Minutes of ESCOTA General Meetings

Minutes from the November 12, 2009 meeting

Date of Meeting: Thursday, November 12, 2009
Presentation: Mental Health Services for Older Adults
Speaker: Michael B. Friedman, LMSW, Chair, The Geriatric Mental Health Alliance of New York

Reeva Mager called the meeting to order and welcomed the group. 
 
Amy Loewenberg, Director of Senior Services of Stanley Isaacs Neighborhood House, spoke about Stanley Isaacs MOWs now available for emergency meals, to begin within 24 hours of referral.  To refer call the East Side case management consortium.

Presentation:

Geriatric Mental Health Alliance of NY; a political advocacy organization that is part of the Mental Health Association of New York City; serves two purposes: 1) political advocacy; 2) Educational programs.  Michael Friedman encouraged all to join, as the political advocacy arm is aided by larger membership.

Using handout, he reviewed the policy goals of the Geriatric Mental Health Alliance and issues that arise in relation to mental health and the elderly.

• Many professionals don’t  take the mental health needs of older people into account and don’t recognize this as a necessity


• Many misconceptions about mental health and older people


• He asserted “you can’t age well without mental health”


• Mental illness has a terrible impact on physical health, including chances of becoming disabled or premature death; medical costs are double or more for co-occurring physical and mental health conditions


• People aged 65+ complete suicide at a 50% higher rate than other age groups


• White men aged 85+ are six times more likely to complete suicide than the general population

 
Connection between Mental Health and nursing home placement

• Behavior of older person with mental illness may be perceived as “out of control” and not manageable in the community by home care agency; this is due to failure of the relationship between home care workers and the older person


• Caregivers are at high risk for mental health problems due to the stress of caregiving


• Few mental health treatment options in skilled nursing facility

 
The elder population will double in the next 25 years.  Consequences of this demographic shift:

• Problems with Social Security


• Strain Medicare resources


• Smaller workforce


• Larger population needing assistance from smaller workforce


• Challenge: how to get the “younger older” population into the helping workforce?


• 20% of older people have a diagnosable mental health problem, including dementia

How is Mental Illness in the older population defined?

• Those with persistent mental health problems their whole lives, now aging


• People with dementia (can also have co-occurring mood or anxiety disorder; both can produce cognitive impairments; mood and anxiety are treatable, impairments often reversible!  However these often go untreated.)


• Severe depression or anxiety disorders


• seniors can end up profoundly isolated


• are the most likely to commit suicide


• are the most likely to be shifted to skilled nursing facility due to behavior problems


• Less severe depression and anxiety disorders; 50% of the population will have a diagnosable mental illness in their lifetime


• Substance abuse – underdiagnosed among older people


• Some lifelong abusers who survive into old age


• More common – late onset abuse or overuse, including alcohol, prescription and over-the-counter drugs and recreational drugs; as the “elderboom” is “the generation of sex, drugs and rock & roll” it is logical to expect an increase in this type of drug use


• Older people may not take into account bodily changes that necessitate change in dosage

 
All of us as we age undergo emotional challenges

• Challenge of retirement – very difficult transition to a change in status


• Losses/diminishment of ability, in both body and mind


• Multiple losses of friends and family


• Greater sense of one’s own impending death

 
Spirituality

• Some sort of spiritual belief is important to most people; many approach aging through some sort of spiritual lens

 
Co-occuring physical and mental illness

• Since most older people have some sort of physical health problem, most older people with mental illness have physical health problems.  These problems must be addressed together.


• People with serious and persistent mental illness run a high risk of obesity and associated illnesses; life expectancy is 10-25 years less than average


• Statistics:


• Older people with chronic illness – approximately 7% are depressed


• Older people with home attendants – approximately 15% are depressed


• Older people in skilled nursing facilities – approximately 25-30% are depressed


• Older people with no major illness – approximately 1% are depressed

Problems with access to treatment

• Shortage in service providers


• Language barrier


• Affordability


• Problems with quality of care & treatment


• Most older people go to primary care provider for help with mental illness


• Most psychotropic medications are prescribed by primary care providers


• Study found PCPs to be minimally adequate at prescribing psychotropic medications 12.7% of the time


• Mental health professionals found to provide adequate treatment 47% of the time


• Not enough providers in workforce to serve all who need treatment


• 2400 geriatric psychiatrists in the country, one half of whom work in academia


• Problems with Medicare and Medicaid reimbursement rates – disincentive for providers to accept Medicare and Medicaid

What to do?  See page two of handout: Policy Goals: Twelve Point Agenda
 
The meeting was adjourned at 5:00pm.

Next Meeting:

Date: Thursday, January 14, 2010
Location: NYC Chapter of the Alzheimer's Association 360 Lexington Avenue, 4th Floor (between 40th and 41st Streets)
Presentation: Alzheimer's Disease: New Treatment Options
Speaker: Jed Levine, Executive Vice President, Alzheimer’s Association, New York City Chapter

Respectfully submitted by Karen DeOssie

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