It isn’t easy getting old. The body grows less reliable than it used to be, the mind slows down, and lifestyle changes can add stress. Even so, many seniors manage to “grow old gracefully,” maintaining their overall health and financial security and staying active with friends and hobbies they enjoy. 

But many older adults struggle with physical and mental health in ways that can worsen chronic issues or create new ones. Chronic pain can lead to a dependence on prescription opioid medications, and depression and anxiety may lead to a misuse of substances like alcohol to escape or numb the feelings. Mental decline that comes with age may develop into symptoms of dementia, which can be worsened by substance use. 

How can you tell if your older loved one is struggling? And what can you do about it if they refuse to get treatment?

Signs of Mental Illness in Older Adults

The National Institute of Mental Health (NIMH) provides a long list of signs of mental disorders in older adults. Many of these signs apply to people of any age – things such as noticeable changes in mood, appetite, or energy level; difficulty sleeping or concentrating; persistent sadness; increased stress and worry; anger and irritability. 

However, it can be easy to confuse signs of aging with signs of mental health issues. For example, sleep and eating patterns change as we get older. Older people may experience increased stress, sadness, or anxiety when undergoing some of the major life changes that are a part of aging (long-time friends dying or a spouse dying, moving to a smaller home or an assisted living facility, living alone for the first time in years, etc.).

Generally, if you know the person well and pay attention, you can probably tell when something has gone outside the normal path of age-related changes. If your loved one is acting erratically or taking undue risks with their own or others’ safety, it’s time to seek help. If they begin to talk about seeing, hearing, or feeling things that no one else can perceive, it’s time to seek help. If they begin talking more about death and expressing hopelessness, seek help immediately.  

While compassionate treatment for mental health and substance use issues in seniors is widely available and effective, what if your loved one refuses treatment?

When Your Senior Loved One Refuses Treatment

Unless your loved one is a danger to themselves or others (a situation we’ll discuss in the next section), it’s their right to refuse treatment. People refuse treatment for many reasons. 

According to the American Psychological Association (APA), people report that cost is the number one reason they avoid getting mental health treatment. Other reasons include:

• They think they can handle the issue on their own
• They don’t know where to go 
• They’re afraid of being committed or of the effects of medication
• They’re worried about what people will think of them
• They don’t think treatment will help

If your loved one is refusing to get treatment, here are some things you can do that might help change their mind. 

• Gently explain the specific behaviors you’re seeing that concern you and how those behaviors affect friends and family members of your loved one. Emphasize that you want your loved one to be happy and healthy.
• Offer to help them find a therapist or a behavioral health facility. If you’re able, offer to help pay any costs not covered by insurance.
• Explain how mental health treatment and/or therapy works – emphasize that it is confidential, that medication is optional, and that it won’t last forever. 
• Tell them they deserve to feel good and to take care of themselves. 

What is an Involuntary Commitment and How Does it Work?

In the event that your loved one continues to refuse treatment and is behaving in a highly risky way that may harm themselves or someone else, involuntary commitment may be an option. 

If your loved one is expressing suicidal ideation, don’t wait to act. Call 988, the Suicide & Crisis Lifeline to speak to a counselor who can help you decide what to do next. The Lifeline is available 24 hours a day, 7 days a week. 

To learn more about how involuntary commitment works in North Carolina, see this flow chart that explains the process. As you’ll learn, the process has many built-in check points to ensure that patients will get the level of help they need and that patient rights are respected. For more information, visit the North Carolina Health and Human Services website.

Help for Older Adults at Raleigh Oaks

If you or a loved one is 56 or older and in need of mental health treatment for depression, anxiety, or complicated grief, reach out to our facility in Garner, NC. We can talk with you about inpatient and outpatient treatment options as well as how we handle involuntary commitments. Regardless of how our patients come to us, we encourage all patients to take back control of their mental well-being in a program we call Passport for Hope.