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We hear over and over again about the extreme staffing shortages in senior living, and particularly about the lack of interest that younger people have in working in this industry.

But one twenty-something is bucking the trend. Alex Pavone, who graduated from Penn State University with a degree in health policy administration, said, “For many people, especially younger adults, senior living isn’t an appealing field. But for me, the industry is really intriguing. With the older population expanding, it poses a lot of opportunities for a long-term career.”

Alex’s interest in senior living started at a young age. Alex’s interest in senior living started at a young age. “Volunteering at a community in high school, a college course in long-term care management, shadowing opportunities, as well as close relationships with my grandmothers,” she said. “These are a few of the things that sparked my interest in the industry.”

Alex’s recent visit to the 2023 LeadingAge Annual Meeting in Chicago made her interest even stronger. “I thought it would be a great opportunity to see what kind of resources are available to the industry,” she said. “The most fascinating thing was seeing the innovative products vendors have brought forward to serve these communities.”

Alex particularly loved the technology offerings. “I was especially interested by technology-based viewing of communities that allows you to ‘walk’ through the community without having to be there in person. This is a great resource for adult children as well as potential residents. Another technology I was excited about was robot restaurant servers.”

Currently working as an account manager and analyst, Alex has a strong work ethic, which runs in the family. Alex has seen her father, Michael Pavone, work to expand his business into many areas, including starting Varsity in 1992 to address the needs of the aging Baby Boomer population.

When asked what she has learned from her father over the years, Alex did not hesitate to share these three pieces of advice:

1. Never give up.
2. Hard work pays off.
3. When you love what you do, you never work a day in your life.

It’s not hard to see that wherever her career takes her (hopefully to senior living), Alex is sure not to work a day in her life.

Over 350 sales and marketing professionals from senior living organizations of all sizes across the U.S. participated in the 2023 Senior Care Marketing & Sales Summit (SMASH) in Henderson, Nevada. Two of Varsity’s roundtable participants attended the sold-out conference. In this post, Mark Hamby, Director of Resident and Family Services at Parkway Village, and Christine Hall, Senior Director of Marketing and Public Relations at Franke Tobey Jones, share with us 11 of the hottest trends that they heard about at SMASH. As you’ll see below, there have been a lot of new changes in the space since we posted about the top 10 senior living market trends during the pandemic.

1. Occupancy has flattened out. The average occupancy across senior living in 2023 was 80%. 20% of communities are under 60% occupied, so more communities are discounting this year.
2. AI is transforming the customer journey. Within five years, every webpage and follow-up email will be completely different for each prospect, with copy completely tailored to their interests.
3. Prospects are aging. 20% of prospects and 25% of new residents are 90+ years old.
4. Digital marketing is more important than ever. For all communities, 40% to 60% of leads are coming in digitally. One important feature that prospects want to see on websites is accurate, transparent pricing. Also, communities need to protect themselves from lawsuits by including HIPAA-compliant copy that assures prospects their information will not be sold.
5. The senior living industry is underperforming. According to Forbes, senior living is the third largest industry, but is also the most underperforming. Our space is doing 9% of total business, but we should be doing closer to 19%.
6. Adult children are shopping online at night. A huge number of adult family members are researching communities between 8 p.m. and 8 a.m. Communities should consider hiring a call center or using a chatbot to ensure customers can get initial information after hours.
7. Speed to lead is critical. 70% of prospects will tour a community within seven days of initial contact, and during that time, sales teams complete about 10 touches. The first community to reach a lead is most likely to get the tour. Sales teams must reach out within 20 minutes to an hour, or the lead will go on to another community.
8. Online reviews are crucial. 91% of people looking for senior living communities are using Google reviews —  the highest percentage of any industry (80% said if the community doesn’t have four stars or more, they won’t consider it).
9. Value-select premium pricing is on the rise. Pricing of same-sized units is no longer identical. Consumers don’t want to pay as much for an apartment that looks out on a parking lot as one with a lake view.
10. Fear of COVID-19 is still the biggest obstacle to move-ins. It’s important to educate prospects, letting them know that fewer than 1% of 800,000 residents have contracted COVID and that communities continue to strengthen their safety policies.
11. Biggest selling tool: a welcoming atmosphere. Prospects put a huge emphasis on how they feel when they walk in to a community. A friendly, engaged atmosphere with smiling staff and residents is the best tool for closing sales.

