A Silent Struggle: Mental Health in Older Men

A Reflection on Depression, Anxiety, and the Weight of Caregiving

By Alexander Nury, Co-author of Survival Guide to Caring for Aging Parents

Ask any older man how he’s doing, and he’ll almost certainly wave his hand and say, “I’m fine.” I should know. I’m one of them. That single phrase carries decades of conditioning — a lifetime of being told that strength meant silence, that need was weakness, and that the weight of the world was ours to carry without complaint.

The National Alliance on Mental Illness (NAMI) says that mental health is an important part of supporting overall physical and emotional well-being. The National Center for Health Statistics found that, although women experience depression more often than older men, men have higher suicide rates. Depression and anxiety in elderly men remain among the most overlooked health crises of our time.

What’s the Difference Between Depression and Normal Sadness in Older Age?

It’s a fair question, and one we spend real time on in Chapter 3 of our book. The tricky part is that older adults rarely say “I’m depressed” out loud (often because they are actually unaware that they are depressed), Instead, they show it, and what they show often gets waved off as “just getting older.” Watch for withdrawal from people and activities, a fading appetite, sleep that’s suddenly all wrong — too much or too little — and a general slowing down. Ordinary sadness lifts with time. These signs of depression, left alone, don’t.

“Assessments can help differentiate between normal aging processes and more serious mental health conditions so that you can pursue appropriate treatments like psychotherapy, medication, or both.” — Chapter 3, Survival Guide to Caring for Aging Parents

The Numbers We Don’t Talk About

Depression and anxiety are not simply by-products of a rough week or a bad mood. In older men, these are serious medical conditions shaped by a convergence of forces: the loss of identity that often accompanies retirement, the death of close friends or a spouse, chronic physical illness, isolation, cognitive decline, and the gradual shrinking of a world that once felt expansive. According to the CDC, older adults account for a disproportionately high rate of suicide in the United States — and elderly men, particularly white men over 75, have the highest suicide rates of any demographic group in the country. Yet they are among the least likely to receive mental health treatment.

Why Men Don’t Ask for Help

Men of the greatest and silent generations were raised in a world where emotional expression was considered self-indulgent, where “handling it” was a virtue, and seeking help — particularly from a therapist or counselor — carried the stigma of instability or weakness. That stigma does not disappear at 70. It stays with us.

Many older men genuinely don’t recognize what they are experiencing as depression or anxiety. They describe it differently — as tiredness, irritability, a loss of interest in things they used to enjoy, or a vague sense that nothing matters much anymore. They are far more likely to mention a physical complaint to a doctor than to say “I think I am depressed.” And because most routine medical appointments don’t include a mental health screening, the condition may go undetected and untreated for years.

Additionally, there are practical barriers such as limited access to mental health providers, transportation challenges, Medicare coverage confusion, and the generational distrust of psychiatry — and then it becomes clear why so many older men are suffering in silence.

The Burden of Older Men as Caregivers

One of the least visible roles in caregiving is the older man caring for an aging parent. In most families, we tend to picture caregivers as middle-aged women, the stoic woman capable of juggling multiple tasks at a time. Statistically, they are the majority — but a significant and growing number of older adult sons and husbands in their 70s and 80s find themselves as primary caregivers for a parent in their 90s or a spouse with dementia. This role brings its own profound emotional toll.

For many older men, caregiving is very unfamiliar territory. It runs counter to how they understand their role in a family and in the world. They may feel grief, frustration, helplessness, and love all at once — and have no framework or community for processing any of it. They may feel isolated as this demand can start to limit their personal networks. Exercise and sleep suffer. And because men are far less likely than women to seek support groups or peer connections around caregiving, the emotional labor also goes unshared and unsupported.

Over time, caregiver burnout in older men often shows not as tearfulness or expressed despair, but as withdrawal, irritability, physical decline, and quiet resignation that might be confused with “he’s just getting old.”

Having experienced many of these feelings as I care for my 95-year-old mother with Alzheimer’s, I can personally vouch for these experiences; I’ve been there.

What Should You Do If You’re Feeling Depressed? Getting Help That Works

The good news is that effective help does exist. Depression and anxiety in older adults are among the most treatable conditions in medicine. The challenge is getting them there.

For those open to it, therapy is a powerful starting point. Cognitive Behavioral Therapy (CBT) has a strong evidence base for both depression and anxiety in older adults and can be done in person, via telehealth, or even through structured self-guided programs. Many older men find individual therapy more approachable than group settings, at least initially. The key is finding a therapist who understands the generational context and works within a supportive framework that does not denigrate these symptoms or treat them as an illness.

Medication, when appropriate, can also be highly effective. Primary care physicians can prescribe antidepressants and anti-anxiety medications, meaning a man does not need to see a psychiatrist or even call himself a therapy patient. For many older men, that framing matters.

Community-based supports — senior centers, faith communities, men’s groups, and volunteer programs — offer connection and purpose without the clinical label. AARP, the Eldercare Locator (1-800-677-1116), and the SAMHSA helpline (1-800-662-4357) are all practical entry points. For older men in a caregiver role specifically, the Family Caregiver Alliance and local Area Agencies on Aging provide respite care, counseling referrals, and peer support resources.

A Final Word

If you are an older man reading this — or love one — I want to say something clearly: the things you are feeling are real, they are valid, and they are not a sign of weakness. A generation of men was taught to equate endurance with strength. But there is a different kind of strength in acknowledging that something is wrong, and I deserve help. Your silence, your suffering, has gone on long enough. Seek the help that you need!

This is one of the themes we return to throughout Survival Guide to Caring for Aging Parents — because caring for the people who taught us not to complain starts with recognizing when they, or we, need help.

If you or someone you love is struggling, please reach out. The 988 Suicide and Crisis Lifeline is available 24/7 by calling or texting 988. You do not have to be in crisis to call — they are there for anyone who is struggling.