Mental Disorders,

Older Adults and Caregivers

Presented by:

Kate Mattias, MPH, JD Executive Director, NAMI Connecticut

Paloma Bayona Program Director, NAMI Connecticut

What Is NAMI?

National Alliance on

Mental Illness – Connecticut

NAMI’s Mission

Support,

education

& advocacy, for people living

with mental illnesses, their

family, friends, professionals

and the public

Audiences We Serve People living with mental illness

Family members/friends of loved ones

with mental illness adults & children

Policy makers and other community

stakeholders

Estimated that one

in five families are

impacted by serious

mental Illness each

year

Overview

Truth about Mental Illness

Mental Illness A medical condition that impacts

centers of the brain;

Biologically based, with genetic links and environmental factors;

Cannot be overcome through "will power“;

Not related to "character" or intelligence;

Affects the chemicals of the brain that determine our moods, thoughts, and perceptions;

One’s situation or environment can bring on stressors that can activate or worsen mental illness.

Who is Most Vulnerable?

Mental illnesses often strike individuals in the prime of their lives:

adolescence and young adulthood;

often when someone is starting higher education or employment;

AND

older individuals; most common is depression but anxiety disorders are common too; can co-occur with physical illnesses and substance use.

Diagnosing

Mental

Illnesses

Mood Disorders

Anxiety Disorders

Thought Disorders: Schizophrenia

General Categories of

Serious Mental Illness

Diagnosing Mental Illnesses No blood test

No brain scan

No “typical” behaviors or signs

No universal medication(s)

Providers have to go on:

The behavior(s) being exhibited

The person’s mood(s)

The person’s thoughts

The length of time the person has

experienced unusual thoughts or behaviors

Where Adults are Diagnosed

Emergency Departments

Rehab Hospitals

Other Health Facilities –

Primary Care Providers

Psychiatric Providers

Family Concerns

Court/Law Enforcement

Why Some Older Adults

Don’t Ask for Assistance

Stigma in seeking help

Not high on list of medical priorities

Concern over loss of independence or control over their life

Fear of being placed in a nursing home or on a “mental health” floor

Don’t want to be a burden

Fear cost of services and medications

Fear they may be exploited financially

Caregivers – Who Are They?

Caregivers – Who Are They?* • 8.4M provide care to adult with an emotional health issue;

• In their role an average of 8.7 years (4 yrs average for any

other kind of condition);

• 33% have been providing care for 10 or more years;

• Loved one typically has serious mental health issues;

typically bipolar disorder, schizophrenia or depression;

• Nearly all help with Instrumental Activities of Daily Living –

transportation, meals, shopping, arranging services;

• Average 31.8 hrs a week assisting loved one (typical

caregiver averages 24.4);

• 20% provide care to someone older than 65

• *(On Pins and Needles: Caregivers of Adults with Mental Illness; National Alliance for Caregiving; 2016)

Caregivers – Who Are They?* • One in seven care for a parent;

• 11% care for a spouse;

• 9% assist with a sibling;

• 45% say their loved one lives with them; 25% are within 20

minutes;

• 51% caring for a male;

• Average caregiver age 54.3 years of age;

• 82% of care recipients take prescription medication; 25% of

caregivers feel the condition not well managed by the

medication;

• 33% caregivers indicate difficulty in getting their loved one

to take prescribed medication • *(On Pins and Needles: Caregivers of Adults with Mental Illness; National Alliance on Caregiving; 2016)

• *(On Pins and Needles: Caregivers of Adults with Mental Illness; National Alliance for Caregiving; 2016)

Caregivers* • 80% help loved one manage finances or paperwork;

• 50% indicate their loved one is financially dependent upon

family or friends;

• 33% have some kind of legal responsibility – power of

attorney, guardianship;

• 40% have had any kind of mental health caregiver

training;

• 53% indicate they need help with own emotional and

physical stress (vs 40% for caregivers of adults without

mental health issues);

* (On Pins and Needles: Caregivers of Adults with Mental Illness; National Alliance on Caregiving; 2016)

Caregivers* • 30% would like a “care navigator” to

assist with accessing appropriate

services and supports;

• Services difficult to find;

• Most are employed;

• Stigma isolates caregivers

* (On Pins and Needles:

Caregivers of Adults with Mental Illness;

National Alliance on Caregiving; 2016)

Burnout – What it Looks Like • Poor sleeping habits;

• Abandoning leisure activities caregiver used to enjoy;

• Losing touch with close friend or family;

• Irritability, including towards the care recipient;

• Lack of energy for regular activities: cleaning, cooking, etc.

