6 Tips for Caring for an Aging Parent With Mental Illness

Caregiving for a parent, grandparent or friend is challenging — add mental illness or cognitive problems on top of that, and it’s even harder. Whether they’re dealing with a new or recurring mental health issue like depression or bipolar disorder or they’re experiencing memory loss, that can make aging extra stressful for them and for you. 

But managing the mental health of the person you’re caring for, as well as your own, is important to the well-being of both of you and the health of your relationship — so here’s advice from experts on how to do so. 

How mental illness and cognitive issues affect older adults 

Among adults ages 60 and older, 14% live with a mental health condition, according to the World Health Organization (WHO). Plus, there are more than 55 million people around the world living with some form of dementia, with almost 10 million new cases diagnosed each year. 

Dementia and delirium are the most common issues that Dr. William Solan, director of geriatric psychiatry at the UW Medicine Center for Behavioral Health and Learning, sees in older adults he helps care for. Serious mental illnesses like depression, schizophrenia or bipolar disorder are also common and often get harder to manage with age. It’s possible for someone to have a mental health condition and dementia or delirium, too. 

Aside from diagnosable mental health conditions, older adulthood is often a time when there is a greater threat of loneliness and a time when people are reflecting on their life’s meaning. Dr. Stephen Thielke, a geriatric psychiatrist at the Center, likes to explain this stage of life by referring to psychologist Erik Erikson’s popular model of development: The last stage, corresponding with old age, is called integrity versus despair.

“You’re asking yourself what was the meaning of your life overall, and are considering your legacy — what people will say about you and what you contributed to the world,” Thielke says. “If you feel that nothing you did was valuable or that you hurt others, you develop a sense of despair.” 

For some, this despair can trigger things like anxiety or depression — or maybe someone’s existing anxiety or depression has worsened as they age, contributing to a sense of despair that could be lessened if their mental health issues were addressed. 

Ways to get help for older adults with mental illness 

Given all of these potential challenges, it’s important to know your options as a caregiver. Whether your loved one lives with you or lives independently or needs a more supported living situation, the most important thing is to seek help. 

“It’s a huge challenge to care for people who have serious behavioral problems, especially if a family caregiver is trying to do everything on their own,” says Thielke.  

Group therapy and programs 

For older adults who are able to function but are still struggling with their mental health, outpatient therapy can be a helpful way to reduce loneliness, connect them with the community and help them understand that they don’t have to hide how they’re feeling (something that older generations were often taught).  

Koriann Cox, a UW Medicine psychologist, has seen this firsthand while leading an intensive outpatient program for older adults. The group is accessible to all adults who are struggling to manage their mental health conditions, including special offerings for older adults. 

“We teach them coping skills and how to manage mental health conditions, often things no one has formally taught them before,” says Cox. “It’s not that they didn’t want to or were not capable of it, they just didn’t have access or believe that they could have access.” 

The program that Cox runs has group therapy sessions three days a week for three hours each day. Patients are usually in the program for 12 weeks, and in addition to attending group therapy sessions, patients also attend medication management and treatment planning and can also engage in individual psychotherapy.  

“We really address the whole person: we teach them that their life can be different if they want it to be,” Cox says. “You can’t always change big structures of your life, but you can change how you engage with your life.”  

If patients are a little resistant or don’t believe it’s possible for their life to change, Cox likes to ask them: But what if it was possible? What if you could do this?  

“There’s such power in that,” she says. 

Care in a hospital 

If someone is having significant behavioral issues, isn’t caring for themselves, is having trouble functioning or is experiencing worsening mental illness, being admitted to a hospital for care may be necessary to help stabilize them and help them function again so they can return home. If they live in the Seattle area, they can look into UW Medicine’s new Center for Behavioral Health and Learning, which provides inpatient care for geriatric patients. 

“What makes it work well is our staff at the Center for Behavioral Health and Learning who are well-attuned to the needs of patients,” Thielke says. “The approach they take, especially with people with cognitive impairment, enables them to take seemingly impossible situations and get people home again.” 

This approach starts with understanding what people need: Often, someone who is having an outburst or being uncooperative is dealing with an underlying basic needs issue that needs to be addressed first. If someone is hungry or thirsty, cold or hot, or in pain, for example, agitation is a natural response. 

“If you can address the unmet need a lot of times people calm down considerably,” Thielke explains. 

Often, Solan’s patients come into an inpatient unit shortly after they first move into a nursing home or assisted living and are feeling confused or having trouble adjusting. Occupational and physical therapy, plus medications, are all key parts of helping people get home again, he says. 

