TRANSCRIPT

The Mental Health Crisis Older Adults Are Facing

(Podcast #057)

Please forgive typos. Transcripts are created by an automated service.

 

0:00  
So I have spent close to 20 years providing mental health care to older adults in their families in some of the most prominent healthcare systems in the United States. And I have seen firsthand that older adults are often left out of the conversation about mental health care, even among professionals. I went here professional say, oh, there had to have dementia, there's nothing more I can do. Or, oh, it's normal to be depressed and older adulthood. Of course, it's not normal. Of course, there's something we can do with families with dementia. And then I'm going to take it a step further and step more personal. My life has been deeply impacted by mental health concerns, both in my family, and in myself. You know, looking at all of these statistics and working with older adults for close to 20 years, I began to think well, what will happen to my 71 year old mom, who struggled with mental health concerns throughout her life? If she has a depressive episode in older adulthood? Will there be people in her community to provide her with effective mental health care? How will she even find them? And then I thought, what will happen to me? If I experienced depression in my older adulthood, I experienced pretty severe depression in my adolescence. And after I had my kids, would I be able to find mental health professionals if I need them... when I'm older? With 67% of older adults with mental health conditions, not getting the mental health care that they need, the odds do not look good for me and my mom, or maybe for you, or your loved one or millions of others.

1:54  
I'm Dr. Regina Koepp. I'm a clinical geopsychologist, which means that I'm a psychologist who specializes with older adults in families. And this is the psychology of aging podcast, your go to resource for mental health and aging.

2:13  
There is a mental health crisis facing older adults in their families. And this is a topic we do not talk enough about. And it's a topic we all need to be aware of. Older Adults 65 and older are the fastest growing age group in the United States. In fact, by 2034, there will be more adults 65 and older than children under the age of 18. As we age, there's a phenomena that happens actually that we we tend to have less mental health concerns. And, and, of course, older adults are incredibly resilient. There is tons of research pointing to this a few a couple of months ago, I did a podcast all about resilience and aging and how older adults are managing in terms of their mental health during the covid 19 pandemic. And that is one important part of this story as it relates to older adults. And then there is another part of the story that we do not talk enough about. I will say we don't talk enough about resilience either. And we do not talk enough about the mental health crisis facing older adults.

 

What are the rates of mental health conditions among older adults?

3:33  
So today I'm going to talk about the rates of mental health concerns in older adulthood. What happens when mental health conditions go untreated in older adults, and what makes this actually a crisis? A minute ago, I said that older adults are the fastest growing age group and there will soon be more older adults than children. That's great news. And about 20 to 22% of older adults, so that's about one in four older adults experiences some kind of mental health condition, including depression, anxiety, and dementia... substance use. In fact, the number of older adults with substance use problems is on the rise. A couple of weeks ago, I had an episode on the facts about alcohol and aging where I talk about rates of substance use, especially alcohol use, which is the most reported drug used by older adults. In fact, 65% of adults 65 and older report risky drinking and that means drinking over the recommended limits, even though mental health conditions do tend to lessen over our lifespan. More than 50% of older adults with depression have their first episode in older adulthood. So what happens when older adults don't get the mental health care that they need for depression, anxiety, dementia, there can be poor health outcomes.

 

What happens when mental health conditions go untreated in older adults?

5:02  
 People with mental health conditions that don't get treated, have worse symptoms in their medical conditions. They use more doctor visits and ER visits, they have a more challenging prognosis of their illness. They have increased disability and impairment. So what that means is, you might require assistance with grooming and bathing. So you'll you'll have more, you'll have decreased functional ability, your quality of life is impaired, you're suffering for reasons that can be corrected and treated and cared for. You'll die sooner, your caregivers will be more stressed out. And sadly, there's a higher risk of suicide. In fact, people aged 85 and older have the highest rate of suicide out of all age groups. And older white men have a suicide rate at almost six times that of the general population. And here's the message I want you to hear. Depression is highly treatable. In older adults anxiety is treatable. In older adults dementia can be cared for in older adults so that caregivers get the support that they need. And then people living with dementia benefit from that. Also, early stages of dementia were actually suicide risk increases. People could be benefiting from treatment for depression, if people are depressed, there's depression often overlaps with cognitive disorders, especially in the beginning of a cognitive disorder. We need to be doing something about this, this is a crisis. Because like I said, without it, people will become more sick use more medications visit the ER more suffer more needlessly because we can treat these things. And let me tell you how we treat them. Depression is as treatable in older adults as in younger adults, anxiety is treatable in older adults, but they often go undetected and untreated. And we're going to talk a little bit about why in a minute.