I’m Ellie Weaver. I’m an account strategist at Varsity, and I’m addicted to “The Golden Bachelor.”

Why is it that a 20-something like me never misses an episode of the new ABC show focused on finding love for a 71-year-old?

At the risk of sounding cheesy, I find the show inspiring. As a young woman, it often feels like I have a ticking clock over my head, which isn’t helped by the questions I get constantly: “When are you getting married? Don’t you want to? When are you giving us grandkids?” (Maybe that’s just my mom.) That being said, it’s nice when you can get the perspective of “The Golden Bachelor,” where the main message is that there’s no time limit on love, and all of the women (and Gerry, of course) are full of renewed hope for love in their future. This message hits differently coming from people of their age and just feels genuine. I’m not alone in my age group in watching. According to The Hollywood Reporter, “The Golden Bachelor” has hit 9 million viewers and almost quadrupled its rating among adults 18-49.

Helping Older Adults Be Seen
I love the way that the show is changing perceptions of aging, showing the contestants as whole people and vibrant romantic interests, rather than stereotypes of who or what a senior “should” be. That’s super important, because seniors, especially women, are often stereotyped as mothers/grandmothers and marginalized. As one contestant, Joan, said, “As you get older you become more invisible. People don’t see you anymore. Like you’re not as significant as when you were young.”

Romance Has No Age
Every week, “The Golden Bachelor” and one of the women go on a romantic one-on-one date. They mix these one-on-one dates with group dates, where Gerry and a handful of the contestants do a group activity, like a pickleball tournament. Besides looking like they’re all having a total blast on these dates, it shows that fun and romance are possible at any age.

On that note, the show doesn’t shy away from its raunchier moments that are on par with your standard Bachelor or Bachelorette season. As Susan quipped in the first episode, “I’m very comfortable with six inches” — in reference to her sky-high heels, of course. But I think that serves a greater purpose, too, that your sex life doesn’t stop when you turn 60, and that seniors are looking for love and passion the same way all people are. Ellen said it best in the first episode: “Everyone’s entitled to love and be loved.”

Girl Talk Over Halo Top
It’s not all romance, though. There are lots of scenes in the women’s downtime, where you can tell they have just as much fun with each other as they do on their dates. When they played a game of “Never Have I Ever” over ice cream, it felt like hanging out with a group of your best girlfriends. A lot of people who may have preconceived notions of what seniors “should” talk about will be blown away by the women of “The Golden Bachelor” swapping stories of their wildest sexcapades over pints of Halo Top.

Sharing the Grief, Too
Grief is also a prominent theme of the show. Gerry mentions his late wife often, and you can tell how much she is still a part of him. Many of the contestants have also experienced losing a partner, and they readily open up to Gerry about their grief. It’s an important representation to see, as I’m sure many seniors feel stuck in an in-between place after the loss of a spouse, not ready to let go and move on. I hope that viewers see themselves in these experiences and feel like they’re not alone.

Up Next: My Analysis of The Finale!
My favorite match for Gerry, Ellen, has already left the show in a rose ceremony, but I am still eagerly awaiting the finale. Stay tuned for this millennial’s analysis of the final episode of “The Golden Bachelor” that reveals Gerry’s perfect match!

Q & A With Sara Breindel, Chief of Staff at Changing the Narrative

Changing the Narrative is a leading national effort to end ageism through evidence-based strategies and innovative public-facing campaigns.

Q. Why did you join Changing the Narrative?
A. I was working in marketing communications for older adults and attended a 2018 training for professionals at Changing the Narrative, which really shifted my perspective. I learned that many of the stories we told about older people were stereotypes — older people are not a homogeneous group. I was drawn to join the organization soon after, first as a content creator and now as chief of staff and co-director.

There’s a lot going on at Changing the Narrative, not just anti-ageist birthday cards, but workshops to promote age-inclusive workplaces, intergenerational conversations, social media campaigns and more. In this culture, we’re doing a disservice to ourselves with many of the stories we tell about what it means to get older — and Changing the Narrative wants to change that.