• Difficulty concentrating;

• Use of alcohol or drugs to relax;

• Headaches, body aches;

• Sense that no one cares for the caregiver;

• Sense of hopelessness for the future;

• Depression, anxiety

Issues Caregiver’s Face • Co-occurring disorders, both physical and

mental/substance use;

• Difficulty getting an accurate diagnosis;

• Appropriate medication; medication compliance;

• Lack of information and support;

• Personal health and mental health concerns;

• Personal Employment – most are employed

• Stigma;

• Isolation;

• Fractured healthcare system;

• Too few geriatric mental health providers and support

services

Caring for the Caregiver Taking care of yourself. Scheduling (and keeping!) doctors’

appointments. Asking for help. Taking a break. These are vital steps

caregivers can take to stay healthy.

Self-Care

• Important to acknowledge that stress is a normal,

sometimes difficult but definitely manageable,

part of caregiving. Stress can manifest itself

in both a physical and emotional way;

it is vital to find an outlet to relieve it!

• Caregiver may need to give him/herself

permission to take care of themselves.

That is fine, and good, and necessary!

Caring for the Caregiver Self-care/stress management can be achieved in many ways:

• General attention to daily activities like healthy eating,

exercising, sleeping, and talking with friends, is vital. Even for

the busiest of caregivers, mini-breaks can be lifesavers.

• Go to a quiet room or step outdoors and just breathe for ten

minutes; clear the mind and focus only on the breath.

• Write in a journal. Say a positive affirmation.

• Light a candle.

• Listen to music.

• Call a good friend.

• You might consider attending a support group. Groups of

individuals who share a common experience and provide each

other with various types of help, i.e., information, resources, and

emotional support.

Mental Illnesses and

Older Adults

Mental Illnesses and Older Adults • Dramatic recent and projected growth in population;

Population aged 65 and older will increase from 20

million in 1970 to 69.4 million in 2030;

Major direct and indirect impact on health outcomes,

service use and costs;

We know treatment works, but effective services

are not reaching those in need;

Lack of rehabilitative interventions;

An alarming under-investment in knowledge

dissemination, service development, and research to

meet future need. Source: Dartmouth Psychiatric Research Center

Poor Quality of Care for Older

Persons with Mental Disorders Increased risk for inappropriate medication treatment

(Bartels, et al., 1997, 2002)

> 1 in 5 older (20%) persons given an

inappropriate prescription (Zhan, 2001)

Research shows older adults are

getting medication but inconsistent

follow up by providers (Psychiatric News; Jan. 2013)

Less likely to get psychotherapy services;(Bartels, et al., 1997)

Lower quality of general health care

and associated increased mortality(Druss, 2001)

Mental Disorders in Older Adults:

The Silent Epidemic Alzheimer’s and other memory disorders (30-

40% co-occurring depression or psychosis);

Most common: depression, anxiety disorders,

severe mental illness, alcohol abuse;

Often overlooked by community

providers and clinicians;

Majority of individuals over age 65

who commit suicide saw primary

care provider the week before.

Dimensions of the Challenge

Less than 3% of older adults

receive outpatient mental health

treatment by specialty mental health

providers; (Olfson et al, 1996).

Only 1/3 of older persons who live

in the community and who need

mental health services receive

them. (Shapiro et al, 1986).

Older adults with mental illness on

target to reach 15 million in 2030. (Jeste, et al., 1999; www.census.gov)

Dimensions of the Challenge

Community Mental Health Services Under-serve older persons

Lack staff trained to address needs of

older adults

Often lack age-appropriate services

Principal Providers: Primary Care and Long-term Care –

insufficient depth of knowledge about

mental illness;

False belief that MH Services are not

covered by Medicare.

Late Life Depression

Co-Existing Medical Conditions

About 25% of people who have heart

attacks suffer from depression post event;

20 – 50% of people who have a stroke will

develop depression within one year;

In one study, elderly people who were

depressed were 4x as likely to die within

four months of a heart attack than those

without depression. Abebaw Mengistu Yohannes, PhD and

Robert C. Baldwin, MD ; Medical Comorbidities in Late-Life Depression; Dec

1, 2008 Psychiatric Times. Vol. 25 No. 14;

Dementia – About 17% with Alzheimer’s

also have major depression;

Symptoms of depression may

precede development of dementia

or Alzheimer’s;

When depression and cognitive

impairment develop simultaneously,

deficits may be mistaken for dementia or

a problem known as “pseudo-

dementia”; Cognitive function may

improve if depression treated.

Co-Existing Medical Conditions

•

Substance Use

Numbers of Older Adults Impacted

by Depression

1-5 % - who live in the community;

12% - who are hospitalized;

14% - who require health care at home;

29-52% - who live in nursing homes;

39-47% - being treated for cancer, heart attack, or stroke.

Risk Factors for Late Life

Depression Female gender

Widowed or divorced; loss of close

friends or poor family relations;

Chronic & disabling illness;

Lack of social support;

Recently bereaved;

Prior history of depression;

family history of mental illness;

Lack of regular physical activity;

Recent placement in nursing home

Late Life Depression

Clinically significant

depression affects

15-20% of older adults

(2M with clinical

depression; 5M with less

severe condition that

impacts quality of life)

Late life depression

associated with:

– Lower physical

functioning;

– Poorer adaptation to

medical illness;

– Lower quality of life;

– Higher health care costs;

– Dementia and Heart

Disease

– Increased mortality from

suicide and illness.

