We are mortal beings, our life on this world is temporary. One thing for certain, and non-negotiable in life, is that we all get old, and eventually die. Our physical, mental and psychological needs change throughout the course of life from infancy, latency, adolescence, adulthood, and older adulthood.

The World Health Organisation reports that there is an increased life expectancy, and a decline in mortality which means there is a huge ageing population. In the UK, the Office of National Statistics states that 18% of the population are people aged 65 and above, with that number expected to rise in the coming years.

Even though people are living longer, the mental health and psychological needs of older adults are not given as much attention as their physical health needs, and in comparison, to the needs of other age groups. This may be because of our avoidance of facing the reality of death, mortality, and the fact that life is not infinite.

Old age defines slowing down, deterioration, regression, weathering away, and a decline of physical stamina, and a waning in mental faculties. Resultantly, the needs of older adults are unique in comparison to any other age groups, and far too complex. These needs are typically aimed at the long-term management of diseases, and preserving life.

The marginalisation of older adults, and prioritisation of their physical health needs over their mental health and psychological needs, has the effect of leaving many older adults experiencing serious and at times enduring mental health and psychological problems, without receiving the mental and psychological support that they need.

The intersection between physical and mental well-being is even more critical in older adults, as the physical health problems tend to cause distress which translates into mental and psychological problems. The physical decline is inevitable as old age makes our bodies less robust, weaker, less healthy and harder to repair and heal, in the same way as they did when we were younger.

By unpacking the issues older adults are likely to experience, we can better understand their challenges and formulate the best support to meet their needs.

Issues that affect older adults’ mental health

Loss and depression

Old age is the stage in life where we are confronted with a lot of losses and a need to make life adjustments. There is a loss of the agile healthy self, loss of identity as a functional adult, loss of independence, loss of vitality, and a loss of role when one retires and starts getting a pension. Many older adults also experience loss of their sexuality – older men tend to experience erectile problems and libido issues, while older women tend to experience dysfunction in sexuality, all due to the changes to the male and female bodies respectively.

There are also other losses older adults uniquely experience, for example, loss of their life partners, through actual death, downsizing a home, children moving away from them, loss of friends through death, and at times loss of cognitive faculties due to old age – one may not be as sharp as they used to be which is a form of loss. Loss is a process which involves grieving and coming to terms with the new reality. This loss and grieving process can be incredibly challenging, especially if one is isolated and unsupported. Without the right amount of support, unresolved grief can turn into depression, which is prevalent in older adults.

Loneliness and isolation

The NHS has highlighted that older adults are vulnerable to loneliness and isolation, which does have a negative impact on their mental health. Age UK, a charity which supports older adults, also reports that in the UK, more than 2 million people aged 75 or over live alone, and 1 million of these people report spending more than a month without any form of contact from family friends, or neighbours. These stunning statistics highlight the prevalence of loneliness which also translates to poor mental health.

Older adults who are isolated from the world tend to struggle with coping with day-to-day life due to physical decline. Many others experience co-morbid physical and mental health problems which they tend not to seek help for. Older adults are also likely to experience accidental falls due to physical frailty, and other forms of accidents, and poorly manage their medication regimen which puts their lives at risk. Loneliness and isolation lead to depression, anxiety and other secondary mental health problems.

Loss of mental faculties

The decline of the physical body also corresponds with the decline in cognitive faculties for many older adults. For some, it’s a mild slowing down, while for others the decline is more severe and manifests in the form of dementia.

Dementia is an illness which mostly affects older adults, although some people are diagnosed much younger. It is denoted by a loss of cognitive abilities and a decline in physical functioning. Dementia can be managed but it cannot be fully treated as it is progressive and degenerative.

The decline in cognitive abilities means some older adults find it difficult to engage in mental activities, and physical activities of daily living in the way that they have done in the past. This is experienced as a loss of identity, and depersonalisation, which precipitates depression. People with cognitive decline and those who received a formal diagnosis of dementia are likely to experience depression. Dementia is known to co-exist with depression as living with memory loss and functional decline induces depressive feelings.

