Barriers & Solutions to Mental Health in Older Adults

An Overview of Barriers & Solutions
© 2013 Griswold International, LLC

“Held annually during
Mental Illness Awareness Week
in October, National Depression
Screening Day (NDSD) raises
awareness and screens people for
depression and related mood
and anxiety disorders.”
National Alliance on Mental Illness (NAMI)


Our Goal for Today
• Increase awareness of mental health issues in
older adults and the importance of treatment
• Drive early and effective….
- Dialogue related to mental health and depression
- Mental health screening and diagnosis
- Treatment that drives positive outcomes


Presented by:

Chris Kelly, MEd

Director of Learning & Development
Griswold Home Care


Thank you for your courage, energy, and dedication!
Healthcare Providers

Professional Caregivers

Family Caregivers

Clients Living with Mental Illness


Lit Review
Social Media
Advocacy
Solutions Webinar & Toolkit


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BRAIN WRITING

Solutions

Brainwriting is…
• a fun, engaging way to brainstorm
• sharing as many ideas as possible within a short timeframe
Brainwriting Process
• Listen for our questions
• When prompted, enter your solutions using the webinar chat function
• Don’t overthink or agonize…There are no right or wrong answers
Brainwriting Outcomes
• Peer-to-peer learning and sharing
• A publication that benefits others who are living with Depression
Important
• Avoid sharing any information that you would not want others to see


Mental Health and Aging in America
• 20% of people age 55 years or older have mental health issues
• The most common mental health conditions for older adults are:
- Mood disorders

- Anxiety

- Severe cognitive impairment

• Depression is the most common mental health condition among
older adults
The State of Mental Health
and Aging in America

Mental Health and Aging

http://1.usa.gov/HfIfqP

http://1.usa.gov/17GDCNq

TOOLS


The Impact
Untreated mental health conditions in older adults have
been connected with chronic conditions such as:
- Heart disease
- Diabetes
- Stroke
- Increased health care costs
- Inability to function
- Disability


The Impact
Older adults with untreated depression have…
- More doctor/ER visits
- Increased use of medicine
- Higher outpatient charges
- Longer hospital stays
- Increased readmission rates
- Highest risk for suicide as
compared to other age groups


Core Barriers –
Older Adults

“Well, I feel as
though most people that
are depressed really feel
unloved - that’s the main thing
or they feel unwanted or they
feel as though that they are
useless…like…I’m no more
use to you any more
so just let me go.”
Quote from older adult
with depression

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782754/pdf/nihms150724.pdf


Core Client Barriers - Awareness,
Beliefs and Stoicism
Older adults are often…
- Unaware of the symptoms
- Stoic about emotional and
physical pain
- Reluctant to “complain”

- Skeptical about the need for
treatment
- Feel they can handle things
on their own

Depression In Older Adults

- Lou Gehrig

Older Americans Behavioral Health

TOOLS

http://bit.ly/1ibEAWU

http://1.usa.gov/19YXM5d

Core Client Barriers Access to Support and Services
Older adults often lack access to care and support due to:
- Medical issues

- Decreased mobility

- Lack of transportation

- “Digital divide” – low access/comfort with e-tools (email, text,
online portal)

- Depression - which triggers isolation


Core Barriers –
Healthcare Providers

“Depression in
elderly people often goes
untreated because many
people think that depression is
a normal part of aging and a
natural reaction to chronic
illness, loss and social
transition.”
National Alliance on Mental Illness
(NAMI)


Core Healthcare Provider Barriers Healthcare Provider Time Constraints, Tools, Access
• Healthcare providers work very hard to recognize and
treat depression
• Recent research highlights that the prevalence of
depression in older adults has lowered
• Common provider barriers remain:
- Inadequate vigilance and screening
- Time constraints
- Misperception/Stigma
- Poor access to older adults
- Using language/terms that clients and family caregivers
cannot identify with
http://www.hufﬁngtonpost.com/2013/07/11/depression-in-older-adults-down_n_3575569.html


Screen, Discuss
and Diagnose
Depression

CDCP - http://www.cdc.gov/aging/pdf/cib_mental_health.pdf

“I didn’t know
anything about depression,
so I didn’t know I was
depressed.”
Older adult with depression


Learn About Depression
It is important to learn about the symptoms of depression and
treatment that can help
About Depression

Caregiving and Depression

TOOLS

http://1.usa.gov/GFAHxt

http://bit.ly/1bTH8rh


Know the Symptoms of Depression
• Memory problems
• Confusion
• Social withdrawal
• Loss of appetite
• Weight loss
TOOLS

• Vague complaints of pain
• Sleeping too much or too little
• Anxious and/or irritated
• Delusions (thinking things that are not
reality-based)
• Hallucinations (seeing, hearing or feeling
things that are not reality-based)

