Growing Mental and Behavioral Health Concerns Facing Older Americans

As America's population ages, the need for mental and behavioral health services continues to increase. Psychologists are playing a critical role in addressing these needs.  Psychologists are studying and treating the mental and behavioral problems associated with growing old, such as loss of spouse, loss of mobility and independence, admittance to a long-term care facility and declining physical and sometimes mental health.  Some of the most critical concerns facing older Americans today are highlighted below.

Mental Health Concerns

  • Twenty percent of people over 55 suffer from a mental disorder, and 2/3rds of nursing home residents exhibit mental and behavioral problems.  Yet, less than 3% of older adults report seeing a mental health professional for their problems.1

  • Older Americans underutilize mental health services because of inadequate funding for mental health services; lack of collaboration and coordination among primary care, mental health and aging service providers; access barriers; stigma surrounding mental illness and treatment; denial of problems; and lack of trained professionals in the provision of geriatric mental health services.1

  • Fear, distress, anger, stress, social support, and relaxation have been shown to influence immune and cardiac functions, susceptibility to infection, pain, asthma and recovery from surgery.2


Depression and Suicide

  • As many as 20% of older adults in the community and up to 37% of nursing home residents suffer from depression, a condition that may lead to suicide.1

  • Symptoms of depression and anxiety in older Americans are overlooked and untreated because they often coincide with other medical illnesses or life events that commonly occur as people age (e.g., loss of loved ones).3

  • Even though older Americans only make up 13% of the population, they account for 20% of the people who commit suicide.  In fact, older Americans have the highest suicide rate of any age group.4

  • Three-fourths of older adults who commit suicide have seen their physician in the past month.5


Alzheimer's Disease and Dementia

  • Dementia, the irreversible deterioration of intellectual ability--often accompanied by emotional disturbances- afflicts as many as 7% of Americans over the age of 65 and 30% over age 85.  People with dementia often suffer from depression, paranoia, and anxiety.5

  • Alzheimer's disease, the most common cause of dementia, today affects between 2.6 to 4.5 million Americans age 65 and over.6 It affects 12 million people worldwide, and it is expected to increase to more than 22 million people by 2025.  In fact, the number of Alzheimer's disease cases doubles every five years from age 65 to 85.7

  • Early diagnosis of Alzheimer's is becoming increasingly possible, due to the sensitive diagnostic tools developed by psychological and medical scientists.


Substance Abuse

  • Alcohol abuse is a major problem for older Americans and is one of the eight leading causes of death for older persons.  Five percent (5%) of older men and 1% of older women have alcohol abuse and dependency problems, which lead to malnutrition, cirrhosis of the liver, osteomalacia, and a decline in cognitive functioning.1

  • It is estimated that 17% of older adults misuse and abuse alcohol and medications. Although the majority (87%) of older adults visit a physician regularly, about 40% of those who are at risk for substance abuse problems do not self-identify or seek services and are unlikely to be identified by their physicians.8


Chronic Illnesses

  • 85% of older adults have at least one chronic illness: Almost 50% have arthritis, 40% have hypertension, 30% have heart disease, 12% have diabetes, 30% have hearing loss, 15% cataracts and 10% have a stroke.2

  • Data show that approximately 70% of all primary care visits were driven by psychological factors (e.g. panic, generalized anxiety, major depression, somatization, stress, adjustment disorders). It has also been found that distressed patients utilize health care at a rate of two to three times higher than non-distressed patients (APA Public Policy Office, 2002).

  • Behavior including such habits as poor diet, inactivity, alcohol and tobacco contribute to the onset of chronic illnesses while other behaviors such as medication compliance, a controlled diet and exercise program often assist in the treatment and recovery (or remission) chronic illnesses.2


Need for More Geropsychologists

  • Out of 32,183 full-time doctoral students, 140 or 0.4% are in programs specializing in aging.

  • Out of 32,789 APA members who are practicing psychologists, 589 or about 2% say their major field is geropsychology. (APA Research Office, 2004)

  • Geropsychologists use behaviorally-based treatments to address primary mental health disorders such as depression and anxiety.   They also offer assistance to older adults in coping with the psychological and emotional consequences of illness, loss of loved ones, relocation to new living situations, and care giving demands. 

  • Geropsychologists address a variety of behavioral health issues such as managing cognitive impairments (including Alzheimer’s disease), urinary incontinence (a leading reason for nursing home admissions), and insomnia that significantly impact the quality of life of older adults.  In addition, behavioral changes are often required to ensure compliance with medication regimens and to manage chronic health conditions.

  • Geropsychologists apply the knowledge and techniques of psychology to help older persons and their families maintain well being, improve quality of life, overcome problems, and achieve maximum potential during later life.  (APA White Paper)

  • Geropsychologists provide prevention, assessment, consultation and intervention services for psychological adaptations in later life (e.g., adapting to age-related changes, bereavement), psychopathology (e.g., dementia, depression), behavioral problems (e.g., medication compliance, incontinence) and problems in daily living (e.g., marital problems, family discord, financial stressors). (APA White Paper)

  • Geropsychologists work with older adults in a variety of settings reflecting a continuum of care that at its best is interdisciplinary. The settings include home, community (e.g., mental health or health care clinics, private practitioners’ offices, adult day care), hospitals/rehabilitation centers, and long term care facilities (nursing homes, assisted living facilities).


REFERENCE LIST

  1. U.S. Department of Health and Human Services, Administration on Aging. (2001).  Older adults and mental health: Issues and opportunities.

  2. Speer & Schneider.  (2003).  Mental health needs of older adults and primary care: Opportunities for interdisciplinary geriatric team practice. Clinical Psychology: Science and Practice, 10(1).

  3. National Institute of Mental Health Fact Sheet. (1999).

  4. National Institute of Mental Health, Older Adults: Depression and Suicide Fact Sheet. (1999).

  5. American Psychological Association.  (1998).  Older adult's health and age-related changes: Reality versus myth. Retrieved from www.apa.org/about/awards/scidir-stutrav.aspx.

  6. American Bar Association Commission on Law and Aging.  Assessment of older adults with diminished capacity: A handbook for lawyers.  Retrieved from http://www.abanet.org/abastore/index.cfm?section=main&fm=Product.AddToCart&pid=4280025.

  7. The Washington Post. (2000, July 10).  Experts fear Alzheimer's epidemic.

  8. Barry, et al., 2001; Substance Abuse and Mental Health Services Administration, 1998.

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