Getting mental health care makes the body healthier — especially for the elderly
Taking care of our minds is an often neglected aspect of aging. What are we going to do about it?
- Studies have shown that depression can worsen in our old age.
- Other mental health concerns, too, are not only debilitating on their own but they can often make it more difficult to treat other health conditions.
- However, recent advances in how we treat mental health in the elderly are making a big difference. Here's how.
It's an unfortunate fact of life that as we grow older, our bodies stop working as well as they once did. Our muscles weaken, tying our shoes can send our backs into spasms, our hearing and vision isn't as sharp as it used to be. It's a time when taking care of yourself is more important than ever.
But we often forget that our minds, too, need to be taken care of. According to the CDC, 20% of people over 55 have some kind of mental health concern. Yet only two-thirds of this group receive treatment for their condition. Out of any other group, older men have the highest suicide rate. One study found that older patients were more likely to be diagnosed with a major depressive disorder, and that their depression grew worse with age. Older participants were more likely to have chronic depression, took longer to be in remission, and experienced depression with greater severity, according to the same study.
While mental health is enough of a concern on its own, it can also make treating physical health issues more difficult. "There is no clear-cut demarcation where behavioral health comorbidities start and where physical comorbidities end," said Dr. Joseph Conigliaro, Northwell Health's chief of general internal medicine. "When a patient with diabetes or congestive heart failure or any number of issues also has depression, anxiety, or schizophrenia, providing consistent care becomes much more challenging."
Percentage of older adults who claim they don't receive the social and emotional support they need by state, which can put individuals at risk for developing mental health conditions.
Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Atlanta, GA: National Association of Chronic Disease Directors; 2008.
Bringing psychiatry to primary care
How can we better meet the mental health needs of elderly patients? In his book, Healthcare Reboot, Michael J. Dowling points to the divide between psychiatry and primary care as a major issue. "While it was true that psychiatrics went to medical school," he writes, "their subsequent clinical training was so far removed from other doctors that they tended to live in a psychiatric silo. In many ways, psychiatrists had walled themselves off from the rest of the medical profession."
A Gallup poll on the perceived honesty of various professions shows another way in which psychiatry has been pushed aside. 85%, 75%, and 70% of respondents reported that nurses, pharmacists, and medical doctors had very high ethical standards, respectively. Only 41% of respondents reported that psychiatrists had very high ethical standards.
One way to bring psychiatry back into the domain of primary care is to do just that; tighten the connections between psychiatrists and general practitioners through the collaborative care model. In this system, a behavioral health care manager and a psychiatrist are incorporated into the primary care setting. The psychiatrist serves as a consultant for the primary care physician and the behavioral health care manager, who could be a psychologist or a nurse trained in managing mental health. The primary care provider has some training in screening patients for mental health issues. Rather than refer them to a psychiatrist, they can instead point them to the behavioral health care manager. This helps normalize the relationship between mental health and primary care and can reduce the stigma associated with seeking help for mental health conditions.
A study on the use of this model for older adults suffering from depression showed resounding success — using the collaborative care model doubled the efficacy of depression treatment. Over twelve months, half of the patients reported an at least 50% reduction in their depression symptoms compared with a 19% reduction in the control group. What's more, the system saves money. For every $1 spent on implementing the collaborative care model, hospitals get $7 back over the course of four years. Today, Northwell Health and other health care organizations have incorporated psychologists and other mental health professionals in their primary care clinics to help deliver the mental health care that elderly patients need.
Virtual reality: Not just for gaming
Addressing mental health issues in the elderly doesn't just have to take place in hospitals and clinics, however. Advances in technology are blurring the lines of where treatment can happen. Rendever, for instance, is a new project by MIT graduates that uses VR to help provide the elderly with mental health treatment. VR has the potential to serve as a powerful therapeutic tool for older adults, especially those in assisted living. Often, older adults in assisted living can feel isolated and trapped in their conditions; VR offers an avenue out of those conditions. In an interview with AARP, a co-founder of Rendever related a story about an isolated former pilot flying a simulated aircraft: "All of a sudden he was sitting in a pilot seat again, and all these stories started bubbling out of him." VR technology like Rendever have been used to treat PTSD, chronic pain, phobias, depression, and drug addiction. There's even some preliminary evidence that VR could be used to keep cognitive function sharp in old age.
From the clinic to the home
One major challenge for the elderly is mobility. It's not always practical for them to travel to a clinic, psychiatrist, or psychologist. The use of "virtual visits" has become increasingly more common for health organizations. Companies like Apple and Samsung are increasingly leveraging their smartphone technologies to provide easier access to healthcare records and tackle chronic conditions. For its part, Northwell researchers have helped pioneer the use of remote intensive care units, or eICUs, to watch over multiple patients at once from a central location.
