Assisted Living for People with Mental Health Disorders

Mental health disorders can occur at any age, and seniors are especially vulnerable to issues such as depression, anxiety and cognitive impairment. Age-related issues such as Alzheimer’s disease, mobility loss and chronic health concerns, such as COPD and diabetes, all impact seniors’ physical and mental health, leading to co-occurring illnesses.

For example, Parkinson’s disease, cancer, arthritis and heart disease can trigger depression in seniors. Given that 49.6% of American adults aged 65 and older live with doctor-diagnosed arthritis, and the median age of a cancer diagnosis is 66 years, it’s easy to see why symptoms of clinical depression are so prevalent among the elderly.

While there’s no one-size-fits-all treatment for mental health disorders, seniors who are struggling with issues such as depression, anxiety and eating disorders may want to consider joining an assisted living community. These facilities provide seniors with the safety and security that comes with knowing staff are always available to lend a helping hand, and many residents find they can rest easy knowing that they don’t need to worry about maintaining a home, shopping for groceries or preparing meals.

Assisted living services include structured social and therapeutic recreational programs designed to help seniors socialize and stay active, key factors in preventing many mental health issues.

Activities such as daily fitness classes, discussion groups, crafting workshops and outings to local attractions help residents develop meaningful connections with their neighbors while learning new ways to cope with stress, grief and the inevitable changes that come with aging. Many facilities also offer medication management services to help ensure that residents take their medications as prescribed, and enhanced medical services such as on-site rehabilitation therapies are often available. Additionally, most assisted living facilities allow residents to hire additional support staff as needed, such as a visiting nurse following an illness or hospitalization.

This guide provides information about common mental health conditions affecting seniors and a state-by-state list of available resources. It also covers housing options for seniors living with mental health disorders, the benefits that assisted living offers and how to find the right community.

Risks and Signs of Mental Health Conditions in Seniors

Like many common health issues, mental health conditions are often caused by a combination of factors including family history, life experiences and biological issues such as a chemical imbalance in the brain. Seniors are at an increased risk of developing mental health disorders linked to age-related illnesses, loss of income, isolation and decreased autonomy.

Common Causes of Mental Health Disorders in Seniors

Seniors who have the following conditions or concerns are at an especially high risk of developing one or more mental health disorders:

• Strokes
• Over- or under-medication
• Alzheimer’s disease
• Loss of a spouse, sibling, child or close friends
• Decreased mobility and autonomy
• Chronic pain
• Heart disease
• Cancer
• Arthritis
• Chronic illness
• Exposure to traumatic events
• Financial stress
• Social isolation and loneliness

Mental Health Warning Signs

Many common mental illnesses lead to disturbances in thought patterns, behaviors and problem-solving skills. Seniors who are experiencing acute or chronic mental health issues may exhibit one or more of the following mental health warning signs:

• Withdrawal from social activities
• Extreme mood swings
• Loss of interest in activities that they previously enjoyed
• Decline in self-care
• Increased irritability
• Growing distrust in medical providers, family members and close friends
• Unusual sleep patterns (over-sleeping or a lack of sleep)
• Significant weight gain or loss
• Hoarding
• Memory loss
• Increased use of over-the-counter and prescription medications
• Negative self talk

Common Mental Health Conditions That Impact Seniors

There are a number of mental health conditions that are prevalent among older adults. Below, we explain some of the most common.

Anxiety Disorders

Feeling anxious or worried is a normal reaction to stressful situations and events, but when those feelings persist, they can interfere with day-to-day functioning. An estimated 10-20% of seniors suffer from one or more anxiety disorders, including:

• Generalized anxiety disorder (GAD): This disorder is characterized by a constant feeling of dread or worrying for no particular reason.
• Social phobia: An anxiety disorder that’s characterized by extreme discomfort in social settings, and worries about being judged negatively by others.
• Panic disorder: Sudden acute events lasting about 10 minutes involving extreme fear and physiological symptoms such as crushing chest pain, nausea, dizziness and/or sweating,

Treating Anxiety Disorders in Seniors

Seniors diagnosed with one or more anxiety disorders may be treated using a combination of prescription medications, talk therapy and participation in therapeutic recreational activities. These activities may include yoga, meditation classes, crafting workshops and gardening.

