Mental and Behavioral Health and Older Americans

As America’s population ages, the need for mental and behavioral health services continues to increase. Psychologists play a critical role in addressing these needs. Psychologists conduct research on and treat the mental and behavioral problems that often accompany growing old.

The Critical Need for More Geropsychologists

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. ¹²

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, psychologists help older persons and their families overcome problems, enhance well-being, and achieve maximum potential during later life. ²

Only 3% of practicing psychologists viewed geriatric patients as their primary professional target. The best estimate of currently practicing geropsychologists – 700 – falls far short of the current need for 5,000 to 7,500 geropsychologists. ¹⁰

There has been little growth in geropsychology training programs in the last 15 years. Data from 1997 indicated the availability of only 13 postdoctoral fellowships and 65 pre-doctoral internships for receiving training in clinical geropsychology. ⁶

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.²

Key Findings

Twenty percent of people over 55 suffer from a mental disorder, and two-thirds of long-term care residents exhibit mental and behavioral problems. ¹³

It is estimated that up to two thirds of older adults with a mental health problem do not receive the services they need while the number of older adults with mental disorders is expected to quadruple—from 4 million in 1970 to 15 million in 2030. ¹⁴

Older adults are less likely than younger persons to both self-identify as having mental health problems and seek specialty mental health services. ⁸

Mental health disorders such as anxiety and depression, adversely affect physical health and ability to function, especially in older adults. For example, untreated depression in an older person with heart disease negatively affects the outcome of the disease. ²

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. ²

Approximately 70% of all primary care visits are driven by psychological factors (e.g. depression, anxiety, and stress), and distressed patients utilize health care at a rate of two to three times higher than non-distressed patients. ⁴

Older Americans underutilize mental health services because of 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. ¹³

Anxiety, Depression and Suicide

As many as 20% of older adults in the community and up to 37% of nursing home residents suffer from depression. ¹³

Depression is a major risk factor for suicide. In 2004, 14.3 of every 100,000 people age 65 and older died by suicide, higher than the rate of about 11 per 100,000 in the general population. White men age 85 and older were the most likely to die by suicide. They had a rate of 49.8 suicide deaths per 100,000. ⁹

Three-fourths of older adults who commit suicide have seen their physicians in the month before their death. ⁹

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. ²

Symptoms of depression and anxiety in older Americans are overlooked and untreated because they often coincide with these other late life problems. ²

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. ²

Alzheimer’s Disease and Dementia

Dementia is a syndrome characterized by decline in memory in association with either decline in other cognitive abilities (e.g. judgment) or personality change. ¹

Two percent of people age 65 to 74 have Alzheimer’s disease, with the proportion increasing to 8 percent to 19 percent of people age 75 to 84, and 29 percent to 42 percent of people age 85 and over. Combining these proportions and U.S. Census data indicates that 2.6 million to 4.5 million people age 65 and older had Alzheimer’s disease in 2000. ¹

People with dementia often suffer from depression, paranoia, and anxiety. Dementia is also often accompanied by behaviors such as wandering and agitation. 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. ²

Psychologists help individuals who are in early stages of dementia build coping strategies and reduce their distress through psychotherapy and psycho educational support groups. Memory training strategies often help to optimize remaining cognitive abilities. ²

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. ³

Psychologists assess a person’s capacity to make medical or legal decisions. They have been the forefront developers of the instruments used to assess specific capacities in older adults. ²

Behavioral Health

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. 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. ²

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. ⁷

Psychologists have developed effective non-pharmacologic treatments for insomnia, including cognitive-behavioral techniques and sleep hygiene instruction. These interventions are useful for older adults whom are especially vulnerable to the adverse effects of sleep medications. ²

Substance Abuse

Alcohol abuse is a major problem for older Americans and is one of the eight leading causes of death for older persons. ²

Combined alcohol and medication misuse is estimated to affect up to 19 percent of older Americans. ¹⁵

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. ²

Chronic Disease

Eighty-five percent (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. ¹¹

Negative behaviors that contribute to the onset of or exacerbate chronic diseases include poor nutrition, inactivity, smoking and alcohol misuse.⁵

Psychologists help older adults manage multiple chronic diseases through treatment adherence and behavioral interventions, including physical activity, biofeedback, nutrition, and stress reduction techniques. ²

This Fact Sheet was prepared in collaboration with Deborah DiGilio, MPH, Director, APA Office on Aging

References

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U.S Department of Health and Human Services, Administration on Aging. (2001). Older adults and mental health: Issues and opportunities. Washington, DC: Author.
American Psychological Association, Presidential Task Force on Integrated Health Care for an Aging Population. (2008). Blueprint for change: Achieving integrated health care for an ageing population. Washington, DC: American Psychological Association.
Substance Abuse and Mental Health Association, Older Americans Substance Abuse and Mental Health Technical Assistance Center. Evidence-Based Practices for Preventing Substance Abuse and Mental Health Problems in Older Adults. Retrieved on January 29, 2009 from: http://www.samhsa.gov/OlderAdultsTAC/EBPLiteratureReviewFINAL.pdf

Contact: Nina Levitt -- American Psychological Association -- October 2008