It may seem as though technology like this wouldn't be useful for psychiatric issues; in fact, the opposite is true. For the elderly, easy access to a psychiatrist may make them more likely to reach out. For patients in assisted-living facilities or unable to travel, "telepsychiatry" is sometimes the only way they can gain access to a psychiatrist.
When it comes to the health of the elderly, a broken hip or a pneumonia diagnosis can overshadow the importance of maintaining a healthy mind in one's older years. Taking care of one's physical health will always be important, especially in geriatric patients, but it doesn't make sense to focus solely on treating a physical health issue while ignoring ongoing mental health concerns. Fortunately, advances in our institutions, systems, and technology are bringing mental health issues back into the spotlight.
Research suggests that aging affects a brain circuit critical for learning and decision-making.
As people age, they often lose their motivation to learn new things or engage in everyday activities. In a study of mice, MIT neuroscientists have now identified a brain circuit that is critical for maintaining this kind of motivation.
Researchers develop the first objective tool for assessing the onset of cognitive decline through the measurement of white spots in the brain.
- MRI brain scans may show white spots that scientists believe are linked to cognitive decline.
- Experts have had no objective means of counting and measuring these lesions.
- A new tool has just been published that both counts white spots and cleverly measures their volumes.
White spots and educated guesses<p>The white spots, or "hyperintensities," are brain lesions, fluid-filled holes in the brain believed to have been left behind by the breaking down of blood vessels that had previously provided nourishment to brain cells.</p><p>Prior to the new research, the quantity of white spots was assessed using an imprecise three-point scale indicating an ascending likelihoods of dementia: A minimal number of spots was considered as level 1, a medium number of spots level 2, and a great number of them level 3.</p>
How the new measurements were derived<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTc1OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNDQ1ODExNX0.vqhQJSvL99KjOe24TOs4E8R7c6-pprbXYSrGcIqbVps/img.jpg?width=980" id="c64d9" class="rm-shortcode" data-rm-shortcode-id="002d9b8ef47b5a86c3a387ad2cd90629" data-rm-shortcode-name="rebelmouse-image" />
Credit: sfam_photo/Shutterstock<p>The team of researchers from NYU's Langone's <a href="https://med.nyu.edu/departments-institutes/neurology/divisions-centers/center-cognitive-neurology" target="_blank">Center for Cognitive Neurology</a> and <a href="https://med.nyu.edu/departments-institutes/neurology/divisions-centers/center-cognitive-neurology/alzheimers-disease-research-center" target="_blank">Alzheimer's Disease Research Center</a> were led by <a href="https://med.nyu.edu/faculty/jingyun-chen" target="_blank">Jingyun "Josh" Chen</a>. They analyzed 72 MRI scans from a national database of older people taken as part of the <a href="http://adni.loni.usc.edu" target="_blank">Alzheimer's Disease Neuroimaging Initiative</a> (ADNI). The scans were mostly of white people over age 70, and there were a roughly equivalent number of men and women. Some had normal brain function, some were presenting moderate cognitive decline, and some had severe dementia.</p><p>Without knowing each individual's diagnosis, the researchers analyzed the white spots in their scans. While the team counted each scan's lesions, the innovation they introduced was the production of a 3D measurement for each lesion's fluid volume. The measurement was derived by measuring a lesion's distance from opposite sides of the brain.</p><p>Measurements of 0 milliliters (mL) were assessed for areas without white spots, with other white spots coming up as containing 60 mL of fluid. Chen's team predicted that volumes over 100 milliliters could signify severe dementia.</p><p>"Amounts of white matter lesions above the normal range should serve as an early warning sign for patients and physicians," Chen tells <a href="https://nyulangone.org/news/white-matter-lesion-mapping-tool-identifies-early-signs-dementia" target="_blank">NYU Langone Health NewsHub</a>.</p><p>When the team compared the likely diagnoses derived from their calculations against the individuals' medical records, they found that their predictions were correct about 7 out of 10 times.</p><p>The researchers compiled their formulas into a tool that's available to physicians online for free online at <a href="https://github.com/jingyunc/wmhs" target="_blank" rel="noopener noreferrer">GitHub</a>. The researchers plan to further refine and test it using an additional 1,495 brain scans representing a more diverse group of individuals from the ADNI database.</p>
The new tool and its limits<p>Chen notes that white spots alone may not tell the entire story of an individual's cognitive decline or the onset of dementia. Other factors must be considered as well, including memory loss, hypertension, and brain injuries.</p><p>Nonetheless, says senior investigator <a href="https://med.nyu.edu/faculty/yulin-ge" target="_blank">Yulin Ge</a>, "Our new calculator for properly sizing white matter hyperintensities, which we call 'bilateral distancing,' offers radiologists and other clinicians an additional standardized test for assessing these lesions in the brain, well before severe dementia or stroke damage."</p><p>Having an objective means of measuring white hyperintensities will allow physicians not only to get a better handle on the association between white spots and dementia, but also to track the spots alongside changes to a person's tau and beta-amyloid proteins, two chemicals implicated in Alzheimer's disease and dementia.</p>
Why not just divide the United States in slices of equal population?
