The Healthy Brain Initiative improves understanding of brain health as a central part of public health practice. The initiative creates and supports partnerships, collects and reports data, increases awareness of brain health, supports populations with a high burden of Alzheimer’s disease and related dementias, and promotes the use of its Road Map series: State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map, and the Healthy Brain Initiative Road Map for Indian Country. The Road Map series provides actionable steps to promote brain health, address cognitive impairment, and address the needs of caregivers. In addition, the Healthy Brain Initiative supports the development of future Road Maps.

CDC is working with funded partners to accomplish the Road Map’s recommended actions. For example, the Alzheimer’s Association helps develop and track Road Map action items, and helps state public health agencies use them. Given that one out of every three American Indian and Alaskan Native elders develops dementia, the Association for State Territorial Health Officials (ASTHO) developed a series of health communication materials to improve quality, availability, and accessibility of public health resources to address the connection between brain health and heart health, Healthy Heart, Healthy Brain.

To learn more, please visit https://www.cdc.gov/aging/nationalinitiatives/national-healthy-nhbi.html.

Mental health is important at every stage of life and it includes emotional, psychological, and social well-being.  As people age, they may experience certain life changes that impact their mental health, such as coping with a serious illness or losing a loved one. Although many people will adjust to these life changes, some may experience feelings of grief, social isolation, or loneliness. When these feelings persist, they can lead to mental illnesses, such as depression and anxiety.  Effective treatment options are available to help older adults and people at every stage of life to manage their mental health and improve their quality of life. Recognizing the signs and seeing a health care provider are the first steps to getting treatment.

Depression and Aging

Depression is not a normal part of growing older

Depression is a true and treatable medical condition, not a normal part of aging. However older adults are at an increased risk for experiencing depression. If you are concerned about a loved one, offer to go with him or her to see a health care provider to be diagnosed and treated.

Depression is not just having “the blues” or the emotions we feel when grieving the loss of a loved one. It is a true medical condition that is treatable, like diabetes or hypertension.

How do I know if it’s Depression?

Someone who is depressed has feelings of sadness or anxiety that last for weeks at a time. He or she may also experience–

• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Insomnia, early–morning wakefulness, or excessive sleeping
• Overeating or appetite loss
• Thoughts of suicide, suicide attempts
• Persistent aches or pains, headaches, cramps, or digestive problems that do not get better, even with treatment

How is Depression Different for Older Adults?

• Older adults are at increased risk. We know that about 80% of older adults have at least one chronic health condition, and 50% have two or more. Depression is more common in people who also have other illnesses (such as heart disease or cancer) or whose function becomes limited.
• Older adults are often misdiagnosed and undertreated. Healthcare providers may mistake an older adult’s symptoms of depression as just a natural reaction to illness or the life changes that may occur as we age, and therefore not see the depression as something to be treated. Older adults themselves often share this belief and do not seek help because they don’t understand that they could feel better with appropriate treatment.

How do I Find Help?

Most older adults see an improvement in their symptoms when treated with antidepression drugs, psychotherapy, or a combination of both. If you are concerned about a loved one being depressed, offer to go with him or her to see a health care provider to be diagnosed and treated.

If you or someone you care about is in crisis, please seek help immediately.

To learn more, please visit https://www.cdc.gov/aging/olderadultsandhealthyaging/mental-health-and-aging.html.

The conditions in places where people are born, live, learn, work, and play are known as social determinants of health (SDOH). These conditions can have a profound effect on a person’s health, including their risk for Alzheimer’s disease and related dementias.

Differences in SDOH contribute to the stark and persistent chronic disease disparities in the United States among racial, ethnic, and socioeconomic groups by systematically limiting opportunities for members of some groups to be healthy. While public health crises and economic uncertainty may focus attention on disparities, health inequities have persisted across generations because policies and practices have systematically limited access to health care and other opportunities.

A growing body of work exists around social and economic factors that may contribute to a person’s health status, including a person’s risk for dementia. Although more work needs to be done to determine the exact relationship between these factors and dementia, here are a few areas that could be considered:

Education

Studies show an association between a higher level of education and better brain health. For example, among adults aged 45 years or older, the proportion experiencing subjective cognitive decline was lowest for college graduates and nearly three times greater for those without a high school diploma. One theory being considered by researchers as to why education levels may affect the risk of developing dementia has to do with cognitive reserve. Cognitive reserve refers to the level of knowledge and education “banked” in early years that may protect and compensate for a decline in cognitive health in later years.

Access to Health Care

Access to health care affects many facets of a person’s physical and brain health. Consistent access to health care services gives people the opportunity for regular preventive health services and early diagnosis of many health conditions, such as diabetes, heart disease, and dementia. Access can also help prevent hospitalizations through the successful management of chronic health conditions. People with dementia often have one or more other chronic health conditions, and care coordination with providers and family care partners is essential to better care and improves health outcomes.

Built Environment

The built environment is the physical environment around us. It includes the spaces where we live, learn, work, and play—our homes, schools, businesses, streets and sidewalks, open spaces, and the options people have for transportation. Built environments can influence overall community health and individual behaviors, such as physical activity and healthy eating. Built environments can affect health both positively and negatively. Healthy community design can improve opportunities for exercise, access to services, and community supports—all of which have a positive impact on brain and physical health.

Loneliness and Social Isolation

A number of studies indicate that maintaining strong social connections and keeping mentally active as we age may lower the risk of cognitive decline and dementia. Experts are not certain about the reason for this association, but it may be due to a strengthening of connections between nerve cells in the brain.

Although it’s hard to precisely measure social isolation and loneliness, there is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health at risk. Recent studies found that:

• Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.¹
• Social isolation was associated with about a 50% percent increased risk of dementia.¹
• Poor social relationships were associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.¹
• Loneliness was associated with higher rates of depression, anxiety, and suicide.¹

¹National Academies of Sciences, Engineering, and Medicine. 2020. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies

To learn more, please visit https://www.cdc.gov/aging/disparities/social-determinants-alzheimers.html.