Although there is a shortage of solutions aimed at the elderly in many areas, the aging process of the population is nothing new. It is a global phenomenon and, in the Brazilian context, Ministry of Health It has already indicated that in 2030 the number of elderly people will exceed that of children and adolescents from 0 to 14 years old by about 2.28 million. This demographic transformation has implications for the entire society with new behavior and consumption patterns, challenges surrounding the reassessment of public policies, greater pressure on the health system, changes in the social structure, economic impact, among other points.
With these aging challenges, there are also market opportunities aimed at addressing these demands, constituting the so-called Silver Economy (or silver economy), previously discussed in second edition of Green Rock Insights. In the health sphere, a latent demand is related to the mental and cognitive health of the elderly population, who are often neglected and isolated from society. It should be noted that, even though today the population lives longer, this is not necessarily reflected in the quality of life, both in the physical and emotional aspects, which are intertwined.
According to the World Health Organization (WHO), about 14% of the population aged 60 and over lives with a mental disorder, and the most common mental health conditions in this population are depression and anxiety. In addition, globally, around a quarter of suicides are committed by the elderly. Regarding risk factors, the WHO points out that at older ages, much of mental health is shaped by the cumulative impacts of life experiences and stress factors linked to aging. Still, loneliness and social isolation are identified as central risk factors for mental health problems in old age.
In Brazil this is not much different. As an example of this scenario, an IBGE survey released by USP Journal in 2021, it indicated that the elderly are the most affected by depression, affecting around 13% of the population aged between 60 and 64 years. Another characteristic feature of the elderly population today is the tendency to isolation, which has been associated with consequences on cognitive health. A study published in July 2023 in the journal Neurology indicated that there may be a relationship between the social isolation of the elderly and a loss of brain volume, and this decrease is often followed by dementia.
The influence of loneliness on the mental health of the elderly
Exclusively for Green Rock, Bruno Camargo, a clinical psychologist with training in Cognitive and Behavioral Therapy and a specialist in Gerontology, points out that loneliness in the elderly is a problem that goes far beyond social isolation, impacting the mental and physical health of the elderly. “As we age, our support networks tighten, making loneliness a very present challenge to deal with both as a society and as a family and individually. Aging is heavily permeated with loss and can plunge the elderly into a very negative cycle with the absence of significant social connections,” Bruno points out.
From a mental health perspective, the psychologist explains that isolation can lead to feelings of emptiness, hopelessness, and discouragement, and can be fertile ground for the development of depression or anxiety disorders, for example. In addition, as indicated in the study mentioned above, Bruno points out that there is a relationship between loneliness and cognitive decline in the elderly, anticipating the onset of dementia, since the lack of social stimuli negatively affects the brain. Still, it also highlights issues of self-esteem and self-confidence in the elderly, which are affected by isolation. “If the elderly are very isolated, they may start to feel useless, which undermines their self-image in relation to their contribution to society and their sense of belonging,” he concludes.
Bruno Camargo also points out that loneliness goes beyond the issue of mental health, also affecting the physical health of the elderly: “We have seen studies that demonstrate that older adults who are lonelier are more likely to have physical health problems, such as cardiovascular diseases, compromised immune system, chronic stress, etc. These issues can be equated to health issues of a smoker or an obese person”. Other aspects that are also negatively influenced by loneliness in the elderly are sleep, which may include insomnia and an impairment in the ability to regenerate rest, in addition to an imbalance in diet and a possible abuse of substances, such as alcohol.
Faced with this isolation scenario, the psychologist points out that support programs are needed to promote active aging, encourage the participation of the elderly in social activities and the maintenance of connections with friends and family. “It is essential to recognize that loneliness in aging is not a weakness, but rather a real, chronic problem that has become very common in our society and requires a lot of attention and understanding,” he concludes.
The issue of stigma and access to mental health services
However, the search for help with the mental health of the elderly is permeated by several challenges, stigma being one of them. Bruno points out that “stigma is often rooted in misinformation and lack of understanding about mental health issues”, so that many elderly people believe that sadness and forgetfulness, for example, are common in the aging process. It is worth mentioning that this type of stigmatized view is a global issue, so that health agencies around the world have publications on this topic, such as the CDC (Centers for Disease Control and Prevention), for example, which has a small paper informing and explaining that depression is not a natural part of the aging process.
In addition to the stigma, which triggers feelings of shame and fear of family judgment on the part of the elderly, another central challenge lies in the difficulty of access, according to the psychologist. “We cannot ignore limited access to mental health services. Many elderly people live in more peripheral areas, have reduced mobility or difficulty moving, so access to this type of care is difficult”.
In this issue of access, Bruno also draws attention to the financial aspect and how mental health monitoring is still seen as an underlying issue: “Unfortunately, today people who have access to private offices are people who inevitably have more financial resources. Most of the elderly I see today have a lot of expenses for medical insurance, other health issues, and medication. I realize that psychotherapy is not a priority, but rather a need that comes after all this. So I imagine that if the resource were reduced more, they would probably rule out psychotherapy.”
The specificities of depression in the elderly
Within the conditions of depression in the elderly, which are becoming increasingly alarming, a key element that cannot be ruled out is that this mental disorder may present differently in the elderly population due to specific factors related to aging. In summary, the psychologist indicates that depression is manifested in the elderly more clearly in physical symptoms than in emotional ones.
