Mental Health Matters: Stumbling Forward Together

Mark stood at his retirement party with a smile that didn't quite reach his eyes. His colleagues praised him for his 35 years as a dedicated teacher. Yet while everyone celebrated, a quiet anxiety grew within him. "What now?" he wondered. In the months that followed, Mark's days felt increasingly empty. His identity had been so deeply tied to his career that without it, he felt adrift. His wife noticed his withdrawal first. Then his children began to worry when he declined family gatherings. "Dad's just so depressed," they would say to each other. What had once been a fulfilling life now felt hollow, and Mark found himself thinking that perhaps it would be better if he weren't around anymore.

May is Mental Health Awareness Month, a time to recognize that mental health challenges affect people of all ages, including our seniors and their caregivers. As a geriatrician who has worked with countless older adults and their families, I've seen how mental health issues can silently erode quality of life, but also how the right support can restore joy and purpose.

The Hidden Challenge of Late-Life Depression

Depression isn't a regular part of aging, yet it affects a surprising number of older adults. Research shows that between 7-10% of community-dwelling older adults meet criteria for major depressive disorder, and up to 15% experience significant symptoms. More than half of these cases represent new-onset or late-onset depression, often triggered by life transitions like retirement, loss of independence, health challenges, or the death of loved ones.

For many men like Mark, identity is deeply anchored in work. When retirement arrives, the abrupt removal of structure, purpose, and social connection can trigger profound anxiety that may spiral into depression. Women may face different but equally challenging transitions, such as becoming a widow or adjusting to an "empty nest" while simultaneously caring for aging parents.

Signs of depression in seniors often look different from those in younger adults. Watch for:

• Loss of interest in previously enjoyable activities

• Withdrawal from social situations

• Unexplained physical complaints

• Changes in sleep patterns

• Neglect of personal care

• Increased use of alcohol or medications

• Talk about being a "burden" or expressions that life has no purpose

Mark's story is heartbreakingly common and preventable. Seniors deserve connection, validation, and emotional support. Depression is not simply "getting older," it is a medical condition that deserves recognition and care. Families and caregivers can make a profound difference by acknowledging emotional struggles and encouraging seniors to seek help.

The Mental Health Struggles of Caregivers

While we focus on seniors' mental health, we must not forget the caregivers who support them. Their mental well-being is equally important and often more severely compromised.

The statistics are sobering:

• Almost 40% of caregivers say they never feel relaxed

• Over 30% experience anxiety or depression

• Between 30-40% report burnout

• Nearly half feel guilty about their negative feelings

I often ask caregivers about "SAAD" – Stress, Anxiety, Anger, and Depression. These feelings aren't just unpleasant, they're harmful to your health. Chronic stress leads to fatigue, disrupted sleep, inflammation, and increased risk of heart disease.

A caregiver once shared with me her strategy for managing stress. Her husband developed Alzheimer's disease, and she cared for him for years as he declined. She told me that she always kept in mind a "line in the sand." The line defined the limit of what she could do. Interestingly, her husband reached the line several times, but she had grown and adapted and could adjust the line. However, the line in the sand was very important to her. As committed to her husband as she was, the line gave clarity to her journey.

Do you have a line in the sand?

Why Some Caregivers Handle Stress Better Than Others

Caregiving is incredibly challenging, but some caregivers handle it better than others. From my experience working with frail and elderly patients, I've observed that it often comes down to three key factors:

1. Why are you in this role? A strong reason makes burnout less likely. Deep love or finding joy in caregiving provides the capacity to endure challenges. Without a strong "why," that little voice asking, "Why am I doing this?" grows louder.

2. Are you able to do what's being asked of me? Caregiving sometimes requires tasks beyond our experience or comfort level. Be honest about whether there's a good match between your abilities and the care needed.

3. Can you set appropriate limits? Even the most dedicated caregivers need boundaries. Identifying your "line in the sand" brings clarity to your caregiving journey.

Self-Care Strategies for Caregivers

The solution isn't just antidepressants. Here are simple ways to take care of yourself:

1. Dedicate time for yourself every day. Even 10 minutes matters. Remember to put YOUR oxygen mask on first.

2. Practice deep breathing. Sit down, breathe deeply through your nose, and exhale while gently saying, "My body is releasing tension." Repeat five times.

3. Find joy in small moments. Listen to favorite music, watch something funny, read, or engage in a hobby.

4. Care for your body. Exercise a little, and treat yourself to a mini massage of your hands, feet, or face.

5. Connect with support. Text or call a friend, join a support group, or find a professional to talk to.

The Surprising Truth About Happiness in Later Life

When we say something is "old," we often mean it's no longer useful or valuable. Apply that definition to people, and the outlook on aging can feel bleak, especially in modern Western cultures.

But is doom and gloom a natural part of getting older? Is it possible to be happy in old age? It's surprising but true that older adults overall report being happier in their later years. The 2024 World Happiness Report found that Americans aged 60 and older ranked as the 10th happiest demographic globally.

