Meeting the Mental Health Challenges of the Elder Boom

People with serious and persistent mental illnesses who are aging

People with mental health problems that develop or are exacerbated in later life including

Dementia

Late onset schizophrenia

Severe anxiety, depressive, and paranoid disorders resulting in social isolation, dysfunction, behavioral obstacles to living in the community, and high rates of suicide

Less severe anxiety and depressive disorders

Alcohol and prescription drug abuse + some lifelong addiction

Emotional problems adjusting to old age.

• Most older adults with mental illnesses also have chronic physical illnesses, and many older adults with physical illnesses have related mental illnesses.

• Family caregivers are the major source of support for older adults with disabling mental illnesses. They are at high risk of developing anxiety, depressive and physical disorders.

• Only 20-25% of older adults with mental disorders receive services from mental health professionals. In New York City approximately 43,000 of 180,000 are served by the public and private mental health sectors combined. An additional 45,000 are served in primary healthcare.

• Low utilization of mental health services reflects problems of access—such as service shortages, problems of affordability, lack of services in the home and community settings, restricted access to medications, and lack of cultural competence—as well as stigma. ageism, and ignorance about mental illness and the effectiveness of treatment.

• Mental health services in both community settings and institutions such as adult and nursing homes are of uneven quality. E.g. only 12.7% of people with mental illness treated by primary are physicians receive “minimally adequate care.” For mental professionals it is 48.3%.

• There is a vast shortage of clinically and culturally competent mental health, health, and aging professionals.

Major Challenges

1. Support to enable people to remain in, or return to, the community and avoid institutionalization in adult and nursing homes

2. Improved access to services through service expansion, increased mobile and community and home-based services, enhanced cultural competence, increased affordability, and open access to needed medications.

3. Enhanced quality of care and treatment in the community and in long-term care facilities through training, dissemination of information about best practices, the development of regulations relevant to older adults, and increased research.

4. Integration of mental health, health and aging services

5. Increased capacity of the system to serve cultural minorities through outreach and enhanced cultural competence

6. Social and economic issues as well as treatment needs must be confronted

7. Opportunities for prevention should be pursued

8. Support for family caregivers of older adults, for older family members caring for adult children with psychiatric disabilities, and for grandparents raising grandchildren

9. Public education to address issues of stigma, ageism, and ignorance about mental health

10. Workforce development to increase the supply and quality of mental health, health, and aging service providers

11. New finance models that (a) will support best practices and innovative services that are responsive to the unique mental health needs of older adults, (b) promote integrated service delivery, (c) provide parity, and (d) create incentives to enhance the workforce.

12. Governmental readiness for the mental health aspects of the elder boom including dedicated leadership and interdepartmental planning and program development.

Return to the top of the page.