel better with appropriate treatment.

How Many Older Adults are Depressed

The good news is that the majority of older adults are not depressed. Some estimates of major depression in older people living in the community range from less than 1% to about 5% but rise to 13.5% in those who require home healthcare and to 11.5% in older hospitalized patients.

How Do I Find Help

Most older adults see an improvement in their symptoms when treated with antidepression drugs, psychotherapy, or a combination of both. If you are concerned about a loved one being depressed, offer to go with him or her to see a health care provider to be diagnosed and treated.

If you or someone you care about is in crisis, please seek help immediately.

• Call 911
• Visit a nearby emergency department or your health care provider’s office
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor

Human beings are social creatures. Our connection to others enables us to survive and thrive. Yet, as we age, many of us are alone more often than when we were younger, leaving us vulnerable to social isolation and loneliness—and related health problems such as cognitive decline, depression, and heart disease. Fortunately, there are ways to counteract these negative effects.

NIA-supported researchers are studying the differences between social isolation and loneliness, their mechanisms and risk factors, and how to help people affected by these conditions. “NIA is interested in exploring potential interventions to address social isolation and loneliness, which are both risk factors for poor aging outcomes,” said Lisbeth Nielsen, Ph.D., of NIA’s Division of Behavioral and Social Research.

Social isolation and loneliness do not always go together. About 28 percent of older adults in the United States, or 13.8 million people, live alone, according to a report by the Administration for Community Living’s Administration on Aging of the U.S. Department of Health and Human Services, but many of them are not lonely or socially isolated. At the same time, some people feel lonely despite being surrounded by family and friends.

“A key scientific question is whether social isolation and loneliness are two independent processes affecting health differently, or whether loneliness provides a pathway for social isolation to affect health,” Dr. Nielsen noted.

Health effects of social isolation, loneliness

Research has linked social isolation and loneliness to higher risks for a variety of physical and mental conditions: high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death.

People who find themselves unexpectedly alone due to the death of a spouse or partner, separation from friends or family, retirement, loss of mobility, and lack of transportation are at particular risk.

Conversely, people who engage in meaningful, productive activities with others tend to live longer, boost their mood, and have a sense of purpose. These activities seem to help maintain their well-being and may improve their cognitive function, studies show.

Breaking ground in loneliness research

Much of what we know about the causes and effects of social isolation and loneliness comes from the groundbreaking research of the late John T. Cacioppo, Ph.D., former director of the Center for Cognitive and Social Neuroscience at the University of Chicago and an NIA grantee.

Dr. Cacioppo’s research found that being alone and loneliness are different but related. Social isolation is the objective physical separation from other people (living alone), while loneliness is the subjective distressed feeling of being alone or separated. It’s possible to feel lonely while among other people, and you can be alone yet not feel lonely.

A pioneer in the field of social neuroscience, Dr. Cacioppo passed away in March 2018. His wife and collaborator, Stephanie Cacioppo, Ph.D., continues this work as assistant professor of psychiatry and behavioral neuroscience at the University of Chicago and director of the university’s NIA-supported Brain Dynamics Laboratory.

“The misery and suffering caused by chronic loneliness are very real and warrant attention,” she said. “As a social species, we are accountable to help our lonely children, parents, neighbors, and even strangers in the same way we would treat ourselves. Treating loneliness is our collective responsibility.”

Although there is more to learn, the understanding of the mechanisms of action of loneliness and its treatment has increased dramatically since scientific investigation began more than two decades ago, according to Dr. Stephanie Cacioppo. Among the novel predictions from the Cacioppo Evolutionary Theory of Loneliness is that loneliness automatically triggers a set of related behavioral and biological processes that contribute to the association between loneliness and premature death in people of all ages. Research is headed toward the systematic study of these processes across generations, Dr. Cacioppo explained.