Q. What is the anti-ageist birthday card project?
A. The idea was to engage people at birthdays, because it’s a time when we all think about aging. Cards are a very visual example of ageism. One example was a card with a picture of a walker and a line that said, “Here’s your next birthday present.” Why is that OK to say?

We launched our first set of birthday cards in 2020. Because we’re headquartered in Colorado, we called for local artists to create general age-positive cards. For the second round of cards in 2023, we engaged with existing designers at small greeting card companies from across the nation, asking for specific messaging that used age-positive language as well as images.

When picking out birthday cards, we want people to take a little pause and think about the message they’re sending. Some cards send a really negative message about getting older. Ask yourself: Is that how I think of my friends and colleagues? That they should feel bad about themselves — old and ugly?

It takes time, but these awareness campaigns can change peoples’ perspectives. The genesis for this idea actually came from one our volunteers, who was about to turn 70, and she had already talked to her friends about her work with us. For the first time ever, she got no negative cards about aging on her birthday.

Q. What is implicit bias and how can birthday cards change that?
A. We’ve all been surrounded with negative messages about older people and we now believe them about ourselves. We don’t realize we have this implicit bias — even about ourselves. Our negative beliefs about aging actually hurt our ability to age well. Receiving positive card messages can help us celebrate a milestone rather than fear it and start to chip away at the idea that aging has nothing to offer.

Q. What can we do to get involved?
A. It’s easy to say, “I’m going to grab the first thing I see in the card aisle.” People might take a second look and ask, “Is this a positive sentiment?” Every time we purchase something, we’re telling the industry, “there’s a market for this.” If we start picking up cards that are more age-positive, it can change what companies sell. People looking for age-positive cards can find them on our site, but wherever you buy them, we encourage you to think about the message you’re sending.

Q. Why is it important to foster a positive picture of aging?
A. Getting older can bring health problems, but it brings great things as well. Greater resilience, wisdom, experience and an ability to form connections all come with age.

A study by Yale University professor Dr. Becca Levy showed that people live an average of 7.5 years longer if they have positive feelings about getting older. Something seemingly small like a birthday card, or our larger initiatives to help end workplace discrimination, can work to create a more positive view of aging.

To learn more about what Changing the Narrative is doing to end ageism, visit their website.

It’s only been two years since Wallis Annenberg GenSpace opened in Koreatown. Already, this destination dedicated to enriching the lives of older adults is a runaway success. Its 200+ members spend four times the amount there than participants at most gathering spaces for older adults.

Research shows that about 5%–20% of people who are eligible to attend a senior center do, and they spend about three hours a month there. “Our members spend three hours signed up in a class every week — four times the amount of time that most members of senior centers spend,” said Jennifer Wong, Ph.D., Director of GenSpace. “That does not account for the time in which they are here sharing and socializing with other people.”

Jennifer came to GenSpace from academia and as a consultant for the California Department of Aging, where she  worked with stakeholders to develop a master plan on aging. “Joining GenSpace was really a chance to work on the ground and invest in community spaces and to see what’s possible,” said Jennifer. “How do we stay engaged and open to feedback to co-create spaces for older adults, who are the backbone of our communities?”

Jennifer wants to help other creators of spaces for older adults enjoy GenSpace’s success. “We have had people come and visit us from as far away as South Africa and Korea — either seeking to add new energy to their current space and programming or create a new center. It’s been really great to be kind of a learning lab — a place to offer our suggestions and our path.”

Here, Jennifer shares nine insights that can help you design a new space for older adults or enrich your current programming.

Nine Principles for Creating Engaging Spaces for Older Adults

1. Include older adults in the planning

“How can you create a space for older adults without including them in the process? Our program priorities were born out of research with focus groups in and around Koreatown. We asked older adults what they wanted and needed in a community space dedicated to them. The result? Programming in five categories: Financial security and safety; health and wellness; arts, crafts and culture; technology and devices; and social connection and storytelling. A sixth program priority is horticultural therapy, born out of a passion of our founder, Wallis Annenberg, to give back gardening and green space to people who may have lost access to it.”

2. Find innovative ways of attracting members

“We went to libraries, senior affordable housing towers, and a foodbank to share our programs and invite potential members in.”

