She thought her anxiety and depression were just part of getting older. Nothing worth talking about, and certainly nothing worth seeking help for. But over time, even routine activities began to feel overwhelming. Her once-consistent participation in chronic disease self-management classes quickly waned. To family and friends, it looked like reluctance. In reality, it was the quiet weight of untreated emotional distress. Her story is not unusual for older adults.
Her experience, along with others expressed anonymously in new multi-state research from the LECOM Health BRIDGES for Older Adults project, conducted in collaboration with the Administration for Community Living, reflects a broad and mounting divide in behavioral health access, comfort with seeking help, and outcomes among older adults—a “growing gray gap.”
A Rising Need and a Shrinking Safety Net
The United States is aging rapidly, and as this demographic shift accelerates, depression, anxiety, and other behavioral health conditions are rising among older adults yet support systems have not kept pace. Generational differences in comfort with mental health care, gaps in access, and limited familiarity with services leave millions of older adults without adequate support.
One survey respondent captured the dynamic bluntly: “Because of my anxiety and depression, I’m less likely to seek help for my chronic conditions. I’ll just say I deserve this pain.”
This candid perspective underscores a central theme of the BRIDGES research: Behavioral health directly influences physical health and participation in chronic disease self-management.
What the Data Reveals
The LECOM Health BRIDGES for Older Adults study draws on more than 400 survey respondents and interviews with community-based organization staff. Across the primary research, a persistent problem emerged: practical and emotional barriers to behavioral health care consistently undermined older adults’ ability to manage their overall health.
‘Only one in three caregivers had helped a loved one access behavioral health services, compared to nine in ten helping with physical-health needs.’
One survey participant understood that he had behavioral health needs but described a lack of understanding of what treatment looks like, where to get help, and how to trust providers. This led to him not seeking necessary treatment. His experience echoed the data.
“After analyzing the data we collected and listening to anecdotal stories from participants, it is clear that older adults, especially those in rural, low-income communities, face a perfect storm that prevents them from accessing care,” said Dr. Danielle Hansen, regional president of LECOM Health, project manager for LECOM Health BRIDGES for Older Adults, and one of the report’s authors.
Key Findings:
- Half of older adults surveyed who had at least one behavioral health symptom had not accessed behavioral health treatment in the past year.
- Three in five reported that their behavioral health condition interferes with participation in chronic disease self-management programs.
- Only one in three caregivers had helped a loved one access behavioral health services, compared to nine in ten helping with physical-health needs.
- Only two in five chronic disease self-management class facilitators surveyed had formal behavioral health training, and 76% said they lacked effective strategies to engage participants with behavioral health conditions.
How Geography and Logistics Widen the Gray Gap
The gray gap widens significantly in rural areas. Older adults living in rural communities were more likely to report barriers to behavioral health access such as provider shortages, having to travel long distances, and technology limitations.
One survey respondent struggles with vision and mobility and relies upon others for transportation. With no bus route near his home and no access to rideshare services, even just calling to schedule a ride is difficult. Making the call is frustrating for him because he can’t hear well or easily see the numbers to dial. He also lacks access to high-speed Internet and has limited experience with technology, further decreasing options for communication. Due to these challenges, he reported sometimes skipping appointments and classes.
His experience illustrates the compounding effect of logistical barriers that many rural older adults face daily.
Behavioral Health Stigma in Older Adults
Stigma emerged as one of the most pervasive obstacles across the BRIDGES data. In the sample of survey participants who took the Endorsed and Anticipated Stigma Inventory (EASI), we found:
- 46% said stigma affects their willingness to seek care
- A similar percentage said they would seek help only if a problem became “really bad”
- One-third expressed concerns about medications, side effects, or feeling pressured into treatments
One survey respondent’s experience reflected this stigma trend. After breaking her hip, she had became increasingly lonely and depressed. When referred to counseling, the woman, an active member of her church, believed that “God would not want her to seek outside help,” and felt that pursuing mental health services would go against her beliefs.
