The number of people aged 65 years and older (P65+) has not stopped growing in recent years. The World Bank estimates that P65+ people will make up 10% of the world’s population in 2022. This percentage has nearly doubled since 1960, when it was just 5%. In absolute numbers, we are talking about an age group that has grown from 150 million in 1960 to 747 million in 2021.
In Latin America, the demographic transition is happening even faster. In 2020, more than 8% of the population was over 65 years of age, and this proportion is estimated to double by 2050, even exceeding 30% by the end of the century.
In Europe and Spain we are not far away. At the beginning of 2024, according to INE, the percentage of P65+ was 23% of the Spanish population, that is, more than 1 in 5 citizens. The upward trend in this population and its low birth rate already place Spain among the oldest European countries.
This figure rises even further in some autonomous communities such as Galicia, which with its 27% is at the top of the oldest European regions. This, together with other socio-demographic characteristics such as population dispersion, makes it an ideal “laboratory” for testing policies aimed at successfully planning for the aging of all EU countries.
The high representation of P65+ people in the Spanish population requires social and health policies tailored to their needs, an understanding of health in general and the integration of its biological, psychological and social aspects.
More chronic illnesses and more losses of loved ones
The particular deterioration in the mental health of P65+ people is due, among other things, to a higher incidence of chronic and disabling diseases, as well as neurodegenerative and mental disorders. In addition, life events such as retirement or bereavement have a strong psychological and social impact.
The reported incidence of mental disorders in primary care consultations in Spain has increased from 25% in 2016 to 36% in 2021, which certainly reflects both an increase in their frequency and intensity in the general population and greater public awareness of them. dramatic consequences. . The most common disorder in 2021 was anxiety disorders (13%) (17% in women and 9% in men), followed by insomnia (7.8%) and depression (4.6%). These frequencies increase with age, especially with depression and insomnia.
It is important not to lose sight of the fact that the older population is at a stage of life in which people are most diverse, including both highly dependent people and people in good physical and mental health. Thus, in 2020, it is estimated that 50% of P65+ people rate their health status positively (more women), 41.3% of those who have mobility problems (also more women) and 26.6% of those who report some degree of cognitive impairment.
In 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 will be about 1,200,000 people with this disease (7% of the population). And so if you include family caregivers in this equation, that would affect about 5,000,000 people.
Among patients treated in primary health care settings, diagnoses of depression, sleep disorders and somatization disorders are very common among people aged 65 years and older. Suicide is the most fatal consequence of mental illness. Spain maintains a stable rate, with slight increases and decreases over the last 30 years and an intermediate situation on a European scale, but with much higher rates among older people, especially among people 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, especially among people aged 65 years and over, which is the leading consumption of these substances in Europe.
Action needs to be taken
The accumulating evidence on mental disorders in this age group and its implications for quality of life, disability and survival requires urgent attention, requiring comprehensive institutional and citizen responses to urgently address this public and social health priority.
It is clear that the incidence of mental disorders among people over 65 has risen faster than policies to address them. Thus, the WHO approach to aging has evolved from 2002, with the launch of the “active aging” model, to 2015-2030, with the slogan “healthy aging” and a multisectoral approach to health in accordance with the UN Decade of Healthy Aging. (2021–2030) and the 2030 Agenda.
WHO recommends focusing efforts on:
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Reduce risk factors associated with disease and increase protective factors for health through healthy habits and exercise.
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Develop protective actions of cognitive function.
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Cultivate a positive attitude towards life.
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Encourage social participation.
This model of healthy aging has given rise to new initiatives and first reactions in some countries such as the UK or France. Although there is no known multisectoral strategy targeting P65+ in Spain, the Health Promotion and Prevention Strategy in the national health system includes a section of recommendations aimed at healthy aging and frailty prevention.
At the health level, consensus documents from numerous national and international interdisciplinary scientific societies, supported by WHO, since the turn of the new millennium have reaffirmed the need for targeted solutions to mental health problems in the last stage of life. as happens with the first period (childhood-adolescence), where the specifics seem more understandable to society. The need for this specificity becomes unquestioned among octogenarians and nine-year-olds, where “psychogeriatric” patients are concentrated and simultaneously accumulate a complex mixture of physical, mental and social problems.
Involve older people in discussions about new policies
These principles have also been advocated in the EU, for example in the 2008 Consensus Document on Mental Health in Older People or the Thematic Conference on Wellbeing and Mental Health in Older People held in Madrid in 2010, with a wide interdisciplinary representation of professionals from our country. One particular point worth highlighting from their findings is the need to involve older people themselves in discussions about new policies and in evaluating their results.
In Spain, the new millennium brought hope when these principles were included in detail in the 2007 National Health System Mental Health Strategy and were even specified in the mental health strategic plans of some autonomous communities, such as the Galician one. However, they never fully materialized, and their development was ignored in subsequent documents (of course, another collateral damage of the economic crisis). In fact, it has only a minor place in the current 2022-2026 edition.
The digital divide problem
The mental health of P65+ people is affected by a number of risk factors that cause a higher incidence of disorders, increasing with increasing life expectancy. Over the past 50 years, society has changed, and the role of older people in it has changed. Technological advances and new digital management and communication platforms are putting older people at a disadvantage, giving rise to the concept of a “digital divide.”
This, coupled with the frequent situation of loneliness caused by the departure of children or the need to live with them or in nursing homes, makes this population group more susceptible to risk factors emanating 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 poorly predictable diseases make this stage of life highly vulnerable to the onset of mental disorders, many of which are related to mood. (depression, anxiety) and their consequences in terms of quality of life and mortality.
It’s worth highlighting the risks associated with ageism, a concept that reflects the way we think, feel and act towards 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 assign tasks to them, etc.
These beliefs are at odds with reality, as today’s increasing life expectancy means that many older people have full ability to perform tasks and professions that have until now been reserved for new generations. The concept of functional ability must be expanded in the professional field, using the potential provided by experience and the associated problem-solving ability.
Overall, the prospects for improving the health and quality of life of the P65+ population require a multisectoral effort, with health – and within it mental health – a cross-cutting concept across all policies.
The article was written on the recommendation of the Spanish Society of Epidemiology.