Meeting the Mental Health Challenges of the Elder Boom
BLOGGER: MICHAEL FRIEDMAN, LMSW
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.)
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Posted 9 months, 4 weeks ago at 12:08. 1 comment
On Being Invisible
Blogger: Renee Fisher
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
Posted 1 year, 3 months ago at 12:08. 2 comments
Stretching to Cover:
The Caregiver’s Guide to Managing Multiple Roles
BLOGGERS: Mary A. Languirand, PhD and Robert F. Bornstein, PhD
The typical caregiver has many roles–daughter or son, spouse, parent, co-worker, sibling, friend…..the list goes on. Some of these are supporting roles, with modest demands, but some are leading roles with multiple responsibilities. The juxtaposition of large and small, crucial and trivial, short-term and long-term requires a lot of cognitive and emotional readjustment. It sounds easy until you try to do it. The sheer energy required to shift perspective from one role to another is one part of the stress. Weighing competing views and opinions is another. When everybody needs a piece of you, allotting your time and energy becomes a complex balancing act.
We’re always amazed at the flexibility shown by many caregivers. There you are, talking on the cell phone with children, or directing clients or office staff on important matters as you tote drugstore bags with Mom’s favorite lipstick and hand lotion, her laundry neatly folded in a duffle on the other arm. When you think about all the steps involved in those processes, and all the details you’re juggling, it’s amazing you can keep it all straight. But what’s the impact–what’s the cost?
Great thinkers encourage us to ‘live in the moment,’ and savor life as it happens. It’s a terrific idea, but when you have many roles the actual experience is very different–at any given moment, you must think about your next move, your next meeting, next week, next month, and next year. Someone recently remarked that most days they begin work while still in the shower–funny, but true. The shower, the drive to work, and the other moments of ‘down time’ can quickly be absorbed in thinking about our responsibilities. We ruminate about work while driving, focus on the kids’ recital during a meeting, generate a grocery list at the recital. The result is the feeling of always being ‘elsewhere’ or in the ‘wrong’ mode. This is less of a problem while in the shower than it is when you’re behind the wheel (since research suggests that half of all car accidents are due to driver distraction), but it’s still a problem.
People are often surprised to see the data on multitasking. Not only is the practice actually less efficient than doing one thing at a time, it also has emotional costs. Not being fully present in what’s happening causes you to miss events going on around you–you’re there, but derive little benefit. Further, those close to you really do notice–and sometimes resent–your ‘absent presence’. Bosses, clients, spouses, and children are notoriously intolerant of anything less than your undivided attention. However, their resentment–whether or not they express it directly–likely pales next to that of an ill or aging loved one.
When you’re ill your world tends to shrink. Makes sense if you think about it: The personal relevance of many matters outside your immediate environment becomes increasingly remote. From a psychological viewpoint, this is good energy conservation–you don’t waste precious time on things that aren’t affecting you. It also captures one part of ‘being in the moment’ quite brilliantly. However, it can be problematic when dealing with those still focused on more distant matters.
When you’ve had a horrible day at work, gotten bad news about the kids, and sloshed through evil traffic in two inches of sleet to deliver your loved one’s laundry (all the while listening to news about the tanking economy and mortgage meltdowns), you should get a little credit for your care giving efforts. You might even want a little sympathy. You’re more likely to get criticized for ‘not visiting enough’ before getting an earful about everything that went wrong while you were away….
So what can you do to cope? Three things:
1. Role pruning
Those who have pondered deep philosophical matters all come around to the same conclusions: Life is precious, time is fleeting, and there aren’t any do-overs. You can’t ever get lost time back, so give some thought to what you’re doing and why. Review each of your commitments, and take a hard look at what you give and get in each. You can’t just ditch some roles when they’re no longer fun. If this were possible, few teenagers would still have their parents’ address or phone number. However, you can re-evaluate the roles you’ve taken on, and change those that aren’t fulfilling. Some burdens are eased by reminding yourself that they’re temporary. You can also delegate responsibilities. In spite of how it may sometimes feel, you are not the only person in the world able to do some tasks. Share the burden–ask for help.
2. Set some limits
Figure out how much time you want to allocate to each role, and stick to those guidelines. True, some flexibility is in order here: Emergent situations do arise, and require appropriate action. However, if some parts of your life seem to generate constant chaos and absorb most of your energies, it might be time to put on the brakes. Leave losing battles, and give more of yourself to those things that re-energize you. This is based on sound psychological principles: Reinforce desirable behavior, and withdraw reinforcement from bad behavior. So if your loved one is truly being impossible, it’s OK to visit briefly and call it a day–you’ll stay longer when she’s in a better mood. You can advise her of what you’re doing and why if you want to, but it really isn’t necessary. The beauty of reinforcement principles is that they impact behavior naturally, regardless of whether the person is aware of it.
3. Take care of yourself
We’re bombarded by the same messages over and over for a reason: they’re important, they’re usually true, and most of the time they work. So here’s a good message: You must reserve time for yourself if you’re going to function optimally. Maintaining your own health is crucial; if you get sick, nobody wins. Exercise, time spent with friends, adequate sleep, proper diet, and a few little indulgences and self-rewards are essential if you want to keep going. Being a good caregiver means taking care of yourself as well. You’re not being selfish–it’s just common sense.
