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.
How Nobel Prize winner physicist Lev Landau ranked the best physics minds of his generation.
Rank 0.5 – Albert Einstein<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0NDY3NS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNjI2NTU4OH0.FtBYC7oJz-ZOiiGC9y0Z50_JvQChmp-ONa3jhR3SuLA/img.jpg?width=980" id="d6f66" class="rm-shortcode" data-rm-shortcode-id="61288810a4f035ec2af8957fad4e9015" data-rm-shortcode-name="rebelmouse-image" />
Albert Einstein With Displaced Children From Concentration Camps. 1949.
Photo by Keystone-France/Gamma-Keystone via Getty Images
Rank 1<p>The group in this class of the smartest physicists included the top minds that developed the theories of quantum mechanics.</p><p><a href="http://en.wikipedia.org/wiki/Werner_Heisenberg" target="_blank">Werner Heisenberg</a> (1901 - 1976) - a German theoretical physicist, who's achieved pop-culture fame by being the name of Walter White's alter ego in <em>Breaking Bad</em>. He is known for the Heiseinberg Uncertainty Principle and his 1932 Nobel Prize award flatly states it was for nothing less than "the creation of quantum mechanics".</p><p><a href="http://en.wikipedia.org/wiki/Erwin_Schr%C3%B6dinger" target="_blank">Erwin Schrödinger</a> (1887 - 1961) - an Austrian-Irish physicist who gave us the infamous "Schroedinger's Cat" thought experiment and other mind-benders from quantum mechanics. The Nobel-prize-winner's <a href="https://en.wikipedia.org/wiki/Schr%C3%B6dinger_equation" target="_blank" rel="noopener noreferrer">Schrödinger equation</a> calculates the <a href="https://en.wikipedia.org/wiki/Wave_function" target="_blank">wave function</a> of a system and how it changes over time. </p>
Erwin Schrödinger. 1933.
Satyendra Nath Bose. 1930s.
Enrico Fermi. 1950s.
Rank 2.5<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQ0NDcwNy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NDE1MDIxM30.Eg6tca61EredHxjqNH29HY3UeJbgBVa1nA13EhXTooU/img.jpg?width=980" id="90f86" class="rm-shortcode" data-rm-shortcode-id="0f1e6c5e13263a77b2061e1191fd8baf" data-rm-shortcode-name="rebelmouse-image" />
Lev Landau. 1962.<p><strong>Rank 2.5</strong> is where Landau initially ranked himself, rather modestly, thinking he didn't produce any foundational accomplishments. He later moved his prominence, as his achievement mounted, to the higher <strong>1.5.</strong></p>
- Anxiety levels are increasing due to the pandemic and political uncertainty right now.
- Anxiety and depression cost the economy $50 billion in health care costs and lost work every year.
- These six books covers anxiety's physiology, environmental factors, and potential treatments.
You’re Wired for Anxiety. And You’re Wired to Handle It | Anne Marie Albano | Big Think<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="006926deaed2698d42ef27cba83f173a"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/mUv37ttgQVE?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><h2>Anxious: Using the Brain to Understand and Treat Fear and Anxiety - Joseph Ledoux</h2><p>Neuroscientist Joseph Ledoux has written <em>the</em> go-to book for understanding everything about anxiety: how it arises in consciousness, its physiological manifestation, reshaping psychotherapy, environmental stressors—you name it. Ledoux argues that you must treat the outward symptoms <em>and</em> inner causes if you want to holistically address anxiety. He points out that uncertainty about the future (and how to prepare for it) is a common trigger for anxiety disorders, which puts 2020 into perspective. </p><p style="margin-left: 20px;">"Patients with panic disorder…have a hypersensitive suffocation alarm system, which falsely detects a dangerous level of CO2 and lead to hyperventilation, which in turn produces an actual rise in CO2 (due to short, fast inspiration). The resulting dizziness and light-headedness lead the person to misinterpret the physiological changes and worry and dread follow in the panic-stick person."</p><h2>The Upside of Stress: Why Stress is Good For You, and How to Get Good At It - Kelly McGonigal</h2><p>Health psychologist Kelly McGonigal flips the anxiety script on its head in this inspiring and motivational work on the advantages of stress. Anxiety is part of life—we've known that since Freud, and intuitively, long before (Kierkegaard had a few things to say as well). What if you can reframe that physiological energy and use it as a catalyst for action? McGonigal offers plenty of ways you can do just that. </p><p style="margin-left: 20px;">"One of the effects of the biological stress response is to make you more open to your experience. You feel things more, and your ability to notice expands. You are more sensitive to other people and to your environment."</p><h2>My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind - Scott Stossel</h2><p>Scott Stossel, a longtime editor of <em>The Atlantic</em>, has suffered from crippling anxiety for years. This half-memoir, half-exposé offers a compassionate gaze into the personal and societal complications of anxiety. Stossel investigates the many attempts at therapy, from the common to the outlandish. Most importantly, he offers real-world advice for controlling and managing symptoms. </p><p style="margin-left: 20px;"> "Conscientious people who were highly neurotic tended to be more reflective, more goal oriented, more organized, and better at planning than average; they tended to be effective, 'high-functioning' workers—and to be better at taking care of their physical health than other workers."</p>
Photo: Lightspring / Shutterstock<h2>The Trauma of Everyday Life - Mark Epstein</h2><p>In this beautiful handbook for life, psychiatrist Mark Epstein puts Buddhism into action. He claims humans are all traumatized in some capacity, which creates lasting and often subconscious anxiety. Epstein uses the vast toolkit of Buddhist philosophy to reengineer trauma as a catalyst for transformation. The first step is not only striving for what is good and pleasant. You have to face trauma head-on. If you do, Epstein assures us, the world is yours. </p><p style="margin-left: 20px;">"The key, taught the Buddha, lies in not taking trauma personally. When it is seen as a natural reflection of the chaotic universe of which we are a part, it loses its edge and can become a deeper object of mindfulness."</p><h2>How Emotions Are Made: The Secret Life of the Brain - Lisa Feldman Barrett</h2><p>We don't react to situations, writes psychology professor Lisa Feldman Barrett. Rather, we constantly create our reality. It only feels like reacting because of how deeply our patterns are imprinted. Fortunately, patterns are malleable. In this spellbinding book about the nature of emotions and human consciousness, Barrett leads the reader through the historical construction of emotions, assuring you that you don't need to be the victim of your mind. You are the author of your experiences. </p><p style="margin-left: 20px;">"[Emotions] are not triggered; you create them. They emerge as a combination of the physical properties of your body, a flexible brain that wires itself to whatever environment it develops in, and your culture and upbringing, which provide that environment." </p><h2>Wayfinding: The Science and Mystery of How Humans Navigate the World - M.R. O'Connor</h2><p>There's something beautiful about getting lost. Not only does it make you notice your surroundings, it activates parts of your brain that remain silent when you default to using Waze for navigation. Science writer Maura O'Connor's exquisite book reminds us of what we've lost in an automated world and the anxiety this "ease" adds to our lives. Of course, she also offers solutions that keep you mentally engaged and emotionally healthy. </p><p style="margin-left: 20px;">"Mapping is an act of committing to memory the experience of bodily movement and reenacting it. It's a kind of performance, like telling a story."</p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank" rel="noopener noreferrer">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
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