August 26, 2014

Caring for Older Adults

More attention must be paid to the mental health needs of older Americans, says an EDC expert.

Mental health care for older adults is in "a state of crisis," says Brad Karlin

Across the United States, many older adults suffer from mental health problems in silence, unaware of treatment options that may improve their quality of life. Untreated, their psychological struggles can have a ripple effect, affecting not only the quality of their lives, but also their families, the health care system, and society at large.

EDC’s Brad Karlin believes that too many older adults (those ages 65 and older) are not getting the mental health care they need. It’s a national problem that will only grow in magnitude as baby boomers enter their 80s and 90s. As chief of mental health and aging, Karlin is working to address long-standing treatment gaps and bridge research and practice to improve the lives of older adults.

Q: How well are we meeting the mental health needs of older adults in the United States?

Karlin: Mental health care for older adults is currently in what many experts would say is a state of crisis. Few older adults seek or receive mental health care. In fact, a national study found that only 1 in 10 older adults with serious mental health needs—such as depression, anxiety, and substance use disorders—received treatment in the past year. One of the greatest barriers to care is that older adults often attribute symptoms of depression or other psychological conditions to aging or medical conditions. Sadly, many older adults who are vulnerable and in need are not getting effective care that can improve their lives.

Q: Why are untreated mental illnesses among older adults such a concern?

Karlin: Many families work hard to care for older adults with mental health issues, which can take a tremendous psychological and emotional toll on loved ones. We also know that it takes older adults with mental illness longer to recover from physical health issues, and that they have an increased risk of mortality and suicide. So helping older adults get the mental health care they need helps relieve the considerable impact that mental illness can have at a number of levels.

Q: What steps can be taken to get older adults appropriate mental health care?

Karlin: It is critical that we educate older adults about, and connect them with, effective treatments that are now available. It’s also important that we train primary care, mental health, and aging service providers on how best to detect and manage mental health issues in older adults. Medicare has taken an important step in increasing older adults’ financial access to care by implementing full parity for outpatient mental health services, which means that it now reimburses treatments for mental illness, such as psychotherapy, at the same rate as it does for physical illness.

Q:What about the needs of individuals with dementia?

Karlin: About 80 percent of individuals with dementia exhibit behaviors such as aggression, agitation, wandering, and care refusal that impact their quality of life and present significant challenges for families and caregivers. Caring for people with dementia is also complicated by the fact that the methods that we use need to change. The clinical mainstay approach has been to use anti-psychotic medications to treat the challenging behaviors associated with dementia, and these have been widely prescribed in nursing home settings. But in recent years, data have shown that these medications have limited effectiveness for the symptoms of dementia, and they carry a death risk for patients with dementia.

Fortunately, increasing research shows the promise of behavioral interventions for people with dementia. In fact, we implemented one intervention—known as STAR-VA—in more than 40 nursing homes in the Veterans Administration health care system. We found that the approach led to significant reductions in the frequency and severity of challenging behaviors and in symptoms of depression and anxiety. Bridging research and practice to make non-pharmacological approaches widely available provides a significant opportunity to improve the lives of older adults with dementia.

Q: What does the future look like for older adults with mental health problems?

Karlin: Researchers estimate that there will be a significant increase in the number of older adults with mental health problems in the coming years, due both to the growth of the older adult population and the anticipated increase in the prevalence of mental disorders, particularly substance use disorders. Now is the time to address enduring barriers to care and realize major opportunities, including the recent changes to Medicare and the development of an array of evidence-based treatments for mental health problems in late life. Our fathers, mothers, aunts, uncles, grandmothers, and grandfathers deserve nothing less.