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 (19 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 |
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