home
RSS
July 10th, 2012
12:20 PM ET

IOM: Elderly need better access to mental health, substance abuse care

Baby boomers in need of mental health and substance abuse services may have a hard time finding health professionals to provide that care unless the treatment system is revamped, according to a new study from the Institute of Medicine.

"The Mental Health and Substance Use Workforce for Older Americans: In Whose Hands?" report concludes that Medicare and Medicaid payment codes must be revised to ensure counseling care and other critical services are covered so that doctors are willing to treat patients with these conditions.

"There is a conspicuous lack of national attention to ensuring that there is a large enough health care work force trained to care for older adults with mental health and substance use conditions," said Dan G. Blazer, one of the report authors and the J.P. Gibbons Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, North Carolina.

"These conditions are relatively common, they can be costly, and they can have profound negative impacts on people's health and well-being. This report is a wake-up call that we need to prepare now or our older population and their extended families will suffer the consequences."

The report centers on older adults who had at least one mental health or substance use issue. It found that while most primary care physicians regularly see older patients, they have little training or education in mental health and substance use in the geriatric population. 

The IOM committee estimates between 5.6 and 8 million elderly Americans have at least one mental health or substance abuse or misuse issue. Most common are depressive disorders and dementia-related problem.

Allowing these problems to go unresovled can mean higher costs and negative health effects. For example, elderly people with untreated depression are less likely to take their medication for other diseases like diabetes or high blood pressure and therefore are more likely to need repeated, costly hospitalizations.

The committee recommends organizations that accredit health and social service schools and license providers make sure all health care providers working with older patients can recognize signs and symptoms indicating a problem.  They recommend financial incentives and mentoring programs be put in place to encourage doctors and other healthcare professionals to get into the field - or if they are already there, stay.

Dr. Eric De Jonge, director of Geriatrics at MedStar Washington Hospital Center, says a shortage of geriatricians and other trained personnel is a critical problem and that the health care workforce must be better prepared to handle the special mental health needs of an elderly population.

"You need to have a team of staff with a variety of skills and that includes home health aides, nurses, nurse practitioners, social workers, psychologists and physicians such as psychiatrists and geriatricians... Due to the shortage of geriatric psychiatrists - which are profoundly rare - and geriatricians, we need to elevate the skills of all these other team members, tap in to the expertise and increase the skills of all this other workforce."

More mentorships and financial incentives to specialize in elder care is critical, De Jong said, since nationwide about 40% of geriatric fellowships and training slots are currently unfilled.

"You have to level the financial playing field for medical students and residents who are coming out of training. They make roughly twice as much money if they go into specialties that are procedure based - fancy procedures which have much higher reimbursement. People with lots of debt come out of medical school and choose a specialty that will help them pay off their debt. Psychiatrists and geriatricians are at the lowest end of the pay scale."

The American Medical Association says starting in 2011, the country's 78 million baby boomers, born between 1946 and 1964, will start turning 65 years old a the rate of 3 to 4 million a year.

An article on the AMA website says: "The statistics are staggering. By age 65, around two-thirds of all seniors have at least one chronic disease and see seven physicians. Twenty percent of those older than 65 have five or more chronic diseases, see 14 physicians - and average 40 doctor visits a year. Situations like these are a nightmare for patients and the physicians who treat them. Variations in therapies, medications and even differing instructions can be confusing, conflicting and hard for patients to remember."

The IOM recommendations the Department of Health and Human Serivces, which sponsored the report, makes sure its agencies take responsibility for building the mental health/substance use workforce for the elderly in order to provide competent care, and called on the agency to restore funding of the Older Adult Mental Health Targeted Capacity Expansion Grant program to the Substance Abuse and Mental Health Services Administration.

The report also calls on Congress to designate funds/earmark funds for programs that specifically target the elderly saying, "Congress should appropriate funds for the Patient Protection and Affordable Care Act workforce provisions that authorize training, scholarship, and loan forgiveness for individuals who work with or are preparing to work with older adults who have mental health/substance use conditions."