Poor physical health

As we get older, our bodies as a system slows down. Old age defines the decline of physical health; many people in older adults experience multiple co-morbidities, for example, high blood pressure, hypercholesterolemia, arthritis, heart problems, age-related poor liver function, diabetes, cataracts etc. Cancer is also highly common in old age.

Some of these chronic physical health problems can only be managed and not fully treated, which puts a demand on older adults' needs to have regular physical health monitoring. The decline in physical health as well as the nature and severity of one’s physical health also has an effect on one’s mental health. Poorly managed physical health can lead to psychological distress which can turn into anxiety, depression, insomnia and other secondary health problems.

Stress and anxiety

Stress is pervasive in older people due to the changes in their lives, which often leaves them feeling out of control. Other causes of stress are loss of support, loss of independence, physical pain, living with chronic physical health issues and stress around death and dying. Stress in old age can also be secondary to managing day-to-day life, and having to make necessary adjustments which can lead to one feeling disempowered and inconvenienced.

Shame also compounds the stress levels, for example in the event where one has to start using incontinence pads due to a weak bladder which causes urinary incontinence. Stress is the mother of anxiety and depression. Increased stress means there is an increased likelihood for anxiety and depression.

Existential reality

The reality of death and dying becomes even clearer in old age. Although death can happen at any stage in life, we become closer to death and become acutely aware of our mortality in old age. This can also trigger existential crises and profound contemplation. Feelings of guilt, regret, shame, anger, fear, and many conflicted feelings about how one has lived their life come to the fore. This can also be a time of coming to terms with the reality what acceptance of what is, and what could have been. This state of reflection and contemplation can tip some older adults into a deep depression.

9 ways to improve mental and psychological well-being in old age

There is an urgent need to promote mental and psychological well-being in old age. Here are some of the ways of improving mental and psychological well-being in old age:

1. Live an active lifestyle

A healthy body translates to a healthy mind. Exercise regularly and do what feels manageable and safe without putting too much pressure on your body.

2. Engage in old hobbies and make new ones

Hobbies make life more meaningful, and you are likely to meet new people and build relationships with others, which minimises the risk of loneliness.

3. Maintain social connections

Combat loneliness by maintaining social connections and building a community around you. Try to connect with family and friends. If your biological family is not as close, or not reciprocating your efforts, make connections with ‘chosen family/s’ and be a part of it.

4. Optimise your physical health

Optimise your physical health by having regular GP checkups. Poorly managed physical health can be a source of distress which has an impact on mental health.

5. Tick things off your 'bucket list'

Reflect on your life and the things that you always wanted to do ‘bucket list’ and engage in them. If it’s a holiday, go and travel if you can. If it’s an art class, join an art class, if it's a salsa club, join the salsa club – the list is endless.

6. Dating

Never be too shy to look for love in old age. Most people believe dating is only for younger adults, which is problematic. If you are single or widowed, and feeling lonely in old age, consider dating again and meeting like-minded people who have similar interests – you may find a special someone and share the reminder of your life with them. Research suggests people who are attached have a better quality of life than people who are single. Life becomes more meaningful, joyful, and purposeful if it's shared and not lived in isolation.

7. Engage in mentally and cognitively stimulating activities

Read books and engage in cognitively stimulating activities. If you like to remain intellectually stimulated, the University of Third Age is a great place to connect with other like-minded intellectuals who have similar interests

8. Therapy

Therapy is not only for younger adults, older adults also need therapy, too. If you are struggling with your mental health or there are some issues you need to address and work through, seeking therapy to get psychological support is a positive. Therapy in old age is hugely beneficial as a way of addressing some of the existential issues, but also addressing loss, depression, anxiety and loneliness.

9. Spoil yourself

Life is too short to not spoil yourself. Age is a number, it’s how you feel that matters.