Mental Health in Older Adults: Overlooked and Undertreated
By Bright Setorglo, PMHNP-BC · July 05, 2026
Mental Health in Older Adults: Overlooked and Undertreated
Mental health conditions affect 20% of adults aged 65 and older, yet the vast majority receive no treatment. The myth that depression and anxiety are "normal parts of aging" leads to underdiagnosis, undertreatment, and unnecessary suffering. Geriatric psychiatry addresses the unique mental health needs of older adults with specialized assessment and treatment approaches.
Why Older Adult Mental Health Is Overlooked
Several factors contribute to undertreatment. Attribution bias leads clinicians and family members to attribute symptoms to physical illness, medication side effects, or "normal aging" rather than recognizing depression or anxiety. Somatic presentation is common in older adults — depression may present as pain, fatigue, or cognitive complaints rather than sadness. Stigma is particularly strong in generations that were taught to "tough it out." Access barriers include transportation limitations, mobility issues, and lack of geriatric-trained providers.
Depression in Late Life
Late-life depression is not normal and is associated with increased mortality, cognitive decline, and suicide risk. Older adults have the highest suicide rate of any age group, with men over 85 having the highest rate of all. Depression in older adults often presents with cognitive symptoms (pseudodementia), apathy, and anhedonia rather than classic depressed mood. It is also associated with vascular changes and small vessel disease, suggesting a different neurobiological substrate than early-onset depression.
Unique Medication Considerations
Older adults metabolize medications differently. Reduced hepatic and renal function prolongs drug half-lives. Polypharmacy increases interaction risks. Anticholinergic medications (including some antidepressants and antipsychotics) worsen cognition and increase fall risk. Start low, go slow, but go is the guiding principle of geriatric psychopharmacology.
Selective Serotonin Reuptake Inhibitors (SSRIs) are first-line for late-life depression. Sertraline and escitalopram have favorable side effect profiles. Psychostimulants may be used for severe apathy or treatment-resistant depression in palliative care settings.
Telepsychiatry for Older Adults
Telepsychiatry eliminates transportation barriers, reduces exposure to infectious illness, and allows family members to participate in appointments from different locations. Technology training and simplified interfaces make telepsychiatry accessible even for patients with limited tech experience.
PathToHope provides geriatric psychiatric evaluations and medication management through telepsychiatry across Oregon, Texas, and Florida.
About the Author: Bright Setorglo, PMHNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner and the founder of PathToHope Wellness and Behavioral Health Wellness & Behavioral Health. He provides comprehensive telepsychiatry services across Oregon, Texas, and Florida.
Disclaimer: This article is for educational purposes only and does not constitute medical advice. If you are experiencing a mental health emergency, call 988 (Suicide & Crisis Lifeline) or 911 immediately.