 

What makes older adult mental health is a health care problem

7:16  
Let's talk about mental health being a health care problem as it relates to older adults. And and this actually argument comes from a congressional briefing in May of 2018. And there was a congressional briefing with the American Psychological Association and a mental health committee with it within Congress. And they talk about mental health care being a health care problem overall. And this is because mental health untreated mental illness increases poor outcomes and death for common conditions like heart disease, cancer, hip fractures, and people with serious mental illness like schizophrenia or bipolar disorder have an 11 to 30 year reduced life expectancy. And that's largely due to increased heart disease, cancer and diabetes. Older adults with mental illness have the highest Medicare costs about two to three times the cost of other Medicare beneficiaries, and substance use within the baby boomer population. That's, you know, baby boomers. 10,000 baby boomers are turning 65 every day Happy Birthday to 10,000 people today. I hope it's the best year yet, the baby boomer population are using more illicit substances and more opioid use with chronic pain or to treat chronic pain. And of course, I mentioned just a minute ago that 65% of adults 65 and older are drinking more than the recommended daily recommendations on drinking for older adults. Do you want to learn more about alcohol and aging? I have a great podcast on that where I go deeper into alcohol and aging and where I discussed three ways that alcohol affects the body differently as we age. Here's another reason that mental health care is a crisis for older adults.

 

Older adults struggle to get adequate mental health care

9:19  
Despite all of what I've already shared. Older Adults are not receiving mental health care, even though mental health conditions are highly treatable in older adults. Unfortunately, very few people older adults receive evidence based mental health services and treatments. Only between 4% to 28% of older adults with mental health and substance use disorders actually receive mental health services. This is despite numerous treatments and services proven to be affected by research. And like I said a minute ago, depression is highly treatable. at the same rate, as younger adults.

 

5 ways to improve access to mental health care for older adults

We could be doing a better job integrating mental health for older adults in primary care. Actually, the beginning of my work at the Atlanta VA health care system. For six years, I was embedded in a primary care clinic for older adults. And I was, I was considered primary care mental health integration psychologists with a specialty in older adults, and families would come to me and a physician or a geriatrician would, would assess the family or the older adult and see if there was any mental health condition, like depression, post traumatic stress disorder, which can also be treated in older adults. And if they would identify any concerns, or family strain or strife, or caregiving issues, or dementia, or new diagnosis of dementia, they would refer the family to me and I was embedded in their clinic. And I would do an assessment and see how the family was doing kind of build some relationship, and then share recommendations and feedback about what might be available for this family or this older adult. And the most common response that I would get coming in was I don't need to see a psychologist first. And we could talk about that because stigma is one of the barriers to getting older adults into care and their families. And then the other piece was at the very end of the meeting, when I would make recommendations and talk about what was available in the way of mental health care. The older adults and families would say I had no idea this kind of service was available. If I had known that this kind of service was available, I would have done this years ago. Or you're not the kind of psychologist that I always imagined I would work with, or Wow. And it would shape it would reshape the image that they had of what mental health care actually looked like. So we could do a better job of integrating mental health care into primary care for older adults.

12:10  
We could do a better job with home and community based mental health outreach services. So there is actually a mental health clinic in Georgia and I'm going to reach out to them, but they provide mental health services by going to older families homes, we could do a better job providing dementia caregiver support.

