The elder boom has begun, and our nation is not prepared. Between 2011 and 2030, the number of adults 65 or older will increase from 40 million to 72 million and from 13 percent of the population to 20 percent. This drives growing concerns about the viability of Social Security, the sustainability of Medicare, and the availability of a workforce to provide health and social services.
Despite widespread concern about the physical health of older adults, mental health needs are mostly not on the national radar screen, a serious oversight for five reasons.
First, contrary to the ageist assumptions of our culture, people can live well in old age, but not without mental health.
Second, mental illness has a terrible impact on physical health. People with mental disorders are more likely to have physical disorders, and people with co-occurring physical and mental and/or substance use disorders are at higher risk for disability and premature death and have far higher medical costs than those with physical disorders alone.
Third, approximately 20 percent of older adults have diagnosable mental and/or substance use disorders, including dementia. This increases to over 50 percent of older adults by age 85, mostly dementia, the prevalence of which doubles every five years beginning at age 60. The range of mental health problems also includes:
Anxiety and depression, which often co-occur with dementia
Psychotic conditions, such as schizophrenia, bipolar disorder and severe depression
Substance use disorders
Fourth, untreated mental disorders contribute to avoidable placement in institutions, such as nursing homes, driving up the costs of long-term care in the U.S. They also contribute to social isolation and high rates of suicide.
Fifth, all older adults face emotional challenges related to social and occupational role changes, diminished — but not lost — physical and mental abilities, losses of family and friends, and the inevitability of death.
Both the public and the private sectors need to take steps to meet the mental health challenges of the elder boom. These include:
Making mental health promotion a key element of the health and aging services systems.
Providing home and community-based services to enable people developing disabilities to live where they choose.
Supporting family caregivers who provide 80 percent of the care for people with disabilities.
Improving access to mental health and substance abuse services in the community.
Improving the quality of mental health and substance abuse services in the community and in residential and institutional settings such as formal and “naturally occurring” senior housing, assisted living and nursing homes.
Fostering integration of physical health, mental health, substance abuse and aging services.
Enhancing the adequacy of services for minority populations, which will grow from 20 percent to 30 percent of the older population by 2030.
Increasing research regarding effective mental health promotion and treatment of mental and substance use disorders and improving translation for research findings into practice.
Providing outreach and public education to older adults and their families regarding mental health, effective treatment and where to find resources.
Addressing the shortage of a clinically and culturally competent workforce, in part by recruiting and training more geriatric professionals and paraprofessionals and in large part by including older adults themselves in the helping workforce in both paid and volunteer roles.
Restructuring methods of financing needed services so as to make them affordable, to enhance integrated care and treatment, and to support services in the home and in natural community settings.
Making the mental health challenges of the elder boom more than a rhetorical priority in both private and public service systems.
In these times of cutback in government spending, addressing the mental health needs of older adults may appear to be an unnecessary frill. But the truth is that failing to address mental health needs will drive costs up in the long run. Ignoring this is very poor policy.
(This article is coauthored by Kimberly Williams, co-founder and Director of the Geriatric Mental Health Alliance of New York.)
Do you ever feel invisible? When my friends and I decided to write a book about women over 50, I asked a lot of women my age what sucked about getting older. I expected to hear the sagging/bagging/dragging thing or maybe the memory thing or maybe even the empty nest thing. I didn’t hear any of that. What I heard over and over was “I feel invisible.” Well, you could have knocked me over with a pair of sensible shoes.
I could relate to these women. I remember certain events in my life vividly: My first kiss. The day John F Kennedy was shot. “Going all the way.” My college graduation. My first wedding. The births of my three children. The day I became invisible. My second wedding. The day my grandson was born.
Whoops, back up. I remember the day, no, the moment, when I became invisible. Walking down the aisle at Safeway. Man coming toward me. Man passing. My brain registering He never saw me. I don’t mean he didn’t oogle me. I mean HE DIDN’T SEE ME. I wasn’t composed of molecules that took up any space in his world. Had someone asked him if he had passed anyone in the aisle, he would have said “No.”
