Iowa Coalition on Mental Health and

Aging

June 22, June 22, 20102010

Lila P.M. StarrAdult Mental Health Specialist

Chairperson, NASMHPD Older Person DivisionIowa Department of Human Services

1305 E. WalnutHoover Building, 5th Floor

Des Moines, IA 50319515-281-7270

Lstarr@dhs.state.ia.us

WELCOME To The…WELCOME To The…

ICMHA MissionICMHA Mission

The ICMHA exists to expand and The ICMHA exists to expand and improve mental health care for improve mental health care for

older Iowans so that they can live, older Iowans so that they can live, learn, recreate, engage in learn, recreate, engage in

meaningful activities and access meaningful activities and access appropriate services in the appropriate services in the

communities of their choice.communities of their choice.

Olmstead Anniversary, Olmstead Anniversary, Today!Today!

Partners in today’s Partners in today’s trainingtraining

ICMHA GoalsICMHA Goals

Please Join the ICMHAPlease Join the ICMHA You have the opportunity to sign up to You have the opportunity to sign up to

be a member, join a workgroup, and be a member, join a workgroup, and receive periodic e-mail updates, training receive periodic e-mail updates, training announcements, and meeting noticesannouncements, and meeting notices

There is NO COST to joinThere is NO COST to join Sign up and view the many excellent Sign up and view the many excellent

resources found on our website: resources found on our website: www.icmha.orgwww.icmha.org

National Coalition on Mental Health and National Coalition on Mental Health and Aging: www.ncmha.orgAging: www.ncmha.org

These Ten things come to you from These Ten things come to you from NASMHPD Older Persons DivisionNASMHPD Older Persons Division

The National Association of State Mental The National Association of State Mental Health Program Directors: Health Program Directors: representatives from each State Mental representatives from each State Mental Health Authority, who are the Health Authority, who are the Commissioner designees to work on policy Commissioner designees to work on policy and practice issues around Mental Health and practice issues around Mental Health for older citizens, make up the Older for older citizens, make up the Older Persons DivisionPersons Division

Ten Things You Need to Know about Mental Health for Older Adults

#1 Co-Occurring Medical Illness #1 Co-Occurring Medical Illness is the Rule, Not the Exceptionis the Rule, Not the Exception

Among older adults with depression, Among older adults with depression, approximately:approximately:

1 / 5 suffer from heart disease1 / 5 suffer from heart disease 1 / 5 have diabetes1 / 5 have diabetes 2 / 5 have arthritis 2 / 5 have arthritis 1 / 2 have hypertension1 / 2 have hypertension

••Outcome: The presence of these chronic Outcome: The presence of these chronic medical conditions complicates identification medical conditions complicates identification and treatment of depression and other and treatment of depression and other mental illnesses in older adultsmental illnesses in older adults

Co-Occurring Medical Illness is Co-Occurring Medical Illness is the Rule, Not the Exception the Rule, Not the Exception

#2 Older Adults Take Multiple Medications #2 Older Adults Take Multiple Medications and their Bodies Handle the Medication and their Bodies Handle the Medication Dosages & Substances Differently than Dosages & Substances Differently than

Younger BodiesYounger Bodies

Older Adults Take Multiple Older Adults Take Multiple Medications…Medications…

#3 Mental & Physical Functioning #3 Mental & Physical Functioning Varies Widely Among Older Varies Widely Among Older

Adults of the Same AgeAdults of the Same Age

Mental & Physical Functioning Mental & Physical Functioning Varies Widely Among Older Varies Widely Among Older

Adults of the Same AgeAdults of the Same Age

#4 Importance of Coordination #4 Importance of Coordination and Collaboration between and Collaboration between Behavioral Health, Aging, & Behavioral Health, Aging, &

Medical Health ProvidersMedical Health Providers

Importance of Coordination and Importance of Coordination and CollaborationCollaboration

For older adults with mental illness, in may be For older adults with mental illness, in may be unrealistic to add another complicated layer of unrealistic to add another complicated layer of self management by adding mental health self management by adding mental health care, psychotherapeutic medication care, psychotherapeutic medication management, the psychiatrist, and the mental management, the psychiatrist, and the mental health case managerhealth case manager

Older adults with mental illness often fail to Older adults with mental illness often fail to receive appropriate and effective treatment receive appropriate and effective treatment within fragmented delivery systems.within fragmented delivery systems.