- Slicing up the country in 10 strips of equal population produces two bizarre maps.
- Seattle is the biggest city in the emptiest longitudinal band, San Antonio rules the largest north-south slice.
- Curiously, six cities are the 'capitals' of both their horizontal and vertical deciles.
Sweeping re-alignments<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTAwOC9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYyMzU3ODA1NH0.u_5xakBvkYwgPtiwLU3z-1e082hBeqwS4Rl1uiJqdF4/img.png?width=980" id="23ff1" class="rm-shortcode" data-rm-shortcode-id="24a5b6ec251a11f3ed7aaefc205dde17" data-rm-shortcode-name="rebelmouse-image" alt="Printed in March 1812, this political cartoon was drawn in reaction to the newly drawn state senate election district of South Essex created by the Massachusetts legislature to favor the Democratic-Republican Party candidates of Governor Elbridge Gerry over the Federalists. The caricature satirizes the bizarre shape of a district in Essex County, Massachusetts, as a dragon-like "monster". Federalist newspaper editors and others at the time likened the district shape to a salamander, and the word gerrymander was a portmanteau of that word and Governor Gerry's last name." />
The original cartoon of the 'Gerry-Mander', published in 1812 in the Boston Centinel.
Image: Elkanah Tisdale (1771-1835), public domain.<p>One way for a political party to manipulate the outcome of elections is to 'gerrymander' electoral districts: manipulate their boundaries to increase the likelihood of a favorable outcome (see also #<a href="https://bigthink.com/strange-maps/53-ever-been-ger..." target="_blank">53</a>).</p><p><span></span>The term is almost as old as the United States itself, and the practice continues to disfigure the electoral map to this day. Perhaps these maps can serve as the inspiration for a radical solution. </p><p><span></span>They show the contiguous United States (i.e. without Alaska and Hawaii) sliced latitudinally and longitudinally into ten straight-bordered bands of varying size, so that each contains exactly 10% of the population. </p><p><span></span>Although certainly not intended as a reflection on electoral redistricting, it's tempting to see these sweeping re-alignments of the US as a suggestion with some potential in that direction. </p>
United Strips of America<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTA4MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NzE1MjQ1MX0.WpISo-g15B5O3qXbHXHf-7lQtAainpO7zPuizXWFOGs/img.jpg?width=980" id="d6656" class="rm-shortcode" data-rm-shortcode-id="72ed7c905283f9979ec0f82d451ad261" data-rm-shortcode-name="rebelmouse-image" alt="Reddit user curiouskip used U.S. Census population data to divide the 'Lower 48' into deciles (ten equal parts), each representing about 30.8 million people. Each decile is consigned its most populous city as 'capital'." />
The contiguous United States, divided into horizontal and vertical deciles.