Robert Bornstein and Mary Languirand 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 just released. Here’s the link: http://www.newmarketpress.com/title.asp?id=901
To find out more about Robert Bornstein, click his photo to read his bio and click the links to read his other blogs.
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Posted 2 years, 11 months ago at 12:08. 1 comment
Coping with Stress in Troubling Times
BLOGGER: ROBERT BORNSTEIN
I teach at a University–in many ways a dream job–and now I’m on break. Classes don’t start until next week. You’d think I’d be relaxed, right? No students, no meetings, no worries. So why am I here in the office at 6AM? Trust me–relaxed is what I’m not. The thing is, break or not, deadlines loom. Emails pour in. There are syllabi to be made.
Stress.
Apparently I’m not alone: It seems everyone I talk to lately is stressed as well. The economy, the housing market–just turn on the evening news. We can’t avoid stress…it’s a part of life. But over the years I’ve found some ways to cope that work for me, and they might work for you too.
The place to start is to understand stress–to know what it is, and just as important, what it isn’t.
Everyone experiences stress–that uncomfortable, pressured feeling you get when overwhelmed by life’s challenges. Studies indicate that almost every one of us reports feeling stressed at one time or another, and nearly 60% of American adults say stress has had a negative impact on their life. We’re all vulnerable.
We know when we’re stressed–we can feel it–but what exactly is stress, and how does it affect us? How does stress impact mind and body?
First it’s important to recognize that stress doesn’t happen to us, it happens within us: It is the body’s attempt to cope with a challenge–the body’s way of mobilizing to confront a threat. Back in high school you probably remember your bio teacher telling you about the “fight or flight” response…nature’s way of gearing us up for action. That’s what stress is–the old fight or flight response. When this response happens once, or a few times, it’s no problem. The problem comes when you experience stress too frequently. Too many fight or flight responses in succession wear you down, deplete your body’s resources, sap your energy, and lower your mood and motivation.
Here’s why: each time you mobilize to confront a threat, your sympathetic nervous system–the part of your nervous system that activates you for action–kicks into high gear. Your pupils dilate and your heart begins to race. You sweat a bit–your palms get moist. Blood flows to your brain so you can make quick decisions. You’re ready to rumble.
Keep in mind–and here’s the problem–the stress response is nature’s way of helping you confront an intruder or run from a tiger, but now, eons later, the same response occurs when you miss the bus, lose your keys, or manage to jam the copier at work. This same fight or flight response occurs when your 401K takes a tumble. But in these situations there’s nothing to do: no fighting, no running. So your body is stuck…you just have to let the situation pass, wait for your heart to stop racing, and try to get back to your routine.
Easier said than done. Those repeated stress reactions sap the body’s energy–you literally wear yourself out. They cause the body to release hormones that can lead to depression. And over time these stress hormones interfere with your immune system–they cause white blood cells to fight off infections less well. No wonder we get sick during high-stress times: it’s not just your imagination, it really does happen.
So stress is not something to be taken lightly, but it’s a topic that researchers have focused on quite a bit in recent years, so we have a good sense now of what works–and what doesn’t. Four strategies are particularly helpful when stress begins to wear you down.
- Aerobic exercise The findings are clear: Aerobic exercise is the single best thing we can do to cope with stress in our lives. Not only does exercise help you feel better and give you a feeling of accomplishment and control, but aerobic exercise also releases hormones that counter stress’s negative effects. Even a modest amount of exercise–a 20 minute walk, for example–can have lasting positive effects.
- Distraction It’s not as good as exercise, but for some people distraction really helps. Especially if your stressor is something chronic–like caring for an ill or aging parent–a bit of time off can do a world of good. And here it’s important to do something engaging–see a movie, for example, or play bridge with friends–so you can focus on something other than what’s bothering you.
- Unburdening Freud was right: Unburdening ourselves of troubling thoughts really is a healthy thing to do. So try not to bottle up your feelings, but find a trusted friend and let her know what’s going on. Email your old college roommate and tell him what a jerk your boss has been. Studies show that disclosing negative thoughts and releasing pent-up emotions strengthens the body’s ability to cope, and enhances the immune system.
- Social support Your parents might have taught you that independence is a virtue–but not always. Being stoic in the face of stress is not the best way to cope…it’s better to seek out the company of others and spend some time with friends. Social support offers the comfort of closeness, and an opportunity for friends to offer advice and reassurance. The opposite is also true: Offering support to others actually helps reduce your own stress levels as well.
How to choose among these strategies? The good news is you don’t have to: research indicates they can be used in combination and when you use them this way their benefits are even greater. So choose the strategies that seem right for you given the challenges you face and your particular style of coping…you know yourself best. If exercise is helpful, and clears your mind of troubling thoughts, terrific–you’re all set. If you’re more of a people person then social support and the opportunity to share the burden might be the way to go.
Whatever strategies you choose, be flexible–if something’s not working, try another approach. And remember, managing stress is a process–it takes time, and it’s never really complete. New challenges confront us every day–that’s life–so you’ll always be findings new ways to cope, and new ways to turn life’s challenges into opportunities for growth and positive change.
Now it’s time for me to get back to work. There are syllabi to be made…
To find out more about Dr. Bornstein, click here to read his bio.
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Posted 3 years, 3 months ago at 12:08. 2 comments