Importance of Coordination and Importance of Coordination and CollaborationCollaboration

#5 Family Members & Other Social #5 Family Members & Other Social Supports are Critical to Successful Supports are Critical to Successful

TreatmentTreatment Many older adults receive informal caregiving Many older adults receive informal caregiving

services from family membersservices from family members Daughters, Daughters-in-Law, Spouses, and Sons Daughters, Daughters-in-Law, Spouses, and Sons

contribute to caring for older family memberscontribute to caring for older family members Friends, neighbors, and other community members Friends, neighbors, and other community members

provide essential services and often act as an early provide essential services and often act as an early warning system for vulnerable and isolated elders. warning system for vulnerable and isolated elders.

Family members may be important providers of Family members may be important providers of Transportation, Activities of Daily Living, Medication Transportation, Activities of Daily Living, Medication Management, and Medical Care SchedulingManagement, and Medical Care Scheduling

These family members should be included in These family members should be included in treatment planning.treatment planning.

Family Members & Other Social Family Members & Other Social Supports Supports

#6 Maintaining Independence #6 Maintaining Independence and Aging in Place is a Commonly and Aging in Place is a Commonly

Held ValueHeld Value Older adults want to “age in place” to the extent Older adults want to “age in place” to the extent

that is possible.that is possible. Treatment of Depression should support the Treatment of Depression should support the

independent community functioning of the independent community functioning of the individualindividual

This should include a discussion regarding the This should include a discussion regarding the potential risks of continuing to live at home, both potential risks of continuing to live at home, both with and without services.with and without services.

The desire to remain at home can be a real The desire to remain at home can be a real motivator for making needed changes.motivator for making needed changes.

Maintaining Independence and Maintaining Independence and Aging in Place is a Commonly Aging in Place is a Commonly

Held ValueHeld Value

#7 #7 PreventionPrevention of Depression in of Depression in Older Adults is Older Adults is PossiblePossible

Prevention of Depression in Prevention of Depression in Older Adults is PossibleOlder Adults is Possible

##8 8 AgeismAgeism is Everywhere and Affects is Everywhere and Affects Treatment Expectations and Treatment Expectations and

OutcomesOutcomes

Ageism is Everywhere and Ageism is Everywhere and Affects Treatment Affects Treatment

Expectations and Outcomes Expectations and Outcomes

#9 Older Adult Depression is #9 Older Adult Depression is Associated with the Highest Rate Associated with the Highest Rate

of Suicide of Suicide Older adults have the highest rates of Older adults have the highest rates of

dying by suicide of any age group.dying by suicide of any age group. Overall males die by suicide at rates 4:1 Overall males die by suicide at rates 4:1

over femalesover females The suicide rate for people age 85+ is The suicide rate for people age 85+ is

twice the national ratetwice the national rate White males over the age of 85 have the White males over the age of 85 have the

highest rates of suicidehighest rates of suicide

Older Adult Depression is Older Adult Depression is Associated with the Highest Rate Associated with the Highest Rate

of Suicideof Suicide

# 10 Psychotherapy Can Be Just as # 10 Psychotherapy Can Be Just as Effective as Medications, but Needs to Effective as Medications, but Needs to

Be Individually Tailored for Older Be Individually Tailored for Older Adults Adults

Psychotherapy Works Psychotherapy Works Adaptation and modifications are necessary Adaptation and modifications are necessary

when working with older adults who may when working with older adults who may have hearing impairment, cognitive have hearing impairment, cognitive impairment, or medication management impairment, or medication management issuesissues

