New Paper Calls for Shift from Hospital and Clinic-Based Treatment to In-Home and Community-Based Interventions

WASHINGTON, June 25, 2018 – A newly published paper titled “Promoting Wellness in Older Adults with Mental Illnesses and Substance Use Disorders: Call to Action to All Stakeholders” in the American Journal of Geriatric Psychiatry (AJGP) summarizes the current state of knowledge on specific mental illness and substance abuse concerns in older Americans, identifies research gaps, and presents recommendations for health education and public policy. The paper also notes the importance of the positive side of aging, including resilience, well-being, compassion, and wisdom. These coping skills are teachable and should be used for enhancing function and reducing morbidity in later life in people with mental illness and substance use disorders.

The prevalence of depressive disorders in older adults is expected to more than double by 2050, and of major concern, substance use disorders—including alcohol use disorder—are also on the rise among older adults. These conditions, which are frequently undiagnosed and untreated among older adults, have a detrimental impact on health and contribute to social isolation, institutionalization, and even high suicide rates. There is also an increasingly high burden of mental illnesses and behavioral problems among older adults with dementia.

“The white paper published in this issue of the AJGP represents a broad consensus among scientists, clinicians, consumers, and federal officials about how to promote well-being among the nation’s increasingly diverse older adults,” said Charles F. Reynolds, III, M.D., AJGP Editor-in-Chief, Distinguished Professor of Psychiatry and UPMC Endowed Professor in Geriatric Psychiatry (emeritus), University of Pittsburgh School of Medicine. “It is extraordinarily timely and important.”

The paper was the result of an October 2017 workshop convened in Washington, D.C. by the Alliance for Aging Research and the Sam and Rose Stein Institute for Research on Aging at the University of California San Diego School of Medicine. The panel brought together top academic, provider, and public policy experts in the fields of geriatric mental health and patient advocacy, as well as representatives from key federal agencies, to explore the essential mental and behavioral health concerns of older Americans.

Panelists identified three topics as the leading areas of essential mental and behavioral health concerns for older Americans: 1) mental health issues accompanying dementia; 2) depression and suicide; and 3) serious mental illness and substance use disorders. Additionally, experts identified the current knowledge gaps in these areas and proposed solutions for addressing the areas of concern. These recommendations are outlined extensively in the paper. The key takeaways include:

1. Mental health issues accompanying dementia
   • Enable home-based care and train health professionals to serve as educators for caregivers to assist with behavioral issues.
   • Raise standards for early diagnosis and personalized management of residents with neuropsychiatric symptoms (NPS).
   • Develop and implement program evaluation systems that include quality care measures and cost effectiveness of new models of care.
2. Depression and suicide
   • Develop and test ways of implementing evidence-based practices to treat depression and prevent suicide, and to train/educate lay people and health care providers.
   • Increase partnerships with organizations outside of health organizations, which can reduce social isolation and loneliness, and nonprofit organizations to improve community outreach.
   • Improve public and family caregiver awareness regarding the increased risk of suicide that is associated with firearms access.
3.  Serious mental illness and substance use disorders
   • Develop and test effectiveness of community-based interventions to identify and treat older adults with co-occurring mental illnesses and substance abuse disorders.
   • Identify and develop multidisciplinary treatment algorithms for appropriate alternatives to opioids for pain.
   • Promote programs that offer integrated living environments and supported decision making for older adults with mental disorders.

Lead co-author Dilip V. Jeste, M.D., Director of the Stein Institute, states, “Older adults who suffer from mental illnesses, including substance use disorders and dementia, are among the most disenfranchised groups in healthcare. Their quality of life is diminished and their lives are cut short. This paper provides an initial roadmap to how we can change this paradigm, but it will take a group effort and political will to prioritize the health and well-being of some of our most vulnerable citizens. The research, treatment, and patient advocacy communities are sounding the alarm for this growing crisis.”

To tackle the challenges with mental illness and substance use disorders, the paper calls for a need to shift away from hospital and clinic-based treatments to interventions and support in the home and community. Some of the recommendations for home-centered care include:

• Developing and implementing strategies that support home-based care that emphasize wellness, prevention, and early intervention;
• Providing support to community-based mental health services;
• Implementing evidence-based suicide prevention programs in community mental health settings and community-based entities;
• Developing alternate ways to use technology to provide mental health resources to rural areas; and
• Including faith-based and community-focused organizations in planning efforts.

The other lead co-author Susan Peschin, MHS, president and CEO of the Alliance for Aging Research, added, “While there is no one answer for every disease, individualized and person-centered care will have the greatest impact in promoting wellness and longevity. The take-home message is that, while there is still much work to be done, there are many actions that communities, clinicians, and families can take right now to help ensure the latter years of their loved one’s lives are spent in happiness, not hopelessness.”

For more information about the October 2017 workshop and efforts to promote healthy aging, visit Alliance for Aging Research.

About the Alliance for Aging Research
The Alliance for Aging Research is the leading nonprofit organization dedicated to accelerating the pace of scientific discoveries and their application to vastly improve the universal human experience of aging and health. The Alliance believes advances in research help people live longer, happier, more productive lives and reduce healthcare costs over the long term. For more than 30 years, the Alliance has guided efforts to substantially increase funding and focus for aging at the National Institutes of Health and Food and Drug Administration; built influential coalitions to guide groundbreaking regulatory improvements for age-related diseases; and created award-winning, high-impact educational materials to improve the health and well-being of older adults and their family caregivers. For more information, visit www.agingresearch.org

Media Contact:
Lauren Smith Dyer
Alliance for Aging Research
[email protected]
(202) 688-1229

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