Mental and behavioral health and older Americans

• Geropsychology is a field within psychology devoted to the study of aging and the provision of clinical services for older adults. As researchers, geropsychologists seek to expand knowledge of the normal aging process and design and test psychological interventions that address problems that commonly arise as people age. As health care practitioners, geropsychologists help older persons and their families overcome problems, enhance well-being, and achieve maximum potential during later life. (APA, 2005)

• The Substance and Mental Health Services Administration (SAMHSA) reports that there is an insufficient supply of trained professionals available to provide mental and behavioral health services to older adults. This shortage will become more dire as the aging population grows and the demand for specialized mental and behavioral health services increases. (SAMHSA, 2007)

• Data indicate that only 3% of practicing psychologists view geriatric patients as their primary professional target.  The best estimate of currently practicing geropsychologists – 700 – falls far short of the current estimated need for 5,000 to 7,500 geropsychologists. (Qualls et al., 2003) 

• Without additional education and training opportunities, psychologists will be unable to meet the increasing demand for mental and behavioral health services as our nation’s population ages. (SAMHSA, 2007)

• Approximately 20% of adults ages 55 and over suffer from a mental disorder, the most common being anxiety disorders (e.g., generalize anxiety and panic disorders), severe cognitive impairment (e.g., Alzheimer’s disease), and mood disorders (e.g., depression and bipolar disorder). (AOA, 2001)  In 2005, nearly half of nursing home residents had dementia, and 20 percent had other psychological diagnoses (Houser et al., 2006)

• Researchers estimate that the majority of older adults with a mental disorder do not receive the services they need. (Bartels et al., 2004)

• Less than 3% of older adults see a mental health professional for their mental health problems. (Lebowitz et al., 1997)

• Older adults are less likely than younger persons to both report having mental health problems and seek specialty mental health services. (Mickus, 2000)

• Mental health disorders such as anxiety and depression, adversely affect physical health and one’s ability to function, especially in older adulthood. For example, untreated depression in an older person with heart disease can negatively affect the outcome of the disease. (APA, 2005)

• Conversely, older adults with medical conditions such as heart disease have higher rates of depression than those who are medically well. Even mild depression lowers immunity and may compromise a person’s ability to fight infections and cancers. (APA, 2005)

• Approximately 70% of the population seeks health care in primary care settings (Regier, 1993), including most older Americans. (Bartels et al., 2004) 

• Older Americans underutilize mental health services for a variety of reasons, including inadequate insurance coverage; a shortage of trained geriatric mental health providers; lack of coordination among primary care, mental health and aging service providers; stigma surrounding mental health and its treatment; denial of problems; and access barriers such as transportation.  (Bartels et al., 2004)

• As many as 20% of older adults in the community and up to 37% in primary care settings suffer from depression.  Approximately 11% of older adults have anxiety disorders. (AOA, 2001) 

• Results from a national survey estimated that 75-95% of nursing home residents have a diagnosable mental disorder, with depression rates estimated at between 30-40%.  Over 50% of residents have some form of cognitive impairment, and many nursing home patients have personality disorders exacerbated by chronic health problems. (Gabrel, 2007)

• Depression is a major risk factor for suicide.  In 2006, 14.22 of every 100,000 people age 65 and over died by suicide, higher than the rate of 11.16 per 100,000 in the general population, with  white men age 85 and over the most likely to commit suicide.  (CDC, 2006) Further in 2007 the National Center for Health Statistics reported that men 65 and older have a higher rate than any other age group and more than twice the national rate for all persons. (NCHS, 2007)

• Three-fourths of older adults who die by suicide have seen their physicians in the month before their death. (NIMH, 2007)

• Some late life problems that can result in depression and anxiety include coping with physical health problems, the death of loved ones, relocation to a new living environment, caring for a spouse with dementia or other disabilities, and managing conflict with family members. (APA, 2005)

• Symptoms of depression and anxiety in older Americans are often overlooked and untreated because they can coincide with other late life problems. (APA, 2005)

• Psychologists use psychological interventions, including various psychotherapies and supportive counseling, to help other adults deal with mental health disorders and late life stressors. These interventions have been shown to be effective either alone or in combination with psychiatric medications. (APA, 2005)

• Dementia is a syndrome characterized by decline in memory in association with either decline in other cognitive abilities (e.g. judgment) or personality change. (APA, 2008)

• Current estimates suggest that 1 in 8 persons over 65 have Alzheimer’s disease and a total of 5.3 million Americans have Alzheimer’s disease. (Alzheimers, 2009)

• People with dementia often suffer from depression, paranoia, and anxiety. Psychologists’ skills in differential diagnosis and treatment are helpful in these complex cases. Psychologists also teach behavioral and environmental strategies to caregivers of those with dementia to deal with these common behaviors. (APA, 1998)

• Psychologists help individuals who are in early stages of dementia to build coping strategies and reduce their distress through psychotherapy and psychoeducational support groups. Memory training strategies often help to optimize remaining cognitive abilities.(APA, 2005) 

• Early diagnosis of Alzheimer’s and effective treatment of the problematic behaviors that often accompany dementia are becoming increasingly possible due to the sensitive diagnostic tools and behavioral and environmental interventions developed by psychologists. (APA, 2003)

• Psychologists also assess a person’s capacity to make health care or legal decisions.  They have been at the forefront in developing instruments used to assess capacities in older adults.(APA, 2005)
  

• Incontinence has significant implications for the independence of older adults.  It is the second most common reason for families to admit their elder relative to a nursing home and is associated with an increased risk of depression. (SAMHSA, 2007)  Psychologists use behavioral training treatments, such as biofeedback and bladder training to reduce incontinence. These treatments have proven to be more effective than drug therapy. (Burgio, 1998)

