How the U.S. — and the World — Can Help Address Loneliness and Mental Health of Older People

As people get older, issues like physical frailty, cognitive decline, grief, and loneliness can take a serious toll on their mental health. Around the world, it is important for countries to monitor and support the emotional, psychological, and social well-being of their aging populations. New survey research from the Commonwealth Fund, looking at adults age 65 and older in the United States and nine other countries, examines why people do not get the mental health care they need.¹

The survey asked questions about mental health and specifically about diagnosed medical conditions, emotional distress, and self-reported isolation. Older adults in Australia, France, the U.S., and Canada reported the highest rates of having at least one mental health concern, with a quarter or more of people in each of these countries reporting this concern. Older adults in the U.S. reported the highest rates of diagnosed mental health conditions, nearly one of five, compared to one of 20 in the Netherlands.

Rates of self-reported emotional distress, defined as having anxiety or great sadness that it is difficult to cope with by yourself, were highest among older adults in France (25%) and Australia (24%).

Older adults are also more likely to report loneliness and social isolation, which can negatively affect their mental health and well-being. Around one of 20 older adults in the U.S. said they often felt isolated from others. Rates of self-reported isolation among older adults were highest in Australia (10%) and lowest in Switzerland (2%).

Older adults with a mental health care issue, including a diagnosed mental health condition, self-reported emotional distress, or feeling isolated from others, were asked why they did not receive mental health treatment or counseling. The most common reason — cited by more than six of 10 older adults in all surveyed countries — was not wanting or needing a health care professional, which could indicate a hesitation to seek treatment or a belief that their mental health condition did not require a health care intervention. Previous research has found that stigma is a major obstacle among older adults seeking mental health services.

In the U.S., 13 percent of older adults reported not getting mental health either because they could not afford the cost, could not find an appropriate provider, didn’t know how to find the treatment they needed, or the wait to see a professional was too long. Fewer than one of 10 older adults in all countries cited affordability and accessibility as main reasons for not receiving care.

How Are Countries Addressing Mental Health and Loneliness in Older Adults?

For older adults, loneliness and social isolation can increase risks for both physical and mental health needs. In recent years, adults age 75 and older had the highest suicide rate among all age groups in the U.S.

Yet, many older adults with mental health issues are not seeing mental health providers because they believe they do not want or need to do so. While this could indicate that their mental health is not detracting from day-to-day well-being, these results could reveal a hesitancy to seek treatment because of ongoing stigma.

Other countries have taken a variety of approaches to address older adults’ mental health. For example:

• In the Netherlands, the government-run program, United Against Loneliness, aims to reduce loneliness among older people by raising awareness, providing yearly home visits to people age 75 and older to explain available supports and services, 24-hour telephone lines staffed by volunteers or social workers, and helping general practitioners refer patients reporting loneliness to local activities.
• The National Health Service in England has created guidelines for “social prescribing” — that is, linking patients to support in their local communities. These efforts to address patients’ nonmedical needs, like loneliness, have been incorporated into the NHS’ long-term plan.
• The U.K.’s Campaign to End Loneliness developed a framework for understanding different approaches to addressing loneliness — primarily for older adults. The framework sets out broad categories of approaches (e.g., providing connector services that reach, understand, and support lonely individuals; addressing infrastructure barriers like transportation, digital access, and built environment; and direct solutions such as one-to-one or group connections). Policymakers at various levels of government can use the framework to think about what approaches currently exist in their jurisdiction and can also be used to identify gaps.

Using the Medicare Program to Help Older Adults’ Mental Health

Medicare, the federal program that provides health insurance for adults age 65 and older in the U.S. and younger adults with significant disabilities, covers both outpatient and inpatient mental health services as well as prescription drugs that treat mental illness. The program also covers annual depression and substance use screenings; some Medicare Advantage plans cover additional services like grief counseling.

Medicare payment reforms finalized for 2024 aimed to expand access to different types of behavioral health care providers. The goal of these reforms was to allow more flexibility in the types of providers that are eligible to be reimbursed and support community-based care.

However, there are still gaps in Medicare mental health coverage. These include inpatient day limits that can impact beneficiaries with chronic mental illness, limited mental health provider networks, and a lack of coverage for serious mental health needs like psychiatric rehabilitation. Medicare beneficiaries experiencing loneliness or isolation are more likely to report poor patient–provider communication, including listening to patients, showing respect, and spending sufficient time with patients. Improving such communication could help connect people with needed mental health services.

Across countries, nearly one of five older adults, or more, reported at least one mental health issue. Without policies aimed at addressing mental health, this problem will only grow as the age-65-and-older population gets larger and is compounded for their family members and caregivers. Ultimately, collaborative learning among health leaders and policymakers is key to improving older adult behavioral health. We face a choice: investing in integrated care, leveraging technology, and bolstering the workforce to ensure timely, high-quality access to vital services across all settings, or failing to meet the critical needs of older adults.