Mental Health Worsening in Aging Population

David Rehkopf, ScD, MPH

Findings of an analysis of nearly 2.5 million patients showed that individuals aged 60—69 years old experienced a pattern of decreasing mental health, while physical and general health remained stable or improved.

David Rehkopf, ScD, MPH, an associate professor of medicine at Stanford University School of Medicine, and colleagues examined trends in general, physical, and mental health measured in US adults who were at least 60 years old. The investigators found that trends in decreasing mental health were greater for individuals with lower income or education than those with higher income or education.

The trends identified by Rehkopf and his team may have important implications for future life expectancy, disability, and the ability for older individuals to engage productively in society.

The team used population data from the Behavioral Risk Factor Surveillance System, a telephone survey given by state health departments with help from the Centers for Disease Control and Prevention. Overall, 2,432,609 respondents participated in the survey—62% women, 6.5% black, 3.2% Latinx, 41% had a household income of $35,000 or less per year, and 10% had less than a high school education.

General and physical health improved or remained stable for individuals at least 65 years old from 2003—2017. For those aged 65–69 years old, 23% said they were in fair or poor general health in 2003, while 19% said so for 2017.

Patients in that population reported stable physical health, which was measured as days per month with illness. Respondents said their days per month with illness was 4.9 days in both 2003 and 2017.

Among those aged 60—64 years old, general health remained stable (23% for both 2003 and 2017), while physical health declined slightly (5 days for 2003 and 5.4 for 2017).

There was a more substantial decrease in mental health problems—days per month with illness—for patients 60—64 years old (2.9 days for 2003 and 3.6 days for 2017), patients 65–69 years old (2.3 days for 2003 and 3 days for 2017), and those 70–74 years old (2.2 days for 2003 and 2.4 days for 2017).

Individuals between 60—69 years old had a significant decrease in mental health over the time period (3.5% increase in number of mentally unhealthy days per year [P <.001]).

To a varying degree, gender, income, and education all affected the mental health of patients at least 60 years old. For example, those with a household income below $35,000 per year experienced more poor mental health days per month (2.9 days in 2003 to 4.1 days in 2017).

If an individual did not have a high school diploma, the number of poor mental health days per month went from 3.6 days in 2003 to 4.4 days in 2017.

The worsening of mental health is not associated with the Great Recession and could be because of the effects of labor market conditions as individuals age.

The trends on mental, physical, and general health could affect life expectancy and disability, the investigators concluded.

The study, “Trends in Mental and Physical Health-Related Quality of Life in Low-Income Older Person in the United States, 2003 to 2017,” was published online in JAMA Network Open.