Image: u/curiouskip, reproduced with kind permission.<p>Reddit user curiouskip used U.S. Census population data to divide the 'Lower 48' into deciles (ten equal parts), each representing about 30.8 million people. Each decile is consigned its most populous city as 'capital'.</p><p><span></span>Looking at the top map, which divides the U.S. into 10 longitudinal strips, we see</p><ul><li>Seattle rules the northernmost slice of territory. It is the broadest, and therefore also the emptiest one.</li><li>The Chicago, Omaha, New York City and Indianapolis strips complete the northern half of the country. And indeed: 50% of the population occupies roughly one half of the country, from north to south.</li><li>The dividing line between the top and bottom halves of the country runs from just north of the San Francisco Bay to halfway across the Delmarva Peninsula.</li><li>Capital cities of the southern strips are San Jose, Charlotte, Los Angeles, San Diego and Houston.</li><li>The Houston Strip is divided into two non-contiguous areas. Florida maintains its panhandle, albeit much reduced. </li></ul><p>The bottom map shows the U.S. divided latitudinally into 10 bands of equal population. </p><ul><li>San Jose and Los Angeles both retain their capital status, this time of the two westernmost strips.</li><li>San Antonio is the main city of the Big Empty, more than twice as wide as the second-broadest band.</li><li>The dividing line between America's eastern and western half, population-wise, is far off-center: it skirts the eastern edge of Chicago, making the western half much bigger than the eastern one.</li><li>Houston, Chicago and Indianapolis also remain the largest cities in their respective bands.</li><li>Further east, Jacksonville and Philadelphia get to rule over their strip of America, while Charlotte and New York City keep winning, both vertically and horizontally.</li></ul><p>Redistricting a country into zones of equal population – and that being your only criterium – will create districts that are randomly diverse, and perhaps also, at least in this case, unmanageably large. </p><p>However, mixing up the political map with a bunch of straight lines as the only instrument is something that has been considered before. Usually, the objective is the wholesale removal of age-old divisions. <br></p>
Perfectly square departments<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTEzOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYwOTQyMzIwOH0.kYuf58g0bjsPL9DGPq5PycZ7PDJMnItT0rfrPonOP3k/img.jpg?width=980" id="89a68" class="rm-shortcode" data-rm-shortcode-id="5b81a43e785997bb1f11f72548659a9f" data-rm-shortcode-name="rebelmouse-image" alt="\u200bCh\u00e2ssis figuratif du territoire de la France partag\u00e9 en divisions \u00e9gales entre elles, proposition annex\u00e9e au rapport du 29 septembre 1789 \u00e0 l'Assembl\u00e9e nationale de la commission dite Siey\u00e8s-Thouret" />
France divided into 80-odd geometrical departments: failed proposal by Jacques-Guillaume Thouret (1790).
Image: Centre historique des Archives nationales – Atelier de photographie; public domain.
European Pie<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTQ0Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTE5NDE3OX0.dPcY1tkO7nwkx6IX98Sleh7AmBpDnwlcJLfC_Z-WBlY/img.jpg?width=980" id="b35d7" class="rm-shortcode" data-rm-shortcode-id="84509a9425e13c0dd8fbe00df28a197e" data-rm-shortcode-name="rebelmouse-image" />
In this rather outlandish proposal, continental Europe's 24 cantons center on Vienna.
Image: PJ Mode Collection of Persuasive Maps, Cornell University.<p>And in 1920, an anonymous author – possibly the Austrian P.A. Maas – proposed slicing up Post-World-War-I Europe as a pie, into 24 slices that would center on Vienna's St. Stephen's Cathedral. Each of those slices would be made up of a wide and random variety of linguistic, ethnic and religious groups – and that would be the point: the better to unite them all into one massive superstate (see also #<a href="https://bigthink.com/strange-maps/a-bizarre-peace-proposal-slice-europe-up-like-a-pie" target="_blank">851</a>).</p><p>Needless to say, both plans never left the drawing board. Would a proposal for the longitudinal and/or latitudinal redistricting of the U.S. have more traction? <br></p>
Coast-to-coast precedents<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDYwMTIwOS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MDM2OTE0OX0.52UjcA_YD9Y9UB9_hoSctI_xBrRDALZ2DRLkIo9a8RM/img.jpg?width=980" id="10784" class="rm-shortcode" data-rm-shortcode-id="1999808ea21e11162fdb9181c3912753" data-rm-shortcode-name="rebelmouse-image" alt="Illustration of the Connecticut Charter boundary, 1662" />
Putting the 'connect' into Connecticut: the Nutmeg State extending from the Pacific to the Atlantic.
Image: Connecticuthistory.org<p>Well, for one, coast-to-coast polities have some pedigree in America's past: some of the first colonies had claims that extended from the Atlantic all the way to the Pacific. </p><p>If history had gone entirely the way Connecticut would have wanted, the state would include such inland cities as Detroit, Chicago and Salt Lake City, and extended to what is now the northern part of California.</p><p>Is such geopolitical weirdness reasonable or feasible today? Absolutely not. But in its randomness, would it be it as unfair as gerrymandering? </p><p><em><br></em></p><p><em>Decile maps of the contiguous United States reproduced with kind permission by u/curiouskip; found <a href="https://www.reddit.com/r/dataisbeautiful/comments/ijyn7p/oc_us_population_deciles_by_latitude_and_longitude/" target="_blank">here</a> on <a href="https://www.reddit.com/" target="_blank">Reddit</a>.<br></em></p><p><strong>Strange Maps #1054</strong></p><p><em>Got a strange map? Let me know at </em><a href="mailto:email@example.com">firstname.lastname@example.org</a><em>.</em></p>
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