The population of people aged 65 and over (P65+) has not stopped growing in recent years. The World Bank estimates that in 2022 the P65+ represented 10% of the world’s population. This percentage has almost doubled since 1960, when it was only 5%. In absolute numbers, we are talking about an age group that has gone from 150 million in 1960 to 747 million in 2021.
In Latin America, the demographic transition is taking place even more rapidly. More than 8% of the population was over 65 years of age in 2020 and it is estimated that this proportion will double by 2050, and even exceed 30% by the end of the century.
In Europe and Spain we are not far away. At the beginning of 2024, according to the INE, the percentage of P65+ amounted to 23% of the Spanish population, that is, more than 1 in 5 citizens. The upward trend in this population and the low birth rates already place Spain among the oldest European countries.
This figure shoots up even more in some autonomous communities, such as Galicia, which with its 27% is at the top of the oldest European regions. This, together with other sociodemographic characteristics such as the dispersion of its population, make it an ideal “laboratory” for testing policies aimed at successfully planning the aging of all EU countries.
The high representation of P65+ in the Spanish population requires social and health policies appropriate to their needs, understanding health as a whole and integrating its biological, psychological and social dimensions.
More chronic illnesses and more loss of loved ones
That the mental health of P65+ people is especially affected is due, among other reasons, to the greater frequency of chronic and disabling diseases and neurodegenerative and mental disorders. Furthermore, life events such as retirement or the loss of loved ones produce a high psychological and social impact.
The recorded frequency of mental disorders in primary care consultations in Spain has increased from 25% in 2016 to 36% in 2021, surely reflecting both an increase in its frequency and intensity in the general population and a greater awareness in society. about its dramatic consequences. The most frequent in 2021 were, at 13%, anxiety disorders (17% in women and 9% in men), followed by insomnia (7.8%) and depression (4.6%). These frequencies rise with age, especially depression and insomnia.
It is necessary not to lose sight of the fact that the group of older people is in the stage of life in which human beings are most diverse, encompassing both very dependent people and people who enjoy good physical and mental health. Thus, in 2020, it is estimated that 50% of P65+ assess their health status positively (more women), 41.3% those who have some mobility problem (also more women) and 26.6% those who report some degree of cognitive impairment.
Within this last group, in the absence of precise data provided by the national health system, associations of relatives of people with dementia estimate that in Spain there would be around 1,200,000 people with this disease (7% of the population). And therefore, by including their family caregivers in the equation, some 5,000,000 people are affected.
Among patients treated in primary care, diagnoses of depression, sleep disorders and somatizations are very frequently collected in people aged 65 years and over. Suicide is the most important fatal consequence of mental illness. Spain maintains a stable figure with slight increases and decreases in the last 30 years and an intermediate situation on the European scale, but with much higher rates in older people, specifically in those over 75 years of age.
On the other hand, the consumption of psychotropic drugs and especially benzodiazepines (drugs to reduce anxiety or sleep) among the Spanish population is very high, particularly in people aged 65 and over, leading the European consumption of these substances.
Measures need to be taken
The accumulated evidence of mental disorders in this age group, and its consequences on quality of life, disability and survival, demands an urgent call for attention, requiring an integrated institutional and citizen response to urgently address this public and social health priority.
It is evident that the frequency of mental disorders in P65+ has grown faster than the policies to address them. Thus, the WHO’s approach to aging has evolved since 2002, with the launch of the “active aging” model, until 2015-2030, with the motto of “healthy aging” and a multisectoral health approach in line with the UN Decade of Healthy Aging (2021–2030) program and the 2030 Agenda.
The WHO recommends concentrating efforts on:
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Reduce risk factors associated with diseases and increase health protection factors through healthy habits and physical exercise.
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Develop protective actions for cognitive function.
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Promote positive attitudes towards life.
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Promote social participation.
This model of healthy aging has generated new initiatives and early reactions in some countries, such as the United Kingdom or France. Although in Spain there is no known multi-sector strategy aimed at P65+, the Health Promotion and Prevention Strategy in the National Health System includes a section of recommendations aimed at healthy aging and the prevention of frailty.
At the level of health care, consensus documents from numerous national and international interdisciplinary scientific societies, with the support of the WHO, have been reiterating from the threshold of the new millennium the need to specifically address mental health problems in the last stage of life, as occurs with the first (childhood-adolescence), where the specificity seems to be more easily understood by society. The need for this specificity becomes peremptory among octogenarians and nonagenarians, where “psychogeriatric” patients are concentrated, who simultaneously accumulate a complex mix of physical, mental and social problems.
Include older people in the deliberations of new policies
These principles have also been advocated within the EU, as in the Consensus Document on Mental Health in Older People of 2008 or the Thematic Conference on Well-being and Mental Health of Older People, held in Madrid in 2010, with a broad interdisciplinary representation of professionals from our country. It is worth highlighting a specific point from their conclusions: the need to include the elderly themselves in the deliberations of new policies and in the evaluation of their results.
In Spain, the new millennium gave rise to hope when these principles were incorporated in some detail into the Mental Health Strategy of the National Health System of 2007, and were even specified in the strategic mental health plans of some autonomous communities, such as the Galician one. However, they have not finally materialized and their development has been ignored in subsequent documents (surely, another collateral damage of the economic crisis). In fact, it only occupies a marginal space in the current 2022-2026 edition.
The problem of the digital divide
The mental health of P65+ is affected by a set of risk factors that generate a greater frequency of disorders enhanced by increasing life expectancy. Society has changed in the last 50 years and so has the role of the elderly in it. Technological advances and new digital management and communication platforms place older people at a disadvantage, giving rise to the concept of the “digital divide.”
This, together with the frequent situation of loneliness derived from the departure of children or the need to live with them or in nursing homes, places this population group in conditions of greater exposure to risk factors derived from the family and social environment. .
The loss of loved ones, friends and, especially, a partner, the experience of retirement and the high incidence of chronic, disabling or poor prognosis diseases make this stage of life highly vulnerable to the appearance of mental disorders, many of them related to mood (depression, anxiety) and their consequences in terms of quality of life and mortality.
It is worth highlighting the risks derived from ageism, a concept that reflects how we think, feel and act in relation to other people based on their age. In the case of older people, we could collect numerous beliefs and prejudices related to physical and mental deterioration, the ability to entrust them with tasks, etc.
These beliefs collide with reality given that, today, the increase in life expectancy has meant that numerous older people have full capabilities to carry out tasks and professions until now reserved for new generations. The concept of functional capacity must be extended in the professional field, taking advantage of the potential provided by experience and the problem-solving capacity linked to it.
Overall, the prospects for improving the health and quality of life of the P65+ require a multisectoral effort, where health – and within it mental health – is a transversal concept in all policies.
Article written with the advice of the Spanish Society of Epidemiology.