June-July 2002

Older Adult Mental Health Services: Ready or not here they come - The Baby Boom as Elders

Today is an era of transition for older Americans. The World War II generation is rapidly disappearing, with an estimated 1,000 WWII veterans having died per/day over the past half-decade. Their children born before, during, and after the war are now moving into their older adulthood. For the next several decades (2010-2030), this generation of 76 million Americans and their slightly older peers, commonly referred to as the baby-boom generation, will move into older adulthood, eventually accounting for 20 percent of the U.S. population (AoA, 2001). The baby-boom generation population cohort (bubble) has radically changed the face of America throughout their lifespan, with institutions from schools to the workplace changing to meet the demands of this very large group. It is likely their expectations for access, availability, and acceptability of mental health services will cause mental health services for older adults to undergo radical change as well.

According to the U.S. Department of Health and Human Services (HHS), Administration on Aging (AoA) approximately 20 percent of older Americans, age 55+, experience diagnosable mental disorders in any given year. Given the eventual cohort of 76 million+ noted above, our system of care will need to develop the capacity and expertise to potentially serve 15.2 million older adults experiencing mental disorders. These disorders include (in order of prevalence):

1. Anxiety Disorders
2. Severe Cognitive Impairment (e.g. dementia, Alzheimer's)
3. Mood Disorders

While these disorders are most common, schizophrenia and other mental illnesses are also seen. The AoA notes there is significant under-reporting of mental disorders among older adults (AoA Fact Sheet, May 2001). The National Association for State Mental Health Program Director's (NASMHPD) noted in a recent task force report that "the elderly remain the most underserved and inappropriately served population in mental health services (Wilson, Kazieczko, & Kast, 1997). In its work coordinating the National Technical Assistance Center for Rural and Frontier Mental Services (CMHS/SAMHSA Contract No. 280-94-0014), the WICHE Mental Health Program noted the following were important considerations in better understanding older adult mental health services (Stockdill and Ciarlo, 2000):

1. Older adults have difficulty in accessing health and mental health services because of stigma, transportation, limited finances, and lack of knowledge/awareness about geriatric mental illnesses.

2. Delayed diagnosis and treatment, related to the above, results in more serious disability, requiring more extensive and expensive intervention.

3. Older adults routinely have serious mental illnesses in combination with other serious/chronic health problems (comorbidity).

Many areas of the WICHE West have higher than average older adult population representations, and it will be essential to the success of our public mental health mission to seek ways to meet the increasing demands of older adults. Many questions about how to best improve access, availability, and acceptability of mental health services to older Americans remain to be answered. The WICHE Mental Health Program will maintain its efforts to explore how best to assist the West in improving systems and preparing a mental health workforce that is capable of competently serving older adults with mental health needs.