Senior Lives Matter

Pride, stubbornness, marginalization — no wonder our elderly ill lack mental health care

A segment of the American population is being left out of important conversations about mental health awareness: the elderly. The reasons are varied.

Older men have the highest suicide rate of any age group.

Senior citizens face issues that younger folks do not. They have multiple health challenges, face dwindling support and social networks, often deal with relocation and moving issues, and cope often with grief, to name just a few things.

They also may be more resistant to screenings or discussions about help. And it can be difficult for people on Medicare to get adequate support in the event that they want it.

So what happens to these left-behind Americans?

“As seniors age, they have many losses,” said Dr. Nancy Turret, a social worker at the New York State Psychiatric Institute in New York City. “What’s really common is that many of their ‘close attachment’ relationships die. Not only is it a big loss — it really makes people look at their own mortality.”

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Too often the message from the rest of society, she said, is that it’s OK for seniors to be depressed because they’re closer to the end of life. This mindset has led to far less support for seniors — who are more likely to experience clinical depression because it’s triggered by other chronic illnesses common to the elderly, such as Alzheimer’s disease, Parkinson’s disease, heart disease, arthritis, and cancer.

“I’ve worked with a lot of people, even in their 90s, who have a better quality of life,” Turret told LifeZette. She said seniors do not have to write off issues like depression and anxiety just because they are older — they are still worth getting help.

In getting help, many can live active, purposeful lives. “They have a lot of talents that haven’t been accessed because they have depressed mood, complicated grief or memory impairments or neurological issues,” she said.

[lz_bulleted_list title=”The Case for Senior Care” source=”World Health Organization”]By 2050, the world population of those age 60 and over will nearly double.|Mental health and emotional well-being are as important in older age as at any other time of life.|Close to 15% of adults age 60 and over suffer from a mental disorder.|Neuropsychiatric disorders among older adults account for 6.6% of the total disability.[/lz_bulleted_list]

About 20 percent of people age 55 or older experience some type of mental health concern. The most common types are anxiety, severe cognitive impairment, and mood disorders such as depression or bipolar disorder, according to the American Association of Geriatric Psychiatry. And more than two million of the 34 million Americans age 65 and older suffer from some form of depression, the National Institute of Mental Health reports.

Older men have the highest suicide rate of any age group. Those 85 years or older have a suicide rate of 45.23 per 100,000, compared to an overall rate of 11.01 per 100,000 for all ages, according to the Centers for Disease Control and Prevention.

Delivering Senior Care
Some seniors can be reluctant to seek help because it was not as socially acceptable to seek help in the past, said Turret. Some seniors do not want help or were raised during a time when it was a sign of weakness to look for assistance.

“There is shame and stigma around mental illness, especially among people who have been taught to ‘tough it out’ their whole lives,” said Paul Gionfriddo, president and CEO of Mental Health America.

Elderly Americans may have been told that depression and anxiety are a “normal” part of aging, and adopt the mindset that they are therefore not worthy of treatment, said Gionfriddo.

Turret’s program in New York City is unique in that it offers free inpatient and outpatient treatment programs as part of a research grant. This includes medication and all testing. Seniors who come in are sometimes resistant, but she is able to engage them and explain how she can help, which is when many become receptive to treatment.

Older Americans receive prescriptions for mental health medications at more than twice the rate of younger adults — but they’re much less likely to get mental health care.

Connecting seniors to resources is one thing — paying for them is another. Medicare will treat mental health care provided by an internist, but many of them are not equipped to deal with more than simple depression, said Turret.

“The ability of Medicare and other providers to cover [mental health problems] is less,” Turret said.

There are also fewer geriatric psychiatrists. Turret once worked as a therapist under Medicare, but opted out because of a low reimbursement rate and the complicated paperwork processes that reduced profitability.

“The system has really created a huge problem,” Turret said. As a result, seniors are left with providers who do not specialize in geriatric issues.

A 2015 study in the Journal of the American Geriatrics Society found that older Americans receive prescriptions for mental health medications at more than twice the rate of younger adults — but they’re much less likely to get mental health care from a psychiatrist. The report warned about issues of seniors using multiple medications. It said primary care doctors may need to better support seniors to ensure medications do not interact, especially if they are obtained from different doctors.

Other than inpatient and outpatient programs or private therapy, Turret said improving senior mental health can be as simple as getting the elderly active in community programs. These can offer helpful social networks and cognitive support, and perhaps their own kind of therapy for seniors who don’t want professional help — but who can find solace in talking with peers.

“Sometimes it’s not the whole story, but it’s a piece of the story that can help,” said Turret.

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