Why so few older Americans get counseling—and how it could help

As life expectancies rise, the demographics of older adults are transforming the concept of aging. By the late 2060s, it is projected that there will be over 2.5 billion individuals aged 60 or above globally—outnumbering those under 18. Moreover, the population aged 80 and beyond is expected to more than triple from 2023 to 2060, reaching approximately 545 million.

This extended lifespan brings forth a myriad of changes that can introduce new questions and concerns for older adults, which some may address through counseling or therapy. However, strikingly, older adults are significantly less likely to seek mental health support compared to younger generations. As a researcher specializing in aging, disability, and mental health, I have delved into the reasons behind this counseling gap among older adults and how it could be effectively addressed.

My perspective suggests that the shortage of counseling services for older adults often stems from outdated notions of aging and what mental health support can offer. A personal anecdote from a 79-year-old acquaintance further illuminated this issue. He observed that during a family member's counseling session, much of the discussion centered on aging and mortality.

He remarked that older adults require spaces to discuss more than just dying; they also need a supportive environment to talk about living, the changes they are experiencing, the decisions they are making, and what is important to them in the present moment.

The scope of counseling in older adulthood extends beyond addressing illness, loss, and bereavement. While these are indeed crucial concerns, therapy can also aid individuals in navigating various life transitions, such as changes in work, health, abilities, relationships, independence, and identity, as well as contemplating future possibilities.

According to 2024 national data, only 7.5% of adults aged 65–74 and 5% of those aged 75 and older received counseling or therapy from a mental health professional, in contrast to 20.2% of adults aged 18–29.

Numerous factors contribute to the reluctance of older adults to seek counseling. Practical barriers include cost, health issues, transportation challenges, and difficulties accessing services. Additionally, many older adults may not initially consider counseling as a viable option, often preferring informal support sources over professional mental health services.

Stigma, negative beliefs about therapy, and financial constraints are among the most frequently cited barriers. Furthermore, age-related stereotypes may also play a role. A 2025 review revealed that both older adults and healthcare professionals who hold negative stereotypes about aging tend to have less confidence in the efficacy of psychotherapy for effecting change or improvement.

While these factors elucidate the challenges in accessing counseling, they do not encapsulate the entire picture.

The transitions associated with aging—some by choice and others due to circumstances—can be daunting. These may include retirement after a long career that defined one's daily life and identity for four decades, the need or desire to continue working but being unable to perform the same job, learning to live with a disability, giving up driving, caring for a spouse, shifting from a long-time residence, initiating a new relationship, or adapting to changes in physical well-being.

Such transitions can impact more than just daily routines; retirement, for instance, can question a person's sense of purpose. Other later-life changes like bereavement, relocation, and shifts in physical health can also influence one's sense of meaning and well-being.

The understanding of mental health support in later life has evolved since the early 2000s. Researchers and practitioners have increasingly recognized the diverse ways individuals experience aging, their inherent strengths, and their potential for continued growth and change. Updated 2024 guidelines for counseling older adults reflect this more inclusive approach, emphasizing individual circumstances, relationships, health, abilities, and the socio-cultural aspects of aging.

This paradigm shift can influence the topics older adults choose to discuss with counselors. For example, giving up driving could be more about retaining independence than merely about transportation. Retiring might raise questions about identity, purpose, and what lies ahead. Managing a disability might require determining what is still achievable and how one envisions moving forward.

Counselors' preconceived notions about aging can also impact these conversations. Studies have shown that even counselors who frequently work with older adults may harbor age-related biases. If a counselor primarily views an older person's challenges through the lens of age, illness, death, or bereavement, they may overlook other significant aspects of their life, such as independence, relationships, identity, purpose, altering roles, and the life yet to come.

Research indicates that older adults can benefit equally from counseling as younger adults, not just for addressing mental health conditions but also for navigating life changes. Counseling can provide a platform to explore not only what has changed but also the implications of those changes and how one wishes to proceed in life.

If contemplating counseling later in life, it is essential to keep in mind that while counseling may occasionally involve grief, illness, and loss, it can also offer a space to ask a different kind of question: What does my life look like now?