Depression Symptoms in Older Adults Symptoms different than that of younger person;

An older person more likely to have sleep or eating

problems (insomnia is a risk factor);

Ambien and Lunesta increasingly prescribed for older

individuals instead of Klonopin or Xanax;

Tends to last longer period of time in older adults; may

increase risk for physical health problems or death;

Depression in older adults is more likely to lead to suicide.

Risk of suicide is serious. Elderly white men are at the

greatest risk, and those ages 80-84 have a suicide rate

more than twice that of the general population.

Depression is a predictor of suicide

Depression Symptoms in Older Adults Somatic or physical symptoms more

common than in other age groups, including heart palpitations, restlessness, fatigue, aches and pains, nausea and vomiting, dizziness, tremors, shortness of breath, fainting;

Because physical symptoms are common, many providers overlook or don’t consider screening for depression;

Cognitive problems, including inability to concentrate or remember things;

Mood disturbances, including irritability, anxiety, or preoccupation with death.

Late Life Depression

No one cause; onset of late-life depression can be

attributed to genetic, biological, or neurological factors;

life changes; illnesses; or a combination;

Some older adults with depression have suffered from

the illness for most of their lives and gone undiagnosed;

Depression in late life is more common in women,

widowed individuals, those who lack a supportive social

network, and those with physical health problems;

Important to recognize that the depression is NOT just “ being down” about one’s condition.

Treating Late Life Depression

Only 10 to 40 percent of elderly patients with

depression are prescribed antidepressant

medication;

Underuse or misuse of antidepressants

and prescribing inadequate dosages are

common mistakes physicians make when treating

the elderly with depression;

Treatments believed to be beneficial in late-life

depression include antidepressants, psychotherapy,

electroconvulsive therapy (ECT) and transcranial

magnetic stimulation (TMS); http://www.narsad.org/dc/pdf/facts.latelifedep.pdf

Treating Late Life Depression

More than 20 antidepressants available;

Some antidepressants may not be as

effective for people over age 60 as they

are for younger persons;

Treatment may take longer to work; may

need to take higher doses;

Treating physician needs to know all the

medications someone is taking —

including vitamins, herbal supplements,

alcohol and tobacco, and recreational

drugs — combination of medications can

impact the effectiveness of treatment.

Treating Late Life Depression Support and education important part of depression

treatment for individual and caregivers;

Studies show older patients with depression benefit

most from aggressive, persistent treatment;

therefore, therapy for older patients should be

continued for a sufficient duration; www.narsad.org/dc/pdf/facts.latelifedep.pdf

Psychotherapy can involve just the person or a

whole family;

Cognitive therapy especially helpful with older adults

once depression is under control;

Group therapy – can provide a communal experience

of guidance and education;

What works is what is important

Community Response to Late Life

Mental Illness

Depression Screening Agencies and staff serving home or

facility-bound individuals need to provide

information on late life depression to

clients and family members;

Screening results can provide the

physician/provider with a reason to

discuss depression and/or other mental

illnesses

Depression Screening Community support to reduce stigma;

Primary care, geriatric physicians,

psychologists and psychiatrists use special

assessments, such as the Geriatric Depression

Scale;

Touted as a “best practice” in primary

care settings;

Caregivers and Older Adults may need to ask

that a screening be performed;

Primary Care physicians need to know where

mental health resources are in the community;

Community agencies need to know about

resources.

Evidence-Based Practices

Mental health outreach services – key role

for community agencies and providers

Integrated service delivery in primary care

Mental health consultation and treatment

teams in long-term care

Family/caregiver support and education

interventions

Psychological and pharmacological

treatments Draper, 2000; Unützer, et al., 2001; Schulberg, et al., 2001;

Bartels et al., 2002, 2003; Sorenson, et al., 2002;

Successful Mental Health &

Aging Coalition Education of Primary Care Physicians/Community

Social Service Providers • Educational Seminars

• Brochures on Aging Mental Health Issues

• Community Resources

• Peer Organizations share successful treatment programs

Education of primary caregivers • NAMI’s Family to Family course

• Introduction to easy screening tools to de-mystify process

Public Education • Public Service Announcements

• Speakers Bureau

• Library Focus – National Depression Day; Mental Illness

Awareness Day

• Aging Mental Health Conferences

Resources

NAMI: www.nami.org;

Education Courses for Family Members

Support Groups for Family Members and People

living with Mental Illness

Professional Education

Older Americans Substance Abuse and

Mental Health Technical Assistance Ctr. www.SAMHSA.gov/OlderAdultsTAC

National Institutes of Mental Health (NIMH)

Mental Health Connecticut (MHC)

Questions and Answers

NAMI Connecticut

www.namict.org