Challenges in Care

Up to a fifth of Americans over 65 years old have mental-health or substance-abuse conditions, according to a report released by the Institute of Medicine, an independent government-advisory group. According to this study, at least 5.6 million up to as many as 8 million older adults in America have one or more conditions, which present unique challenges for their care. And, the health-care system isn’t set up to adequately address their concerns.  With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation.

Substance abuse appears to be a growing problem among Baby Boomers, and there’s no reason to believe the trend will stop. Between 2002 and 2007, the percentage of people aged 50 to 59 nearly doubled to 9.4%, and non-medical use of prescription drugs also increased substantially to 4% from 2.2%.
Also, of particular concern are depression and dementia-related behavioral or psychiatric symptoms. Some of this may be brought on by the events more commonly experienced later in life, such as the death of loved ones.  Another factor in the looming increase in demand on the mental health-care system is simply a larger number of aging Americans.

However, older people are less likely to seek psychiatric treatment compared with younger ones, and the availability of services and professionals geared to treat this population is lacking, according to the report.
Many older people with mental-health problems also have physical ailments, so clinicians have to be especially careful to avoid unsafe drug interactions.

An older person’s goals for mental-health treatment also may be different than a younger patient’s. Instead of a total cure, an older individual may just want to function better while reducing the amount of needed medications.

For decades, policymakers have been warned that the nation’s health care workforce is ill-equipped to care for a rapidly growing and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity, and lack of basic competence and core knowledge in key areas.  An expert committee assessed the needs of this population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach can adequately address the issue. Overcoming these challenges will require focused and coordinated action by all.