3. Know your audience

“With our Koreatown location, there are up to 10 spoken languages here at a time. Our eldest member is 101 — older adults are no longer a monolith. Our team is sensitive to the needs of all of these cultures and ages.”

4. Find the right people

“GenSpace is located in a beautiful age- and disability-friendly space created through a partnership with architect Susanne Stadler, but it is only as strong as the people in it. The reason why people come back is not because of the place, but because of the warm, welcoming and dedicated team members, instructors and volunteers.”

5. Partner on programming

“Our incredible programming team creates wonderful opportunities and also partners with outside organizations to tailor their unique programs to GenSpace. A partnership with Music Mends Minds has brought musical and education programming designed for older adults with dementia to different audiences here. We also partnered with the YMCA to hire its most-attended instructors, resulting in fitness and wellness classes that are packed to capacity with a waitlist. Our horticultural therapist also partnered with LA Compost on a workshop series on the latest composting techniques and with an organization that specializes in growing and drying lavender.

6. Pivot to meet your members’ needs

“Our members came to us and said ‘we’d love to have a knitting club’ — to work on their own projects and connect through knitting. We started a class, then expanded to crochet. They are some of my favorite classes. In another instance, Kiara Burns, an instructor who teaches a seated barre class, found it was getting so full that she used her experience with it to create a different class — a seated strength class.”

7. Focus on change through education

“Through our leadership initiative, graduate students in the fields of gerontology, public health, occupational therapy and communications pair their academic knowledge with hands-on experience at GenSpace. Engaging with our members is the most important part of their academic career.”

8. Connect with the outside community

“Our generous founder, Wallis Annenberg, has close ties to the entertainment industry, and we hold events that serve as a forum for debunking stereotypes around aging. We hosted Hollywood icons Jane Fonda, Lily Tomlin, Billy Porter and Sally Field, to celebrate their hit movie ’80 for Brady’ and talk about the importance of positive portrayals of older adults on screen.”

9. Bring generations together on equal ground

“GenSpace has created a true multigenerational environment. Younger and older adults mentor each other in different areas, but it’s really about creating opportunities to share new experiences.”

Find more information about Wallis Annenberg GenSpace and its innovative programs here.

5 Questions With Larry Carlson

Retired President and CEO of United Methodist Communities of New Jersey and innovator in dementia care

Q.Why do you want to reimagine life for people dealing with dementia?
A. After 40 years in this industry, I felt that there must be a better way to provide a dignified and meaningful life for individuals dealing with a dementia diagnosis. One in three seniors dies from Alzheimer’s, more than breast cancer and prostate cancer combined. In the past, aging care corporations put residents in their little areas, and it would be like locking them away. It is not normal for people to live in a unit of 25 people. We were trained to say “no” to things, like to go outside. I want to say “yes.”

Q. What was your inspiration for “Avandell,” the new dementia village you are planning?
A. In 2017 my wife and I visited The Hogeweyk Dementia Village  in Amsterdam, and we thought, “Why isn’t anyone doing this in the U.S.? I wanted a departure from the current model of care, so residents could live in a more homelike environment. At Avandell, there will be 15 cottages where seven people with the dementia diagnosis will live, for a total of 105 people on 18 acres. It is more of a family scale where we can group people with similar values, like music, sports or art. Each house will have seven bedrooms, a kitchen, living room, dining room, porch and den. The cottages will all be in a circle, joined together with breezeways and discreet fences, and there will only be one way in and one way out. Residents can go outside and explore. There will be farm animals, a greenhouse and a butterfly garden. They can experience the weather, because experiencing the weather is normal. There will be heated sidewalks for safety.

Watch the Avandell Video

Q. How will meals be handled?
A. The house will have a budget and residents will decide what to eat for the day. They will go to the grocery store and pick out what they want. Why? Because it is normal to go to the grocery store and cook dinner together. The caregiver and house coordinator will guide the process. It will be a more natural rhythm of life.

Q. What did you have to change about The Hogeweyk model to make it acceptable in the states?
A. The regulations in the United States are made for a “big box” building. By building breezeways to connect our 15 houses, it will allow the building to function as one. It was really working with the Department of Health to get the regulations to sync with what we want to do.

