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Aging Boomers to Face Hard
Time Finding Mental Health Care; Report Urges
Geriatric Training
By Associated Press, The
Washington Post
July 10, 2012
WASHINGTON
— Getting older doesn’t just mean a risk for physical
ailments like heart disease and bum knees: A new
report finds as many as 1 in 5 seniors has a mental
health or substance abuse problem.
And as the population rapidly ages over the next two
decades, millions of baby boomers may have a hard time
finding care and services for mental health problems
such as depression — because the nation is woefully
lacking in doctors, nurses and other health workers
trained for their special needs, the Institute of
Medicine said Tuesday.
Instead, the country is focused mostly on preparing
for the physical health needs of what’s been called
the silver tsunami.
“The burden of mental illness and substance
abuse disorders in older adults in the United States
borders on a crisis,” wrote Dr. Dan Blazer of Duke
University, who chaired the Institute of Medicine
panel that investigated the issue. “Yet this crisis is
largely hidden from the public and many of those who
develop policy and programs to care for older people.”
Already, at least 5.6 million to 8 million Americans
age 65 and older have a mental health condition or
substance abuse disorder, the report found — calling
that a conservative estimate that doesn’t include a
number of disorders. Depressive disorders and
psychiatric symptoms related to dementia are the most
common.
While the panel couldn’t make precise projections,
those numbers are sure to grow as the number of
seniors nearly doubles by 2030, said report co-author
Dr. Peter Rabins, a psychiatrist at Johns Hopkins
University. How much substance abuse treatment for
seniors will be needed is a particular question, as
rates of illegal drug use are higher in boomers
currently in their 50s than in previous generations.
Mental health experts welcomed the report.
“This is a wake-up call for many reasons,” said
Dr. Ken Duckworth of the National Alliance on Mental
Illness. The coming need for geriatric mental health
care “is quite profound for us as a nation, and
something we need to attend to urgently,” he said.
Merely getting older doesn’t make mental health
problems more likely to occur, Rabins said, noting
that middle age is the most common time for onset of
depression.
But when they do occur in older adults, the report
found that they’re too often overlooked and tend to be
more complex. Among the reasons:
—People over 65 almost always have physical health
problems at the same time that can mask or distract
from the mental health needs. The physical illnesses,
and medications used for them, also can complicate
treatment. For example, up to a third of people who
require long-term steroid treatment develop mood
problems that may require someone knowledgeable about
both the medical and mental health issues to determine
whether it’s best to cut back the steroids or add an
antidepressant, Rabins said.
On the other side, older adults with untreated
depression are less likely to have their diabetes,
high blood pressure and other physical conditions
under control — and consequently wind up costing a lot
more to treat.
—Age alters how people’s bodies metabolize alcohol and
drugs, including prescription drugs. That can increase
the risk of dangerous overdoses, and worsen or even
trigger substance abuse problems.
—Grief is common in old age as spouses, other
relatives and friends die. It may be difficult to
distinguish between grief and major depression.
That also means a loss of the support systems that
earlier in life could have helped people better
recover from a mental health problem, said Dr. Paul
D.S. Kirwin, president of the American Association for
Geriatric Psychiatry. Adding stress may be loss of a
professional identity with retirement, and the role
reversal that happens when children start taking care
of older parents.
“There’ll never be enough geriatric
psychiatrists or geriatric medicine specialists to
take care of this huge wave of people that are aging,”
Kirwin said.
The Institute of Medicine report recognizes that. It
says all health workers who see older patients —
including primary care physicians, nurses, physicians’
assistants and social workers — need some training to
recognize the signs of geriatric mental health
problems and provide at least basic care. To get
there, it called for changes in how Medicare and
Medicaid pay for mental health services, stricter
licensing requirements for health workers, and for the
government to fund appropriate training programs.
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