Older people's mental health is a product of both earlier life course experiences and experiences specific to later life. The role and impact of age-related risks and inequalities on psychological well-being and mental health is the focus of Chapter 4. It is important to acknowledge that ‘later life’ is now positioned as a social category of some significance: a period of life in which ‘practices of distinction’ take place and risks to mental health can be exacerbated and/or take root (Krekula, 2009, p 8).

In broad terms there are two sets, or groups, of age-related risks. The first set are those arising directly from experiences common to old age and include physical ill health, bereavement and loss. As has been explored in Chapter 3 while some of these risks, for example physical ill health are in part at least, a product of life course exposure to disadvantage, they are risks that tend to be more prevalent as people age. The second set of risks arises from ageism and age discrimination, and their intersection with other structural inequalities, such as sexism for older women.

Individual age-related risks

Most of the evidence relating to heightened risks of developing a functional mental health problem in later life relates to depression. The most significant risk factors for depression are losses as a result of ill health and disability, caring, bereavement, retirement and ‘daily hassles’ (Godfrey, 2009). As noted in Chapter 2, it is important to recognise that while these issues do not necessarily lead to depressive symptoms they do have a negative impact on psychological well-being and may act as triggers for the development of depression (Steptoe et al, 2015). Some commentators would argue that the boundary between depression and impaired psychological well-being is uneven especially when ‘symptoms’ may be short term or mild (Keyes, 2002). There is growing evidence that older people will ‘suffer in silence’ or mask their negative feelings with alcohol or medication.

Physical ill health and disability

As noted in Chapter 1, the prevalence of ill health and long-term conditions increases with advancing age (Age UK, 2016a). Sixty-nine per cent of people aged over 75 have at least one illness or disability.