Though lonely in her unique situation, research shows that she is not alone in her stigmatized view of behavioral health. Her story is similar to those of many older adults for whom stigma, whether cultural, generational or personal, remains a strong deterrent to accessing care.
Survey results confirmed that those with household incomes of less than $25,000 were more likely to endorse stigmatizing beliefs and report barriers to care. Black and Hispanic respondents were more likely to express mistrust in provider relationships and treatment effectiveness, reflecting long-standing inequities in healthcare access. Men also reported higher resistance to seeking help, consistent with cultural norms around masculinity and vulnerability.
‘Caregivers cited insufficient training to recognize symptoms, challenges reinforcing program content, burnout and financial strain.’
Together, these stigmatic factors create a layered, complex barrier to behavioral health care that cannot be addressed with a one-size-fits-all solution.
“These intersecting challenges mean that even well-designed chronic disease programs are struggling to reach those most in need,” Dr. Hansen said.
Structural and logistical barriers also compound stigma, as the LECOM BRIDGES for Older Adults report identifies cost, transportation, and limited provider availability as primary obstacles. In fact, facilitators surveyed reported that 72% of participants with behavioral health conditions were prevented from attending programs because of transportation issues.
Closing the Gray Gap
According to the LECOM Health BRIDGES for Older Adults authors, closing the gray gap requires addressing emotional and logistical barriers in tandem. Emotional barriers that prevent older adults from considering care—such as stigma, low symptom awareness, financial stress, social isolation, and trust barriers— must be addressed first. Then, logistical needs like transportation, technology, accessibility accommodations, and local service availability can be tackled to effectively adopt practical solutions.
Community-based organizations, Aging & Disability Network agencies, and caregivers are essential partners in both phases. Yet many lack the tools or support needed. Nearly 70% of facilitators reported low confidence in making behavioral health referrals. Caregivers cited insufficient training to recognize symptoms, challenges reinforcing program content, burnout, and financial strain.
“In addition to speaking directly to those with behavioral health concerns, we’re also looking to support those around them,” Dr. Hansen said. “Caregiver- and organization-inclusive strategies such as symptom-recognition training and practical tools for referral follow-through are a major part of what we’re doing.”
Practical Strategies and What Works
Ultimately, the report outlines pragmatic, evidence-informed responses. These include:
- Integrating behavioral health into chronic disease self-management using brief tools like the Patient Health Questionnaire-9 (PHQ-9), a diagnostic tool monitoring the severity of depression in adults, and General Anxiety Disorder-7 (GAD-7), an initial screening tool for generalized anxiety disorder.
- Embedding stress-management practices and peer support into existing programs.
- Scaling facilitator training in Mental Health First Aid, trauma-informed care, crisis response, motivational interviewing, and cultural competence.
- Strengthening referral networks through centralized directories and partnerships between aging services and behavioral health providers.
- Expanding low-tech and no-tech options, such as in-person offerings or by-the-book information, rather than virtual meetings and online resources, especially for rural communities.
- Tracking outcomes over time to measure intervention effectiveness.
“These steps recognize that behavioral health is essential for managing chronic disease, maintaining independence, and aging with dignity,” Dr. Hansen said. “The data also lends itself to clear strategies we can take to emphasize behavioral health and improve the overall health of our aging population.”
A Path Forward
The BRIDGES for Older Adults report underscores a clear conclusion: behavioral health must be viewed as integral—not incidental—to aging well and to chronic disease management. Untreated depression, anxiety and substance use undermine chronic disease management, increase isolation, and drive higher-cost emergency care.
But solutions are within reach. By reducing stigma, building workforce and caregiver capacity, and expanding access, communities can narrow the growing gray gap and support older adults with dignity, connection and support.
Brandon Boyd, MS, is director of Public Relations and Community Outreach for LECOM Behavioral Health in Erie, Penn.
Photo credit: Shutterstock/PeopleImages
