It began in 1949 as Mental Health Week, an initiative of the nonprofit advocacy group Mental Health America, and in the late 1960s expanded to become National Mental Health Month. Throughout the country this May, various communities will hold activities and events in an effort to raise awareness and funding for the expansion of mental health research and treatment.
While mental health issues affect people of all ages, seniors are often overlooked. And yet, many members of the senior population are affected by depression, anxiety, and suicidal tendencies. It’s imperative that as their medical professionals, we stay up to date with the most current research, symptoms to watch for — whether they’re obvious or subtle — as well as the most effective treatments available so that we can keep our senior patients informed.
Dispel the Misconception
Depression, anxiety, and suicidal tendencies are only a few of the mental health conditions that millions of people struggle with and often try to hide every day, and seniors are no exception. About 20 percent of adults aged 65 and older cope with a mental disorder such as dementia, according to a paper published in American Psychologist.
There’s a widely held misconception that some mental health conditions are simply a natural part of aging, but that erroneous assumption could be detrimental to the health of your senior patients. Research has found that older adults who display signs of a mental health disorder are less likely than younger generations to seek out proper treatment from any doctor, let alone from a specialist. If they do seek help, they are often more comfortable speaking with a general practitioner or family physician who has cared for them for years, rather than visiting a specialist who’s a stranger to them. National Mental Health Month is the perfect opportunity to bring awareness to your senior patients and their families so that seniors understand that what they’re experiencing might not be a normal sign of aging.
Your senior patients should also be informed of the mental illnesses for which there are no cures, such as Alzheimer’s and Parkinson’s disease, including palliative treatments for delaying the conditions’ progress or easing symptoms. These diseases have such a wide spectrum of symptoms that a proper diagnosis of mental illness could easily be overlooked.
Talk About Depression
In many cases, depression can either be misdiagnosed or undertreated due to being mistaken as a normal side effect of medical conditions such as stroke, heart surgery, or cancer. Medical professionals are just as likely as their patients to make this incorrect assumption, especially in those circumstances. Seniors might find it unsettling to discuss depression if they’ve viewed it as a sign of mental instability in the past, or they may have improper insurance coverage for mental health treatment and intentionally overlook their symptoms in an effort to avoid out-of-pocket costs. These concerns could also lead to a lack of proper diagnosis and treatment.
Depression often occurs in conjunction with other health conditions such as heart disease and diabetes. If left untreated, even mild depression can reduce your senior patient’s immunity, hindering his body’s ability to recover. When your patient has suffered the loss of a spouse or is facing the diagnosis of a terminal illness, depression might be mistaken for grief.
Help your patients and their families distinguish depression from other conditions by informing them of the signs and symptoms to watch for, including:
- Feelings of sadness that won’t subside
- Irritability, or feelings of hopelessness or anxiety
- Difficulty concentrating or retaining details
- Loss of appetite or overeating
- Suicidal thoughts or attempts
- Difficulty sleeping, constant tiredness, or too much sleep
- Headaches, body aches and pains, and digestive cramps
Patients and their caregivers should be aware that sometimes, medication side effects can mimic symptoms of depression, while other medications may cause it. Seniors may experience depression as a side effect of such medications as steroids, hormones, and those for arthritis and high blood pressure. Since seniors often take multiple prescriptions, it can be easy for a misdiagnosis to occur.
Treatment of depression commonly involves antidepressant drugs, but these are not without possible side effects such as nausea, headaches, or restlessness. Psychotherapy is another option to discuss. This newer style of treatment addresses habitual behaviors to see if they are in some way causing the depression. Electroconvulsive therapy, also known as electroshock therapy, might be used in severe cases that don’t respond to other treatments.
Address Anxiety in Seniors
Until recently, it was accepted by many, including some in the professional medical community, that anxiety declines with age, and if it is present in a senior, that it’s just a natural part of aging. But medical professionals now recognize that seniors are just as likely to experience anxiety disorders as other age groups. Senior anxiety in particular could result from experiencing bereavement, chronic illness or pain, or medication complications. These instances of anxiety should not be ignored.
