Providing care for older adult patients comes with a multitude of special considerations, but the unique needs and preferences of these patients can make mental health treatment particularly challenging. As we detailed in the July 2016 issue of Network Matters, older adults are at an increased risk for depression, yet it is often misdiagnosed and undertreated. The same holds true for many other behavioral health disorders, such as anxiety and dementia. One crucial factor for primary care physicians to watch for in older adult patients is loneliness, which can negatively affect many aspects of daily life and lead to increased functional decline.
Detecting behavioral health disorders
Primary care physicians are especially important in the coordination of mental health treatment for older adult patients. Because of the coexisting physical conditions they often have, older adults are significantly more likely to seek services in the primary care setting than in a specialty mental health setting.
According to the World Health Organization, more than 20 percent of adults ages 60 and older suffer from a mental or neurological disorder, yet older Americans underutilize mental health services for a number of reasons, including lack of coordination among primary care, mental health, and aging service providers; stigma surrounding mental health and its treatment; denial of problems; and access barriers such as transportation. The best way to combat the under-treatment of mental health issues in older adult populations is early detection in primary care settings and regular follow-up.
The care for an older adult patient will likely involve collaboration between the primary care physician and behavioral health practitioners, and may consist of referring the patient for psychotherapy, prescribing medication, or a combination of both. In most cases, older adults see a notable improvement in their symptoms when provided with an appropriate treatment plan.
Culturally competent care
The aforementioned barriers to treatment can be even more challenging in certain ethnic populations. Increasing diversity in America’s older population means an increased need for culturally competent care to address certain needs (for example, Hispanic and Portuguese-speaking patients may require more coaching to help reduce the stigma of depression or substance use disorders). Celi Esquivel, Director of Health Equity and Civil Rights Compliance Officer at Harvard Pilgrim, is focusing on the effect of strategies that improve community health and health literacy, with an integrated medical and behavioral health approach, on vulnerable populations.
The effect of loneliness
Loneliness and social isolation, which are common among older adults, are closely linked with depressive symptoms, and other negative health consequences such as an increased risk of Alzheimer’s and decreased mobility and motor function.
It may be helpful for primary care physicians to routinely asking probing questions to gauge whether or not older patients feel an adequate sense of companionship and social fulfillment. Ask about family and support systems and encouraging patients to engage in activities that promote a sense of purpose can aid in detecting social isolation and helping patients cope with it. Detecting feelings of loneliness early and taking steps to combat it can improve the physical and mental health status of older adult patients.
How Optum/UBH can help your patients — For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at 800-292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum at 888-777-4742.