“We are going to see elderly people with a lot of fatigue, chronic pain, eating problems, weight gain or loss, health problems, changes in appetite. In cases of depression in adolescents and adults, there is generally a predominance of more emotional symptoms, such as more intense sadness. The elderly, as a rule, first have physical symptoms, which lead to an underdiagnosis of depression, since they are very confused with health problems that are common in older people,” he explained. Added to this specificity, Bruno points out that the elderly are less likely to report their feelings of sadness, which makes it difficult to detect depression.
In addition, the treatment of depression in the elderly must also take into account different factors, such as medical comorbidities, physical symptoms, access to a mental health service and possible medications that will be administered to the elderly, since they have a more sensitive body susceptible to psychotropic drugs. Furthermore, the psychologist points out that, in general, the elderly have a more positive response to Cognitive Behavioral Therapy, which will deal with cognitive restructuring and problem solving.
Bruno also highlights the issue of high suicide rates, a point indicated by the WHO as a global concern, which is reflected in Brazil. “We also have to draw attention to suicide prevention, which is a very important topic, since the elderly have a much higher suicide rate than other age groups. They arrive more 'at the de facto routes'. In this sense, the detection and treatment of depression is very important.”
Mental health of the elderly as a market opportunity
In this emergency scenario surrounding the mental health of the elderly and the challenges surrounding this scenario, there is Sanii, Healthtech focused on improving the quality of life of this population with a solution aimed at healthy and active aging. In an exclusive interview, Michael Kapps, one of the company's founders, points out that despite the high demand, solutions for healthy aging are very limited in Brazil and what exists is, in general, very fragmented.
“In Europe or Japan, for example, there is a lot of public infrastructure surrounding the aging of the population, in addition to a culture focused on the community. Brazil doesn't have much of that, risk factors are not addressed and this will become a ticking time bomb: we will have a lot of people with chronic diseases, degenerative diseases, etc. So we realized that this is a great opportunity to build an impactful company with a solution to this demand,” she says.
Michael also shares that the profile of the 60+ population has changed a lot and that stereotypical idea of the frail elderly and alone at home while their child seeks help cannot be taken as a rule. The founder of Sanii reveals that, of the thousand elderly people the company spoke to over a period of a few months, around 2 ⁄ 3 of the cases the search for a service came from the elderly themselves. He points out that this varied according to age and that women were very prominent, so that 90% of the demand for care came from the female audience, which is closely linked to a cultural issue. However, it should be emphasized that this search occurred mainly around a message of improving neurological health, and not specific mental health care, which is viewed with a view of prejudice, especially for this age group.
“At the beginning our message was very focused on the idea of 'longevity', but that's a bit of an abstract concept for people. Then we started to touch on one of the biggest pain points for the elderly, which is neurological health. We noticed that the elderly admit and want to work on the issue of memory, attention, and cognition. There is a natural cognitive decline with aging, there is the issue of genetic factors, but there is much to be done to improve these conditions. We noticed that a message more focused on 'neurological health' and 'brain health' draws attention and there is a greater demand, especially by the elderly themselves”.
This active search for the elderly contrasts with Bruno Camargo's experience as a psychologist. In the case of Bruno, he says that, in general, it is families that seek help for their elderly, since they tend to minimize their complaints in order not to do much work and not want to have an impact where they live. This contrast relates to prejudice with the idea of seeking mental health help and the message that seeking a psychologist still transmits to society.
Michael Kapps corroborates this issue of the stigma surrounding mental health care, stressing that many elderly people don't tell their children about how they feel. “The elderly don't think they need therapy and if we say 'we're going to send a psychologist to talk to you', there's a lot of resistance. But at Sanii we were able to shape this discourse a bit to mitigate some of that resistance, pointing out that the psychologist will be there to train the memory of this elderly person, for example”.
Regarding the impact of the pandemic, Michael understands that this period brought particularly difficult consequences for this population. “The first effect of the pandemic is post-traumatic stress, in the sense that these elderly people saw many friends and people their age dying. In addition, the pandemic increased the risk of developing mental health problems, neurodegenerative diseases, dementia, Alzheimer's, etc. Many elderly people found themselves alone for two years and this isolation impairs brain connections. Still, another important point was the creation of bad and wrong habits. For example, many have become used to staying home alone, and we know that social isolation creates many problems and is a risk factor for mental health,” she points out.
In this sense, in Sanii's proposal, Michael explains that the company performs a 360 assessment, applies tools to understand the cognitive part, the issue of elderly care, short-term memory and logical reasoning, in addition to understanding the social issue and the critical points in which the elderly are inserted. Other points that are analyzed include the profile of the elderly, tastes, interests, and family history. All of this assessment takes place between two and three sessions and the Healthtech it also seeks to understand the roots of each case. Based on these surveys, a care plan is drawn up for the elderly that involves stimulating activities, use of technology, socialization, groups of activities, among other points.
“From our experience so far, the elderly have really liked the plans and they adapt very well. We are at the beginning, our sample is still small, but the results are promising. Another point is that we have clinical assessment scales, but we realize that the main concern of families is whether the elderly are happy and whether they have created a connection with the proposed activities. In this sense, we seek engagement, happiness, and quality of life. We want to occupy a space of family trust”, he concludes.
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