mental health and aging

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 & DevelopmentGriswold Home Care

Thank you for your courage, energy, and dedication!

Professional CaregiversHealthcare Providers

Family Caregivers Clients Living with Mental Illness


Lit Review

Social Media

Advocacy

Solutions Webinar & Toolkit



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

BRAIN WRITINGSolutions

Orange Arrow Button: Minimizes or expands the GoToWebinar control panel.


• 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

Mental Health and Aging in America

TOOLS

http://1.usa.gov/17GDCNqhttp://1.usa.gov/HfIfqP

The State of Mental Healthand Aging in America Mental Health and Aging


The ImpactUntreated 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 ImpactOlder 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


“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

Core Barriers –Older Adults

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

- Lou Gehrig


Core Client Barriers - Awareness, Beliefs and StoicismOlder 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

TOOLS

http://bit.ly/1ibEAWU http://1.usa.gov/19YXM5d

Depression In Older Adults Older Americans Behavioral Health


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


“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 Barriers –Healthcare Providers


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


http://www.huffingtonpost.com/2013/07/11/depression-in-older-adults-down_n_3575569.html

“I didn’t know anything about depression,

so I didn’t know I was depressed.”

Older adult with depression

Screen, Discussand DiagnoseDepression

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


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

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

Learn About Depression

TOOLS

http://1.usa.gov/GFAHxt http://bit.ly/1bTH8rh

About Depression Caregiving and Depression


• Memory problems• Confusion • Social withdrawal • Loss of appetite • Weight loss

Know the Symptoms of Depression• 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)

TOOLS

http://1.usa.gov/19sleuG http://bit.ly/1ibTLzvhttp://bit.ly/1fgHz38

Depression in OlderPersons Fact Sheet

Screening for Depression in Adults and Older Adults in Primary Care

American PsychiatricAssociation


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.

Talk About Depression

TOOLS

http://bit.ly/1ioFaRm

How to Talk to Your ElderlyParent About Depression

http://1.usa.gov/1bfewYm

Discussing Sensitive Topics


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

Screen for Depression

TOOLS

http://bit.ly/163MP55

http://stanford.io/1bWD7SL

Geriatric Depression Scale

The Hamilton RatingScale for Depression


Get an Early, Accurate DiagnosisA diagnosis of depression should include:- A physical exam - A review of medicines- A clinical interview

- Speaking with family members or close friends- Blood tests and lab studies- Imaging studies

http://1.usa.gov/1cdWNFT

Diagnosis and Treatment ofDepression in Adults: 2012Clinical Practice Guideline


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

“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

CDC Promotes Public Health Approach to Address Depression Among Older Adults

© 2013 Griswold International, LLC© 2013 Griswold International, LLC© 2013 Griswold International, LLC© 2013 Griswold International, LLC© 2013 Griswold International, LLC© 2013 Griswold International, LLC© 2013 Griswold International, LLC

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

Geriatric Psychiatrist

OccupationalTherapist

Physical Therapist

Home Care Professional

Advocacy/Support Group

Speech Therapist

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

Depression Care Management (DCM)

Dietician

Wellness Coach

Social worker/Geriatric Care Manager/Psychologist

Your care teamshould include:


Innovative Treatment Approaches

TOOLS

• 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

http://bit.ly/1a9OiX1

A Guide to Mental Wellness in Older Age

http://bit.ly/1gFja93

Cognitive–Behavioral Therapy

http://bit.ly/163RaW0

WRAP Plus


• 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

About Geriatric Psychiatrists

TOOLhttp://bit.ly/19vx8ny

Find a Geriatric Psychiatrist


Cognitive Behavioral Therapy can help older adults to understand and change the thoughts, feelings and beliefs that might be related to depression.

About Cognitive Behavioral Therapy (CBT)

TOOLS

http://bit.ly/18bZjo1 http://bit.ly/17fMsrf

Find a Therapist ServiceHow to Adapt Cognitive-

Behavioral Therapy for Older Adults


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

Supporting Family Caregivers

TOOLS

http://bit.ly/17fMFdO http://bit.ly/1bTH8rh

Caregiver Action Network Toolbox Caregiving and Depression


For Healthcare Providers:Using Technology

http://bit.ly/17J03l6

Geriatricby Doctot


For Clients and Family Caregivers:Using Technology

http://bit.ly/17bUFKI

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

http://bit.ly/1ce5ccx

Digital Technology for the Family Caregiver

http://bit.ly/Hfc77G

Lotsa Helping HandsMobile App


Support Groups Can HelpThe most practical coping strategies for depression can be found through support groups.

http://bit.ly/GFAIBu http://bit.ly/17fO0kU

DBSA Chapters/Support Groups NAMI Support and Programs



Key Takeaways

Depression and mental health issues ARE NOT a normal part of aging

Education, discussion, screening and diagnosis are challenging but essential

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

Untreated mental health conditions in older adults have a serious impact


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mental health and aging

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