As America's senior citizens age, their need for healthcare resources increases, including the need for mental health services. The over-65 population in the United States is expected to double to 15 million by 2030 and will comprise about 20 percent of the population. In 2000, Alabama residents 65 and older numbered about 580,000 and by 2025 that number is projected to be near 1 million, according to the Center for Business and Economic Research at the University of Alabama.
The National Mental Health Association states that the mental health system traditionally has overlooked and underserved the older adult population, and while there are some programs in place to help the elderly with mental illness, many seniors are slipping through the cracks.
Dr. Ed Logue, medical director of the geriatric psychiatric unit at Baptist Princeton, said mental health problems often go undetected in elders. "Because of the mindset that elderly patients are getting physically debilitated and progressing toward dementia, we so often miss the depression that many of them have because of losses they have suffered," Logue said. "Depression will look like dementia because these aging adults don't think as clearly as they used to. If they're treated for dementia instead of depression, it will get worse."
Because depression is the most common mental illness among the elderly, Logue said primary care physicians should always make mental health evaluations part of their examination of a senior patient. Dr. Armand Schachter, a psychiatrist with Grayson & Associates at Brookwood Medical Center, agrees. "In the elderly we should look for heart disease, cancer, depression and dementia," he said. "If you can't find a medical illness for the symptoms, don't assume it's just old age. Question the patient and check for depression, Alzheimer's, etc."
Logue added that depression manifests as physical illness and exacerbates physical symptoms. "If a patient comes to see the doctor more than usual, there often is an underlying psychological problem," he said.
Once recognized, depression is treatable, but many times elderly patients don't access treatment services soon enough. Schachter said it can be because the patient doesn't know that help is available for geriatric mental illness or doesn't want the stigma of being treated for a mental illness. Whatever the reason, the longer the patient waits to get help, the less responsive he or she may be to the treatment. "The first step is to get these patients into the office for care," Schachter said. "We can't go out and bring them in off the street, but if we see them we can help."
Schachter said it is important that the family be involved to ensure the patient gets the best treatment. "The patient will always say they're fine, but the family can tell you about the time they got lost or how they're not eating well," he said.
Another reason elderly patients may not seek treatment for mental health issues is because of disparate reimbursement from Medicare. Under current law, Medicare requires beneficiaries to pay a 20 percent co-payment for Part B services. However, the American Association for Geriatric Psychiatry says the 20 percent co-payment is not the standard for outpatient mental health services. For these services, they are required to pay a 50 percent co-payment. As a result, many seniors do without needed mental illness treatment because of the cost. "Even commercial insurance carriers are disparate," said Logue, "so even when a patient is diagnosed with a mental illness they may not be able to afford the treatment."
Schachter said many communities in Alabama have community health centers where people can receive treatment. "We go to these centers regularly to provide services for people who can't afford them otherwise," he said.
Senators Olympia Snowe (R-Maine) and John Kerry (D-Mass.) introduced the Medicare Mental Health Copayment Equity Act of 2003, S. 853, which would eliminate the discriminatory 50 percent co-payment requirement. Once phased in over a six-year period, patients seeking outpatient treatment for mental disorders would pay the same 20 percent co-payment required for any other illness. To date, no action has been taken on this proposed bill.
Elderly mental health issues have become more widely recognized by government agencies in recent months. At the 2005 White House Conference on Aging in December, delegates voted to place mental health issues at the forefront by voting them among their top 10 resolutions, according to the Geriatric Mental Health Foundation. On June 28, 2006, the Senate Committee on Health, Education, Labor and Pensions approved reauthorization of the Older Americans Act, S. 3570, which would make grants to states for the development and operations systems for the delivery of mental health screening and treatment services for older adults and for programs to increase public awareness, reduce stigma and reduce age-related prejudice and discrimination regarding mental disorders in senior adults.