There are varied types of anxiety disorders that it may be helpful to inform your patients about. These include:
- Generalized anxiety disorder: when daily life events and circumstances cause extreme worrying
- Panic attacks: sudden, irrational, and random episodes of fear
- Acute stress disorder: often follows an emotionally distressing or extremely traumatic experience
- Post-traumatic stress disorder: diagnosed if an acute stress disorder continues beyond one month
- Phobias: irrational fears of objects or situations
Treatments for most types of anxiety disorders are often a combination of talk therapy sessions with a professional counselor and prescription medications. You can reassure your senior patients and their loved ones that any medications would initially be prescribed at a low dosage, depending on surrounding circumstances of the anxiety and current prescriptions.
Prevent Senior Suicide
The most common reason for suicide in older adults is unrecognized or misdiagnosed depression that therefore goes untreated. Seniors over the age of 85 accounted for more than 18 percent of suicides in the United States in 2013, according to statistics from the Centers for Disease Control and Prevention reported on by the American Foundation for Suicide Prevention. That’s the second highest rate by age. Eighteen percent is even more significant when taking into consideration that seniors only make up about 13 percent of the United States population. These statistics are a prime example of why fund-raising and awareness is so vital.
Some suicide warning signs that seniors and their caregivers should be aware of include:
- Withdrawal from others, especially from family and friends
- Continuous apparent sadness or depression
- Feelings of hopelessness, helplessness, or being trapped
- Personality and dramatic mood changes
- Loss of interest in favored activities
- Impulsivity or recklessness
- Changes in sleeping or eating habits
- Creation of a will and giving away of prized possessions
Medical professionals can use National Mental Health Month as a time to promote access to mental health care and bring awareness to technological advancements in treatments that may help prevent the risk of suicide. Encouraging your patient to seek out a support group that consists of her peers can also play an important role in her survival and mental stability.
Cover the Costs
Once you’ve engaged in a discussion with your patients about their mental health, don’t forget to discuss the costs of treatment — especially since concern about its expense may have prevented them from considering treatment in the first place. Many seniors are on a tight monthly budget and can afford few out-of-pocket expenses.
Medicare does not cover the costs of treatments performed by licensed professional counselors. However, it does cover services rendered by psychiatrists, clinical psychologists, psychiatric specialists, and social workers, including group therapy and patient education. If new medication requires monitoring, those short outpatient visits should be covered as well. As long as services are deemed medically necessary by a specialist, there should be no limitations on Medicare coverage, so remind your patients to always seek treatments and services from a clinician who’s enrolled in the Medicare mental health program.
Some Medicare Part B carriers may have local medical review policies, also known as local coverage determinations. Through these policies, it may be decided that certain services will not be covered even if a doctor deems them medically necessary. Let your senior patients know that they can always appeal any denial of coverage as long as a clinician has concluded that a condition necessitates specific treatments.
If your seniors are financially eligible, they can apply for Medicaid coverage. This coverage includes providers who are out of network (such as some specialists), co-pays, out-of-pocket expenses, and coinsurance. The Affordable Care Act expanded Medicaid so that it now provides coverage for a much broader range of medical costs, but what’s specifically covered varies from state to state. If your patient is under an Alternative Benefits Plan, coverage for mental health services should be included.
The Mental Health Parity and Addiction Equality Act of 2008 requires insurance companies to offer mental health coverage at an equal or comparable level to what they offer through their physical health insurance policies. This should greatly expand coverage for seniors and make it easier for them to seek out the care of a professional mental health clinician, knowing that their treatment costs will be covered.
National Mental Health Month is an excellent opportunity to bring awareness to serious conditions that often get overlooked. Initiating the discussion and, if necessary, following up with a basic treatment plan and referral to a specialist, could save your patient’s life.