Older Adults Are Being Overlooked When it Comes to Mental Heath Care

dr-sewellDaniel D. Sewell, MD
Director, Senior Behavioral Health, UC San Diego Medical Center
President, American Association for Geriatric Psychiatry

(This blog post originally appeared on CareForYourMind.org, a resource created by the Depression and Bipolar Support Alliance (DBSA) and Families for Depression Awareness (FFDA) to help society engage in critical discussions and decisions about mental health.)

For most individuals in the U.S., accessing mental health care is a struggle, but older adults may have it worst of all. Due to stigma, misinformation, and false beliefs about aging, they frequently go without adequate care for depression and other psychiatric illnesses and psychological problems. Too often, doctors offer prescription drugs as a cure-all solution, and fail to address the overall mental health and well-being of the older patient.

The truth is, addressing mental health issues in older populations requires paying more attention, not less. In aging adults, depressive symptoms can point to a physical illness, while physical pain or other physical complaints can often be a sign of mental health issues.

The good news is, when accurately diagnosed, mental health issues are just as treatable in older populations as in younger, but it takes commitment and understanding. In order to help aging Americans get healthier and happier, the system needs to properly address the physical and mental needs of these patients.

What gets in the way of patient-centered care?
Research shows that older adults are often less comfortable seeking care from a mental health professional than their younger counterparts. Due to historical shame and ignorance surrounding mental illnesses and psychological problems, stigma tends to be more powerful among those who came of age before the 1960s.

Depression is also experienced, witnessed, and treated differently in older adults. In this population, depression symptoms can present as physical complaints, irritability, and/or cognitive impairment rather than overt signs of sadness such as crying. Alternatively, psychiatric symptoms can often point to a physical ailment that’s been overlooked. Depression can also be an early sign of dementia.

Additionally, medical illnesses are too often misdiagnosed or wrongfully labeled as purely psychiatric illnesses. To test this theory, we did a six-month chart review in our geriatric psychiatric inpatient unit and discovered that 34% of patients referred to our unit had a previously unrecognized or documented but inadequately treated medical illness—and that illness was likely the source of the psychiatric symptoms. Based on that data, one out of three older patients may actually need medical care versus behavioral health care.

Insurance issues
Insurance companies also get in the way of good care. To cite one shocking example, a nurse employed by a continuing care community in my area was checking in on a patient. When she arrived, she saw the resident on the balcony, with one leg over the railing, clearly about to jump. Luckily, the nurse was able to pull the patient back. I was immediately contacted. When I tried to get pre-authorization for inpatient care from the patient’s insurance company, they told me she didn’t meet the criteria for care because she hadn’t actually jumped. Continue reading

Mama R: Living it up at 97

altshul headshotSara Altshul
AGS Staff Writer

Until a few months ago, my mother-in-law lived alone in the Brooklyn apartment building she’d owned for 40 years—“alone” only in a manner of speaking.

Over the years, her sons or daughters occupied two or three of the other apartments in the building; now, one son lives above her and another lives next door. Both look in on her several times a day.

At 97, Mama’s sense of humor is still sharp. Up until recently, she knew to the penny how much money was in her bank accounts. So when she forgets that she’s asked one of us the same question three times in 30 minutes, we all understand. She uses a walker to get around and still never misses a shower, wedding, or other family event.  A few months ago, 40 of us celebrated her birthday at a Chinese restaurant, at her request.

As her frailty became more obvious over the last year, we hired an attendant to look after her during the day. At night, one of her sons would usually have dinner with her (often, Mama cooked the meal herself), or her daughter would come by with groceries and prepared several meals for the week. We created a rotating schedule so that one of us stayed with her over the weekends.

But still, we worried. She’d nap much of the day, she kept the lights off (her thriftiness is a family legend) and she seemed to lose the zest for life that was her hallmark. Another hallmark? Her stubbornness. She adamantly refused to move in with any of us, despite the fact that several of us have homes perfectly set up to accommodate her. Continue reading

A Flu Shot is The Best Shot at Prevention for People 65 and Older

cdc-dj-vaccination-clinic_title-2Daniel B. Jernigan, MD, MPH
Director of the Influenza Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

For millions of people, the flu can mean a fever, cough, sore throat, body aches, and fatigue for a week or more. But did you know that if you are 65 years or older, you are at increased risk of serious flu-related complications, like pneumonia?

