What is good health? I think it’s safe to say that the answer to that question is not the same for everyone. To some it may mean the absence of disease. For others it may be effectively managing a chronic condition. But for many of us, good health involves a combination of physical, psychosocial and emotional well-being and the interplay between all three.
As a psychiatrist specializing in the care of older adults, I focus on mental health disorders that older patients experience. According to the Centers for Disease Control (CDC), “it is estimated 20% of people age 55 years or older experience some type of mental health concern. Men aged 85 years or older have a suicide rate of 45.23 per 100,000, compared to an overall rate of 11.01 per 100,000 for all ages.”
The CDC website goes on to say, “In fact, the mental health of older Americans [was] identified as a priority by the Healthy People 2010 objectives and the 2005 White House Conference on Aging.”
This blog post is the first in a series addressing common mental health disorders and treatment. In this post I will provide a platform for discussion by outlining prevalent conditions that older patients experience and why there is a need for geropsychiatrists who understand their special needs. I will address specific disorders in detail in future posts.
Medical specialties usually arise out of an acknowledgement that there is a special knowledge base that one should have to be expert in treating patients in any particular area. For example, if you just look at medicine in general, there is a specialty in pediatrics, which evolved out of the recognition that children aren’t just small adults.
Likewise, older patients are not just adults with wrinkles. They actually develop health problems that are distinct from middle aged or younger people, and they also metabolize medications very differently than younger adults. They have unique public health problems associated with cognitive impairment and drugs associated with typical treatment of psychiatric conditions. One of those problems is falls, which is a serious health risk for seniors.
Older adults are also more susceptible to cognitive impairment, including neurodegenerative disorders (commonly known as dementias) such as Alzheimer’s disease. Geropsychiatrists often get involved in treatment at various stages. There is a high incidence of anxiety and mood problems that accompany cognitive impairment, which are two conditions that top the list of mental disorders that older patients experience.
Both psychiatrists and primary care physicians share the responsibility of caring for patients with dementia. We overlap a lot in every aspect of patient care, including screening, diagnosis, and disease management. In fact, there was an announcement in the fall from the American Psychiatric Association stating that psychiatrists are being asked to take on more of the medical management of patients with dementia.
The need for geropsychiatrists is growing, and the profession is not keeping pace. Geropsychiatry fellowships don’t even fill their training slots. A significant reason for this is that reimbursement for geriatric services, which is largely Medicare-based, is not enough to maintain a practice. Hebrew SeniorLife is generous in supporting medical care and finding ways to make up for what Medicare doesn’t provide. This is a big benefit to the residents and patients that my colleagues and I treat.
Older adults may be reluctant to acknowledge mental health issues and to seek treatment. For their generation, mental disorders carry a big stigma. So coupled with the dearth of providers, treating older patients who may be quietly suffering from treatable mental illness is a challenge.
The more we shine light on elderly mental health, the more likely diagnosis and treatment of these patients will grow and improve. I am optimistic that as the field of geriatric medicine in general grows we will find ways to make sure we do all we can to promote overall wellness for adults as they age. This includes acknowledging that mental illnesses are conditions that can be managed like any other disease, which is critical to maintaining overall health and quality of life.
Don’t miss parts II and III, subscribe to the Hebrew SeniorLife blog and receive an email notification whenever new blogs are published.
About Hebrew SeniorLife Primary Care
Hebrew SeniorLife offers a primary care practice specializing in the care of older patients. The practice is available to both Center Communities of Brookline residents as well as non-resident seniors from the greater community. The Hebrew SeniorLife Medical Group at Center Communities of Brookline is located in the Sloane Family/Century Bank Primary & Specialty Care Clinic at 100 Centre Street in Brookline.