Q. Where does the project stand right now?
There are neighbors who do not want a “depressing” dementia village in their backyard. We won the zoning, but they are appealing it. We have to fight those battles. This project will ultimately be successful, it will just take time and money. It should be noted that a community like Avandell can be built anywhere. We intentionally developed the care model so it could be re-created somewhere else.

Learn more about the development of the dementia village model in Larry Carlson’s book, “Avandell: Reimagining the Dementia Experience”, or on his YouTube Channel.

If you’re in the Continuing Care at Home space, you already know the challenges programs can face, which can look very different in year three (or later) than they do in year one.

To help professionals from programs across the country come together and address their individual and collective obstacles, we’re holding quarterly hybrid CCaH sessions. The next session will be tomorrow, Wednesday, September 6, from 10 a.m. to 2 p.m. ET. Sign up now if you haven’t already by emailing .

An Early Look at Our Special Guest’s Presentation

We’d like to introduce our special guest, Steve Hopkins, CEO of the Jordan River Group. Here is a preview of the insider perspective he will be bringing to our session.

After extensive research, combined with his experience working with CCaH organizations, Steve has found that starting a program, although a major challenge, is not the primary challenge. Accelerating its progress is. He has tracked the progress of several programs, and his findings were that roughly 70% (including some programs he helped launch) were underperforming after five to seven years. One market study Steve recently completed showed that there were 8,000 age- and income-qualified older adults in the area, yet the program had only 200 members. Not only that, there are only about 40 programs across the country — and there is room for many more.

Steve is passionate about the field of CCaH and wants there to be more programs for older adults to consider, and more success for those programs.

In this session, he will be asking the question, “What are the barriers that prevent those who launch a program from accelerating it to its best scale? He’ll share the results of his research and the insights he has gleaned that can help programs reach their maximum potential.

Steve will cover challenges such as:

• How to prevent a CCaH program from plateauing at a certain level of market penetration
• Why organizations that offer residential living need to use a completely different approach to market their associated CCaH programs
• The barriers that prevent really good prospective providers from going forward
• Why it’s important to accelerate early growth so that a large member base with fewer health needs can help programs achieve long-term financial stability
• Why it’s critical for the aging services industry to strengthen its position in CCaH now — so that insurance companies don’t create their own offerings and take over the field

Don’t miss Steve’s vibrant discussion at tomorrow’s CCaH Working Session,10 a.m.–2 p.m. ET. The agenda will also include general sharing from participants and discussion on our qualitative survey results and quantitative interview insights. To sign up, contact Derek Dunham at .

About the Presenter

Steve Hopkins brings 20 years of experience in senior living to the table. He spent his first decade as Chief Operating Officer of Evangelical Homes of Michigan, complemented by a second decade with a specialized focus on the CCaH space. As CEO of the Jordan River Group, he has worked directly with six organizations to launch CCaH programs.

Kendrick Brinson is addicted to photographing Sun City, Arizona, where the average age is 73. An acclaimed  documentary, commercial and editorial photographer whose clients include The New York Times, National Geographic and Smithsonian Magazine, Kendrick first visited Sun City more than a decade ago. This census-designated, self-governed community is home to 40,000 people on 40 acres. Over several years, Kendrick has photographed nearly all of it. Here is her perspective on life in this unique place.

Q. Why did you first come to Sun City?
A. I used to work at a newspaper and when I left to do full-time freelance photography, I was looking for something happy and fun to work on. I saw a movie about Sun City, then learned that 49 years earlier, Time Magazine had done a story on Sun City and its founder Del Webb. Sun City was the first place of its kind — and it’s still one of the largest —where people can decide what their retirement will be like. For Sun City’s 50th anniversary, I said, “I have to go there.” Then I returned and I returned and I returned.

Q. What’s unique about Sun City?
A. Sun City reimagined the idea of what retirement could look like. It’s a place of exploring, play, learning and community. And the landscape is so different from where I’m from in South Carolina — cactus-lined streets … golf carts on the streets … 1960s homes … giant palm trees. The light is even different here. People own their homes and they pay a very affordable yearly fee to be in the 100+ active clubs and use any of the seven pools, 11 golf courses, seven recreation centers, three country clubs and two libraries — all owned by the Recreation Centers of Sun City.