Bipolar Disorder (Manic-Depressive Illness)

Previously known as manic-depressive illness or manic depression, bipolar disorder is characterized by dramatic shifts in an individual’s mood, energy levels and cognitive functioning. An estimated 2.8% of American adults have bipolar disorder, and research shows that about one-quarter of those with the illness are seniors aged 60 who suffer from older age bipolar disorder (OABD).

Depression

Depression is a common, treatable mental health disorder that impacts millions of Americans each year. The Centers for Disease Control and Prevention reports that at any given time, nearly 5% of adults aged 18 and older have ongoing depressive symptoms lasting 2 or more weeks, such as:

• Low energy or fatigue
• Disrupted sleep patterns
• Over or under-eating
• Cognitive issues, including memory loss and difficulty making decisions
• Irritability
• Feeling sad and/or anxious
• Loss of interest in hobbies and social interactions
• Suicidal thoughts

Why Seniors Are Vulnerable to Depression

Depression often co-occurs with other health issues such as cancer, heart disease and Alzheimer’s disease, and given that four out of five seniors have one or more chronic health issues, this demographic is at an increased risk of developing depression compared to younger adults. In fact, individuals diagnosed with depression are 40% more likely to develop life-limiting cardiovascular and metabolic diseases than the general population.

Common Causes of Depression in Seniors

Social isolation, loneliness and chronic stress are all linked to depression, as are a family history of depression, a lack of physical activity and substance misuse.

Treating Depression in Seniors

Seniors with depression may benefit from a combination of prescription medications, talk therapy and complementary therapies such as exercise, a structured day program and informal peer support groups. Elders with depression linked to social isolation may find that joining an assisted living community helps give them a sense of belonging while reducing the day-to-day stress that comes with managing a household.

Eating Disorders

Eating disorders have long been thought to only impact teens and young adults, but rates of bulimia, binge eating and anorexia nervosa are rising among seniors. Older women are much more likely to develop an eating disorder than their male counterparts, and one study estimates that 3.8% of women aged 60-70 meet the clinical criteria for having an eating disorder.

Common Causes of Eating Disorders in Older Adults

Eating disorders among seniors may be triggered by:

• Stress related to grief and loss
• Hormonal changes
• Distress over age-related changes to their appearance
• Lack of access to healthy, affordable food
• Underlying medical issues such as insensitivity to certain foods
• Depression and suicidal ideation
• Attempts to manage diet-related chronic illness

Treating Eating Disorders in Seniors

Unfortunately, most treatment programs for those with eating disorders aren’t geared toward seniors, so seeking treatment can be a challenge. Older adults who are suffering from an eating disorder can seek support through their primary care provider and specialists who can check for underlying medical issues and take steps to treat comorbidities such as depression. Other treatment options include peer support groups, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and nutritional supports.

Medication Abuse

Prescription and over-the-counter (OTC) medication use is exceptionally high among seniors. A recent survey showed that 69% of U.S. adults aged 40-79 use at least one prescription drug, while over 22% use five or more prescription medications at any given time. According to the National Institute on Drug Abuse, close to 1 million Americans aged 65 and older live with a substance abuse disorder (SUD).

Many seniors who are addicted to prescription or OTC medications, alcohol or illicit drugs also have one or more mental health disorders, known as a co-occurring disorder.

Why Seniors Are Vulnerable to Substance Abuse

• As people age, their livers become less capable of processing alcohol and other intoxicants, making them more likely to become impaired on relatively small amounts of drugs and/or alcohol.
• OTC and prescription drug use among older adults is widely accepted, while there is little public awareness regarding substance abuse in seniors.
• Seniors with limited access to health care services may choose to self-medicate or be over or under-medicated.

