More and more Bermudian families are finding themselves in a role they never quite prepared for: caring for an ageing parent while also raising children, managing work, navigating financial pressures, and trying to hold together their own wellbeing in the process.

Behind many front doors across the island, difficult conversations are already happening — around memory loss, depression, isolation, personality changes or the quiet fear that someone they love is no longer quite themselves.

Yet despite how common these experiences are becoming, mental health in older adults is still not something we talk about enough.

Many older Bermudians grew up in a time when mental health struggles were viewed as deeply private, or even shameful. There is also a lingering belief that depression, anxiety, withdrawal or emotional distress are simply a normal part of ageing. But they are not.

Ageing does bring change — loss, grief, medical issues, physical decline and shifts in independence. But emotional suffering should never simply be accepted as inevitable.

One of the challenges in caring for older adults is that mental health symptoms are often more complicated than they first appear. Physical illness, medication interactions, loneliness, neurological changes and cognitive decline can all affect emotional wellbeing in later life.

That complexity is part of why proper assessment matters.

Sometimes psychiatric symptoms can also be an early sign of dementia or another cognitive disorder. Dementia is often thought of only as memory loss, but emotional and behavioural symptoms are also very common, affecting the vast majority of people living with the condition at some stage of illness — including depression, agitation, paranoia, hallucinations, sleep disruption or significant changes in personality.

These symptoms can be deeply distressing not only for the person experiencing them but also for the people caring for them.

In my previous clinical work, I often saw family members carrying enormous emotional strain while trying to support an older loved one through dementia and other complex mental health challenges. Many were quietly balancing caregiving, work, children, finances, grief and emotional exhaustion while trying to keep everything afloat.

Many caregivers quietly carry enormous emotional strain for long periods of time.

Many caregivers neglect their own health and wellbeing because the demands placed upon them become overwhelming. Others experience depression, anxiety or guilt while trying to support someone they love through an incredibly difficult stage of life.

Supporting the mental health and wellbeing of caregivers is just as important as supporting the person living with dementia.

As rates of dementia continue to rise, these challenges are becoming increasingly important for communities everywhere, including Bermuda. In the United States, the number of people living with dementia is projected to nearly double between 2020 and 2050. While dementia itself may not at present be reversible, there are treatments and supports that can meaningfully improve behavioural symptoms, emotional wellbeing and quality of life for both patients and families.

Good mental healthcare is about more than symptom management. It is about helping people maintain dignity, connection, identity and quality of life.

Throughout my training and clinical work, I have also developed a particular interest in psychodynamic psychotherapy — a form of therapy that helps people to better understand patterns in their emotions, relationships and experiences.

Ageing often brings old questions back to the surface — around identity, loss, purpose, regret, relationships and change. Therapy can provide space to process those experiences rather than simply carry them quietly.

The need for support, connection, dignity and emotional wellbeing does not disappear as we grow older.

Ageing may change many things but it should never mean suffering in silence.

• Elizabeth Hathaway is an adult and geriatric consultant psychiatrist at Solstice. For more information, go towww.solstice.bm