12:29  
My friend, Dr. Natalie Edmonds with dementia careblazers has some great resources for dementia caregiver support. We could do a better job with mental and physical health, self management, the Global Council on Brain Health has a great resource on ways to improve quality of life and wellness for older adults. And many of those strategies actually prevent mental health conditions. And then we could do a better job screening for mental health conditions, like depression, anxiety, and screening for substance use disorders.

 

A family faces a mental health dilemma: Managing mental health concerns at end of life

13:07  
A family recently reached out to me that their older, loved one was drinking a lot. And every time she would go to her primary care clinic, I think they actually would screen and she would lie. And the family was distraught about what to do, do we let her drink she has a terminal medical condition, but probably going to live for a few more years. Do we let her drink and not say anything or not intervene? And she's very depressed and very anxious. What do we do? I made the recommendation that even though she's lying to her doctor, that they let her doctor know, in writing how much she's drinking. So at minimum, the doctor can make decisions about medications, so that the doctor doesn't prescribe harmful medications that would interact with the alcohol. But there is treatment for substance use in older adults. And I struggle because so many of the so much of the feedback that this family was getting was she's terminal, just let her do what she wants to do. And that that might be true. I'm really one of the most lenient people I know when it comes to autonomy. What I what I struggled with hearing so much of the feedback, which was she's dying, just let her do what she wants to do. You know, she's not imminently dying. She's she has a terminal condition, but she's not on death's door. And she's suffering. And the whole point of palliative care is to ease suffering. And so I was in a dilemma with this family because on one hand, yes, the older adult has the right to make her choice about drinking. On the other hand, she's suffering and she also has the right to hear options available to her. And, she's been fed the same message as we have been fed about older adulthood and being a burden and all these ageist thoughts, right? But what if we could help her with the depression and the anxiety and the drinking, so that at least her quality of life is improved while she's in her final few years of life. We can treat depression in older adults. There's an ageist belief that older adults cannot change, or I'm dying any way when there's no imminent death coming, or what's the point or I don't want to be a burden. These are all ageist constructs that keep older adults out of care.

 

What are the benefits of mental health care for older adults

15:49  
Let's talk more about the benefits of mental health care. So when people do get treated, they get healthier, faster, when they have a medical problem, they get out of the hospital sooner, they have improved quality of life, the caregivers are less stressed out, they extend their length of life with more happiness, and their risk for suicide decreases. Also, older adults prefer and wish to live in their home for as long as possible. So according to AARP, report, 87% of people 65 and older reported that they desire to remain in their current homes and communities. The prevention and treatment of mental health conditions and older adults, helps people to achieve this goal of aging in place.

 

Why are older adults left out of the mental health conversation?

16:44  
So why are older adults left out of the mental health conversation? Well, there are several reasons. Of course, there is lack of education and information about what's typical with aging, and not typical with aging. So there's often the thought, Oh, it's normal to have dementia when you're older, or it's normal to be depressed. I mean, everybody's dying around you, wouldn't you be depressed, or we imagine we would be depressed as we age, and we project that onto older adults. And that's not true. Most older adults are not depressed and depression is not a normal part of aging. Most older adults do not have dementia. And dementia is not a normal part of aging. Anxiety is not a normal part of aging. So there are all of these ages, beliefs that shape or miss shape. What is accurate about aging? And because we don't, we don't have any concerns about that, well, that sadness is normal, or that anxiety is normal or memory loss is normal at that level. Well, that's wrong. Depression is not normal anxiety is not normal substance use at problematic levels, not normal. dementia, not normal, and there's a lot we can do to help. So we have to one shift our view about what's typical with aging, and not typical. And you do that by getting education by listening to this podcast or reading other reputable sources.

18:17  
And then there's also access barriers, like how do you even go about finding a provider? I don't know what kind of a provider do I even need? It's also confusing. There's a neuropsychologist and therapists, what's the difference between a therapist and a psychologist? What is a psychiatrist? There are so many questions and not clear answers for many families. And then once you get the answers, where do you even go? How do you even find somebody. And then there's a lot of stigma around mental health conditions and treatment, especially for older adults. I'm not crazy. I don't need to go to see a crazy doctor, or denial of problems. And this is especially complicated when people have dementia and depression or anxiety. Because sometimes with a dementia disorder, it's hard to see the scope of the changes. And so we might deny what's happening. And there's also a lack of professionals actually trained in providing mental health to older adults. And we need to change all of this.

