Mental health care for the older adults is gaining more importance in the current world as 1 in every 4 aged 60 or above is suffering from a mental disorder. With a WHO prediction of future world (by 2050), where nearly one-fourth of the world’s total population will be aged 60 or above, the mental health-related issues certainly need more holistic approach and intersectoral collaboration. The gradually declining general health condition of this population, along with a failing sense of autonomy, compromised cognitive function, and poor decision-making capacity, leads to dependency upon others that automatically brings the ethical (and legal) concerns into health care and its decision. In a changed and more technology dependent and consumer-driven world, healthcare interventions are no exception, further raising the chance of conflict between treatment decisions and human rights of the individual. Also, the palliative and end-of-life care, both closely related to mental, are different worldwide based on culture and country-specific legislation, ultimately leading to more confusion among the clinicians. These gray areas and various dilemmas toward a comprehensive mental health care for the geriatric population have also been reflected inadequately in appropriate policymaking, proper budget allocation, or suitable community-based approach, which certainly needs a major paradigm shift with clear ethical and legislative support for a smoother and confident implementation of the same.