Understanding the biology of loneliness

Losing a sense of connection and community changes a person’s perception of the world. Someone experiencing chronic loneliness feels threatened and mistrustful of others, which activates a biological defense mechanism, according to Steve Cole, Ph.D., director of the Social Genomics Core Laboratory at the University of California, Los Angeles. His NIA-funded research focuses on understanding the physiological pathways of loneliness (the different ways that loneliness affects how your mind and body function) and developing social and psychological interventions to combat it.

For example, loneliness may alter the tendency of cells in the immune system to promote inflammation, which is necessary to help our bodies heal from injury, Dr. Cole said. But inflammation that lasts too long increases the risk of chronic diseases.

Loneliness acts as a fertilizer for other diseases,” Dr. Cole said. “The biology of loneliness can accelerate the buildup of plaque in arteries, help cancer cells grow and spread, and promote inflammation in the brain leading to Alzheimer’s disease. Loneliness promotes several different types of wear and tear on the body.

People who feel lonely may also have weakened immune cells that have trouble fighting off viruses, which makes them more vulnerable to some infectious diseases, he added.

NIA-supported research by Dr. Cole and others shows that having a sense of mission and purpose in life is linked to healthier immune cells. Helping others through caregiving or volunteering also helps people feel less lonely.

“Working for a social cause or purpose with others who share your values and are trusted partners puts you in contact with others and helps develop a greater sense of community,” he noted.

Researching genetic and social determinants of loneliness

In another NIA-funded study, researchers are trying to understand the differences between social isolation and loneliness and how they may influence health. They are also trying to identify potential interactions between genes and the environment of older adults affected by social isolation and loneliness.

Previous studies have estimated the heritability of loneliness between 37 percent and 55 percent using twins and family-based approaches. “Individuals who are not prone genetically to feeling lonely may, for example, suffer much less from social isolation, while others feel lonely even though they are surrounded and part of a rich social life,” according to Nancy Pedersen, Ph.D., a professor of genetic epidemiology at the Karolinska Institutet in Stockholm, Sweden. “We are also interested in understanding what role socioeconomic status plays in such associations.”

Using data from twin studies, Dr. Pedersen and researchers found that both social isolation and loneliness are independent risk factors, and that genetic risk for loneliness significantly predicted the presentation of cardiovascular, psychiatric (major depressive disorder), and metabolic traits. Family history does not strongly influence this effect.

“We need to identify people who are most prone to suffer from social isolation and loneliness and those who would benefit most from interventions,” said Dr. Pedersen. “Interventions for social isolation may look very different from interventions for those who feel lonely.”

Beyond genetics, understanding social determinants of health, and the role of social and interpersonal processes in healthy aging and longevity, is another research direction at NIH. Scientists are beginning to apply this framework to research on social isolation and loneliness.

“Future research will need to clarify the extent to which loneliness and social isolation are malleable, and if so, what are the most effective approaches? Demonstrating that we can move the needle on these risk factors is a critical first step toward developing effective interventions,” said Dr. Nielsen. Research is also needed to clarify how great a change in loneliness or social isolation is required to achieve a meaningful change in health, she added.

Veterans may have memories of combat or service that are still upsetting years later. For some, PTSD symptoms may be worse in later years as they age. Learn how as an older Veteran, you may still be affected by your past service. There are tips to find help as well.

PTSD Symptoms Later in Life

Many older Veterans find they have PTSD symptoms even 50 or more years after their wartime experience. Some symptoms of PTSD include having nightmares or feeling like you are reliving the event, avoiding situations that remind you of the event, being easily startled, and loss of interest in activities.

There are a number of reasons why symptoms of PTSD may increase with age:

• Having retired from work may make your symptoms feel worse, because you have more time to think and fewer things to distract you from your memories.
• Having medical problems and feeling like you are not as strong as you used to be also can increase symptoms.
• You may find that bad news on the television and scenes from current wars bring back bad memories.
• You may have tried in the past to cope with stress by using alcohol or other substances. Then if you stop drinking late in life, without another, healthier way of coping, this can make PTSD symptoms seem worse.

