Why so few older Americans get counseling – and how it could help
Changes that often accompany later life can raise questions and concerns that people may explore in counseling or therapy. Space_Cat/iStock via Getty Images People are living longer, reshaping what it means to grow old.
By the late 2060s, an estimated 2.5 billion people worldwide will be age 60 or older, which exceeds the number of people under 18. The population aged 80 and older is projected to more than triple between 2023 and 2060, reaching about 545 million. These figures illustrate a global demographic shift toward longer lifespans, reshaping societal structures and individual experiences of aging. As people live longer, they also face more years of navigating changes related to health, independence, work, and relationships. This trend highlights the growing need for support systems that address the unique challenges and opportunities of later life.
Despite the increasing challenges of aging, older adults are far less likely to receive counseling or therapy compared to younger adults. National data from 2024 shows that only 7.5% of adults aged 65 to 74 and 5% of those 75 and older received counseling or therapy from a mental health professional. In contrast, 20.2% of adults aged 18 to 29 sought such services. This gap suggests that many older adults do not view counseling as a viable option for addressing their concerns. Practical barriers like cost, health issues, transportation, and difficulty accessing services contribute to this disparity, along with stigma and negative beliefs about therapy.
Negative stereotypes about aging can discourage older adults from seeking counseling. Research indicates that both older adults and health professionals may hold these biases, which can reduce confidence in the effectiveness of psychotherapy for older individuals. A 2025 review found that such stereotypes may lead to the assumption that aging primarily involves illness, loss, or bereavement, overlooking other important aspects of life like identity, relationships, and purpose. These misconceptions can limit the scope of support older adults consider for themselves, making it harder to address the full range of challenges they face.
Aging involves numerous transitions, some chosen and others imposed by circumstances. These may include retirement after a 40-year career, adjusting to a disability, giving up driving, caring for a spouse, moving from a longtime home, starting a new relationship, or facing changes in independence. Such transitions can disrupt daily routines and challenge a person’s sense of meaning and purpose. For example, retirement may raise questions about identity and what comes next, while bereavement or relocation can affect emotional well-being. These experiences highlight the need for support that addresses the broader implications of aging, not just health concerns.
Counseling in later life is often associated with addressing grief, illness, or loss, but it can also help older adults explore other important questions. A 79-year-old acquaintance noted that older adults need opportunities to talk about living, not just dying. Counseling can provide a space to discuss changes in work, health, abilities, relationships, independence, and identity, as well as to consider future goals. Updated 2024 guidelines for working with older adults emphasize the importance of addressing individual circumstances, relationships, health, abilities, and social realities, reflecting a broader view of aging and mental health support.
Even counselors who work with older adults may hold age-related biases that shape their approach. If a counselor focuses primarily on age, illness, or death, they may overlook other critical areas of an older adult’s life, such as independence, relationships, identity, purpose, or changing roles. Research has found that these biases can limit the effectiveness of counseling. To ensure support aligns with an individual’s needs, it is important to choose a counselor with experience working with older adults and to assess whether the conversation addresses the issues that matter most to the person seeking help.
Research shows that older adults can benefit from counseling as much as younger adults, not only for mental health diagnoses but also for navigating life changes. Counseling provides a space to discuss what has changed and what it means, as well as to explore how someone wants to live moving forward. For example, it can help address questions about identity after retirement, purpose in later life, or adjustments to disability. When considering counseling, it is important to remember that issues like retirement, caregiving, changes in independence, or relationship shifts are valid reasons to seek support.
If you are considering counseling later in life, the American Psychological Association recommends asking about a counselor’s experience. Inquire whether they have worked with older adults and whether they have expertise in the specific issues you want to address. In the first few sessions, pay attention to how the conversation feels, as counseling is collaborative and comfort with the provider matters. If the discussion does not address your concerns, it is reasonable to express this or consider finding another counselor who is a better fit. The goal is to find someone who can help you explore what you want your life to look like now.
