Mental health and ageing: a dimension too often forgotten

Behind the clichés (“it’s normal to be sad when you’re old”, “he doesn’t speak any more, he’s isolating himself, it’s his age”), there are actually undiagnosed depressions, undetected suicidal thoughts and untreated psychiatric disorders, with major human and medico-economic consequences.

For Dr Hanon, there are three clichés that have the greatest impact:

• getting older “naturally” makes people sad;
• being old and depressed is inevitable;
• such issues are necessarily linked to early-onset dementia.

However, on the ground, the reality is quite different: mobile psychogeriatric teams mainly work on categorised depressions, addictions and old psychiatric disorders that continue to exist much more frequently than on neurocognitive disorders.

Depression in the elderly is described as an invisible disease: it can’t be seen in people’s faces, but instead hides behind somatic complaints, sleep disorders and gradual withdrawal. And in the absence of specific training, these signals are trivialised. 

The figures raised are striking:

• suicide rates are twice as high in the over-75s as in the general population;
• three quarters of those who died by suicide had seen their doctor in the previous month.

This means the problem isn’t one of access to care, but of non-recognition. The question is simply not asked. Out of taboo. Out of awkwardness. Out of fear of “not knowing what to do” if the answer is yes.

This means the problem isn’t one of access to care, but of non-recognition. The question is simply not asked. Out of taboo. Out of awkwardness. Out of fear of “not knowing what to do” if the answer is yes.

However, the speakers are clear: being asked the question does not lead to patients acting on the idea. On the contrary, it provides relief. Many patients express their appreciation: “Thanks for asking, I didn’t dare talk about it.”

Professor Robert recalls recent scientific data showing that the border between physical and psychological is even more porous with age.

• Physical fragility (muscle loss and slow walking) promotes depression.
• Severe depression accelerates muscle wasting and frailty.

This vicious cycle is associated with chronic low-grade inflammation that also affects the brain. Research shows that older adults with severe psychiatric disorders have a physiological brain age that is greater than their actual age.

In other words: mental health is a central determinant of healthy ageing, just like mobility or nutrition.

Dr Kruczek emphasises an aspect that is too infrequently addressed: enjoyment. Reactivating what they enjoyed before: reading, travelling, writing, seeing friends again, going back to a cultural activity and sometimes even talking about sexuality – a largely taboo subject – can be a powerful therapeutic tool.

These approaches give people a place in society and a sense of meaning once more, directly helping them emerge from depression. In several clinical examples mentioned, patients over 80 years old regained a fulfilling life after appropriate care.

Professor Vandel talks about a mental health gap among the elderly: psychiatric disorders represent a major burden for society, but after the age of 65, there are fewer resources allocated to their care.

Psychogeriatrics has only recently been recognised as a subspecialism. The speakers all agree that the priority should be to provide mass caregiver training at all levels to allow them to:

• identify depression in elderly patients (which does not resemble depression in young adults);
• dare to ask about suicide;
• prescribe the right treatment dose at the right time (and do not outsource on principle).

Medico-economic studies show that an undetected depressive episode in an elderly person multiplies health costs threefold, including emergency hospital visits, falls, repeated consultations and inadequate treatment.

Investing in early detection and management is therefore not only an ethical requirement, but a measure of the health system’s efficiency.