(WASHINGTON, DC) High suicide rates among older Americans show a need for better understanding of signs and symptoms of clinical depression among the public and healthcare professionals alike. This need is illustrated by the fact that most older adults who commit suicide visited a physician in the month prior to taking their own lives.
"Many older adults who take their own lives know something is wrong, but they are unable to identify what the problem is. Unfortunately, primary care physicians often are unable to identify clinical depression either," Laurie Young, PhD, Executive Director of the Older Women's League (OWL), said at a May 25 Congressional Briefing.
OWL sponsored the briefing with Sen. Hillary Clinton (D-NY), Sen. Susan Collins (R-ME), and Rep. Patrick Kennedy (D-MA). Lawmakers' staff discussed upcoming legislation that would support mental health services for older adults, particularly those with low incomes.
Presenters also included Allan Anderson, M.D., of the American Association for Geriatric Psychiatry, who described the biological, psychological and social issues adults face as they age; Sue Levkoff, Sc.D., of the Positive Aging Resource Center, who described older adults' service needs, especially for integration of mental health in primary care settings; and Alixe
McNeill, M.P.H., of the National Council on the Aging, who described model service programs.
The need is great. Older adults commit suicide at a rate higher than any other age group in the U.S. Although adults aged 65 and older comprise only 13% of the U.S. population, they accounted for 18% of the total number of suicides that occurred in 2000, according to the National Institute of Mental Health. People aged 85 and over have the highest rate of suicide (19.4 per 1,000); the second highest rate (17.7 per 100,000) is among adults aged 75 to 84.
New research from NIMH shows that basic interventions to address depression in primary care settings can relieve suffering and reduce suicidal ideation among older adults. In a recent study, older adults were first screened for depression and those testing positive were either assigned to a "care manager" or received "usual care" (no care manager). Seventy percent of those with a care manager had no more suicidal urges, compared to 44 percent of those without a care manager.
Research also shows that the sooner older adults with mental illness or degenerative diseases like Alzheimer's get a proper diagnosis and treatment, the better their long-term outcomes will be.
But current policy does not promote diagnosis or treatment of mental illness among older Americans. Currently, when an older person goes to a doctor for treatment of a physical illness, Medicare pays 80% of the bill, and the patient is responsible for 20%.
However, when that same person seeks help for a mental illness, Medicare pays only 50% of the bill, leaving 50% for the patient to pay. Medicare also does not reimburse physicians for
screening for mental illness.
Unfortunately, older adults themselves bear the brunt of shortsighted health policy priorities. Because many seniors live on a fixed budget, and the Medicare program does not prioritize mental health diagnosis and treatment, many simply go without needed mental health care.
"Older women disproportionately suffer the consequences of undiagnosed and untreated mental illness. Women are more likely than men to experience depression. They live six years longer than men, on average, further expanding the possibility of undiagnosed illness. And as caregivers, women often cope with undiagnosed and untreated mental health disorders in others," said Young, of OWL.
Research shows that when an older person's physical illness is complicated by a mental illness, they have more visits to primary care physicians, use more medications, and are more likely to have emergency room visits or hospital admissions. Also, their treatment outcomes are worse. For example, rehabilitation from a hip fracture or a heart attack is less successful and more expensive when complicated by depression.
Although 20 % of older Americans have a mental illness, research shows that fewer than one in four of them get any mental health care. "Public policy should promote mental health, not discriminate against people with mental illness," Young said. "With proper diagnosis and treatment, older Americans with mental illness will be in a better position to live fuller, more satisfying lives."
OWL sponsors Older Americans' Mental Health Week May 23-29, 2004 with 17 cosponsors.
The National Mental Health Association and the National Council on the Aging are lead cosponsors in the campaign.
Additional partners include: the American Association for Persons with Disabilities; AARP; the Alzheimer's Association; the American Association for Geriatric Psychiatry; the American
Association of Homes and Services for the Aging; Families for Depression Awareness; Freedom of Fear; the National Alliance for Caregiving; the National Association of Social Workers; the National Coalition for the Homeless; the National Organization on Disability; the Older Adult Consumer Mental Health Alliance; the Rosalynn Carter Institute for Human Development; the Suicide Prevention Action Network; the John Hopkins University School of Nursing; and the Women's Research & Education Institute.
Funding for Older Americans' Mental Health Week is provided by Eli Lilly and Company with support from Pfizer, Inc. For more information see owl-national.
As the only national grassroots membership organization to focus solely on issues unique to women as they age, OWL strives to improve the status and quality of life for midlife and older women. OWL is a nonprofit, non-partisan organization that accomplishes its work through research, education, and advocacy activities conducted through a chapter network. Now in its 23rd year, OWL provides a strong and effective voice for the more than 58 million women age 40 and over in America.
Patrick Cody
202-965-0580
For Immediate Release
Contact: Patrick Cody
202-965-0580
May 25, 2004
Elizabeth Runkle 202-628-0444x 14
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