Aging Boomers’ Mental Health Woes Will Swamp Health System: Report

TUESDAY, July 10 (HealthDay News) — The United States faces an
unprecedented number of aging baby boomers with mental health or substance
use issues, a number so great it could overwhelm the existing health care
system, a new report warned Tuesday.

“The report is sufficiently alarmist,” said Dr. Gary Kennedy, director
of geriatric psychiatry at Montefiore Medical Center in New York City. “I
think [the report authors] are right.”

Kennedy was not involved with the report, The Mental Health and
Substance Use Workforce for Older Adults: In Whose Hands?
It was
mandated by Congress and issued by The Institute of Medicine in light of a
“silver tsunami” of health care needs expected to accompany a senior
population that will reach 72.1 million by 2030.

The “silver tsunami” is the result of simple supply-and-demand forces
gone awry, the report authors explained.

Up to 8 million older Americans, or 20 percent of the current senior
population, suffer from some form of mental health condition, often
depression, at-risk drinking or dementia-related behavioral and
psychiatric symptoms, according to the IOM report. (A basic diagnosis of
Alzheimer’s disease was excluded from the study.)

And 2 million seniors have severe mental illnesses, a number that is
“greatly under-appreciated,” said Dr. Peter Rabins, one of the authors of
the report.

Also, as baby boomers age, studies indicate that their use of illicit
drugs will continue.

“The reality is the Woodstock Generation has come of age,” said
Kennedy. “Their background is with psychedelic drugs, marijuana,
recreational drugs, non-narcotics . . . It’s a real problem.”

Against these growing problems, meanwhile, the number of health
providers and other service providers is shrinking in proportion. And that
means, according to the report, that “a health care workforce that is not
prepared to address either [mental health/substance use] problems or the
special needs of an aging population is a compelling public health
burden.”

“The number of individuals with specialty training in both aging and
either mental health or substance use issues is extremely small,” said
Rabins, who is a psychiatry professor at Johns Hopkins School of Medicine
in Baltimore.

Nor are candidates rushing to fill the pipeline, Kennedy added,
probably because of lower pay in geriatric specialties.

Each of these populations — the elderly, and those with mental health
and/or substance use issues — require special care. But the two in
combination represent a special challenge.

Older people metabolize both alcohol and drugs differently from younger
people, putting them at risk for overdoses. According to one estimate,
almost two-thirds of emergency room visits for adverse drug reactions in
2008 were by elderly people.

Also, elderly people — particularly those with depression — may be
less able to adhere to complicated medication regimens for mental and
physical ailments.

And medications to treat mental health issues may not react well with
other medications needed to treat high blood pressure, diabetes and the
host of other physical problems that become common as people age.

“The biggest challenge appears to be the fact that these problems
rarely occur in isolation. Most [elderly] people who have mental health or
substance use problems also have a physical health problem,” said Rabin.
“That’s not true in younger age groups.”

The report provides a number of recommendations for solutions, in what
basically amounts to an overhaul of the health care system.

Key to handling the future explosion of seniors with mental health
issues and/or substance use issues will be organizing a better health care
workforce.

“We really need to be training the existing workforce, which interacts
with both older people and mentally ill people, to have the skill set of
the other group,” said Rabins. “People with general mental health
training, such as social workers, psychologists and psychiatrists, have
very little training in treating the elderly. Those in the aging network
have very little experience treating mental illness.”

Better provisions, including funding, need to be made for training
professionals to care for this population. This includes primary care
providers, nurses and nursing-home assistants.

And Medicare/Medicaid reimbursement schedules need to be overhauled to
make sure the services this population requires are covered.

The report also said the federal government should coordinate all the
efforts that involve these two vulnerable populations.

In addition, Kennedy suggested that partial forgiveness of
medical-school loans would “turn around the onward direction of trainees
coming into the geriatric field.”

More information

Visit the Institute of
Medicine
for more on the report.

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