Treating Medication Abuse Among Seniors

Treating medication abuse among the elderly may involve a variety of approaches, including ensuring that seniors have access to comprehensive health care services. Elders who struggle with substance abuse may also benefit from a structured environment such as an assisted living community where their medications are managed by a team of professional caregivers.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder, better known as PTSD, is a mental health condition that develops following exposure to a life-threatening event, dangerous situation or other sudden traumatic experience. An estimated 6% of Americans will have PTSD at some point in their lives, and the disorder is more common in women than in men. The risk of experiencing ongoing PTSD symptoms is much higher among veterans, even if the event connected to the disorder occurred decades ago.

According to a report by the Department of Veterans Affairs, some seniors with PTSD may experience a worsening or reemergence of PTSD symptoms as they age. This may be due to age-related medical problems and declining mobility that make seniors feel vulnerable, or because older adults tend to have fewer activities to distract them from memories linked to traumatic events.

PTSD Symptoms in Seniors

The prevalence, severity and duration of PTSD symptoms vary widely among those with the disorder. PTSD often presents as a co-occurring condition along with one or more other physical or psychiatric issues such as substance abuse, traumatic brain injury, chronic pain or depression. Seniors with PTSD tend to present with concerns such as sleep disturbances, short and long-term memory loss, and a loss of appetite.

Treating PTSD in Seniors

PTSD treatments for seniors may include a combination of individual therapy, prescription medications, involvement in a peer support group and Eye Movement Desensitization and Reprocessing (EMDP).

Suicidal Ideation

Suicidal ideation is a significant problem among older adults. Nearly one in five suicides in the United States occur among individuals aged 65 and older, and one-quarter of all seniors who attempt suicide succeed.

Suicidal ideation and attempts are quite common among older adults who report feeling lonely and isolated, particularly following the loss of a spouse or close family member as well as in those who have a history of suicide attempts. A loss of independence, reduced mobility and chronic illness can also contribute to suicidal ideation and self-harm among seniors, as can a decline in cognitive ability.

Preventing Suicide Among Seniors

Although there’s no one-size-fits-all solution for seniors who have suicidal intention, addressing the root causes of their self-harming thoughts and feelings can help reduce the risk that they’ll attempt to take their own life.

This can involve:

• Using talk therapy to help seniors process feelings of grief
• Engaging in therapeutic social and recreational programming to decrease isolation and increase community connections
• Addressing physical health issues that cause chronic pain, limited mobility, incontinence and other age-related concerns
• Using pharmacological treatments to address underlying mental health disorders related to suicidal ideation, such as depression and PTSD
• Moving into a residential care facility that offers around-the-clock supervision by staff trained to notice changes in seniors’ mood and affect, negative talk and passive suicidal talk.

Housing Options for Seniors Living With Mental Health Conditions

Seniors who are living with one or more mental health conditions, but who don’t need around-the-clock medical care or supervision, may be best suited to either in-home or assisted living care.

In-Home Care

Seniors who have mental health disorders may prefer to continue living independently with support from a homemaker or home health care provider.

Pros:

• Home care may be a good option for seniors with mild mental health disorders who require limited assistance with activities of daily living.
• Home care can be ideal for seniors with mental health disorders that limit their ability to get along with others in a communal setting such as an assisted living facility.
• Seniors who currently have a strong support network consisting of family members, neighbors and service providers may find that in-home care meets their ongoing needs.
• There are state and federal grants and waivers that can subsidize some or all of the costs of community-based services and supports.

Cons:

• Nationwide, home care and home health care services cost $4,957 and $5,148 per month, respectively. These average costs are several hundred dollars more than the $4,500 median for assisted living care. Given that assisted living includes room and board, the total monthly cost of in-home care plus food and housing expenses can be double the cost of assisted living.
• Full-time in-home care provides seniors with 44 hours of services per week, which means seniors are left unsupported for a large portion of each day.
• Seniors with mental health disorders related to Alzheimer’s disease and other types of progressive-degenerative memory loss are at a high risk of wandering when living independently.