Simple modifications such as repetition, Simple modifications such as repetition, breaking tasks into smaller units, speaking breaking tasks into smaller units, speaking clearly, reducing background noise, and clearly, reducing background noise, and using appropriate names (For example, Mr. using appropriate names (For example, Mr. or Mrs.) can overcome some of the barriersor Mrs.) can overcome some of the barriers

Psychotherapy Can Be Just as Psychotherapy Can Be Just as Effective as Medications, but Needs to Effective as Medications, but Needs to

Be Individually Tailored for Older Be Individually Tailored for Older AdultsAdults

RESOURCES FOR AGING AND RESOURCES FOR AGING AND COMMON MENTAL HEALTH AND COMMON MENTAL HEALTH AND

CO-MORBID DISORDERSCO-MORBID DISORDERSWebsites: Websites:

Administration on Aging: http://www.aoa.gov Administration on Aging: http://www.aoa.gov American Association for Geriatric Psychiatry: American Association for Geriatric Psychiatry:

http://www.aagponline.org http://www.aagponline.org American Geriatrics Society: http://www.americangeriatrics.org American Geriatrics Society: http://www.americangeriatrics.org American Society on Aging: http://www.asaging.org American Society on Aging: http://www.asaging.org Center for the Study and Prevention of Suicide: Center for the Study and Prevention of Suicide:

http://www.rochesterpreventsuicide.org http://www.rochesterpreventsuicide.org Geriatric Mental Health Foundation: http://www.gmhfonline.org Geriatric Mental Health Foundation: http://www.gmhfonline.org Gerontological Society of America: http://www.geron.org Gerontological Society of America: http://www.geron.org National Association of Geriatric Education Centers: National Association of Geriatric Education Centers:

http://www.nagec.org http://www.nagec.org National Council on Aging: http://www.ncoa.org National Council on Aging: http://www.ncoa.org Older American’s Substance Abuse and Mental Health Older American’s Substance Abuse and Mental Health

Technical Assistance Center: http:// Technical Assistance Center: http:// www.samhsa.gov/OlderAdultsTAC www.samhsa.gov/OlderAdultsTAC

Positive Aging Resource Center: http://www.positiveaging.orgPositive Aging Resource Center: http://www.positiveaging.org

ADDITIONAL RESOURCES FOR AGING ADDITIONAL RESOURCES FOR AGING AND COMMON MENTAL HEALTH AND AND COMMON MENTAL HEALTH AND

MULTI-OCCURING DISORDERSMULTI-OCCURING DISORDERS

Older Adults: Depression and Suicide Facts: Older Adults: Depression and Suicide Facts: http://www.nimh.nih.gov/publicat/elderlydepsuicide.http://www.nimh.nih.gov/publicat/elderlydepsuicide.cfmcfm

Facts about Depression in Older Adults: Facts about Depression in Older Adults: http://www.apa.org/ppo/issues/olderpressfact.htmlhttp://www.apa.org/ppo/issues/olderpressfact.html

Late-Life Depression: A Fact Sheet: Late-Life Depression: A Fact Sheet: http://www.gmhfonline.org/gmhf/consumer/factsheehttp://www.gmhfonline.org/gmhf/consumer/factsheets/depression_factsheet.htmlts/depression_factsheet.html

Depression and Older Americans: Depression and Older Americans: http://www.nmha.org/ccd/support/factsheet.older.cfhttp://www.nmha.org/ccd/support/factsheet.older.cfmm

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Please remember to visit the Please remember to visit the website, www.icmha.org, and website, www.icmha.org, and simply sign up! simply sign up!

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IOWA COALITION ON IOWA COALITION ON MENTAL HEALTH AND MENTAL HEALTH AND

AGINGAGING Lila P.M. Starr

Adult Mental Health SpecialistChairperson, NASMHPD Older Person

DivisionIowa Department of Human Services

1305 E. WalnutHoover Building, 5th Floor

Des Moines, IA 50319515-281-7270

Lstarr@dhs.state.ia.us