“People’s immune systems can become weaker with age, which places older adults at high risk of serious flu-related complications,” says Dr. Lisa Grohskopf, a medical officer with CDC’s Influenza Division.

While flu seasons vary in severity, people 65 years and older bear a comparatively greater burden of serious flu-related illness compared to other age groups during most flu seasons. Data from recent seasons shows that between about 70 to 90 percent of seasonal flu-related deaths in the United States have occurred among people 65 years and older. For hospitalizations, this number is between about 50 and 70 percent.

This is why flu vaccination is especially important for people 65 years and older. While flu vaccine can vary in how well it works, there are a lot of scientific data showing that flu vaccination prevents illness and hospitalizations, even among people 65 and older for whom the vaccine may not work as well. A new CDC study published this summer in the journal Clinical Infectious Diseases (CID) found that flu vaccination reduced the risk of flu-related hospitalization among people 65 to 74 years by 61%. Vaccinated people 75 and older were similarly protected (57%).

Continue reading

Older Adult Falls: A Growing Danger

grantbaldwin_210x240Grant Baldwin, PhD
Director, Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention

Do you know an older adult who has fallen recently? Chances are that you do, since every second of every day, an older American falls, as highlighted in the Centers for Disease Prevention and Control’s (CDC’s) recent Morbidity and Mortality Weekly Report (MMWR), Falls and Fall Injuries Among Adults Aged 65 Years and Over — ­­­United States, 2014. Falls are very common among older Americans. Research shows that individuals in certain groups are more likely to fall, such as women and American Indians/Alaskan Natives. Another striking finding was that in one year, an estimated 7 million falls required medical treatment or caused restricted activity.

So, what can healthcare providers do to reduce falls? CDC developed the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative that gives all members of the healthcare team (e.g., physicians, nurses, pharmacists, physical therapists, and caregivers) guidance on how to make fall prevention part of their routine care for older adults.

The CDC STEADI initiative is based on the American and British Geriatrics Societies’ guidelines on fall risk assessment and follow-up. STEADI includes information for providers on how to screen for fall risk, assess fall risk factors, and provide or make referrals to evidence-based interventions that can reduce patient risk. Continue reading

Older Adults and Substance Abuse Awareness

Palmer MH high(8) res

Alice Pomidor, MD, MPH, AGSF
Professor
Florida State University School of Medicine

Mary Palmer, PhD, RN, FAAN, AGSF
Helen W. and Thomas L. Umphlet Distinguished Professor in Aging
UNC School of Nursing

It’s been called the “invisible epidemic.” In recent years, for the first time, the number of older adults receiving treatment for substance abuse is outpacing that of younger adults.

There are many reasons why the number of older adults who are receiving treatment for substance abuse is on the rise. With aging come very real challenges that can make some older adults more likely to abuse alcohol or drugs.

Job loss, either through retirement or downsizing, caretaking for (or losing) a spouse, children moving away, illness, and financial worries are among the challenges older adults can face. What’s more, some older adults have had had lifelong problems with alcohol or drugs that can become more serious as they age.

What is Substance Abuse?

Substance abuse is an umbrella term that means misusing legal or illegal medications and drugs, as well as misusing alcohol and tobacco. Officially, substance abuse is the use of chemicals that lead to an increased risk of problems and an inability to control your use of the substance.

Addiction, dependence, or “getting hooked” on a drug or alcohol can have especially dangerous consequences for older adults. These substances can cause mental problems, kidney and liver disease, and can cause falls resulting in injuries. Even if you’ve never had a problem with alcohol or drugs, you can become dependent on them in your later years.

Because many older adults manage more than one chronic illness, they may take one or more medications that can interact harmfully. The drugs you take may also react badly with alcohol. The symptoms you may experience as a result may seem to you like typical signs of aging, such as confusion, forgetfulness, dizziness, or sleepiness. In fact, symptoms like these may be reactions due to substance abuse. Continue reading