“Do not go gentle into that good night,/ Old age should burn and rave at close of day;/ Rage, rage against the dying of the light.” – Dylan Thomas
Being physically fit, healthy, and optimistic, no matter your age, ensures a long life of
independence and productivity. But chronic illnesses, the risks of accidental injuries, and mental health problems increase exponentially as we get older. For instance, at least 90% of older adults in America have at least one chronic disease, and three out of four have at least two. That, alone, is pretty depressing. In addition, every 15 seconds, an older American falls and ends up in the emergency room.
To make matters worse, 25% of older adults suffer from some form of mental illness, whether it’s depression, anxiety, substance abuse, or suicidal thoughts – and yet only a third of them will ever receive the preventive services or treatment they need.
Mental illness is not a normal part of growing older. Even if an older person has never suffered a mental health problem before, the unique challenges of aging can easily trigger one. And poor mental health translates into declining physical health, slower healing, decreased quality of life, increased disability, and a tremendous strain on families, communities, and the entire healthcare delivery system.
Depression: More than “the Blues”
According to the World Health Organization (WHO), depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease. Women are more likely to suffer depression than men, but men are more likely to attempt suicide if their depression goes untreated.
Depression is much more serious than the moodiness people suffer after a single upsetting life event. But seniors experience bereavement, loss of income/retirement, chronic illnesses, isolation, and psychological trauma much more often than a younger person does – and oftentimes all at once.
At least seven million older Americans suffer from depression. In a social culture that worships youthful beauty, economic achievement, and physical prowess, it’s very hard to stay cheerful and self-confident when you start feeling creaky and cranky and you’re worried about the bills. And too many older Americans avoid discussing or seeking help for their mental health problems, fearing they’ll be labeled as “senile,” a worry-wart, or a hypochondriac.
Anxiety: More than “the Jitters”
Oftentimes, older people who are depressed also show signs of anxiety, ranging from vague complaints to panic attacks, and sudden phobias to obsessive-compulsive behavior (like hoarding) and full-blown symptoms of post-traumatic stress disorder (PTSD). According to the Centers for Disease Control (CDC), close to 8% of people over 65 have been diagnosed with anxiety – but that doesn’t include the people who’ve not been properly diagnosed or treated.
Substance Abuse: More than “a Little Help for my Nerves”
Whether it’s self-medicating with too many cocktails, too many pain pills, or improper use of prescription drugs, the number of older adults suffering from substance abuse is predicted to reach five million by 2020. Related to that are behavioral changes triggered by prescription drug interactions, medication mismanagement, and nutritional deficiencies.
Suicide: More than “You’ll be Sorry when I’m Gone”
Every day, 17 older Americans kill themselves. The statistics are shocking – people over 85 years old have the highest suicide rate of any age group. Those aged 75-84 have the second-highest rate, and suicide attempts in adults over 65 are five times more deadly than in any other age group. Older white males commit suicide at almost six times the rate of the general population.
Mental Health Care for Seniors: Follow the Money
So why don’t older people get the mental health care they need? It’s a complex issue, with
contributing factors like the out-of-pocket cost, lack of trained mental health professionals, the stigma of mental illness, inaccurate diagnosis and follow-up care, and the profound level of ignorance, disinterest, and inaction on the societal/governmental level.
Our healthcare delivery system is not structured to address the mental health problems of older adults. People 60 and older constitute 13% of the US population right now, about 43 million people, yet they utilize only about 8% of available psychiatric/mental health services.
Medicare covers 80% of the cost for physical health issues, but it only covers 50% for treatment of a mental health problem – and patient co-pays for mental health services are higher, too. This alone would discourage someone on a fixed budget from seeking counseling or treatment – as a result, less than 3% of all Medicare reimbursement is for psychiatric treatment of older Americans.
But this Medicare reimbursement scheme sets up a domino effect that discourages psychologists, social workers, and psychiatrists from specializing in geriatric mental health, despite the rapidly ballooning need. Fewer and fewer mental health practitioners will be willing to accept new Medicare patients if they don’t get reimbursed fairly by government agencies or if they have to hassle with insurance companies all the time.
“First, do no Harm”
In addition, medical misdiagnosis of mental illness in older patients is rampant – it’s estimated that primary care physicians (PCPs) fail to properly diagnose depression in older patients half the time, and only 50% of the older patients who do discuss depression with their doctor end up receiving any treatment for it. Meanwhile, misdiagnosed depression can result in a suicide. In a 1990 study, 20% of senior suicides had seen their doctor the day before, 40% had seen them within the past week, and more than 80% had visited their PCP within the past month.
Very few primary care/family practice physicians receive enough training in the care and management of their geriatric patients, where the interaction of physical, social, economic, and psychological problems is much more complicated than in younger patients. People over 60 years old face unique stresses and worries – declining agility and energy, financial pressures, grief, loss of friends and extended family support, disrupted routines and living circumstances, chronic illnesses, and multiple medications.
It’s an incredibly short-sighted national healthcare paradigm, and it lights the fuse on a public health and budgetary time-bomb in the future. The elderly population in the US is projected to double to 84 million within just a few decades – more than one in five Americans will be over 65 years old by 2050.
Mind, Body, Soul
Good mental health is the interwoven flip side of good physical health and longevity – it
promotes faster recoveries, optimism, and longer independent lives for older people. It’s simple math – affordable and accessible mental health care for all seniors would greatly reduce the eventual burden on Medicaid/Medicare and our healthcare delivery systems.
