This is a much-needed update... A few months ago, within my organization, I accepted a new position as a Senior Mental Health Advocate. We launched the Senior Mental Health Program, the first of its kind in our county and even State.
I have a vested personal interest in seeing the success of the Senior Mental Health program. Since I was instrumental in obtaining the grant funding that provided for my position. More importantly, the implementation of a Senior Mental Health Program provides a needed resource for thousands of seniors; their family caregivers and professional caregivers; and a much-needed resource for fellow colleagues in social and human services, particularly those, serving older adults.
Geriatric mental health is as unique, diverse, and variable as any other population needing mental health services. Geriatric mental health illness is a significant issue amongst older adults. However, the field of geriatric psychiatry is relatively young, about 40 years old. With some countries started recognizing the sub-specialty in the early 2000’s (Paquette et al., 2015). The field of Geriatric Psychiatry began with the work of German Psychiatrist and neuropathologist Alois Alzheimer. Geriatric Psychiatry has been struggling to move past its dementia and Alzheimer study roots, as it addresses other factors of mental illness including but not limited to Bipolar and Manic Depression among the aging.
Symptoms related to Alzheimer’s disease, related dementias, and common ailments/diseases among aging can trigger clinical depression. Depression can be an early warning sign of disease (NIH, 2021). While simultaneously, neurological conditions like dementia and Alzheimer’s disease and physical diseases common among the aging population can aid in masking depression.
Depression is a common illness worldwide including 5.7% of those 60 years and older (WHO, 2021). Like the United States, despite having health care access people in low to middle-income countries, who experience Depression still do not receive the care and treatment they need. Significant barriers include a lack of trained healthcare and mental health providers and social stigma associated with mental health disorders (WHO, 2021). This makes it a significant public health concern leading to increased disability and morbidity.
As a result, the presentation of depressive symptoms may often be confused with symptoms or reactions related to chronic illnesses. Mental illness among older adults can often go overlooked by general health practitioners and go untreated in older adults (CDC, 2021; Van Damme et al., 2018). Older adults with depression are expected to double by 2030, this is due to the aging “baby boomer” generation and expected greater life expectancy (Jeste et al., 1999).
Life changes like a loss of a spouse; changes in living environments (institutional living); or changes in socioeconomic status and economic instability, can result in feelings of sadness and anxiety among older adults. But clinical depression, where feelings of sadness and anxiety are persistent for more than 4 weeks, is not a normal part of aging (NIH, 2021). There are variabilities between populations of older adults, many are socioeconomic related. Community-dwelling older adults can present with depressive symptoms ranging from less than 1% to about 5%; but this rises steeply to 13.5% for those who require home healthcare and homebound and up to 11.5% for those older adults who are hospitalized (CDC, 2021). Hospitalized older adults, with a mean age of 70+, with depressive symptoms of hopelessness had higher incidences of all-cause mortality (Gruber & Schwanda, 2020). The masking of symptoms like chronic ailments and disease among the aging; along with apprehension due to cost; or lack of knowledge of depressive symptoms; and risk factors for suicide often go undiagnosed, under-diagnosed, or under-reported among older adults. Suicide in general is also a public health crisis. In 2019, 47,500 deaths in America were by suicide (AHR, 2019). While thousands are successful in their attempts, millions fail or struggle in silence. It’s estimated that 12 million adults seriously contemplated suicide, 3.5 million planned it, and 1.4 million tried it (AHR, 2019). While older adults comprise only 12% of the population, mortality statistics indicate that older adults disproportionately comprise 18% of all suicides (NCOA, 2021). While these statistics are disturbing, the percentage may be higher, since suicide rates among the elderly go underreported by 40% (AAMFT, 2022). This is due to the categorization of deaths resulting from passive self-harm, such as refusal of food, medications, or liquids (AAMFT, 2022). While suicide is one of the leading causes of death, it is often preventable.