Depression in Older
Persons Fact Sheet

Screening for Depression in Adults
and Older Adults in Primary Care

American Psychiatric
Association

http://bit.ly/1fgHz38

http://1.usa.gov/19sleuG

http://bit.ly/1ibTLzv

Talk About Depression
This is easier said than done. Depression and other mental health conditions
are difficult to discuss due to the long-standing stigma of mental illness.
How to Talk to Your Elderly
Parent About Depression
TOOLS

Discussing Sensitive Topics

http://1.usa.gov/1bfewYm
http://bit.ly/1ioFaRm

Screen for Depression
There are several validated screening tools that help clients,
providers and family caregivers to recognize and discuss depression.

TOOLS

Geriatric Depression Scale

The Hamilton Rating
Scale for Depression

http://stanford.io/1bWD7SL
http://bit.ly/163MP55


Get an Early, Accurate Diagnosis
A diagnosis of depression should include:
- A physical exam
- Speaking with family members or close friends
- A review of medicines
- Blood tests and lab studies
- A clinical interview
- Imaging studies

Diagnosis and Treatment of
Depression in Adults: 2012
Clinical Practice Guideline
http://1.usa.gov/1cdWNFT


Seek Innovative
Treatment
Approaches

“Once diagnosed,
80 percent of clinically
depressed individuals can be
effectively treated by medication,
psychotherapy, electroconvulsive
therapy (ECT) or any
combination of the three.”
National Alliance on Mental Illness


Seek Innovative
Treatment
Approaches
CDC Promotes Public Health Approach to
Address Depression Among Older Adults

“For older adults
(age 60+), the top
recommended treatment
is home or clinic-based
depression care
management (DCM).”
Task Force on Community
Preventive Services

http://1.usa.gov/1atPwMV

Depression Care
Management (DCM)

Family Doctor/Physician’s Assistant/
Nurse Practitioner/ Nurse

Care management and coordination is
critical to successful treatment for
older adults with depression.

Geriatric Psychiatrist
Physical Therapist
Dietician

Your care team
should include:

Advocacy/
Support Group

Wellness Coach

Occupational
Therapist
Speech Therapist

Home Care
Professional
Social worker/Geriatric
Care Manager/Psychologist

Innovative Treatment Approaches
• Cognitive Behavioral Therapy (CBT) – A form of counseling that helps a
person to understand and change the thoughts, feelings and beliefs that
might be related to depression
• Medicine • Client and Family Education • Support Groups • Wellness
• Electroconvulsive Therapy (ECT) and other brain stimulation therapies
A Guide to Mental
Wellness in Older Age

Cognitive–
Behavioral Therapy

WRAP Plus

http://bit.ly/1a9OiX1

http://bit.ly/1gFja93

http://bit.ly/163RaW0

TOOLS


About Geriatric Psychiatrists
• Older adults can be sensitive to medicine, but with proper support,
medicine can play an important role
• Geriatric Psychiatrist can play a key role in:
- Assessing the need for medicine/s - Choosing the right medicine and dose

TOOL

Find a Geriatric
Psychiatrist
http://bit.ly/19vx8ny


About Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy can help older adults to understand
and change the thoughts, feelings and beliefs that might be related
to depression.
Find a Therapist Service

How to Adapt CognitiveBehavioral Therapy for Older Adults

http://bit.ly/18bZjo1

http://bit.ly/17fMsrf

TOOLS


Supporting Family Caregivers
• Family Caregivers also live with depression
• It is important for family caregivers to take care of themselves

TOOLS

Caregiver Action Network Toolbox

Caregiving and Depression

http://bit.ly/17fMFdO

http://bit.ly/1bTH8rh


Using Technology

For Healthcare Providers:

Geriatric
by Doctot
http://bit.ly/17J03l6


Using Technology

For Clients and Family Caregivers:

Lotsa Helping Hands
Mobile App

The 3 Minute Test for Depression,
Anxiety, Bipolar Disorder and PTSD

Digital Technology for
the Family Caregiver
http://bit.ly/17bUFKI

http://bit.ly/Hfc77G

http://bit.ly/1ce5ccx


Support Groups Can Help
The most practical coping strategies for depression can be
found through support groups.
DBSA Chapters/Support Groups

NAMI Support and Programs

http://bit.ly/GFAIBu

http://bit.ly/17fO0kU


Key Takeaways
Depression and mental health issues ARE NOT a
normal part of aging
Untreated mental health conditions in older adults have
a serious impact
Education, discussion, screening and diagnosis are
challenging but essential

Older adults and their family caregivers CAN BENEFIT
from treatment and support

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