But there’s been very little public awareness, media outrage, or political initiative to rectify and defuse this looming crisis. Older Americans have paid their taxes, contributed to their communities, and played by the rules. Like veterans returning from a war, they deserve the best healthcare possible, whether for their physical ailments or mental health issues.
Symptoms of a Mood Disorder
-Noticeable and fluctuating changes in energy, sleeping habits, appetite, activities
-Difficulty concentrating, staying focused, or making decisions – “zoning out” and day-dreaming
-Constantly feeling edgy, restless, irritable, agitated, fearful, pessimistic
-Feeling unhappy, sad, or hopeless, suicidal thoughts; feelings of guilt, worthlessness, or regret
-Obsessive thoughts, sudden phobias, or compulsive behaviors
-Self-medicating with alcohol, recreational drugs, or pain medications – risky behaviors
-Vague physical complaints with no known cause; chronic fatigue, listlessness, lack of interest
-Self-neglect – sloppiness, poor hygiene, skipping meals, unpaid bills, ignoring doctor’s orders
-Withdrawal from normal social contacts and activities; lack of joy, pleasure, amusement
Is it Depression – or Dementia?
Too often, symptoms of depression or anxiety in older people are dismissed as “normal” signs of aging. Even worse is when they’re assumed to be signs of creeping senility or Alzheimer’s disease.
But while some of the symptoms of depression and early dementia may overlap, they are two distinctly different disorders. First of all, depression is a sudden mood disorder, a mental illness oftentimes triggered by cumulative traumatic life events – but it is treatable. Dementia is a gradual cognitive disorder – a brain disease – and it is progressive and irreversible.
A depressed older adult may have trouble concentrating, but they’re oriented to time and space, remember what they ate for breakfast, and know who they’re talking to. A person suffering from dementia becomes increasingly disoriented, gradually unable to remember faces or simple tasks, or to communicate or think coherently.
Teaching Old Dogs New Tricks
Here are ten easy ways to maintain your overall wellness as you grow older:
1. You may not want to do any more heavy lifting, dog-chasing, snow-shoveling, or gutter-
cleaning, but you can always do simple household chores that gently stretch your muscles and improve your balance (like changing the bed sheets, emptying the dishwasher, washing the car, or doing some waist-high gardening. Try tai chi or chair yoga – instead of Zumba or jai alai.
2. Your internal organs and cardiovascular system need exercise, too. We all spend too much time frozen in the sitting position, whether it’s in front of a television or computer screen or in a car. Get out of the house and take a walk up the street to buy the Sunday newspaper or bagels, instead of driving there. Your legs need constant exercise for you to stay healthy, well-balanced, and trim. Stroll through a park or along the beach and get some fresh air in your lungs.
3. Give your brain a workout – instead of passively watching a screen for hours on end, read a book, do crossword puzzles, play chess, have an intelligent conversation with someone, keep a daily to-do list of chores, errands, and projects. Keep learning – visit a museum, take a day-trip, attend a free workshop, check out the local library.
4. Eat real food. If you’re nibbling on leftovers, canned goods, take-out and microwave-meals, you are not eating real food, and your body isn’t getting the nourishment it needs. Plan out a simple weekly menu that covers all the food groups, wean yourself off compulsive snacking, and use fresh, instead of packaged, ingredients. Reduce your salt intake and hold the mayo. Learn to make a few simple dishes from scratch, then invite someone over for a home-cooked meal.
5. Just like your car, you need regular tune-ups and maintenance. Don’t skip annual physical exams, preventive screenings, lab tests, or immunizations. Ask your doctor for a thorough review of all your medications to make sure that drug interactions aren’t causing your physical or mental distress.
6. Take care of your eyes, your teeth, and your feet – don’t scrimp on new eyeglasses, dental cleanings, or shoes that fit properly. If you can’t read the fine print on your prescription bottle, if you can’t chew your food, or if you can’t walk ten feet without wincing, your quality of life will be greatly diminished. Medicare supplement plans can help lower your out-of-pocket costs for routine vision, hearing, and dental exams. Check out medical credit cards like CareCredit, and take advantage of free or low-cost medical services available through your community (e.g., podiatrists, dental hygienists).
7. Fall-proof your home (just like how you baby-proofed it when your kids were little). Injuries from falling are a major cause of hospitalization, disability, and mental distress for older people. Make sure there are railings and safety grab-bars throughout the house, non-slip flooring, adequate lighting, and uncluttered walkways. Arrange for someone else to shovel the snow, de-ice the sidewalks, and clean the gutters.
8. Get more involved in your neighborhood – join a church choir, check out the local senior/recreation center and YM/WCA, volunteer at the pet shelter, mentor a student, attend a town meeting. People with strong social and community ties live longer, happier, healthier lives.
9. Laughter is still the best medicine – tickle your funny bone every day, whether it’s telling a joke or listening to your favorite late-night comedian, watching a silly movie like Borat or reruns of I Love Lucy. Laughter releases the “happy hormones” in your body that counteract the stress hormones, and it takes your mind off your troubles for a while. (Read Norman Cousin’s Anatomy of an Illness.) Smile more.
10. Live fully in each moment – while dwelling on the past, obsessing about the future, or always trying to do ten things at once, you can’t focus on what you’re really feeling, both physically and emotionally. You need to de-clutter your mind of distractions and pessimistic thoughts, if only for a few minutes at a time throughout the day, and just “be.” Some people find that meditation or prayer gives them a calmer outlook. Others find that same peacefulness by watching a sunset, feeding the ducks, floating in a pool, or listening to instrumental music. Instead of always feeling pressured to be “doing” something 24/7, step back and just enjoy a few minutes of doing nothing but experiencing the moment. Carpe diem.