Q. What are some of your favorite subjects to photograph there?
A. I like the colorful, quirky, fun shots, like a costumed dog parade or a Halloween party. I love anytime I can capture people not taking themselves too seriously. One resident’s wife told him he needed to get off the couch and stop watching TV. He made this little golf cart out of a couch and a TV and drives it around.

My favorites are the cheerleaders: The Sun City Poms. One of the members just turned 90 — they have beautiful uniforms. It’s like a sisterhood. At first glance, when you see the cheerleaders perform, you think, “I wouldn’t be surprised if this person was 17 or 18” — but it’s actually a 78-year old throwing pom poms. These are people our grandmothers’ ages, and this is not what we expect, and this is what they’re doing.

Q. What’s it like connecting with residents?
A. People are always trying to connect me with other people to photograph — I feel very welcome there. I’ve played pickleball there, and when I go to the dances people coerce me to do the foxtrot. I get a little taste of retirement.

Q. What have you learned from visiting Sun City?
A. When we’re young, we go in the direction of what we love. Along the way we pick up messages like “you’re a terrible painter,” and we might stop doing it. But at Sun City, you don’t have to be the best cheerleader or the best at pickleball — you’re doing it because your friends are doing it and because it feels good to do.

People are having fun and they’re staying young and they’re staying healthy. I love this idea that we can get back to the things we really loved as a kid. It’s kind of like eternal summer camp.

Sun City has helped me look at aging in a way that’s appealing and exciting, contrary to our culture that worships youth. I’ve come to view getting older as a thing to look forward to — and a gift every day.

See more of Kendrick Brinson’s photos on her website.

Guest post by Natalie Clark, Community Manager; and Kaitlyn Mulligan, Social Media Strategist; Pavone Group

Hardly a day goes by without hearing buzz about “AI.” Generative AI is a type of artificial intelligence technology that can produce content, such as text, images and other media, in response to prompts. And this year, we’ve seen a huge wave of AI tools entering into the social media space. 

Snapchat was the first on the scene to add AI features. Since Snapchat is well known for its focus on privacy, people were a bit nervous when it introduced its AI bot. Essentially, the AI added commentary about things people were “snapping” and messaging about. Thankfully, Snapchat listened to its community and “My AI” is now solely for those who have a paid Snapchat membership. 

As for Meta, the parent company of Facebook, Instagram, Threads and WhatsApp, it is being a bit more cautious about developing AI tools. Currently, Meta is developing an AI tool that would enable you to ask questions of an AI system within any direct message. This is something that may be more useful for senior living brands in responding to clients or prospects, helping you to write better answers. 

TikTok is also looking to latch onto the AI hype with an AI chatbot, which it’s calling Tako. Different from what Snapchat and Instagram are doing, Tako can be used to find relevant TikTok content that matches your preferences or to track down videos you’ve seen before. Generally, it makes users’ lives easier. Speaking of which, AI-generated content on TikTok must now be disclosed with either a sticker or a disclaimer indicating the content has been created by AI, similar to an “ad” hashtag you’d see on Instagram.

In general, as AI starts to help users search for social content, keywords are becoming even more important for social posts. For your brand, make sure to use keywords in captions and copy, so that those using AI tools will be directed to your profile with their queries. 

While senior living prospects may be slower to adopt social media, we should always keep in mind that we also want to reach their adult children, and even the younger generation, for hiring talent. So we need to stay on top of these AI trends to connect with all these audiences.

Guest post by Dr. Tamir Aldad, CEO of Mindful Care

I’m an addiction psychiatrist by training. In my work, I found that access to care was a major issue for seniors experiencing mental illness. In fact, my grandmother was dealing with really bad depression and we had nowhere to take her. That is part of why, in 2018, I founded Mindful Care, the first-ever chain of psychiatric urgent care clinics. We provide care to seniors in independent living, assisted living and skilled nursing communities.

One Definition of Mental Illness

Let’s start our discussion about older adults by talking about mental illness in general. Mental illness is a huge category ranging from depression to bipolar disorder to eating disorders and more. The common denominator is the fluctuation that affects people’s daily living. If someone has changes in their thinking and cognition, their ability to relate to others, and their functioning each day, those all are high criteria for mental illness.