It was a real turning point for me. I never had to think about my visibility before. It was just sort of there. But from that day on, I didn’t take visibility as a given. I made sure I looked people in the eye and smiled when I passed them. I spoke up when sales people started to deal with other customers when I had been there first. I no longer allowed people to cut in front of me in line or to take a parking space I had been waiting for. And I got rid of all the long baggy jumpers I had been wearing, just because they were so comfortable. In other words, I began to think about how I was going to be visible in the world. The result was incredibly energizing.
The conclusion I came to was that being visible had little to do with youth or sex appeal. It came from a feeling of empowerment, and from a belief that I should be noticed. There’s a commercial on TV now that shows a woman all dressed up, coming down the stairs. The voiceover says “It’s (whatever the product is) the difference between ‘I’m here’ and ‘Here I am.’” That pretty much sums it up for me.
All this is not to say that there aren’t times that I choose to be invisible, to fly under the radar. Sometimes, under the right circumstances, that can be liberating and/or comforting. And, at other times, it allows me to get away with things, like standing in line at the checkout, eating the nuts that haven’t been weighed yet (Now Husband Dan hates when I do that.) Visible. Invisible. I simply want the choice.
Note to Safeway Guy: If we ever share the same aisle again, I’ll bet you’ll notice me.
Renee Fisher
Co-author, Saving the Best for Last: Creating Our Lives After 50
There are days when it takes all the self control I possess to be with Carol, a pleasant 87 year old woman with mild age-related cognitive loss. I can empathize with the complaints about the kids who don’t visit often enough, the aide who forgets to put her phone within reach, and the salad with the wilted lettuce. However, I sometimes think that if I hear one more repetition of the story about how her husband bought her a cherished emerald ring in 1973, I may tear out my hair. It’s a long story, it never changes, and I believe I’ve heard it at least twice a month for the past three years.
Short-term memory tends to fade with advanced age, as it is based on such factors as ability to attend to the environment, maintain focused concentration, and track complex information. As illness, diminished energy and perceptual changes erode some of those capacities, the ability to recall recent information diminishes. In contrast, memories from years past strengthen, having been reviewed and repeated (and revised and edited) many times. Caregivers often marvel that Mom can’t remember her upcoming doctor’s appointment, but can tell you what she paid for milk in 1964.
You might think that listening to the same story over and over would be a neutral or—at worst—a mildly boring experience. After all, we hear all sorts of things repeatedly—recorded messages on trains and busses, the music in TV jingles, liturgical passages at religious ceremonies—and many people find the familiar tolerable, and even soothing. Why then, do so many caregivers report that hearing yet again about Dad’s heroic actions in the fields of Korea or Mom’s days as a cheerleader can drive them to drink?
Much of the frustration comes from the fact that this sort of repetition is one of the most inescapable “proofs” that someone has reached a point where they are more comfortable in the past than in the here-and-now, and that this isn’t likely to change. The effort of attending to current realities is too much, and they’ve surrendered to the comfort of the familiar. The content of these repeated tales is also rather telling, as it can give some clues to those events and experiences that impacted the person most profoundly: If a parent’s most cherished memory relates to things that happened long before you were born, what does that say about you?
Repetition apparently isn’t limited to the senior set… When emailing a younger colleague recently, I shared a past experience that I thought resonated with some current events, and was quite chagrined when reminded that I’d already told that story. I felt rather hurt that my misplaced effort at empathy (and the chance to recount how I’d saved the day ‘back in the day’) apparently generated boredom and annoyance, along with the message that I’m forgetful. No kidding—I really don’t remember having told that one before…
Once I moved past the hurt feelings, I began to think about getting my act together and scoring some points in the present, instead of resting on past laurels, which is probably a good thing. I also began to develop a new appreciation for Carol’s experience. I thought about my own response to her oft-told story about the emerald ring, and how I regularly discount her need to re-live a time when she felt loved and special. I just hope profoundly that I don’t communicate my impatience as clearly as my colleague did.
I can’t honestly say that the story took on a new glow when I heard it again, but I did realize that maybe Carol shares it with me because our interactions remind her of that time when she felt valued, and appreciated, with years of life yet to be lived and goals yet to be accomplished. Maybe I need to put more effort into helping her to recapture those feelings in her current relationships.
Realize that when someone relates an experience to you you’re hearing about it for a reason. Don’t just hear, listen.
Mary Languirand and Robert Bornstein are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here’s the link: http://www.newmarketpress.com/title.asp?id=901
