“Vulnerability is not a fixed state”: Swiss report on healthy aging

A recent ADVANCE report in Switzerland explores the factors contributing to mental distress among older adults and the stigma surrounding it.

Mental health in older adults is not just about the absence of disorders but also about emotional resilience and the ability to handle life's challenges.

“Mental stress is affecting older adults in various ways. We have identified two main pathways: there’s a factor affecting older adults’ mental health that’s leading to social isolation – being alone, feeling alone, being within the network, being on your own. The other is cognitive functioning starting to develop cognitive problems that is associated in different areas of cognitive functioning with mental health," says Melanie Mack, Postdoctoral Research Fellow at the Center for the Interdisciplinary Study of Gerontology and Vulnerabilities (CIGEV) of the University of Geneva.

Mack explains that these two domains interact. This means that stress impacts cognitive function, and noticing a decline in mental abilities can increase stress even more.

Switzerland has around 156,900 people currently living with dementia and an alarming 33,000 new cases each year. This number can double over the next 30 years if we do nothing. The interaction of mental health issues, depression and stress with cognitive decline, especially in socioeconomically vulnerable groups, do not only threaten well-being as we age but also lead to significant healthcare costs. 

Read the full report on Enhancing Mental Health and Cognitive Function in Older Adults: A Swiss Perspective on Public Health Interventions and Stigma Mitigation Strategies Informed by a Desk Review.

Vulnerability in Swiss older adults

Vulnerability in older adults primarily refers to the increased susceptibility to mental and cognitive decline, which poses a significant challenge for both healthcare systems and policymakers.

Vulnerability is not a fixed state. It’s more like a gradient that can change. For example, if your partner passes away, you are probably more vulnerable. If your family moves closer, or you gain a new social circle, you may become less vulnerable.

Older adults in Switzerland are a highly diverse group, and their health outcomes vary depending on factors like education, income, gender, and migration status. These differences can increase vulnerability among certain groups. While older adults are generally considered a vulnerable population, some face additional challenges.

Mack's team identified certain vulnerabilities. For example, those who are pre-frail, mobility-impaired, or living with chronic pain may be at higher risk of health complications. Others may struggle with age-related hearing loss, fear of falling, or managing multiple medications. Emotional challenges, such as prolonged grief after losing a partner, can also severely impact mental and physical health.

"Vulnerability in older adulthood can be understood across three key areas," explains Mack. "First, cognitive functioning, where age-related losses can range from normal changes to conditions like dementia. Second, physical health, which includes risks such as reduced strength, mobility limitations, and chronic conditions like hearing loss or pain. Finally, mental health is a crucial dimension, with risks such as prolonged grief, especially after the loss of a partner, as well as loneliness. When declines occur in these key areas, susceptibility to mental and cognitive decline increases." 

Stigmatisation

The ageing process is often accompanied by negative views in which older people are perceived as dependent, expensive, inactive and a burden on society. These widespread age stereotypes and discrimination, known as ‘ageism’, are present in various areas of society, particularly in the workplace and healthcare. 

Sadly, it's not uncommon for older patients to feel patronized by health professionals. This can show up in subtle ways, such as doctors using "elderspeak"—speaking slowly, using overly simple language, or adopting a condescending tone, much like they would with a child. Sometimes, medical staff may rush through explanations or skip them altogether, handing over medication without clearly discussing why it's needed or what the potential risks and benefits are. In other cases, older patients might feel invisible, as doctors direct questions and information to younger family members instead of addressing them directly. These experiences can leave older adults feeling disrespected and overlooked in decisions about their own health.

“We are dealing with both sides here, but of course, the internalized stigmatization of age often originates from societal attitudes,” adds Mack explaining that the fear of being stigmatised by others also prevent older adults from taking advantage of mental health interventions.

What can be done?

Mack emphasized that addressing these vulnerabilities and stigma requires a holistic approach that considers the unique circumstances and needs of older adults.

In Switzerland, ADVANCE is conducting a study to test two programs to enhance mental health and cognitive functioning among older adults in Switzerland: Self Help Plus (SH+) for stress management and memory training (COG).

“We will address two factors. One is the mental health part, and the other one is the cognitive part. And that's important because those two challenges depend on each other. For example, people who are more isolated, who are more lonely, often also have a lower cognitive function. So this is really an integrated effort and so we try to target both at the same time. Therefore, we are developing and evaluating an intervention that combines cognitive training with stress management training,” explains Mack.

Cognitive functioning and mental health are highly connected. So, by targeting both, Mack’s team hopes to improve those aspects more effectively.

Actually, that's our main goal—improving resilience as well as cognitive health. We believe that the combined intervention will lead to better outcomes in terms of cognitive functioning and mental health than the individual components.

SH+ has not yet been tested in older people without a migration background in Switzerland and the combination of stress management and memory training has not yet been studied in detail. The study aims to find out whether the combination of the two programs works better than each program on its own.

“We will try to do this across the whole society in Switzerland. We will try to recruit representative samples so that we can see how people with different socioeconomic statuses respond to these interventions. And we will also compare them to either cognitive training alone or mental health stress management training alone, so that we can see whether the combination is better than just one of the other options. And then also by designing an intervention that can be scaled up and conducting a cost evaluation, we aim to provide something that can really be used widely for society”, says Mack.

Moreover, the ADVANCE team in UNIGE believes that it is important to design the programs in such a way that the broadest and most diverse group of older people can benefit from them. Therefore, the team has established a Society Advisory Groups (SAG) who provides feedback on the study and the planned intervention.

“Our SAG consists of a diverse group of stakeholders. We have healthcare professionals, gerontology experts, people working as nurses, people working in research facilities and individuals involved in NGOs. We also have people who are directly involved with older adults, including members of the older adult communities themselves."

"It is really valuable to have this diverse group because they can provide feedback on what older adults need and whether our intervention is well-designed for this demographic. For example, the older adults can offer insights into what is relevant to them, while other experts can identify gaps or needs that may not be immediately obvious”, explains Mack when asked how this SH+ for older adults in Switzerland is being co-created.

A pilot test of this study starts April 2025 and will be followed by clinical trials from Fall 2025 until 2026. 

Read this European-level policy guidance and priority actions to advocate for mental health with greater respect for human rights while tackling structural injustices.

Contact

Melanie Mack
Postdoctoral Researcher, University of Geneva
Melanie.Mack@unige.ch 

Joyce Anne Quinto
Project and Communications Manager
joyce.quinto@sund.ku.dk

This work package has received funding from both the Swiss State Secretariat for Education, Research and Innovation (SERI) and the EU Horizon Programme under Grant Agreement No. 101080323 (2023-2028).