Question

What are some of the challenges in the delivery of mental health services for the elderly?

Answer 1

Older adults, those aged 60 or above, make important contributions to society as family members, volunteers and as active participants in the workforce. While most have good mental health, many older adults are at risk of developing mental disorders, neurological disorders or substance use problems as well as other health conditions such as diabetes, hearing loss, and osteoarthritis. Furthermore, as people age, they are more likely to experience several conditions at the same time.

Clinical presentation of older adults with mental disorders may be different from that of other adults, making detection of treatable illness more difficult.

ther are challenged in diagnosis and treating mental health problems of older elderly:

●Many older adults present with somatic complaints and experience symptoms of depression and anxiety that do not meet the full criteria for depressive or anxiety disorders.

Detection of mental disorders in older adults is further complicated by high co-morbidity with other medical disorders.

●The symptoms of somatic disorders may mimic or mask psychopathology, making diagnosis more taxing.

●Older individuals are more likely to report somatic symptoms than psychological ones, leading to further under identification of mental disorders.

Primary care providers carry much of the burden for diagnosis of mental disorders in older adults

●However, the rates at which they recognize and properly identify disorders often are low.

●With respect to depression, a significant number of depressed adults are neither diagnosed nor treated in primary care.

Identified Barriers to Treatment

●Patient barriers (e.g., preference for primary care, tendency to emphasize somatic problems, & reluctance to disclose psychological symptoms).

●Provider Barriers (e.g., lack of awareness of manifestation of mental disorders, complexity of treatment, and reluctance to inform patients of a diagnosis).

●Mental Health Delivery Systems Barriers(e.g., time pressures, reimbursement policies).

●Stereotypes about normal aging can also make diagnosis and assessment of mental disorders in late life challenging.

●Ageism within the Mental Health Delivery System

Transitioning to a Medicaid only system in providing Mental Health Services.

●The fact that older persons in greatest need of mental health services will not self-refer.

●Inadequate ways of identifying older persons in need mental health services.

Inability of primary health care providers in identifying depression in older persons.

●Inadequate reimbursement for psychiatric and/or mental health services and its impact in community based systems.

●Downsizing of geriatric beds in State Mental Hospitals and relocating those patients to community based settings.