Personal Health : The Aged Mind: More Care Needed
What the three dozen experts in gerontology and mental health had in mind over the weekend was the minds of others--specifically the aging among us. And here are some of their revelations.
* About 15% of Americans 65 or older who are living at home have a clinically significant degree of depression and dysphoria--persistent anxiety or physical discomfort.
* Conservative estimates place the number of nursing home patients with diagnosable mental disorders at 60%.
* Alzheimer’s disease, usually an ailment of the old that impairs memory and often leads to a general physical deterioration, is expected to soar from 1,414,000 cases nationally in 1980 to 2,008,000 in the year 2000, an increase of 42%.
* Yet, of the more than $49 billion paid out in Medicare hospitalization benefits in fiscal year 1986, only 3% went for mental health services.
These were among the facts that emerged during a two-day national conference at UCLA titled “Mental Health and Aging: Looking Into the 1990s.” And the primary message from all those who gathered at the campus Neuropsychiatric Institute was that the mental health needs of the aging are just as important as their physical needs.
Bernice L. Neugarten, professor emeritus in the department of Behavioral Sciences at the University of Chicago, said the public doesn’t perceive mental health care for the elderly as one of the major problems of society.
And this at a time when, as she observed, “people live longer after they get old. . . . It is probably the first time in our history that a woman can be a granddaughter and a grandmother simultaneously.”
In addition, she said, “people are retiring earlier and living longer. . . . Less than 60% of men ages 55 to 64 are reckoned as still being in the labor force.”
Continued Growth Expected
Neugarten mentioned that, from 1980 to 1985, the number of centenarians in America increased from 15,000 to 25,000--and their number is expected to grow to 110,000 by the turn of the century.
Dr. Gary W. Small, assistant professor of psychiatry at UCLA, said that the U.S. population 65 and older was 22 million in 1975 and is expected to be 64 million by 2030; of these, 4.4 million were diagnosed as mentally ill in 1975, a number that is forecast to grow to 13 million by 2030.
“However,” he said, “the number of geropsychiatrists was 17 in 1975, and will be only 1,900 in 2030 if training programs maintain their current rate of production. This would mean that if the time were divided evenly, each patient would have 20 minutes annually with one of these specialists.”
“It is no longer useful to maintain a rigid distinction between mental and physical illness” as regards older persons, said Dr. Lissy F. Jarvik, professor of psychiatry at UCLA and coordinator of the conference.
In discussing worldwide projections for Alzheimer’s, Jarvik pointed out that while Japan is expected to suffer the greatest percentage increase by the year 2000--a total of 76.6%--projections show that the United States will have the greatest prevalence--2,008,000 cases.
Dr. Henryk M. Wisniewski, director of the New York State Institute for Basic Research in Developmental Disabilities, said that Alzheimer’s disease is the price being paid for living longer.
Many of those people who live longer end up in nursing homes--and the news there is grim.
Dr. Gary Gottlieb, director of geriatric psychiatry at the University of Pennsylvania, said, in devoting part of his presentation to depression, that “in institutional long-term care facilities such as nursing homes, about 25% of the best functioning residents suffer from major depression.
“Patients with physical illness and disability who are also depressed are less likely to regain function than similarly disabled patients who are not depressed,” Gottlieb added.
Risk to Longevity
And while it has always been known that depression is a risk factor for suicide, said Dr. Carl Eisdorfer, chairman of the Department of Psychiatry at the University of Miami, it now has been discovered that depression shortens the life span.
“It is part of a mechanism that culminates in increased mortality and and morbidity,” he added.
As for costs, Manuel R. Miranda, staff director of the House Select Committee on Aging, said that out-of-pocket health care costs among the elderly have risen from 12% to 18% over the last 10 years.
And he pointed out that nursing homes have to be careful not to identify too many of their patients as mentally ill--lest the place be classified as an institution of mental disease and lose Medicare and Medicaid funding.
But he also had good news--the fact that the committee, chaired by Rep. Edward R. Roybal (D-Los Angeles), has a bill making its way through Congress (H.R. 111), entitled the Mental Health and Aging Act.
At present, there is a 190-day lifetime Medicare and Medicaid limit on inpatient care in psychiatric hospitals. Among its other provisions, the bill would erase this cap.
For outpatient care, there is a $1,100 annual limit, of which 50% must be paid by the recipient. The bill would reduce this percentage to 20%.
(Miranda, who is also a professor at the UCLA School of Social Welfare, said he got the feeling that one of the obstacles the proposed legislation may face is that mental health “wasn’t a glamour issue.”)
More Good News
And there was further good news. In discussing what is being used to fight mental illness in upper age groups, Dr. Charles F. Reynolds III, professor of psychiatry at the University of Pittsburgh, dealt with what sleep records can tell:
“We can use changes in sleep patterns as a way of predicting which older patients with depression and cognitive impairment will improve versus those patients who will show a progressive cognitive decline.”
Those patients who will improve are the ones who show the capacity for a rebound in dream sleep after sleep loss, Reynolds explained.
As did Yvonne Santa Anna of the staff of the House Select Committee on Aging, many speakers made reference to the numbers of nursing home residents with mental disorders.
Susan Pettey, of the American Assn. of Homes for the Aging, countered that the facilities are developing new programs, such as dealing with wandering and confused patients, and the use of behavior modifying drugs.
One problem the homes face, she said, is resistance by both family and patients to take advantage of existing mental health resources.
A Lingering Stigma
Karen Hale, associate director of the Mental Health Assn., Texas, agreed, stating that there is the difficulty of “people’s willingness to seek help.” She said there are, in the opinion of some, few issues with greater stigma than mental illness.
Theresa Varner, of the American Assn. of Retired Persons, mentioned the problem of “skepticism among the elderly of the value of mental health services.” And she conceded that, in the past, her powerful national organization may have given too much attention to portraying older Americans as “vibrant and not vulnerable.”
In summation of the conference, Arthur S. Flemming, Secretary of Health, Education and Welfare in the Eisenhower Administration and currently chairman of the National Citizens’ Board of Inquiry Into Health in America, spoke of the access of older persons to mental health care:
“We shouldn’t be happy, and our nation shouldn’t be happy.”
Alzheimer’s Disease in 1980 and in 2000 In millions of population * Percentage increase between 1980 and 2000 SOURCE: Dr. Lissy Jarvik