This may seem counterintuitive. After all, being old is challenging. Prices go up but savings often go down. Physical abilities decline and chronic illness is much more common. So why do seniors tend to be happier?

Seniorhood is a whole new chapter in life that can be fairly long, often 20 years or more. Good physical health and financial security are a big plus, but that's only part of the story. Somehow, seniors adapt and take advantage of old age. They discover purpose in new ways. A former accountant might find joy in beekeeping. A retired teacher might dance in a Zumba class or meet friends at McDonald's every morning.

"I'm happier than I've ever been doing what I really enjoy," one woman in her 70s told me after she picked up beekeeping.

Happy seniors grow and find new activities, often very different from what they did earlier in life. They find something fulfilling and purposeful. They also appear to be wiser, with greater emotional wellbeing: "I used to worry about what others thought of me, but now I realize it's their opinion, not my truth."

Want a quick check-in on your own happiness? Ask yourself:

1. Do I take care of my health daily?

2. Do I do something I enjoy each day?

3. Do I feel worthy at this point in life?

4. Do I have love in my life?

If your answers are mostly yes, you're probably doing well. If not, know that happiness in later life is possible, but it may require intentional change.

My Own Journey: Stumbling Forward Through Depression

Physicians aren't superhuman. We get sick too. And not just physically. I've experienced depression, just like many of my patients. For me, it wasn't only professional stress. It was personal pain, the kind that sneaks up on you when life changes and you lose your sense of identity.

When I left full-time practice, I faced a void. After decades of people needing me, suddenly I felt invisible. That emptiness was real. My therapist put it plainly: without my white coat, I felt like a nobody. I went back to work as a survival tactic, not a long-term plan.

Over time, I realized I needed something more sustainable. With some nudging from my adult daughter, I started exploring new things. It was uncomfortable. I didn't have clear answers. I tried this and that for a couple of years before anything felt right.

Getting mentally healthy isn't like treating high blood pressure. There's no one pill, one visit, one fix. For me, it's been a series of small, sometimes awkward steps. I took some computer and business classes. I didn't know much going in, but I knew more coming out. I started accepting invitations I would have usually declined. One led to consulting with a startup founder who couldn't believe I was a doctor. That turned into three years of learning a new business world.

I joined a ROMEO group (Retired Old Men Eating Out), and also a mixed-age "GUYs" group. I'm the oldest one, and nobody uses titles. One of my closest friends in that group is a handyman who never finished college. He has no idea why I value him so much, but I do. We watch sports and talk about life. And yes, I've met people just by wearing a sports cap.

I also take my "wellness vitamins" every day. Not pills, but rituals. Exercise, coffee, journaling, and work. When I journal, I ask myself: Did I have fun? Did I feel purpose? Did I connect? Did I care for myself mentally, spiritually, and physically? If I didn't, I try to double up the next day.

Letting go of comparison was hard. Watching others lead "fuller" lives made me feel like I wasn't doing enough. I've had to learn not to measure my worth through importance or productivity. These days, I focus more on doing things I enjoy, not things that make me feel important.

I used to dread seeing seniors in a parachute circle at adult day programs. To me, it looked like everything I feared about aging. But now I see it differently. That circle is a metaphor, keeping the ball in play, participating, staying connected.

I don't know how my story ends, but I'm still writing it. Depression didn't get the last word. I didn't find a magic solution, I stumbled forward, tried, failed, tried again. But eventually, I found a way to feel whole again. Older, wiser, and still growing.

The GOLD Approach to Mental Health

When addressing mental health for seniors and caregivers, I recommend the GOLD approach:

Get help early. Mental health challenges rarely improve on their own. Early intervention can prevent a downward spiral and restore well-being more quickly.

Open up about feelings. Silence and stigma only deepen suffering. Creating safe spaces to discuss mental health struggles is essential for healing.

Learn coping strategies that work for you. While everyone's mental health journey is unique, evidence-based techniques can help most people.

Develop a support network. No one should face mental health challenges alone. Connection is powerful medicine.

Stumbling Forward Together

Mental health challenges aren't weaknesses or character flaws but human responses to difficult circumstances. By acknowledging these challenges and taking proactive steps to address them, seniors and their caregivers can experience better mental well-being.

Remember, there's no shame in asking for help. Whether you're an older adult struggling with the transition to retirement or a caregiver feeling overwhelmed, reaching out is a sign of strength, not weakness.

Antidepressants do help, but they are seldom a panacea. If you're feeling discouraged by their partial impact, remember that stumbling forward is often successful. Keep trying, keep moving, and keep connecting.

We owe it to those who paved the way for us to ensure that their later years are not defined by loneliness and despair, but by dignity, purpose, and love.

Warmest Aloha,

Dr. Warren Wong

PS: I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.