• Insomnia is prevalent among older adults; 30-60% of all older persons have one or more sleep complaints such as difficulty falling and staying asleep, early morning awakenings, excessive daytime sleepiness and daytime fatigue. (McCurry, 2007) Psychologists have developed effective non-pharmacologic treatments for insomnia, including cognitive-behavioral techniques and sleep hygiene instruction. These interventions are useful for older adults who are especially vulnerable to the adverse effects of sleep medications. (APA, 2005)
  

• Alcohol abuse is a significant problem for older Americans. (Bartels et al., 2004)

• It is estimated that 17% of older adults misuse and abuse alcohol and medications. Although the majority 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 service and are unlikely to be identified by their physicians. (HHS, 1998)

• Alcohol abuse can lead to malnutrition, cirrhosis of the liver, osteomalacia, and a decline in cognitive functioning, and may be triggered or exacerbated by aging. (HHS, 1998)

• The number of older adults in need of substance abuse treatment is estimated to increase from 1.7 million in 2000 and 2001 to 4.4 million in 2020. (Gfroerer et al., 2003) 

• Psychologists can help older adults boost their motivation to stop drinking, identify circumstances that trigger drinking, and learn new methods to cope with high-risk drinking situations. (APA, 2005)

• An estimated 85% of older adults have at least one chronic illness: approximately 50% have arthritis, 40% have hypertension, 30% have heart disease, 12% have diabetes, 30% have hearing loss, 15% cataracts and 10% have experienced a stroke. (Speer, 2003)

• Negative behaviors that may contribute to the onset of or exacerbate chronic diseases include poor nutrition, inactivity, smoking and alcohol misuse. (Healthy People, 2010)

• Psychologists help older adults manage multiple chronic diseases through treatment adherence and behavioral interventions, including physical activity, biofeedback, nutrition, and stress reduction techniques. (APA, 2005) 

Administration on Aging. (2001). Older Adults and Mental Health: Issues and Opportunities. Washington, DC: U.S. Department of Health and Human Services

Alzheimer's Association. (2009). 2009 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia, 5 (3), 234-270.

American Bar Association Commission on Law and Aging and American Psychological Association (2008). Assessment of older adults with diminished capacity: A handbook for psychologists. Retrieved from: http://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf

American Psychological Association, Government Relations Office. Growing Mental and Behavioral Health Concerns Facing Older Americans.Retrieved from: http://www.apa.org/about/gr/issues/aging/growing-concerns.aspx

American Psychological Association Office on Aging (2005). Psychology and Aging:  Addressing Mental Health Needs of Older Adults. Retrieved from: http://www.apa.org/pi/aging/resources/guides/aging.pdf

Bartels, S.J., Blow, F.C., Brockmann, L.M., & Van Citters, A.D. (2005). Substance abuse and mental health care among older Americans: The state of the knowledge and future directions. Rockville, MD: WESTAT.

Burgio K.L., Locher, J.L., Goode, P.S., et al. (1998). Behavioral vs Drug Treatment for Urge Urinary Incontinence in Older Women: A Randomized Controlled Trial. Journal of the American Medical Association.280, 1995–2000.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2006) Web-based Injury Statistics Query and Reporting System (WISQARS) Retrieved from: www.cdc.gov/ncipc/wisqars

Center for Substance Abuse Treatment (1998). Treatment improvement protocol (TIP) #26.  Substance abuse among older adults. Rockville, MD: US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration.

Gabrel, C. & Jones, A. (2000) The National Nursing Home Survey: 1997 Summary. National Center for Health Statistics. Vital Health Statistics, 13, 147.

Gfroerer, J., Penne, M., Pemberton, M., Folsom, R. (2003). Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort, Drug and Alcohol Dependence, 69 (2), 127-135.

Healthy People 2010. (2007). Midcourse Review. Retrieved from: http://www.healthypeople.gov/data/midcourse/html/execsummary/introduction.htm

Houser, A., W. Fox-Grage, & Gibson, M.J. (2006). Across the States: Profiles of Long-Term Care and Independent Living. Washington, DC: AARP Public Policy Institute.

Lebowitz, B. D., Pearson, J. L., Schneider, L. S., et al. (1997). Diagnosis and treatment of depression in late life. Consensus Statement update. Journal of the American Medical Association, 278(14), 1186-1190.

McCurry, S. M., Logsdon, R. G., Teri, L., & Vitiello, M. V. (2007). Evidence-based Psychological Treatments for Insomnia in Older Adults. Psychology and Aging, 22(1), 18-27.

Mickus, M., Colenda, C. C., & Hogan, A. J. (2000). Knowledge of mental health benefits and preferences for type of mental health providers among the general public. Psychiatric Services, 51, 199-202.

National Center for Health Statistics. (2007) Health, United States, 2007. Hyattsville, MD: U.S. Government Printing Office.

National Institute of Mental Health. (2007). Older Adults: Depression and Suicide Facts. Retrieved from: http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts-fact-sheet/index.shtml

Substance Abuse and Mental Health Services Administration. (2007) An Action Plan for Behavioral Health Workforce Development. Retrieved from: http://www.samhsa.gov/Workforce/Annapolis/WorkforceActionPlan.pdf

Qualls, S. H., Segal, D. L, Norman, S., Niederehe, G., & Gallagher-Thompson, D. (2002). Psychologists in practice with older adults: Current patterns, sources of training, and need for continuing education. Professional Psychology: Research and Practice, 33(5), 5435-5442.

Regier, D., Narrow, W., Rae, D., Manderscheid, R., Locke, B., & Goodwin, F. (1993). The de facto mental health and addictive disorders service system. Archives of General Psychiatry, 50, 85–94.

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