The state of mental health and ageing in America
In the rat race of achievements and success, mental health is often brushed under the carpet. Nevertheless, it is a pressing public health issue that needs to be addressed. WHO defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.
Because mental health is essential to overall health and well-being, it must be recognised and treated in all Americans including the older adults, with the same urgency as physical health. For this reason, mental health is becoming an increasingly important part of the public health mission.
With the increasing rates of prevalence of Major Depressive Episodes (MDE), more Americans are insured but the coverage of mental or emotional difficulties nearly doubled by 2017. There is still an unmet need for mental health treatment among youth and adults. Youth are not being identified as having an emotional disturbance, which can keep them from accessing necessary help.
The challenges for better public health are to identify risk factors, increase awareness about mental disorders and the effectiveness of treatment, remove the stigma associated with mental disorders and receiving treatment for them, eliminate health disparities, and improve access to mental health services, particularly among populations that are disproportionately affected.
Mental Health Problems in Older Adults
People aged 55 years or older experience some type of mental health concern. The most common conditions include anxiety, severe cognitive impairment, and mood disorders such as depression or bipolar disorder. Mental health issues are often implicated as a factor in cases of suicide. Older men have the highest suicide rate of any age group.
The Significance of Depression
Depression, a type of mood disorder, is the most prevalent mental health problem among older adults. It is associated with distress and suffering.
The presence of depressive disorders often adversely affects the course and complicates the treatment of other chronic diseases. Unfortunately, depressive disorders are a widely under-recognised condition and often are untreated or under-treated among older adults.
Life satisfaction is the self-evaluation of one’s life as a whole and is influenced by socioeconomic, health, and environmental factors. Life dissatisfaction is associated with risky health behaviours such as smoking, physical inactivity, and substance abuse. The overall assessment of life satisfaction or dissatisfaction directly affects the mental health of an individual.
However, it is important to note that depression is treatable and a healthy social support system plays a major role in this regard. Social support serves major support functions, including emotional, informational, and instrumental support. Adequate social and emotional support is associated with reduced risk of mental illness, physical illness, and mortality.
Frequent Mental Distress (FMD) may interfere with major life activities, such as eating well, maintaining a household, working, or sustaining personal relationships. FMD can also affect physical health. Older adults with FMD were more likely to engage in behaviours that can contribute to poor health, such as smoking, not getting recommended amounts of exercise, or an unhealthy diet. Women have a greater vulnerability to developing FMD than do men.
Depression is more than just a passing mood. Rather, it is a condition in which one may experience persistent sadness, withdrawal from previously enjoyed activities, difficulty sleeping, physical discomforts, and feeling “slowed down”. The only distinction between a depressed and a non-depressed person is that the fallback to a normal life activity is quicker in a non-depressed person whereas depressed person finds it quite difficult to retrieve to a normal state of functionality.
A lifetime diagnosis states that anxiety, like depression, is among the most prevalent mental health problems among older adults. The two conditions often go hand in hand. Half of older adults who are diagnosed with major depression also meet the criteria for anxiety.
Late-life anxiety is not well understood but is believed to be as common in older adults as in younger age groups although how and when it appears is distinctly different in older adults. Anxiety in this age group may be underestimated because older adults are less likely to report psychiatric symptoms and more likely to emphasise physical complaints.
Older adults with depression also visit the doctor and emergency room more often, use more medication, incur higher outpatient charges, and stay longer in the hospital.
Over the last decade, depression and other mental health problems have gained increased attention from the public health community. Mental health, including treatment of depression, is one of the Healthy People 2010 Leading Health Indicators requiring priority action. The World Health Organisation has launched a new initiative focused on depression in public health.
With this issue brief, the Centers for Disease Control and Prevention (CDC) and the National Association of Chronic Disease Directors (NACDD) are seeking to increase awareness that depression is a public health issue and can be effectively addressed through community-based programs.
These three programs designed to improve low rates of treatment engagement among older adults and to identify and treat people who are not responsive to initial treatments follow the depression care management model, a systematic and team-based approach to treating depression in older adults. A psychiatric consultant supervises the care manager and makes antidepressant recommendations to the primary care provider. The intervention can be a clinic or home-based. In the home-based intervention, the depression care manager makes home visits and coordinates with other members of the collaborative care team outside of the participant’s home.
IMPACT (Improving Mood-Promoting Access to Collaborative Treatment) IMPACT focuses on improving the quality of depression care so that a significantly larger proportion of patients benefit from treatment. Patients are followed in a proactive manner that measures the effectiveness of treatment regularly and prompts a change in the treatment plan if the patient is not adequately improved. IMPACT is a program for older adults who have major depression or dysthymic disorder. The intervention is a stepped, collaborative care approach in which a nurse, social worker, or psychologist works with the participants’ regular primary care provider to develop a course of treatment.
PEARLS (Program to Encourage Active Rewarding Lives for Seniors) PEARLS is a brief, time-limited, and participant-driven program that teaches depression management techniques to older adults with depression. It is offered to people who are receiving home-based services from community services agencies. The program consists of in-home counselling sessions followed by a series of maintenance session contacts conducted over the telephone.
Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) Healthy IDEAS is a community depression program designed to detect and reduce the severity of depressive symptoms in older adults with chronic health conditions and functional limitations through existing community-based case management services. Healthy IDEAS integrates depression awareness and management into existing case management services provided to older adults such as those that offer assistance with home-based care. The program also seeks to improve the linkage between community ageing service providers and health care professionals through appropriate referrals, better communication, and effective partnerships.