Iowa Coalition on Mental
Health and Aging
Lila P.M. Starr
Adult Mental Health Specialist
Chairperson, NASMHPD Older Person Division
Iowa Department of Human Services
1305 E. Walnut
Hoover Building, 5th Floor
Des Moines, IA 50319
515-281-7270
[email protected]
June 22, 2010
WELCOME To The…
ICMHA Mission
The ICMHA exists to expand and
improve mental health care for older
Iowans so that they can live, learn,
recreate, engage in meaningful
activities and access appropriate
services in the communities of their
choice.
Olmstead Anniversary,
Today!
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The language that you see in the ICMHA
Mission, “live, learn, recreate, engage in
meaningful activities and access
appropriate services in the communities of
their choice,” comes directly from the
landmark Supreme Court Decision in
Olmstead vs. EW and LC – which was
rendered on this date,
Partners in today’s
training
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ICMHA Goals
Please Join the ICMHA
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You have the opportunity to sign up to be a
member, join a workgroup, and receive
periodic e-mail updates, training
announcements, and meeting notices
There is NO COST to join
Sign up and view the many excellent
resources found on our website:
www.icmha.org
National Coalition on Mental Health and
Aging: www.ncmha.org
Ten Things You Need to Know about
Mental Health for Older Adults
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These Ten things come to you from NASMHPD
Older Persons Division
The National Association of State Mental Health
Program Directors: representatives from each
State Mental Health Authority, who are the
Commissioner designees to work on policy and
practice issues around Mental Health for older
citizens, make up the Older Persons Division
#1 Co-Occurring Medical Illness is the
Rule, Not the Exception
Among older adults with depression,
approximately:
 1 / 5 suffer from heart disease
 1 / 5 have diabetes
 2 / 5 have arthritis
 1 / 2 have hypertension
•Outcome: The presence of these chronic medical
conditions complicates identification and
treatment of depression and other mental
illnesses in older adults
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Co-Occurring Medical Illness is the
Rule, Not the Exception
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An Older Adult may present to his/her physician with:
•Cancer, Congestive Heart Failure and Depression share
these symptoms
#2 Older Adults Take Multiple Medications and
their Bodies Handle the Medication Dosages &
Substances Differently than Younger Bodies
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Older adults regularly take an average of:
2/3 of Older Adults with Depression take 5 or more
medications
1/3 of Older Adults without Depression take 5 or
more medications
Older Adults Take Multiple
Medications…
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Prescribing for Older Adults is a specialty:
Mantra: “Start Low and Go Slow”
#3 Mental & Physical Functioning
Varies Widely Among Older Adults of
the Same Age
Young children are fairly homogeneous
 Biological, Psychological, and Social
developmental milestones include:
These are measured in months of age.
Mental & Physical Functioning Varies
Widely Among Older Adults of the
Same Age
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Aging can be described as:
#4 Importance of Coordination and
Collaboration between Behavioral
Health, Aging, & Medical Health
Providers
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It would not be uncommon for an older adult to receive:
Importance of Coordination and
Collaboration
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For older adults with mental illness, in may be
unrealistic to add another complicated layer of
self management by adding mental health care,
psychotherapeutic medication management, the
psychiatrist, and the mental health case manager
Older adults with mental illness often fail to
receive appropriate and effective treatment
within fragmented delivery systems.
Importance of Coordination and
Collaboration
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Treatment silos:
•Evidence Based Models for integrating behavioral and
medical health treatment exist and should be used to
provide effective treatment to older adults
#5 Family Members & Other Social Supports
are Critical to Successful Treatment
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Many older adults receive informal caregiving services
from family members
Daughters, Daughters-in-Law, Spouses, and Sons
contribute to caring for older family members
Friends, neighbors, and other community members
provide essential services and often act as an early
warning system for vulnerable and isolated elders.
Family members may be important providers of
Transportation, Activities of Daily Living, Medication
Management, and Medical Care Scheduling
These family members should be included in treatment
planning.
Family Members & Other Social
Supports
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The Gatekeeper Model
Recruits community service personnel who have
frequent contact with older persons
These community folks are trained to identify and refer
at-risk older adults for assessment. Trained assessors are
available to evaluate the physical, mental , and social
needs of the older person and refer them to the
appropriate agencies and providers.
#6 Maintaining Independence and
Aging in Place is a Commonly Held
Value
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Older adults want to “age in place” to the extent that is
possible.
Treatment of Depression should support the
independent community functioning of the individual
This should include a discussion regarding the potential
risks of continuing to live at home, both with and without
services.