PTSD symptoms can occur soon after a traumatic experience, but this is not always the case. Here are some common symptom patterns:

• Some Veterans begin to have PTSD symptoms soon after they return from war. These symptoms may last until older age.
• Other Veterans don't have PTSD symptoms until later in life.
• For some Veterans, PTSD symptoms can be high right after their war experience, go down over the years, and then worsen again later in life.

Late-Onset Stress Symptomatology (LOSS)

Many older Veterans have functioned well since their military experience. Then later in life, they begin to think more or become more emotional about their wartime experience. As you age, it is normal to look back over your life and try to make sense of your experiences. For Veterans this process can trigger Late-Onset Stress Symptomatology (LOSS).

The symptoms of LOSS are similar to symptoms of PTSD. With LOSS, though, Veterans might have fewer symptoms, less severe symptoms, or begin having symptoms later in life. LOSS differs from PTSD in that LOSS appears to be closely related to the aging process. People with LOSS might live most of their lives relatively well. They go to work and spend time with family and friends. Then they begin to confront normal age-related changes such as retirement, loss of loved ones, and increased health problems. As they go through these stresses, they may start to have more feelings and thoughts about their military experiences.

Having symptoms of LOSS is not upsetting for all Veterans. While some find that remembering their wartime experience is upsetting, many find that it helps them to make meaning of their wartime experience.

What Can You Do to Find Help?

If you are having a hard time dealing with your wartime memories, there are a number of things that you can do to help yourself. There are also ways you can seek help from others.

• Do things to feel strong and safe in other parts of your life, like exercising, eating well, and volunteering.
• Talk to a friend who has been through the war or other hard times. A good friend who understands and cares is often the best medicine.
• Join a support group. It can help to be a part of a group. Some groups focus on war memories. Others focus on the here and now. Still others focus on learning ways to relax.
• Talk to a professional. It may be helpful to talk to someone who is trained and experienced in dealing with aging and PTSD. There are proven, effective treatments for PTSD. Your doctor can refer you to a therapist.
• Tell your family and friends about LOSS and PTSD. It can be very helpful to talk to others as you try to place your long-ago wartime experiences into perspective. It may also be helpful for others to know what may be the source of your anger, nerves, sleep, or memory problems. Then they can provide more support.
• Don't be afraid to ask for help. Most of all, try not to feel bad or embarrassed to ask for help. Asking for help when you need it is a sign of wisdom and strength.

Changes in physical and mental abilities that may occur with age can be difficult to detect—for older adults and their family members, friends, and caregivers too. To help in determining when an older adult may need assistance in the home, the Eldercare Locator has compiled a list of 10 warning signs. Any one of the following behaviors may indicate the need to take action. It is also important to inform the older adult’s physician of these physical or psychological behavior changes.

Has your loved one:

• Changed eating habits, resulting in losing weight, having no appetite, or missing meals?
• Neglected personal hygiene, including wearing dirty clothes and having body odor, bad breath, neglected nails and teeth, or sores on the skin?
• Neglected their home, with a noticeable change in cleanliness and sanitation?
• Exhibited inappropriate behavior, such as being unusually loud, quiet, paranoid, or agitated, or making phone calls at all hours?
• Changed relationship patterns, causing friends and neighbors to express concerns?
• Had physical problems, such as burns or injury marks, which may result from general weakness, forgetfulness, or misuse of alcohol or prescribed medications?
• Decreased or stopped participating in activities that were once important to them, such as bridge or a book club, dining with friends, or attending religious services?
• Exhibited forgetfulness, resulting in unopened mail, piling of newspapers, not filling their prescriptions, or missing appointments?
• Mishandled finances, such as not paying bills, losing money, paying bills twice or more, or hiding money?
• Made unusual purchases, such as buying more than one subscription to the same magazine, entering an unusually large number of contests, or increasing purchases from television advertisements?

Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, act, make choices, and relate to others. Mental health is more than the absence of a mental illness—it’s essential to your overall health and quality of life. Self-care can play a role in maintaining your mental health and help support your treatment and recovery if you have a mental illness.

About Self-Care

Self-care means taking the time to do things that help you live well and improve both your physical health and mental health. When it comes to your mental health, self-care can help you manage stress, lower your risk of illness, and increase your energy. Even small acts of self-care in your daily life can have a big impact.