The American Psychological Association (APA) has three member psychologists that were part of the committee. “This IOM report provides a foundation for our nation to build a psychology and mental health workforce to meet the needs of our rapidly growing and increasingly diverse aging population,” said APA CEO Norman B. Anderson. “The report reflects successful advocacy by the mental and behavioral health community and includes key policy recommendations, which the APA looks forward to promoting in partnership with federal, professional, and community leaders.”

In September, the APA plans to brief members of Congress on the report's key findings and recommendations.


soundoff (5 Responses)
  1. Portland tony

    Some of the statements made in this article are nothing but unadulterated crap. ' Two thirds of all ...Seniors.... that have at least one chronic condition and see on the average 7 physicians' Why? '25% of ...seniors have five or more chronic illnesses and see 14 or more physicians

    July 11, 2012 at 08:09 | Report abuse | Reply
    • Portland tony

      Statement is incomplete ...but trying to complete is impossible because of automated censorship!

      July 11, 2012 at 08:36 | Report abuse |
  2. Timmy Suckle

    I kissed my way up to VP at a health insurance company. Now I take over $500,000 of your health care dollars for NO VALUE ADDED to your health care. And that’s just me. Now think about how many other VPs, Directors, Managers, etc. are at my company alone. Now multiply that by thousands of others at hundreds of other health insurance companies. From 10 to 25% of your health care dollars go towards administration that adds NO VALUE to your health care. But my company’s PAC dollars will continue to fool you little people into thinking that a single payer system will be bad. Little people like you are so easy to fool. Little people also don’t realize that a single payer system is the ONLY system that would allow little people (as an entire country) to negotiate better health care prices. Little people don’t realize that the Medical Cartels already know that. And that is the reason why the Medical Cartels spend so much PAC money from the hospitals and doctors lobbying against a single payer system. Some little people say that a single payer system would cost you little people more. But if that were true, then wouldn’t the hospitals and doctors WANT that extra money? Yes they would. So why do the Medical Cartels lobby against a single payer system? It’s because the Medical Cartels know it would allow little people to negotiate better health care prices. And that’s what the Medical Cartels are afraid of. Period.
    But us big wigs at insurance companies, hospitals, and pharmacy companies don’t ever need to worry about health care no matter what it costs. We get our health care paid for one way or another by you little people. And we get the little people that work at our companies to contribute to our PACs. And us big wigs say it’s to protect the little peoples’ jobs. But in reality it would be in the little peoples’ best interest to NOT contribute to the PAC. Again, little people are so easy to be fooled. I won’t ever have to worry about losing my job with so many little people being brain washed by the Medical Cartels’ PAC money. Not only that, the Medical Cartels’ PAC money is used to elect so many republicans that will never allow a single payer system. Republicans have always fought against any meaningful health care reform. But that’s what our Medical Cartels’ PACs pay them for. Politicians can be bought so easily.
    Pretty soon the only people that will be able to afford health care is us big wigs. And that’s the way it should be. We don’t want you little people using up the resources when we need them. And once again, I thank you little people for capping my SS tax at the $106,800 level. Now I only pay 1.3% SS tax and you little people pay 6.2%. Also, thank you for extending my tax breaks. I’m using the extra money on my vacation houses.

    July 12, 2012 at 09:17 | Report abuse | Reply
    • Hans

      Hey good stuff keep up the good work! I read a lot of blogs on a daily basis and for the most part, people lack sabstunce but, I just wanted to make a quick comment to say I'm glad I found your blog. Thanks,)A definite great read :)

      September 13, 2012 at 22:20 | Report abuse |
  3. Adrianec Latnerq

    Thanks for your handy post. In recent times, I have come to understand that the symptoms of mesothelioma are caused by the build up connected fluid between lining of the lung and the upper body cavity. The ailment may start in the chest place and distribute to other parts of the body. Other symptoms of pleural mesothelioma include fat reduction, severe respiration trouble, a fever, difficulty eating, and irritation of the neck and face areas. It ought to be noted some people having the disease usually do not experience every serious signs or symptoms at all.

    July 31, 2012 at 10:31 | Report abuse | Reply

Post a comment


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.