Mental Illness in Older Adults: Underappreciated and Underrecognized

Older adults are more likely than any other age group to have mental illness, due to risk factors such as changes in their physical health; losses of their support system, spouse and friends; lack of a sense of purpose; substance disorders; and decline in functioning ability. Seeing as older adults are a very vulnerable population, but with fewer resources than others, and less likely to seek help, they need lots of attention. Unfortunately, healthcare providers and older adults often mistake depression, in particular, for a natural response to aging. This can lead to providers not screening for or treating it.

The Four Ds of Mental Illness in Older Adults

Here are the “four Ds” we should keep in mind when it comes to recognizing and treating mental illness in older adults:

Dementia: Life-altering loss of cognitive functioning
Dementia affects approximately 10% of people 65+ in the United States, according to a 2022 Columbia University study.

Delirium: An acute, fluctuating syndrome of altered attention, cognition and awareness
Delirium affects an estimated 14% to 56% of all hospitalized elderly patients, 20% of which experience complications while hospitalized directly because of delirium.

Depression: The persistent feeling of sadness or loss of interest that may include changes in sleep, appetite, energy level, concentration, daily behavior or self-esteem, and thoughts of suicide
Depression is increasing in the 65-plus population with suicide rates being a very serious problem, and it needs more awareness and attention.

Demoralization: A psychiatric experience of existential despair, hopelessness, helplessness, and loss of meaning and purpose 
Demoralization requires a certain level of empathy because it stems from despair and hopelessness at not being able to function at the same level anymore.

Many people don’t realize how widespread these symptoms of mental illness are. The two conditions that get neglected the most in the senior population are depression and demoralization. 

Causes and Risk Factors for Senior Mental Illness

Physical disability and changes in physical and cognitive health are a big risk factor for mental illness, as is a change in environment, like a sudden hospitalization or a move to assisted living. Grief is also a very common risk factor.

Other risk factors to watch for are long-term illness, substance abuse, medication interactions, the illness or loss of a loved one, and poor diet or malnutrition.

10 Symptoms of Mental Illness to Watch for in Your Residents

1. Sad or depressed mood lasting longer than two weeks
2. Social withdrawal, loss of interest in things that used to be very enjoyable
3. Unexplained fatigue, energy loss or sleep changes
4. Confusion, disorientation, problems with concentration or decision-making
5. Increase or decrease in appetite; changes in weight
6. Memory loss, especially recent or short-term memory problems
7. Feelings of worthlessness, inappropriate guilt, helplessness, thoughts of suicide
8. Physical symptoms that can’t otherwise be explained: aches, constipation, etc.
9. Changes in appearance or dress, or problems maintaining the home or yard
10. Trouble handling finances or working with numbers

Helpful Mental Health Goals and Interventions

Here are some goals and interventions that can help older adults experiencing mental illness:

 Validate the individual’s feelings

• Nurture a healthy adjustment to their stage of life
• Help promote acceptance of loss — letting go
• Explore and treat “survivor guilt,” which is often present when an elderly person has survived one of their children
• Explore for and treat a deep sense of guilt for wishing a loved one would die
• Foster involvement in life activities as fully as possible — especially exercise, which is not only healthy for the body, but for emotional well-being
• Use reminiscence therapy — discussion of past activities and experiences with another person or group
• Practice an integrated care model, where one person acts in the role of case manager, and the entire team shares information about the older person’s health

Overcoming Obstacles to Care and Stigma

One major obstacle to care is that people think symptoms of mental illness are a normal part of aging. Our culture teaches us to think these feelings are normal, when they’re not. What I’ve found effective with older adults is to not use formal terms like “‘mental illness” or “depression,” as they are loaded words and can have inherent bias. My approach is to treat feelings and validate them. It’s helpful to meet people where they’re at and recognize that these feelings can be embarrassing and hard to talk about. Encourage your team to do so as well.

If you’ve gotten to know a resident and they’re not acting like themselves, alert your team. Most importantly, create an environment where people are welcome however they are and however they feel.

If you have any other questions about mental health in seniors or want to learn more about Mindful Care, please feel free to engage with me at .