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How to Support Older Adults With Serious Mental Illness

Ways that caregivers can make sure their loved ones are doing well

By Judy Stringer and Benjamin Rose Institute on Aging

Managing serious mental illnesses, such as schizophrenia, bipolar disorder and recurring depression, is difficult at any stage of life. But aging creates a new set of challenges, according to Tamar Cooper, associate director of Behavioral Health Services at Benjamin Rose Institute on Aging in Cleveland.

man by the window, mental illness
Credit: Adobe

Older adults with serious mental illness, or SMI, often have co-occurring conditions, such as diabetes, respiratory illness and cardiovascular diseases, which complicate SMI treatment, Cooper said. Age-related metabolism changes and cognitive declines, meanwhile, jeopardize medication effectiveness.  

"They may forget their medications or take the wrong dosage," Cooper said.

Then there are external stressors – the loss of a spouse or friend, for example, or prolonged isolation – that can trigger emotional responses that exacerbate mental disorders. 

"Recognizing the signs of a relapse may be difficult because many older adults with severe mental illnesses were diagnosed at a much younger age," she said. "Caregivers often don't know what to look for."

The good news is that older adults with SMI do benefit from the proper medical interventions. Caregivers, Cooper said, play an important role in helping their loved ones stay the course.

"An important question to ask is 'How do you know if you are not doing well?'"

That begins with ensuring they are maintaining regular doctor visits and taking medications correctly. But given the severe nature of these conditions, Cooper suggests an even more hands-on approach.

Aging Successfully with SMI

The U.S. Department of Health and Human Service's Substance Abuse and Mental Health Services Administration estimates that approximately 20% of Americans over 65 experience mental health issues, with up to roughly 5% having an SMI. People with SMI die earlier than the general population, the agency finds, and are at higher risk for multiple adverse health outcomes.

Cooper said dangerous interactions between a patient's "psychotropic" prescriptions, such as mood stabilizers and antidepressants, and the medicines, vitamins and herbal supplements they are taking for other conditions is one of the biggest concerns, as adults with SMI age and experience mounting health challenges. People should consult with their health provider to discuss possible drug interactions or negative side effects.

Drug adherence is another common problem. Older adults are more likely to experience forgetfulness, because of cognitive declines or other risk factors like stress or lack of sleep, Cooper said. Or, upon feeling better, they may intentionally go off their SMI medications.

"There are also issues like the longevity of the treatment course and changes that might be necessary as the patient gets older," according to Cooper.


She said managing SMI among older adults, especially those living independently, requires special attention on the part of spouses, partners, children and other family and friends lending their support. Her advice:

  • Benchmark behaviors: Because SMI is most often diagnosed during early adulthood or midlife, Cooper said caretakers who were not present at that time should inquire about relapse signals. "An important question to ask is 'How do you know if you are not doing well?'" she said. Also, pay attention to the person's behaviors and environment, so you can easily spot any troubling changes, such as a sudden disinterest in hobbies or lack of personal upkeep.
  • Take the person's medications seriously: Cooper said accompanying your loved one on medical office visits – virtual or in-person – is a great way to help guard against problems associated with drug interactions. Supply prescribing physicians with a list of all the medicines he or she is currently taking, including over-the-counter ones. Back at home, help your loved one follow the proper regimen by placing medications in specially designed pill dispensers or create a pill board for multiple medications. Also, make sure the older person is aware of the danger of mixing alcohol with psychotropic drugs and be on the lookout for signs of alcohol abuse.
  • Get releases: Mental health disorders combined with age-related illnesses can compromise an older adult's ability to make sound decisions regarding care or sometimes even recognize their own care needs. Ahead of any problems, work with your loved one and health care providers to complete paperwork that gives you access to his or her medical information, Cooper suggested. You might also consider obtaining a legal power of attorney to make decisions, including medical ones, on his or her behalf, should that become necessary.  

Beyond these particular concerns, the needs of an older adult with SMI are not so different than that of any other aging adult, Cooper said. She stressed the importance of reaching out to older family members and neighbors and helping them stay connected and engaged, especially given the significant impact the lingering coronavirus pandemic is having on this population.

Tamar Cooper, mental illness, next avenue
Tamar Cooper

"There is so much going on right now that complicates all of our lives, but it does so especially when we are not feeling well or suffer from isolation, as many older people do," Cooper said. "It impacts our mood and our perspective, makes us anxious and stressed. That is why it is so important to address those emotional needs of older adults, before they develop into something more serious."

Editor's Note: This article is part of an editorial partnership between Next Avenue and the Benjamin Rose Institute on Aging, a Cleveland-based nonprofit whose mission is to advance support for older adults and caregivers.

Judy Stringer photo
Judy Stringer is a freelance writer and editor with more than 25 years of experience contributing to media outlets. Many of her frequent articles appear in Crain’s Cleveland Business, where she also writes for the paper’s custom content division, Crain Content Studio. In addition to business, she covers community news and oversees special sections about senior living, wellness and home improvement for ScripType Publishing, a collection of nine monthly magazines in Summit and Cuyahoga counties in Ohio. Read More

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