Baby boomers will likely face an array of health conditions as they grow older but, in many cases, will find only insufficient treatment options. According to a report by the Institute of Medicine (IOM), health care providers are currently not prepared for the coming challenges of what has been called a "silver tsunami" because of the sheer size of this aging generation. These challenges include both physical and mental health care needs, the latter of which have so far been mostly ignored or neglected.
Nearly one in five Americans age 65 and older suffer from mental health problems, including depression, memory loss and diminished cognitive functions. The report also mentioned substance abuse as a growing contributing factor to age-related mental decline. These numbers will only go up as the elderly population will grow from just over 40 million in 2010 to well over 70 million by 2030.
At a time when there is already great concern over the affordability of health care in general, finding funds for the treatment of mental illness and substance abuse will be even more difficult. Nevertheless, the IOM calls for an overhaul of Medicare and Medicaid payment rules in favor of covering care, counseling and other services for older patients with mental health problems. At this point, both programs rather deter treatment of such conditions based on their existing coverage and reimbursement policies.
A lack of national attention to these issues combined with an ill-equipped health care work force that doesn't understand the special needs of older adults only worsens the situation, according to Dr. Dan G. Blazer, a professor for psychiatry and behavioral science at Duke University Medical Center in Durham, North Carolina, who chaired the IOM panel that wrote the report. He calls the findings a "wake-up call that we need to prepare now or our older population and their extended families will suffer the consequences."
Geriatric health care is in many ways different from general health care and requires specialized training. Older people undergo metabolic changes, making it more difficult for them to tolerate certain medications and thereby increasing the risk of overdosing. Also, age-related cognitive impairments can affect the ability to comply with medication instructions. Other existing physical health problems can mask or distract from mental health needs and leave those undiagnosed and untreated. Grief and depression caused by loss of loves ones, social isolation or alcohol and drug abuse can accelerate the mental decline.
All health care workers in frequent contact with older patients, including primary care physicians, nurses and social workers, must be able to recognize the symptoms of mental health problems and provide at least some basic form of treatment, says the report. Regrettably, there are relatively few opportunities for medical professionals to get more training in geriatric mental health care. There are also not enough financial incentives that would encourage them to enter this field.
The report concludes with a warning to lawmakers about the significant shortcomings of the nation's health care force facing a rapidly aging population. The IOM panel urges Congress to provide additional funding of resources to evaluate, coordinate and facilitate the efforts of health care workers taking on these enormous challenges.