“A lot of times that first placement is the most difficult. If they come to us, then go to another place, by then they seem to calm down and accept it,” he says. 

Assisted living, nursing homes and other community care 

Some people may balk at the idea of sending off a loved one to live in a nursing home or assisted living, preferring to keep the person at their own home or with family. In reality, it can be helpful for everyone involved when care is accessible 24/7 from people whose (paid) job it is to provide care.  

“A lot of people blossom in assisted living or at a nursing home versus at home,” says Solan. “A lot of times they’re isolated at home, but now they have a community.” 

In many cases, even when people feel isolated or despairing initially, they can get to a point where they feel more satisfied with how their life has gone. 

How caregivers can support their loved one — and their own mental health 

As a caregiver, it’s easy to get caught up in the other person’s needs and neglect your own. 

“There’s a huge reward in providing that love and caring for someone else, but it’s exhausting; if you’re neglecting your own mental or physical well-being, you probably should be looking for ways of getting help,” says Thielke. 

Self-care is vital for caregivers, and it encompasses many different things. Here are a few strategies to try.  

Learn their wants 

As much as possible, learn what your loved one wants before they reach a point where they can no longer communicate that to you. 

This includes creating a living will, getting finances in place and knowing if and when they would want to be resuscitated after a medical emergency. Better yet, have them create an advance directive, which combines a living will with power of attorney for medical situations where someone is not coherent enough to consent to interventions.

Completing power of attorney forms before your loved one is unable to make their own decisions about their finances or healthcare is relatively easy in Washington and can prevent issues further down the road. Pursuing guardianship over your loved one may be a good idea if they are not able to make their own decisions or care for themselves; again, it’s best to start this process sooner rather than later.

Shift your relationship 

If you’re struggling with your caregiver responsibilities — maybe your loved one doesn’t express gratitude, is resistant to your help or is unwilling to admit they need it — changing the way you relate to your loved one is an act of self-care.  

First, this means recognizing you can only do so much and that the other person’s behavior isn’t your responsibility. 

“You can only control your own behavior,” says Mollie Forrester, a licensed social worker and director of Patient and Family Experience at the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. “You need to give yourself permission to do self-care and remind yourself you’re trying your best; recognizing your limits is also part of self-care.” 

If your loved one has dementia, you don’t need to feel like you have to correct their mistakes or misrememberings — or bad behavior. People with dementia or certain types of mental illness can sometimes say or do things that are out of character, rude or inappropriate.  

“I tell a lot of people their loved one is not the same person they used to be; the person they were wouldn’t want to treat you the way they are now,” Solan says. “It’s the disease. It’s not intentional. You don’t blame people with diabetes for having high blood sugars; this is the same.” 

Detaching a bit emotionally, if possible, might be helpful. It’s also important to remind yourself that you’re doing what you need to do to keep them safe and as healthy as possible. 

Shifting your relationship dynamic might also look like stepping back a little in certain situations when you and your loved one are in disagreement about what they should do or how they should live. 

“Listen and know when to encourage and push a little bit, and then when to sit back and respect their autonomy,” says Cox. “If they feel forced, it’s not going to be a positive experience for anyone. Instead, offer encouragement; say, ‘I hear you, I won’t make you do that, what might it be like if you did?’” 

Get support and find community  

Whether it’s confiding in a friend, talking with a therapist or attending a support group for family and caregivers of people with memory issues or mental illness, making sure you aren’t alone is important. 

For people who can’t commit to regular in-person meetups or who would rather learn caregiver coping skills on their own, you can look for online programs, like the one that will soon be available from the Center for Behavioral Health and Learning. 

The Family and Caregiver Training and Support Program, aka FACTS, will teach families and caregivers many skills, from how to communicate with the person they care for to the different types of therapy, treatment and resources available for their loved one, says Forrester.  

The program is designed for people whose parent or loved one is dealing with cognitive or other mental health issues. Launching in the summer of 2024, the program will be available only to families whose loved one is being cared for at UW Medical Center – Northwest campus, but eventually Forrester hopes the program will be rolled out across UW Medicine.   

One key takeaway for caregivers? It doesn’t have to be doom and gloom all the time. While the challenges your loved one — and you — face are real, there is hope and opportunities for good things to come to both of you. 

“For the most part, if older adults are given a chance to reflect and connect with others, they navigate it quite well,” Thielke says. “There’s evidence that quality of life improves after middle-age, so you shouldn’t expect to be miserable as you get older, even if you may have more health challenges. In fact, you can take advantage of opportunities to learn, grow, help others and enjoy yourself.”