By: Pierluigi Mancini PhD

Aging with dignity and purpose is a universal aspiration. Yet for older adults living with serious mental illness (SMI), the path to vibrant aging is often blocked by systemic barriers, social isolation, and fragmented healthcare. While the conversation around aging has increasingly embraced wellness, vitality, and engagement, too often older adults with psychiatric disabilities are left out of that narrative. It’s time to change that.

When we talk about vibrant aging, we’re not just referring to staying physically active or picking up new hobbies, although those can be wonderful. Vibrant aging for individuals with SMI means living in a community that recognizes their value, supports their goals, and ensures equitable access to integrated care. It’s about thriving—not just surviving—through the later years of life.

Researchers have consistently shown that mortality rates in patients with a severe mental illness are significantly higher than in the general population. One study found that individuals with SMI die 10–20 years earlier on average, due to a complex mix of factors including inadequate healthcare access, stigma, and social disconnection. As we work to build more age-friendly communities, we must ensure that older adults with SMI are not overlooked.

1. Embracing Recovery-Oriented Care for Older Adults

Recovery doesn’t have an expiration date. The belief that recovery is limited to younger individuals is outdated and damaging. Recovery-oriented care must be tailored to the unique needs of aging adults, recognizing their lifetime of resilience and helping them identify meaningful goals, whether they be social, spiritual, or personal.

Peer support programs have emerged as a vital component of this effort. These programs offer emotional and practical guidance from individuals with lived experience, helping to reduce isolation and empower older adults to navigate their health systems more effectively. Despite their proven benefits, such supports are rarely prioritized for older adults. This must change. Aging should open a new chapter of recovery, not close the book.

2. Combating Isolation Through Connection

Loneliness and isolation are not just emotional states, they are critical health risks. The National Academies of Sciences, Engineering, and Medicine report that social isolation among older adults is associated with increased risk of dementia, heart disease, stroke, depression, and premature death. These risks are compounded for older adults with psychiatric disabilities who may also face discrimination, trauma histories, or language barriers.

Solutions exist. Structured group activities, culturally responsive community engagement, and intergenerational programs can help reestablish social bonds. Peer-led interventions are especially promising in creating safe spaces of shared experience and mutual respect, essential for fostering long-term recovery and well-being.

3. Access to Holistic and Integrated Healthcare

Older adults with serious mental illness are often forced to navigate a fragmented healthcare system, mental health services on one side, physical health on another, and substance use treatment somewhere in between. The result is poorer health outcomes, higher healthcare costs, and shorter lifespans.

As Bartels and colleagues emphasized, integrated care models designed specifically for older adults with SMI are not just beneficial, they are essential. These models simultaneously address psychiatric, medical, and social needs, ideally in co-located settings and with attention to cultural and linguistic responsiveness. When care systems treat the whole person, body, mind, and spirit, older adults are far more likely to engage and thrive.

4. Supporting Purposeful Aging

Aging can be a time of creativity, service, and joy, when the right opportunities are available. Whether through community gardens, volunteering, technology training, or arts programs, purposeful aging allows individuals to remain engaged and feel valued.

One promising example comes from the National Health and Aging Trends Study, which examined the impact of engaging in a favorite activity. Among participants with dementia, those who regularly engaged in meaningful activities experienced greater functional independence and lower levels of depression. Similarly, cognitively healthy older adults saw benefits in memory, mood, and overall function. Programs that facilitate this kind of engagement can become lifelines, not luxuries.

5. Advocating for Systems That Work

Transforming outcomes for older adults with psychiatric disabilities requires more than better programs, it requires systemic change. Medicaid expansion, affordable housing, workforce development, and language access must all be prioritized if we are to remove the structural barriers that stand in the way of recovery.

One key action is to build equity into every layer of mental health program design. That means training staff to serve aging populations, requiring that services address cultural and linguistic needs, and challenging stereotypes that frame aging as decline. Instead, we must amplify stories of older adults who are thriving in recovery, and celebrate aging as a time of reflection, resilience, and contribution.

The journey toward vibrant aging for people with serious psychiatric disabilities is not a solitary one. It is a shared responsibility across providers, families, policymakers, and communities. We must ask ourselves: Are we designing systems that reflect the voices and values of the people they’re meant to serve?

The answer must be yes, and that yes must come with action.

Let us challenge assumptions. Let us build structures that sustain hope. And let us embrace the vision that every older adult, regardless of diagnosis, deserves to age with dignity, purpose, and joy.

References

• Bartels SJ, DiMilia PR, Fortuna KL, Naslund JA. Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity: Evidence-Based Models and Future Research Directions. Psychiatr Clin North Am. 2018 Mar;41(1):153-164. doi: 10.1016/j.psc.2017.10.012. Epub 2017 Dec 13. PMID: 29412843; PMCID: PMC5806142. https://pubmed.ncbi.nlm.nih.gov/29412843/
• de Mooij LD, Kikkert M, Theunissen J, Beekman ATF, de Haan L, Duurkoop PWRA, Van HL, Dekker JJM. Dying Too Soon: Excess Mortality in Severe Mental Illness. Front Psychiatry. 2019 Dec 6;10:855. doi: 10.3389/fpsyt.2019.00855. PMID: 31920734; PMCID: PMC6918821. https://pubmed.ncbi.nlm.nih.gov/31920734/
• Joo JH, Bone L, Forte J, Kirley E, Lynch T, Aboumatar H. The benefits and challenges of established peer support programmes for patients, informal caregivers, and healthcare providers. Fam Pract. 2022 Sep 24;39(5):903-912. doi: 10.1093/fampra/cmac004. PMID: 35104847; PMCID: PMC9508871. https://pubmed.ncbi.nlm.nih.gov/35104847/
• National Academies of Sciences, Engineering, and Medicine. (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. The National Academies Press. https://doi.org/10.17226/25663 https://nap.nationalacademies.org/catalog/25663/social-isolation-and-loneliness-in-older-adults-opportunities-for-the
• Regier NG, Parisi JM, Perrin N, Gitlin LN. Engagement in Favorite Activity and Implications for Cognition, Mental Health, and Function in Persons Living With and Without Dementia. J Appl Gerontol. 2022 Feb;41(2):441-449. doi: 10.1177/0733464821999199. Epub 2021 Mar 18. PMID: 33733908; PMCID: PMC8448794. https://pubmed.ncbi.nlm.nih.gov/33733908/