The desire to remain at home can be a real motivator for
making needed changes.
Maintaining Independence and Aging
in Place is a Commonly Held Value
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An effective care plan may need to include steps
for:
#7 Prevention of Depression in Older
Adults is Possible
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Prevention should not be limited to the young.
Targeted strategies to identify and treat mental illness in
older adults can be effective
Common triggers for depression
Prevention of Depression in
Older Adults is Possible
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Existing Programs can help prevent
and/or treat the onset of a depressive
disorder in older persons:
#8 Ageism is Everywhere and Affects
Treatment Expectations and Outcomes
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“Depression is normal in Old Age”
“If I had all those medical problems, I’d be depressed,
too”
The stigma of mental illness, combined with an Ageist
culture, can discourage older adults from seeking
treatment.
Ageism is Everywhere and
Affects Treatment Expectations
and Outcomes
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Only a minority of depressed older adults receive
treatment for clinical depression.
Workers, families, and older adults must be educated
and empowered about treatment for mental illness and
the prospects for recovery at any age.
The public must be educated about mental health and
aging issues.
The Iowa Coalition on Mental Health and Aging provides
a voice for advocacy around this issue.
#9 Older Adult Depression is
Associated with the Highest Rate of
Suicide
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Older adults have the highest rates of dying by
suicide of any age group.
Overall males die by suicide at rates 4:1 over
females
The suicide rate for people age 85+ is twice the
national rate
White males over the age of 85 have the highest
rates of suicide
Older Adult Depression is Associated
with the Highest Rate of Suicide
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Older adults who die by suicide have often seen
their primary care physician within one month
Community training to help identify warning
signs and call for help are available
# 10 Psychotherapy Can Be Just as Effective
as Medications, but Needs to Be Individually
Tailored for Older Adults
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Psychotherapy Works
Adaptation and modifications are necessary
when working with older adults who may have
hearing impairment, cognitive impairment, or
medication management issues
Simple modifications such as repetition,
breaking tasks into smaller units, speaking
clearly, reducing background noise, and using
appropriate names (For example, Mr. or Mrs.)
can overcome some of the barriers
Psychotherapy Can Be Just as Effective as
Medications, but Needs to Be Individually
Tailored for Older Adults
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All are effective treatment for depression
For older adults with recurrent depression, the
combination of antidepressant medication and
psychotherapy is shown to be more effective than either
approach alone
RESOURCES FOR AGING AND COMMON
MENTAL HEALTH AND CO-MORBID
DISORDERS
Websites:
 Administration on Aging: http://www.aoa.gov
 American Association for Geriatric Psychiatry:
http://www.aagponline.org
 American Geriatrics Society: http://www.americangeriatrics.org
 American Society on Aging: http://www.asaging.org
 Center for the Study and Prevention of Suicide:
http://www.rochesterpreventsuicide.org
 Geriatric Mental Health Foundation:
http://www.gmhfonline.org
 Gerontological Society of America: http://www.geron.org
 National Association of Geriatric Education Centers:
http://www.nagec.org
 National Council on Aging: http://www.ncoa.org
 Older American’s Substance Abuse and Mental Health Technical
Assistance Center: http:// www.samhsa.gov/OlderAdultsTAC
 Positive Aging Resource Center: http://www.positiveaging.org
ADDITIONAL RESOURCES FOR AGING AND
COMMON MENTAL HEALTH AND MULTIOCCURING DISORDERS
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Older Adults: Depression and Suicide Facts:
http://www.nimh.nih.gov/publicat/elderlydepsuicide.cf
m
Facts about Depression in Older Adults:
http://www.apa.org/ppo/issues/olderpressfact.html
Late-Life Depression: A Fact Sheet:
http://www.gmhfonline.org/gmhf/consumer/factsheets
/depression_factsheet.html
Depression and Older Americans:
http://www.nmha.org/ccd/support/factsheet.older.cfm
PLEASE JOIN ICMHA!
Please remember to visit the website,
www.icmha.org, and simply sign up!
 Or, “check off” the YES available to
you today, with your sign in sheet
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You’ll receive regular e-mails about training
opportunities, meeting notices, work groups, and policy
issues at state and national level
IOWA COALITION ON
MENTAL HEALTH AND AGING
Lila P.M. Starr
Adult Mental Health Specialist
Chairperson, NASMHPD Older Person Division
Iowa Department of Human Services
1305 E. Walnut
Hoover Building, 5th Floor
Des Moines, IA 50319
515-281-7270
[email protected]