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Providing Behavioral Healthcare to Seniors is a Growing Problem
This piece was prompted by a recent forum report from the National Academy of Medicine that concluded, “Existing systems are not prepared to provide the mental health care services needed by the growing population of older adults.”
The US population continues to age. In 1980, individuals at least 65 years of age accounted for about 10% of the population. By 2020, this ratio had increased to almost 1 in 5. By 2050, it is anticipated that it will increase even further to almost 1 in 4. Today, there are about 55.8 million older adults in the US.
The behavioral health of these older persons is a very important issue. SAMHSA estimates that almost 12% (6.5 million) have had a mental health condition and that slightly more than 6% (3.6 million) have had a substance use condition in the past year. For those with a substance use condition, slightly less than 80% have had an alcohol use condition and slightly more than 20%, an illicit drug use condition. Thus, almost 1 in 5 older adults experiences a behavioral health condition each year. Over their lifetimes, even larger percentages of older people would be expected to have these conditions.
Behavioral healthcare received by older persons is also very important. Of the 6.5 million older persons estimated by SAMHSA to have a mental health condition, only about 2% (130,000) used inpatient services, only about 27% (1.8 million) used outpatient mental health services, and about 43% (2.8 million) used prescription medication services. For those with a co-occurring mental health and substance use condition, about 63% received some form of behavioral health care. Overall, less than one-half of older persons with a mental health condition received any care.
Yet, also according to the SAMHSA estimates, far, far fewer of the 3.6 million older persons with a substance use condition received any care at all. Results show that less than 1% received care for their condition (only 214,000 persons among those with an alcohol condition and only 27,000 persons among those with an illicit drug condition). Thus, in practical terms, except for those who have co-occurring conditions, other seniors who have a substance use condition receive virtually no care.
Finally, also of interest are older people without mental health conditions who use mental health services. SAMHSA estimates this group to be slightly more than 9% (4.6 million) of older people. Their use of services is distributed as follows:
- Inpatient services, 0.5% (247,000);
- Outpatient services, 32% (1.5 million); and
- Prescription medication services, 85% (3.9 million).
Several observations are warranted to assess these findings:
- First, there actually is cause for great alarm. Behavioral healthcare for older persons with substance use conditions is virtually nonexistent. Older people with these conditions who receive no care at all are at increased risk for all types of accidents, including falls, or even earlier mortality. Such accidents increase the likelihood of losing the capacity to live independently and to require assisted living or nursing care.
- Second, less than half of older people with a mental health condition receive any care. Undoubtedly, this lack of services relates to the high rate of suicide in this age group, as well as to high levels of social isolation and loneliness, as many of these older people are subject to the “diseases of despair.”
- Third, the group without mental health conditions who use mental health services is of great interest. For some, this may be a situation where care providers have failed to recognize a real condition. For others, it likely reflects the lack of community and family support typical of many older people that, if addressed, could reduce or eliminate the need for these services.
Going forward, the behavioral healthcare field will need to take steps to reach and provide services to the large number of older persons with behavioral health conditions who currently are not receiving care. In many instances, this likely will not be achieved through traditional office visits. Rather, it will involve steps such as actual outreach at senior centers, libraries, and other community settings frequented by older people, care delivered through integrated care arrangements with primary care physicians, virtual care arrangements with groups representing senior homeowners, etc. An improved range of services covered by Medicare and better provider inclusion in Medicare, coupled with improved reimbursement rates, can facilitate these developments.
Growth in the proportion of older persons in US society also can have major consequences beyond behavioral healthcare. For example, the overall capacity of our workforce is decreasing, the programs and services available in our communities are changing, and our retirement systems, such as Social Security, are strained. Behavioral healthcare will need to be attentive to these changes and assess their consequences upon our ability to serve older people in the future.
Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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