Older adults experience a greater risk for suicide because of the high rates of depression among other risk indicators. Mortality by suicide rates is also disproportionate for older adults because they plan their deaths more carefully and use more lethal methods. 1 in 4 seniors who attempt suicide succeeds as compared to 1 in 200 youths (NCOA, 2021). Men aged 65 and older experience the greatest rate of suicide among all others (NCOA, 2021). The added burden of the COVID-19 pandemic and increased social isolation and loneliness due to public health safety measures have added to the urgency in intervening and reducing major depression and suicide risks among older adults (Balasuriya et al., 2021).
A more confounding aspect of geriatric mental health delivery is the older adults themselves. The high stigma around acknowledging and seeking mental health services is significant among the aging population. It can be cultural and generationally related. It has led many to manage their symptoms on their own.
The complexity of geriatric mental health reflects the type of older adult that exists today. It’s also a broader analysis of individual and societal ideas and values about the quality and caliber of older adults’ lives. How they should look and feel as we age. We are challenging the idea that older adults should be content with living in chronic pain; self-isolation and loneliness; immobility and inactivity; and that somehow, all of these, are acceptable parts of the aging process. It is NOT.
As the growing swell of mental health awareness grows, and the reconciliation between old ideas and attitudes about mental health and seeking mental health services among various populations changes. I challenge you to consider that we are all one tragedy, one loss or accumulating losses, or some life-and-course-altering change away, from realizing these compounding truths for ourselves, including older adults. The Senior Mental Health Program doesn’t only challenge and address older adults’ own stigma around mental health; it also challenges others’ views on the value of geriatric mental health. This is my new role.
References: AAMFT (2022). American Association for Marriage and Family Therapy: Suicide in the Elderly, Retrieved from https://aamft.org/Consumer_Updates/Suicide_in_the_Elderly.aspx?WebsiteKey=8e8c9bd6-0b71-4cd1-a5ab-013b5f855b01
AHR (2022). American Health Rankings: Senior Report: Illinois, Retrieved from https://www.americashealthrankings.org/explore/annual/measure/Suicide/state/IL
Balasuriya et al. (2021). The Association Between History of Depression and Access to Care Among Medicare Beneficiaries During the COVID-19 Pandemic. Journal of general internal medicine, 36(12), 3778–3785. https://doi.org/10.1007/s11606-021-06990-4 Centers for Disease Control and Prevention (CDC) (2021). COVID-19: People with Certain Medical Conditions. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html Gruber, R., & Schwanda, M. (2021). Hopelessness during acute hospitalization is a strong predictor of mortality. Evidence-based nursing, 24(2), 53. Jeste et al. (1999). Consensus Statement on the Upcoming Crisis in Geriatric Mental Health: Research Agenda for the Next 2 Decades. Arch Gen Psychiatry, 56(9):848–853. Medicare.gov (2022). Medicare: Mental Health Care (outpatient), Retrieved from https://www.medicare.gov/coverage/mental-health-care-outpatient
NIH (2021) National Institute on Aging: Depression and Older Adults, Retrieved from https://www.nia.nih.gov/health/depression-and-older-adults
NIH (1999) National Institute of Mental Health. Older adults: depression and suicide fact sheet. Netscape, Retrieved from http://www.nimh.nih.gov/publicat/elderlydepsuicide.cfm
NCOA (2021) National Council on Aging: Mental Illness Is Not a Normal Part of Aging, Retrieved from https://www.ncoa.org/age-well-planner/resource/mental-illness-is-not-a-normal-part-of-aging Paquette et al. (2015). L'éclosion de la gérontopsychiatrie à l'Université de Montréal, une histoire à découvrir [The history of geriatric psychiatry at the University of Montreal: Pioneers, milestones, and future outlook]. Sante mentale au Quebec, 40 (2), 205–227.
Soones et al. (2017). Two-year mortality in homebound older adults: An analysis of the National Health and Aging Trends Study. Journal of the American Geriatrics
Society, 65(1), 123-129. Van Damme et al. (2018). Late-life depression: issues for the general practitioner. International journal of general medicine, 11, 113–120.
WHO (2021). Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx). Retried from http://ghdx.healthdata.org/gbd-results-tool?params=gbd-api-2019-permalink/d780dffbe8a381b25e1416884959e88b