Ageist stereotypes are a chronic stressor in the lives of older adults, yielding lower self-perceptions of aging, and impacting behavior and health. Negative attitudes and beliefs about aging predict worse cognitive performance, and also predict the development of Alzheimer’s disease biomarkers. In contrast, older adults with positive age beliefs with dementia risk factors were nearly 50% less likely to develop the disease than their peers who held negative beliefs. Reframing messages about aging can be highly effective in decreasing implicit bias toward older adults.
Depression and Anxiety
While rates of depression and anxiety are lower among older adults than younger, their course is more chronic, and older adults with subclinical depression report much higher rates of functional impairment. Depression is linked to decreased physical mobility, poor medication adherence, increased symptom burden, longer hospital stays, and mortality in older adults. Older adults are 40% less likely than younger adults to pursue or engage in MH treatment, and when they do seek treatment older adults are less likely to receive adequate services.
Evidence-based Treatment Programs for Mental Illness
The national growth in the older adult population is anticipated to include a disproportionately larger growth in the number of older adults with schizophrenia spectrum disorder and other Serious Mental Illnesses (SMIs). Older adults with SMI constitute approximately 3-4% of the population and have among the greatest health disparities in the nation, as evidenced by a 15-25 year reduced life expectancy. In addition, only 25% of individuals with SMI received EBPs. The greater risk and incidence of adverse outcomes associated with SMI and medical comorbidity calls for innovative models of integrated health care that address high rates of chronic health conditions in this high-risk group.
Substance Use Disorders
Substance use is increasing with the baby boomer generation, particularly alcohol, and alcohol use disorders (AUD). These are linked to depression, anxiety, dementia and a higher death rate in older adults. While older adults are twice as likely to engage in integrated primary care models for at-risk drinking than referral services, these programs are rarely available. Illicit drug use among baby boomers aged 50-59 doubled from 2002-2007, with 90% reporting a lifelong history of use. Further, from 2002 to 2014, the rate of older adult opioid misuse doubled. Given age-related changes in metabolism, any amount of alcohol or drugs may effect older adults adversely. Unfortunately, many providers are often uncomfortable addressing substance use among their older patients, which can lead to overlooking the underlying cause of physical health and cognitive problems.
Age-Friendly Health Systems
Geriatric experts examined EBPs for older adult health and boiled them down to the 4Ms: What Matters, Mobility, Medication, and Mentation, named the Age-Friendly Health System framework. The 4Ms have been associated with decreased hospitalization and associated costs; increased patient satisfaction; decreased falls; decreased adverse drug events; and increased function, quality of life, and lifespan. Combining the freely available 4Ms framework with more directed behavioral health EBPs may vastly improve the health and wellbeing of older adults.
Military Veteran Resources
Many older Americans served in the military and/or take care of an older adult who served in the military. The Department of Veterans Affairs has many programs to support older Veterans and their families and caregivers. Veterans may access online resources and integrated mental health services across health care programs. VA also provides a range of specialized geriatric services for Veterans and families to help them cope with complex medical, cognitive, and mental health conditions in later life.
Additional community resources.