The World Health Organization has included New York City in its global network of age-friendly cities. It's an important initiative that highlights attributes that cities should provide, as the world cares for an increasingly aging population. It's also an important achievement for New York City and all those both in and out of City government who have contributed to this high standard. The WHO's guide to "Global Age-Friendly Cities" is offered as a starting point to be built upon, however, and a crucial element that should be added is mental health.
The challenge of an aging world is a major one that significantly impacts urban areas. As the WHO guide emphasizes, "the number of people aged 60 and over as a proportion of the global population will double from 11% in 2006 to 22% by 2050. By then, there will be more older people than children (aged 0-14 years) in the population for the first time in human history." In addition, "as of 2007, over half of the global population now lives in cities.... By 2030, about three out of every five people in the world will live in cities."
In New York City, according to a report by the New York Academy of Medicine: "In 2005, approximately 1.3 million New York residents were age 60 or older. By 2030, this age group will increase by nearly a half million people to 1.8 million." At present, "almost 12 percent of the population is over age 65, and in some neighborhoods that proportion reaches 20 percent."
The WHO checklist of "core age-friendly features" focuses on important physical and social attributes that fall into the following eight categories: age-friendly outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community and health services. The last category references the importance of mental health services but only briefly.
For instance, in discussing the need for a wider range of health services, it cites mental health services and the need for care for those with dementia. In addition, among the "aging well" services mentioned is mental health counseling.
The mental health needs of older people are more central than that, however. Approximately 20 percent of adults 65 and older experience a mental and/or substance abuse disorder in any given year. These disorders lead to decreased quality of life for older adults and their family members. They are major contributors to social isolation and high suicide rates. Mental disorders also complicate health conditions and may result in premature, unnecessary, or avoidable institutionalization. Clearly, you cannot age well without your mental health.
In order for age-friendly communities to adequately respond to the mental health challenges of an aging population, they will need supports to help older adults with mental health problems age in the community and avoid institutionalization. This will require improved access to mental health and substance abuse services, especially in the home and in community-based settings; integration of mental health and substance abuse services into places where older adults go for other reasons, including primary care, long-term care, and aging service programs; and support for family caregivers, who provide the majority of support for people with disabilities.
As the older population becomes increasingly diverse, it will also require culturally and linguistically competent services to effectively serve minority populations. In addition, communities will need services to help older adults and their family members navigate the complex systems of care. This should include telephonic and/or Internet-based information, referral and assistance about mental health and substance abuse services, as well as outreach and education to help them understand mental and substance use disorders, know about available treatments and services, and know where to go for help.
Age-friendly communities should also support efforts to help older adults maintain mental health and to prevent the development of mental or substance use disorders. Older adults can also be a great resource to each other, and opportunities should, therefore, exist for them to participate in addressing the mental health or substance abuse needs of their peers.
Lastly, all of this requires sufficient funding for geriatric behavioral health services and the inclusion of the behavioral health sector in local planning for age-friendliness.
In New York City, the Mayor's Office, the City Council, and the New York Academy of Medicine deserve enormous credit for initiating and implementing the effort to include New York City in the WHO's global network of age-friendly cities. A next step in preparing for an aging population should be the incorporation of these mental health components into the evolving characterization of age-friendliness.
The author is Director of the Center for Policy, Advocacy, and Education of the Mental Health Association of New York City.
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