Here are some tips to help you get started with self-care:

• Get regular exercise. Just 30 minutes of walking every day can help boost your mood and improve your health. Small amounts of exercise add up, so don’t be discouraged if you can’t do 30 minutes at one time.
• Eat healthy, regular meals and stay hydrated. A balanced diet and plenty of water can improve your energy and focus throughout the day. Also, limit caffeinated beverages such as soft drinks or coffee.
• Make sleep a priority. Stick to a schedule, and make sure you’re getting enough sleep. Blue light from devices and screens can make it harder to fall asleep, so reduce blue light exposure from your phone or computer before bedtime.
• Try a relaxing activity. Explore relaxation or wellness programs or apps, which may incorporate meditation, muscle relaxation, or breathing exercises. Schedule regular times for these and other healthy activities you enjoy such as journaling.
• Set goals and priorities. Decide what must get done now and what can wait. Learn to say “no” to new tasks if you start to feel like you’re taking on too much. Try to be mindful of what you have accomplished at the end of the day, not what you have been unable to do.
• Practice gratitude. Remind yourself daily of things you are grateful for. Be specific. Write them down at night, or replay them in your mind.
• Focus on positivity. Identify and challenge your negative and unhelpful thoughts.
• Stay connected. Reach out to your friends or family members who can provide emotional support and practical help.

Self-care looks different for everyone, and it is important to find what you need and enjoy. It may take trial and error to discover what works best for you. In addition, although self-care is not a cure for mental illnesses, understanding what causes or triggers your mild symptoms and what coping techniques work for you can help manage your mental health.

For other ideas for healthy practices for your mind, body, surroundings, and relationships, see the National Institutes of Health (NIH) Wellness Toolkits.

When to Seek Professional Help

Seek professional help if you are experiencing severe or distressing symptoms that have lasted two weeks or more, such as:

• Difficulty sleeping
• Appetite changes that result in unwanted weight changes
• Struggling to get out of bed in the morning because of mood
• Difficulty concentrating
• Loss of interest in things you usually find enjoyable
• Inability to perform usual daily functions and responsibilities

Don’t wait until your symptoms are overwhelming. Talk about your concerns with your primary care provider, who can refer you to a mental health specialist if needed. If you don’t know where to start, read the National Institute of Mental Health (NIMH) Tips for Talking With Your Health Care Provider fact sheet. Learn more about how to get help or find a provider on the NIMH’s Help for Mental Illnesses webpage.

What to Do in a Crisis

If you are thinking about harming yourself or attempting suicide, tell someone who can help right away or dial 911 in an emergency. You also can call the National Suicide Prevention Lifeline (Lifeline) at 1‑800‑273‑TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, 7 days a week. All calls are confidential.

Contact social media outlets directly if you are concerned about a friend’s social media updates, or dial 911 in an emergency.

Positive relationships with friends and family help us thrive. Without social connections, it’s easy to feel lonely or isolated.

Many of us have been spending more time alone in our homes lately. While anyone can feel lonely, certain factors increase your risk. Major life changes or losses can increase feelings of loneliness.

Older adults are at greater risk because they’re more likely to live alone. Mobility issues can make it harder to leave the house. And sensory issues like vision and hearing loss can contribute to feeling isolated.

No matter what your age, it’s important for your health to stay socially connected. Loneliness can take a toll. It’s linked to higher rates of depression and heart disease, and can weaken your immune system. Here are some strategies to help stay connected if you’re feeling lonely.

Get your heart going. Exercise has been shown to reduce stress and boost your mood. Whether it’s sweating to a workout video or taking a walk around your neighborhood, exercise can help.

You might also consider getting a pet. Animals can be a source of comfort and companionship.

Many people are using technology to connect with friends and family virtually. Take time to reach out to others by phone or online. A call or video chat can remind you that you’re not alone.

Providing social support or helping others in need can give meaning to our lives and help combat feelings of isolation or disconnection.