 

Why is this topic so important to me?

19:23  
So why is this topic so important to me? So I have spent close to 20 years I started grad school in 2003, providing mental health care to older adults in their families in some of the most prominent healthcare systems in the United States. And I have seen firsthand that older adults are often left out of the conversation about mental health care, even among professionals. I wouldn't hear professionals say oh, there had to have dementia. There's nothing more I can do. Or, oh, it's normal to be depressed and older adulthood. So it's not normal. Of course, there's something we can do with families with dementia. And then I'm going to take it a step further and a step more personal. My life has been deeply impacted by mental health concerns, both in my family. And in myself. You know, looking at all of these statistics and working with older adults for close to 20 years, I began to think well, what will happen to my 71 year old mom, who struggled with mental health concerns throughout her life? If she has a depressive episode in older adulthood? Will there be people in her community to provide her with effective mental health care? How will she even find them? And then I thought, what will happen to me? If I experienced depression in my older adulthood, I experienced pretty severe depression in my adolescence. And after I had my kids, would I be able to find mental health professionals if I need them? When I'm older? With 67% of older adults with mental health conditions, not getting the mental health care that they need, the odds do not look good for me and my mom, or maybe for you, or your loved one or millions of others, I decided to do something about this.

 

Introducing the Center for Mental Health and Aging

21:27  
I'm creating the Center for Mental Health and Aging, which is the go to place online for the mental health care of older adults. I want every older adult who needs mental health care to get the specialized care and attention they need to live their best life. I want that for my mom, I want that for me. And I want that for you and your family. I want you to have support and peace of mind and the best life free of suffering. So the Center for Mental Health and Aging aims for to make that happen. So here's what it will look like. Our mission is to make it easier for older adults in their families to get the mental health care that they need. By providing free evidence based information about Mental Health and Aging. Through this podcast, through blogs through a guides that will have on the website. We're also going to make it easier for older adults and families to get the mental health care that they need by improving access to mental health care. And so what we're going to do is have a provider directory of all mental health providers who specialize with older adults, therapists, psychiatrists, and neuro psychologists who can help with a dementia evaluation. That's how we're going to do this more education that's accessible to the public, and easy to understand... and access to mental health providers through the provider directory. We want to build the only and largest mental health provider directory for older adults in the United States. And I hope you will join me.

 

Are you a licensed therapist, psychiatrist or neuropsychologist who specializes with older adults?

23:19  
Are you a licensed therapist, psychiatrist or neuropsychologist who specializes with older adults? I would love for you to have a profile in the Mental Health and Aging provider directory. I would love for you to join me in the movement to make mental health care for older adults and caregivers easier to find. Together we'll build the largest geriatric and the only geriatric mental health provider directory in the nation. Let's make it easier for older families to get the mental health care that they need. By helping them get access to you to be the first to know when this provider directory is available. Go To www.drreginakoepp.com/facts and that will take you to download a guide which is the five must know facts when you're working with older adults. If you go if you go there and download that guide, you will be the first to know when the provider directory is available. And I cannot wait until the Center for Mental Health and Aging is launched. I'm counting down the days. I cannot wait. So head on over to my website www.drreginakoepp.com/facts and you'll be the first to know let's make it easier for older families to get the mental health care they need by helping them get access to you.

 

Subscribe & Leave a Review

24:53  
That's all for today. If you like this episode, I would really appreciate a subscription Wherever you listen to this podcast and a review, and here's why you can join the movement to because the more people who subscribe and leave a review for this podcast, the more the podcast algorithm sends this podcast to other people who might be looking for similar things. And this begins to spread the message around Mental Health and Aging are mental health care for older adults. I can't do this by myself, I really need your help. Together, we can do this. Together, we can address the mental health crisis for older adults and their families. I'll see you next week. Same time, same place. Lots of love to you and your families. Bye for now.

 

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