"It's Just Part of Getting Old": The Ageism Problem in Mental Health Care
I am going to be honest with you. Few things in medicine frustrate me more than this.
An 85 year old woman stops enjoying the things she used to love. She sleeps poorly, eats less, withdraws from her family. Someone finally brings her to a doctor, and the response is a shrug: "Well, she's 85. What do you expect?"
We expect better. Or at least we should.
Depression is not a normal part of aging
Let me say this as clearly as I can: depression is not a natural consequence of getting older. Neither is debilitating anxiety. Neither is losing all interest in life.
Yes, later life comes with real losses. Health changes, retirement, the death of friends and partners. Grief and adjustment are normal. But persistent depression that affects someone's appetite, sleep, energy, and will to live is a medical condition at 80 just like it is at 20. The difference is that at 20, we treat it. At 80, we too often explain it away.
This assumption has consequences. Older adults are significantly less likely to be referred for mental health treatment than younger adults with the same symptoms. And here is the part that we should not find acceptable: older adults, particularly older men, have among the highest suicide rates of any age group. These are not people who could not be helped. These are people who were not offered help.
The forms ageism takes in the exam room
Ageism in mental health care is not exactly loud. It usually sounds reasonable, which is what makes it dangerous. It sounds like:
"At her age, therapy probably won't do much." False. Older adults respond to psychotherapy, including cognitive behavioral therapy, as well as younger adults do. Some studies suggest they engage more consistently, because they show up, do the homework, and take it seriously.
"He's too old to start a medication." Age requires thoughtful and careful prescribing. Older adults absolutely can benefit from psychiatric medication when it is chosen carefully, started low, and monitored well.
"That's probably just dementia." Depression in older adults can look like cognitive impairment. It can cause poor concentration, slowed thinking, and memory complaints. This is sometimes called pseudodementia, and it is treatable. Writing off a treatable depression as inevitable cognitive decline means someone loses years of good life they could have had.
"She doesn't want to talk about feelings anyway." Many older adults grew up in an era when mental health was not discussed, and some do describe symptoms in physical terms, such as fatigue, pain, or stomach trouble. That is a reason to ask better questions, not a reason to stop asking.
Older patients internalize it too
The cruelest part of ageism is that patients feel it. I have heard some version of "I don't want to be a burden" and "people my age don't complain about these things" more times than I can count. When the culture tells you your suffering is just what aging looks like, you stop reporting it. When you stop reporting it, doctors stop finding it. The silence gets mistaken for wellness.
If you are an older adult reading this: your mental health matters exactly as much now as it did at 30. You are not a burden. You are a patient, and you deserve a doctor who treats you like one.
What good care for older adults actually looks like
Good mental health care in later life is not complicated in principle. It looks like taking symptoms seriously instead of attributing them to a birth year. It looks like screening for depression and anxiety at routine visits, because older adults often will not volunteer it. It looks like reviewing the medication list, since some commonly prescribed drugs can worsen mood or cognition. It looks like considering the whole picture: sleep, hearing loss, chronic pain, isolation, and grief, all of which affect mental health and all of which can be addressed.
And it looks like offering the same menu of treatments we offer everyone else. Therapy. Medication when appropriate. Social connection as a genuine prescription.
For families: what to watch for
If you have an aging parent or grandparent, do not accept "it's just age" as an answer to withdrawal, hopelessness, appetite changes, sleep changes, or statements like "I'm just tired of everything." Push for a real evaluation. Ask directly whether depression has been considered. You may need to be the advocate they were never taught to be for themselves.
Why I care about this
I went into psychiatry believing that mental health care should be preventive, thorough, and available across the whole lifespan, not just the decades insurance companies and culture find convenient. Every time an older adult gets dismissed, we lose the chance to give someone more good years with their family, more mornings that feel worth waking up for.
Aging is inevitable. Suffering without help is not. If someone you love, at any age, is struggling, treat it like the medical issue it is. Because it is one.
