The U.S. population is aging rapidly, bringing the need for more widespread comprehensive medical care to the forefront. Specifically speaking, integrated healthcare with a structure that connects mental and emotional health to physical health is an ideal model for a multi-pronged approach that recognizes the prevalence of mental health stigma — especially among older adults.
Let’s examine a few factors involved in implementing more integrated care into mental health treatment for aging adults.
The barriers can be cultural as well as generational. For example, in rural North Carolina, researchers interviewed 478 adults over 60 and found that the most commonly cited barrier to treatment was the belief that “I should not need help.” The idea of self-sufficiency — in addition to a lack of access to resources, transportation, or mistrust of medical providers — leaves many older adults with the impression that they have few options available to them.
In addition to rural culture, some ethnic cultures may stigmatize mental health issues more than others. For example, research has shown that Asian-Americans are three times less likely to seek mental health care than white Americans. However, some psychiatrists have found that educating the whole family is an effective way to communicate with Asian-American patients.
Non-Financial Barriers to Care
It may be surprising to learn that nonfinancial barriers to care, such as accessibility, are more problematic than financial concerns when it comes to older adults successfully accessing mental health care.
Current trends like telehealth clinics and digital access to healthcare providers could help assuage the shortage of rural healthcare providers – especially mental health counselors and psychiatrists capable of prescribing much-needed medication both discreetly and efficiently.
According to the University of Cincinnati, nonfinancial barriers include accommodation, availability, accessibility, and acceptability:
“ … While 18.5 percent of participants stated affordability was their most common reason for unmet needs or delayed care, 21 percent stated that nonfinancial barriers were more frequent reasons for delayed care.”
While accommodation has to do with hours of operation and availability denotes a supply of clinicians, programs, and facilities that adequately serves nearby patients, accessibility indicates transportation options and travel time. The last factor, acceptability, is less intuitive: this characteristic has more to do with patients accepting a clinician’s characteristics, such as gender or ethnicity; or accepting the clinical type or neighborhood. The latter details may be more of an issue with older patients with cultural or gender-related religious beliefs or generational differences.
Integrated Medical Teams
What if it were to become standard to receive comprehensive care that incorporates mental and physical health assessment in one visit? Colleen Cordes, director of Arizona State University’s Doctor of Behavioral Health Program, notes that,
“Since the Affordable Care Act, there has been a heavy emphasis on more integrated care. There is an immense emerging need for this kind of workforce, without extensive knowledge of how we train the people who will comprise it.”
U.S. News and World Report recently covered this emerging trend, noting that some primary care health systems are trying to bypass the mental healthcare stigma by integrating mental health care with physical checkups — making it as easy as a routine medical exam with your regular physician. If a team of experts stands at the ready, in the event of a mental health diagnosis that requires treatment, team-based primary care simplifies the integrated care approach by housing all necessary experts under the same proverbial roof.
Our healthcare system could make significant headway by treating the brain and body as connected, rather than separate — ideally avoiding repetitive trips to different providers. A more integrated approach would also prevent unnecessary substance abuse as the result of treating chronic pain and depression simultaneously, for example.
The American Psychological Association published a resource addressing how integrated healthcare benefits adults as they get older, noting the strong connection between mental and physical health — for example, anxiety is apparently related to memory decline, and untreated depression has been tied to accelerated heart disease. Moreover, better collaboration between healthcare providers can decrease the stress associated with navigating confusing medical systems.
Beneficial Lifestyle Choices
Aging adults need access to whole-person health and wellness resources, as well as a lifestyle that easily facilitates an active social and mental life. The Doctor Weighs In recently addressed the question of whether retirement can increase life expectancy. The answer is complicated: it depends upon whether there are ample resources for leading a fulfilling lifestyle.
For example, seniors who move to continued-care retirement communities (CCRCs), especially if their spouse or life partner has passed away, tend to experience positive health benefits because of socialization. Residents living in extended care communities are also granted convenient access to healthcare providers, making them more likely to get screened for health problems than isolated seniors living near fewer resources.
However, unsurprisingly, aging adults with less access to resources and capital may suffer due to lack of timely treatment. This is why, according to the World Health Organization,
“There is a pressing need to develop comprehensive community-based approaches to prevent declines in capacity and to provide support to family caregivers.”
Issues such as malnutrition, mobility loss, and psychological problems have been included in the WHO-initiated guidelines for home-based integrated care.
The reality for many people, once they reach an advanced age, is cohabitation with family members who may not be medically trained as nurses or caretakers. Just as the cost of giving birth in a hospital environment has risen, so has the cost of assisted living also gone up — leading more people to choose home-based options for both the beginning and the end of life.
Because of this, WHO targeted non-specialist healthcare providers who can assist in preventing or reversing declines in physical and mental capacity. Those with financial barriers like lack of adequate insurance might also try preventative management such as regular exercise, spiritual practice, and meditation, as well as making sure to obtain adequate sleep by following a regular bedtime schedule and taking natural sleep aids like valerian and chamomile.
As continued awareness allows people to seek help for mental health issues, organizations such as NAMI are encouraging online communities to address mental health stigma by talking about it out in the open. The more people are aware of the normality of mental health issues like anxiety and depression, the more older adults are likely to reach out, when in need of integrated care.
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What is the state of healthcare in your place of residence? Share your experience with integrated treatment and team-based health care in the comments section below.