Creating A Continuum Of Care For Older Persons With Behavioral Health Needs In Southeast Pennsylvania: continued
Statement of Need
Although elderly persons with psychiatric disabilities are recognized as a "special needs population" and Pennsylvania has one of the nation's highest proportions of older residents, funding allocations to address their needs of this group have not been a priority in the Commonwealth's budget.
Data on older Pennsylvanians presents a demographic imperative for increasing the funding for behavioral health services. According to the Pennsylvania Department of Aging:
- 2.5 million people age 60 and over represent 15 percent of the population
- The fastest growing age group, people 85 and over, consists of almost 255,000
- 520,000 older individuals live alone, an increase of 29 percent from 1980 to 1990
- 22 percent of older adults live near or below the poverty level
Philadelphia statistics portray this picture:
- People age 60 and over constitute 20 percent of the population
- About 40 percent of older persons in Philadelphia live alone
- 33 percent of older adults are non-white
- 16 percent of older adults live in poverty
- Only 2.8 percent use the Mental Health System
Epidemiologists estimate that psychiatric impairment affects 18 to 25 percent of the nation's senior citizens. Despite this, mental health service utilization by this group is minimal; only four to six percent of adults served by community mental health centers in the nation are elderly. Another alarming statistic is the elderly suicide rate, the highest for any age cohort. An average of 17 elderly persons commit suicide per day, approximately 7,000 per year. In 1996-97, 67 older Philadelphian's committed suicide.
For older adults, substance abuse is defined as excessive use or misuse of alcohol, drugs or medication despite persistent personal or interpersonal problems caused or exacerbated by the effects of the substance, which lasts for at least one month or which has occurred repeatedly over a long period of time (DSM-IV). The Philadelphia Corporation for Aging reports that hospitalization for alcohol-related problems occurs more frequently than those for heart attacks, and cost Medicare more than $230M a year. Over 65 year olds are second only to 45-65 year olds for alcohol-related hospitalizations. Research indicates that as many as 20 percent of individuals over the age of 65 have some problem with alcohol.
Misuse of everyday medications is another problem the elderly are particularly vulnerable to, and costs "billions of dollars and thousands of lives" every year, according to the Alliance for Aging Research (AAR). An AAR study in 1998, When Medicine Hurts Instead of Helps, reports that older adults are more at-risk for drug reactions due to the number of medications they take and the biological changes that occur with aging and disease. Adverse medication effects include increased risk for memory loss, hip fractures, and/or automobile-related injuries.
In spite of this distressing information and evidence of need, neither the public sector nor private behavioral health systems have given this problem sufficient attention or resources. Elders with behavioral problems living in their own homes, in boarding homes, or with relatives, tend to be overlooked and undeserved. The lack of mental health care for nursing home residents is even more acute. Likewise, there is need for services that are culturally sensitive and multi-lingual as the elder population becomes more ethnically diverse.
Behavioral health services are those that include mental health and substance abuse services. Because of the special needs of older adults with behavioral health problems, practitioners trained in these issues and skilled working with this population deliver the most effective care. Geriatric specific behavioral health services are services provided by practitioners who have been informed by current gero-psychological data and trained in assessment, treatment and intervention strategies appropriate to older adults. Geropsychiatric practitioners must be versed in the myths and realities of aging and knowledgeable about the problems that older adults face. They must be aware of the barriers that have kept older adults from seeking or receiving help. They must be cognizant of the unique interaction of physical and mental health in older adults. And they must know the particular perspectives that diverse cultures bring to their understanding of mental health and aging.
Geriatric experts concur that older people do not seek help for their psychological distress for the following reasons: the stigma of mental illness; limited information about the benefits of psycho-social interventions; limited access to available services, the tendency of physicians to attribute physical and psychiatric symptoms to the aging process; minimal outreach to older adults; inadequate reimbursement from Medicaid and Medicare; and lack of public awareness.