By Liz Seegert
The National Council on Aging defines mental disorders as “health conditions that are characterized by alterations in thinking, mood or behavior (or some combination thereof), associated with distress and/or impaired functioning.”
As the U.S. population ages, the need for mental and behavioral health services is increasing. Addressing and treating mental and behavioral health problems is especially important for older adults living in underserved communities, and for those living in poverty, according to the American Psychological Association (APA).
Recent studies indicate that about one-fifth of adults age 65 and older (20.4 percent) met the APA criteria for a mental disorder (including dementia) over the prior 12 months. While many older adults suffer from depression (covered previously in this tip sheet by Judith Graham), anxiety and mood disorders also are common. The nonprofit organization Older Women’s League (OWL) notes that good mental health is important for overall wellbeing. Left untreated, mental health disorders can:
- Reduce function.
- Increase risk of substance abuse.
- Diminish quality of life.
- Lengthen recovery time of physical illness.
- Increase risk of suicide.
More than half of nursing home residents have some form of cognitive impairment. Many also have personality disorders, made worse by chronic health problems. Older adults with evidence of mental disorder are less likely than younger and middle-aged adults to receive mental health services, and when they do they are less likely to receive care from a mental health specialist, according to the APA.
Mental Health America, a community-based nonprofit working to helping to promote mental health as a critical part of overall wellness, says that mental illness is not an inevitable part of aging. Older people actually experience fewer mental health conditions (aside from cognitive impairment) as they age, but approximately 6.9 percent of people aged 65 to 74 experience “frequent mental distress.” Many experience mental health and substance use conditions associated with loss of functional capacity, even though a formal diagnosis may not be justified.
Mental health also can decline due to physical impairment from conditions such as stroke, Parkinson’s disease and cancer. Side effects from medications can play a role. Older adults without a history of substance abuse may end up abusing medications, alcohol, or drugs, according to OWL.
The National Council on Aging estimates that 27 percent of older adults under the care of an aging professional have symptoms of anxiety that may not warrant a formal diagnosis, but still significantly affect daily functioning. These symptoms include panic disorders, post-traumatic stress syndrome, phobias and obsessive-compulsive disorders.
The APA points out that, in general, older Americans tend to underutilize mental health services. One reason may be inadequate medical coverage: Medicare covers 80 percent of a physical health problem, but only 50 percent of a mental health problem. There also is a shortage of a trained geriatric mental health providers, and primary care physicians may not recognize signs of mental health disorders or attribute the symptoms to other disorders.
Even if they are not in denial about their problem, many seniors still attach a stigma to mental health problems, and so are reluctant to seek help. Even when willing to seek help, seniors can struggle with access barriers, such as reliable transportation to appointments.
Outreach programs needed
Mental health outreach programs enable early intervention and facilitate access to preventive services for at-risk older adults. The National Institute on Aging estimates that that over 40 percent of at-risk individuals over age 60 go unserved or remain unidentified. Outreach programs can offer individuals assessments and referrals to appropriate community treatment and supportive services. Ideally, care is coordinated between the primary care provider, mental health professional, social worker or other community support professional. Support groups and peer counseling can be effective in removing stigma, preventing problems from becoming crises, and helping older adults face life transitions, chronic stressors, and other difficulties.
Mental health outreach programs strive to keep older adults in the community by providing individually tailored, supportive services that enable them to maintain and even improve their level of functioning. Counseling, medication monitoring, chore or visiting nurse services provided through an area agency on aging can be preventive if they reach the older adult before the point of crisis.
The World Health Organization (WHO) says that mental health among older adults is a global challenge:
- Anxiety disorders affect 3.8 percent of the elderly population.
- Substance use problems affect about one percent.
- Approximately a quarter of deaths from self-harm are among those aged 60 or above.
- Substance abuse problems among the elderly are often overlooked or misdiagnosed.
Challenges in geriatric mental health
In encouraging older adults and their families to seek help for mental health issues, care professionals must focus on:
- Early identification of high-risk individuals and families.
- Implementing preventive measures.
- Promoting mental health as effectively as they do physical health.
Many older adults do not recognize their own mental health needs or do not know how to access and use the service delivery system. Those who live alone, are geographically isolated, frail, or physically disabled have particular difficulty accessing services.
Those who seek help may struggle to find a qualified geriatric psychiatrist. The Institute of Medicine noted in its 2012 report that opportunities for geriatric mental health training are limited. There were only 58 geriatric psychiatry fellows nationwide in 2011-12; and since 2006 less than half of the available geriatric psychiatry fellowships have been filled.
Depending on state requirements, counseling may be offered by an array of care professionals, including social workers, advance practice nurses, physician assistants, primary care physicians, psychologists, psychiatrists and even pharmacists who are certified in psychiatric pharmacy. Older adults and their families may be confused about who to turn to, particularly as care models shift and professional roles change to meet the needs of the growing aging cohort.
Language matters
Remember that a person with a mental illness, should not be called “a depressive”, “a bipolar” or “a schizophrenic.” The National Center on Disability and Journalism has a helpful style guide.
Resources
- The CDC’s Healthy Aging Data Portfolio offers an interactive map for exploration of specific mental health disorders, such as anxiety or frequent mental distress. Data can also be segmented by age group.
- 10 Facts about Mental Health – from OWL.
- This fact sheet on anxiety in older adults and this one on preventing suicides in older adults from the National Council on Aging.
- How to look after your mental health later in life, a guide from the UK Mental Health Foundation.
- The Bazelton Center for Mental Health Law.
- Health and Psychosocial Needs of LGBT Older Adults – comprehensive research study.
- American Association for Geriatric Psychiatry.
- National Association of State Mental Health Program Directors
- Your state department of mental health or state department of aging, mental health services.
Sources
- Robert Blancato, national coordinator of the Elder Justice Coalition. bob@elderjusticecoalition.com
- Kimberly Williams, M.S.W., director of the Geriatric Mental Health Alliance of New York. 212-614-5772
- Dilip Jeste, M.D., chief of the geriatric psychiatry division, and director of the Stein Institute for Research on Aging, at the University of California, San Diego. 858-534-4020 or djeste@ucsd.edu
- Helen Lavretsky, M.D., professor of psychiatry at the University of California, Los Angeles, and geriatric psychiatrist at the UCLA Semel Institute for Neuroscience and Human Behavior. 310-794-4619
- Renato Daniel Alarcon, M.D., emeritus professor of psychiatry at the Mayo Clinic College of Medicine. Alarcon.Renato@mayo.edu
