Baby Boomers Likely to Face Inadequate Care for Mental Health, Substance Abuse;

Millions of baby boomers will likely face difficulties getting diagnoses and
treatment for mental health conditions and substance abuse problems unless there
is a major effort to significantly boost the number of health professionals and
other service providers able to supply this care as the population ages, says a
new report from the Institute of Medicine.  The magnitude of the problem is so
great that no single approach or isolated changes in a few federal agencies or
programs will address it, said the committee that wrote the report.

The report calls for a redesign of Medicare and Medicaid payment rules to
guarantee coverage of counseling, care management, and other types of services
crucial for treating mental health conditions and substance use problems so that
clinicians are willing to provide this care.  Organizations that accredit health
and social service professional schools and license providers should ensure that
all who see older patients — including primary care physicians, nurses,
physicians’ assistants, and social workers — are able to recognize signs and
symptoms of geriatric mental health conditions, neglect, and substance misuse
and abuse and provide at least basic care, the committee said.

Top leaders of the U.S. Department of Health and Human Services need to
promote national attention to building a work force of sufficient size that is
trained in geriatric mental health and substance abuse care.  They should ensure
that all the department’s relevant agencies are devoting sufficient attention
and resources to these conditions.

“There is a conspicuous lack of national attention to ensuring that there is
a large enough health care work force trained to care for older adults with
mental health and substance use conditions,” said committee chair Dan G. Blazer,
J.P. Gibbons Professor of Psychiatry and Behavioral Sciences and vice chair for
faculty development, Duke University Medical Center, Durham, N.C.  “These
conditions are relatively common, they can be costly, and they can have profound
negative impacts on people’s health and well-being.  This report is a wake-up
call that we need to prepare now or our older population and their extended
families will suffer the consequences.”

The committee conservatively estimated that between 5.6 million and 8 million
older Americans — 14 percent to 20 percent of the nation’s overall elderly
population — have one or more mental health conditions or problems stemming
from substance misuse or abuse.  Depressive disorders and dementia-related
behavioral and psychiatric symptoms are the most prevalent.  Rates of accidental
and intentional misuse of prescription medications are increasing.  Although the
rate of illicit drug use among older individuals is low, studies indicate that
it will likely increase as the baby boomers age.

Inattention to older adults’ mental health conditions and substance misuse is
associated with higher costs and poorer health outcomes, the report notes.  For
example, older individuals with untreated depression are less likely to properly
take medications for diabetes, high blood pressure, and heart disease, and they
are more likely to require repeated costly hospital stays.

Training in geriatric care for these problems is necessary, the committee
emphasized.  Age alters the way people’s bodies metabolize alcohol and
medications, increasing the general risk for overdoses; these changes also can
worsen or cause alcoholism and addiction.  Older adults are also more likely to
have physical conditions and impairments in thinking and ability to function
that can complicate the detection and treatment of mental health problems and
substance misuse or abuse.  For example, cognitive impairments can affect an
older person’s ability to comply with medication directions.

Medicare and Medicaid payment policies deter effective and efficient care for
substance abuse and mental health conditions by limiting which personnel can be
reimbursed and which types of services are covered, the committee found.
Effective care includes helping patients self-manage their conditions and
monitoring to prevent relapses, services that can be provided by a range of
trained providers and in a variety of care settings.  The Centers for Medicare
and Medicaid Services should evaluate alternative payment methods that would
better reflect and fund effective services and coordinated team-based care for
mental health and substance abuse, the report says.

Most primary care providers will have frequent contact with older patients,
yet their training includes little if any education on geriatric mental health
and substance use, the report notes.  Few opportunities exist to specialize in
geriatric care for these conditions, and financial incentives and mentorships
are not in place to encourage health professionals to enter or stay in this
field.  Health professionals’ training across all disciplines should include
competence in these areas, and they should be expected to be able to respond
appropriately to signs of mental health or substance use problems to the full
extent of their scope of practice, the committee said.  Congress should
appropriate the funds to carry out the provisions in the Patient Protection and
Affordable Care Act that support loan forgiveness and scholarships for
individuals who work with or are preparing to work with older adults with mental
health conditions or substance use problems.

Resources for HHS programs that have supported or could support geriatric
care for mental health and substance abuse have been dwindling and in some cases
are being eliminated, the committee noted.  The report urges HHS leaders to
ensure each agency provides sufficient attention and funds to grants and other
programs to build an adequate work force able to provide this

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