Improving the Quality of Life of Older Adults With Psychiatric Disorders

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SPECIAL REPORT: GERIATRIC PSYCHIATRY

The population of older adults in the world is growing at a rapid rate.¹ By 2030, 1 in 6 individuals worldwide will be 60 years or older. By 2050, this population is expected to rise to 2.1 billion. Simultaneously, the population of individuals 80 years or older is expected to triple to 426 million by 2050. Approximately 14% of adults 60 years or older have a psychiatric disorder, and these disorders account for 10.6% of the total years lived with disability for this age group.² Common psychiatric disorders among older adults include personality, anxiety, mood, substance use, and neurocognitive disorders, especially due to Alzheimer disease (AD).^3,4

Although psychiatric disorders are common among older adults and cause significant disability, they are often undiagnosed and untreated.⁵ When compared with younger individuals, older adults are less likely to receive a psychiatric diagnosis (P < .001), have fewer visits with a psychiatrist (P < .001), receive less psychotherapy (P < .001), but have greater rates of psychotropic medication visits (121.4 per 100 population vs 56.8 per 100 population).⁶ Additionally, nonpsychiatrists often prescribe most of the psychotropic medications for older individuals, with 1 study identifying that only 4.8%, 3.5%, 17.3%, and 12.9% of the visits for antidepressants, anxiolytics, antipsychotics, and mood stabilizers among the older population were with a psychiatrist.⁷ Furthermore, inadequate assessment and treatment of common psychiatric disorders among older individuals can worsen outcomes including decreasing their quality of life, and increasing morbidity and mortality rates.^5,8

Currently in the United States, there are only 2.6 geriatric psychiatrists per 100,000 older adult population.⁹ Rhode Island (14.1), New York (7.5), and Hawaii (7.0) are the states with the highest concentration of geriatric psychiatrists per 100,000 older adults. Oklahoma (0.2), Mississippi (0.0), and North Dakota (0.0) are the states with the lowest concentration of geriatric psychiatrists per 100,000 older adults. During the 2024-2025 academic year, there were 60 Accreditation Council for Graduate Medical Education–accredited geriatric psychiatry fellowship programs in the US, with only 44 on-duty trainees enrolled in these programs.¹⁰ The corresponding numbers during the 2019-2020 academic year were 62 accredited programs, and 42 on-duty trainees enrolled in these programs.¹¹ Given the overwhelming evidence that the workforce needed to provide appropriate psychiatric care to older adults in the US is falling behind, there is an urgent need to intervene to rectify this situation.^12,13

One way to improve the care of this vulnerable population is to educate professionals about the best practices in caring for older adults with psychiatric disorders. To assist with this important task, Psychiatric Times has compiled a 2-part Special Report focused on psychiatric disorders among older adults. We hope that our readers find these articles interesting and informative. Additionally, we hope that the information in these articles will help clinicians improve the quality of life of the older adults with psychiatric disorders who are under their care.

Dr Tampi is a professor and chair of the Department of Psychiatry at Creighton University School of Medicine and Catholic Health Initiatives Health Behavioral Health Services, both in Omaha, Nebraska. He is also an adjunct professor of psychiatry at Yale School of Medicine and a member of the Psychiatric Times editorial board.

References

1. Aging and health. World Health Organization. October 1, 2024. Accessed August 20, 2025. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

2. Mental health of older adults. World Health Organization. October 20, 2023. Accessed August 20, 2025. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

3. Reynolds K, Pietrzak RH, El-Gabalawy R, et al. Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry. 2015;14(1):74-81.

4. 2024 Alzheimer’s disease facts and figures. Alzheimer’s Association. 2023. Accessed August 20, 2025. https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf

5. de Mendonça Lima CA, Ivbijaro G. Mental health and wellbeing of older people: opportunities and challenges. Ment Health Fam Med. 2013;10(3):125-127.

6. Maust DT, Kales HC, Blow FC. Mental health care delivered to younger and older adults by office-based physicians nationally. J Am Geriatr Soc. 2015;63(7):1364-1372.

7. Maust DT, Oslin DW, Marcus SC. Effect of age on the profile of psychotropic users: results from the 2010 National Ambulatory Medical Care Survey. J Am Geriatr Soc. 2014;62(2):358-364.

8. Lehmann SW, Ellison JM, Sakauye K, et al. Raising the bar on geriatric mental health competency training. Psychiatric Times. December 3, 2020. https://www.psychiatrictimes.com/view/raising-bar-geriatric-mental-health-competency-training

9. Beck AJ, Page C, Buche J, et al. Estimating the Distribution of the U.S. Psychiatric Subspecialist Workforce. University of Michigan School of Public Health Behavioral Health Workforce Research Center. December 2018. Accessed August 20, 2025. https://www.healthworkforceta.org/wp-content/uploads/2023/07/BHWRC_Estimating-Distribution-of-US-Psychiatrist.pdf

10. Number of Accredited Programs and On-Duty Residents/Fellows for the Academic Year by Specialty, 2024-2025. Accreditation Council for Graduate Medical Education. Accessed August 20, 2025. https://apps.acgme-i.org/ads/Public/Reports/ReportRun

11. Number of accredited programs and on-duty residents/fellows for the academic year by specialty, 2019-2020. Accreditation Council for Graduate Medical Education. Accessed August 20, 2025. https://apps.acgme-i.org/ads/Public/Reports/ReportRun

12. Lyness JM. Geriatric workforce crisis in the United States. International Psychogeriatric Association. Accessed August 20, 2025. https://www.ipa-online.org/resources/workforce-issues/geriatric-workforce-crisis-in-the-united-states

13. Rowe JW. The US eldercare workforce is falling further behind. Nat Aging. 2021;1(4):327-329.