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Behavioral health measures among older adults have worsened over the past decade.

Drug Deaths

There are a variety of reasons why older adults are particularly at risk for drug overdoses. They may unintentionally misuse prescription medications like opioids, are more likely to be taking prescription medications than other populations and face other risk factors including social isolation. Drug abuse is particularly dangerous for this population: Older adults face a reduced ability to metabolize medications due to age-related changes in the liver.
Between 2008-2010 and 2018-2020
Nationally, the number of deaths due to drug injury (unintentional, suicide, homicide or undetermined) per 100,000 adults ages 65 and older significantly increased 100% from 4.2 to 8.4, corresponding to an increase of 8,620 deaths over this period. The drug death rate significantly increased in 35 states, led by: 352% in Connecticut (2.3 to 10.4 deaths per 100,000 adults ages 65 and older), 323% in Maryland (3.5 to 14.8) and 222% in New Jersey (2.7 to 8.7).
Among adults ages 65-74, drug deaths increased 147% from 4.7 to 11.6 deaths per 100,000 — the largest increase compared with all other age groups 15 and older. Both males and females experienced significant increases in the drug death rate: 172% for males (4.3 to 11.7 deaths per 100,000 adults ages 65 and older) and 38% for females (4.2 to 5.8).
Disparities in 2018-2020
The drug death rate was lowest in Nebraska (3.3 deaths per 100,000 adults ages 65 and older), Iowa (4.5) and Mississippi (4.8); it was highest in the District of Columbia (49.5), Nevada (15.5), Maryland (14.8) and Rhode Island (11.7).
The drug death rate significantly varied by race/ethnicity and gender. The rate was 10.4 times higher among Black adults (19.8 deaths per 100,000 adults ages 65 and older) than among Asian adults (1.9) and 2.0 times higher among males (11.7) than among females (5.8).

Frequent Mental Distress

Frequent mental distress is an indicator of health-related quality of life and the burden of mental illness in a population. Frequent mental distress is characterized by 14 or more days of self-reported poor mental health in the past month and is associated with risk factors for poor health.
Between 2011 and 2020
Nationally, the percentage of adults ages 65 and older who reported their mental health was not good 14 or more days in the past 30 days significantly increased 8% from 7.5% to 8.1%. Frequent mental distress among older adults significantly increased 81% in Hawaii (4.2% to 7.6%), 61% in Michigan (6.6% to 10.6%) and 57% in Washington (5.3% to 8.3%).
Some income, education, gender and racial/ethnic subpopulations experienced significant increases in frequent mental distress. Among adults ages 65 and older, increases greater than the national change included:
Disparities in 2020
Frequent mental distress among older adults was lowest in North Dakota (4.8%), South Dakota (5.1%) and Wisconsin (5.8%); it was highest in Michigan (10.6%), the District of Columbia, Kentucky and Nevada (all 10.3%) and West Virginia (10.2%).
Frequent mental distress significantly varied by race/ethnicity, income, education and gender; differences by metropolitan status were not notable. The prevalence among adults ages 65 and older was higher among:
  • American Indian/Alaska Native adults (15.6%), 4.0 times higher than among Asian adults (3.9%). The prevalence was also significantly higher among American Indian/Alaska Native adults than among Black (6.8%) and white (7.8%) adults.
  • Those with an annual household income below $25,000 (12.5%), 2.4 times higher than among those with an income of $75,000 or more (5.2%); the prevalence was significantly lower among those with incomes of $75,000 or more and $50,000 to $74,999 (6.3%) compared with all other income levels.
  • Those with less than a high school education (12.0%), 2.2 times higher than among college graduates (5.4%).
  • Females (9.4%) than among males (6.5%).

Depression

Between 2011 and 2020
Nationally, the percentage of adults ages 65 and older who reported being told by a health professional that they have a depressive disorder significantly increased 9% from 13.0% to 14.2%. Depression significantly increased in seven states, led by Washington (12.6% to 20.0%), Hawaii (7.1% to 10.9%) and West Virginia (12.4% to 19.0%). During the same period, depression significantly decreased in Alaska (19.2% to 10.4%) and Illinois (13.4% to 8.2%). All income and some education, racial/ethnic and gender subpopulations experienced significant increases in depression.
Disparities in 2020
Depression among older adults was lowest in Illinois (8.2%) and highest in Washington (20.0%). The prevalence significantly varied by race/ethnicity, gender, income and education; differences by metropolitan status were not notable.

Excessive Drinking

Between 2011 and 2020
Nationally, the percentage of adults ages 65 and older who reported binge drinking (four or more drinks for females or five or more drinks for males on one occasion in the past 30 days) or heavy drinking (eight or more drinks for females or 15 or more drinks for males per week) significantly increased 16% from 6.4% to 7.4%, affecting 3.8 million older adults in 2020.
Some racial/ethnic, gender and education subpopulations experienced significant increases in excessive drinking; changes by income were not notable. Excessive drinking significantly increased in Kansas (4.0% to 5.9%), Nebraska (5.4% to 7.2%), North Carolina (4.0% to 6.4%), Ohio (4.6% to 7.8%) and West Virginia (2.1% to 4.3%).
Disparities in 2020
Excessive drinking among older adults was lowest in Utah (2.7%) and highest in Wisconsin (11.8%). The prevalence significantly varied by income, education, race/ethnicity, gender and metropolitan status.

Suicide

Suicide is a tragic public health issue that leaves a lasting impact on families and communities. Recorded suicide attempts among older adults are usually more lethal than those among younger age groups. Older adults may also exhibit passive self-harm behaviors that can result in death, such as refusing food, medications or liquids; these are rarely recorded as suicide attempts or deaths by suicide.
Between 2009-2011 and 2018-2020
Nationally, the number of deaths due to intentional self-harm per 100,000 adults ages 65 and older significantly increased 13% from 15.0 to 16.9, corresponding to an increase of 9,239 deaths over this period. In 2018-2020, 27,412 older adults died by suicide. The suicide rate significantly increased in nine states, led by: 40% in Connecticut (9.6 to 13.4 deaths per 100,000 adults ages 65 and older), 37% in Ohio (11.9 to 16.3) and 34% in Oklahoma (16.3 to 21.8).
Disparities in 2018-2020
The suicide rate was lowest in the District of Columbia (8.8 deaths per 100,000 adults ages 65 and older), New Jersey (9.4), New York (9.7) and Massachusetts (9.8); it was highest in Wyoming (35.5), Montana (30.7) and Nevada (30.4).
The suicide rate varied by gender, race/ethnicity and age. The rate was higher among:
  • Males (31.6 deaths per 100,000 adults ages 65 and older), 6.2 times higher than among females (5.1).
  • White adults (20.2), 4.7 times higher than among Black adults (4.3). The rate was significantly higher among white adults compared with all other racial/ethnic groups.
  • Adults ages 85 and older (20.0) than among adults ages 65-74 (15.4). The rate was significantly higher with each increase in age group.

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