Assisted Living Communities

Assisted living facilities are noninstitutional, community-based settings geared toward older adults who want to enjoy a worry-free retirement lifestyle.

Pros:

• Assisted living rates include room and board, some nonmedical care and access to a wide range of social and recreational activities that can be therapeutic for those living with a mental health disorder.
• Assisted living facilities provide seniors with three nutritionally balanced meals each day, which helps ensure that those living with a mental illness receive the nutritional support they need.
• Residents in assisted living facilities have access to daily social and recreational programming such as games, small group outings, fitness classes and crafting workshops, all which can help reduce symptoms of depression, anxiety and other mental health disorders.
• Assisted living facilities are staffed on a 24/7 basis.
• The monthly rates charged by assisted living facilities include daily or weekly housekeeping and linen services, which can be helpful for those with mental health disorders that impact their ability to maintain their living space.

Cons:

• Assisted living may not be the best option for seniors who struggle to function in a congregate care setting.
• The staff-to-resident ratio in assisted living facilities may not allow for the level of care required by some seniors who are living with moderate-to-severe mental health disorders.
• Seniors with certain mental health disorders may dislike the structure offered in assisted living facilities.

The Benefits of Assisted Living for Seniors with Mental Health Disorders

Assisted living provides a number of physical, emotional and mental health benefits for many seniors, and that’s especially true for those who are struggling with mental health disorders. These communities are best suited for those who are no longer willing or able to maintain their own home, but who don’t need a nursing home level of care.

How Assisted Living Communities Can Help Seniors with Mental Health Disorders

Although assisted living facilities don’t offer clinical mental health services, the nature of these communities combined with the services, supports and amenities they offer can create a therapeutic environment that’s helpful to those living with mental health disorders.

Relief From Day-to-Day Responsibilities

Assisted living care includes room and board, which means that residents don’t have to worry about maintaining a home, shopping for groceries or preparing their own meals. For many seniors, the services offered in an assisted living community can relieve the day-to-day stress that comes with living independently.

A Sense of Belonging

Assisted living residents enjoy relief from the isolation and loneliness that affects many seniors who live independently. Communal living provides seniors with the opportunity to make new age-appropriate friends, join social groups and clubs, and participate in meaningful activities.

Safety and Security

Many seniors feel anxious about their personal safety, especially if they live alone. Since assisted living facilities are staffed on a 24/7 basis, residents enjoy the peace-of-mind that comes with knowing caregivers are always available. Most assisted living facilities also offer enhanced security features such as electronic access controls, CCTV security cameras and in-house medical alert systems.

Why and When Someone with a Mental Health Condition Should Consider Assisted Living

Assisted living facilities provide seniors with structure, stability and a sense of belonging while eliminating the day-to-day stress that comes with maintaining a household. Individuals with mental health disorders may want to consider joining an assisted living community when it becomes too overwhelming and physically risky to perform the tasks that come with living independently, such as cooking, cleaning and managing their living expenses.

Assisted living can also be a good option for seniors who find that living among their peers helps them feel less anxious or agitated.

Finding the Right Assisted Living Community

What to Look for in an Assisted Living Community for Seniors With Mental Health Disorders

• Staff available 24/7 to notice and report any red flags that would go unnoticed if the senior were living alone.
• A robust activity program that includes a variety of individual and small-group activities.
• A dedicated memory care unit with enhanced security features to reduce the risk of wandering (for seniors with mental health disorders related to memory loss).
• Access to enhanced mental health services, such as a visiting physiatrist, social worker or other medical professional who specializes in mental health care.
• Proximity to outpatient mental health services offered through a hospital or specialty clinic.

Downloadable Checklist for Finding a Community for Seniors with Mental Health Conditions

State Resources for Mental Health Assistance

Click on your state on the map below to learn about your state’s mental health resource department and view its contact information and available services.

*American Samoa  –  *Guam  –  *United States Virgin Islands