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."

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.

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.

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.

Photo by Anthony Metcalfe on Unsplash

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.

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As with much health advice, the simplest prescriptions seem to be the most effective. Common sense reigns supreme. That's the consensus of a new study, published in Scientific Reports on June 13, which offers the most basic guidelines imaginable: spending at least two hours a week in nature will do wonders for your health.

The researchers, based at the U.K.'s Exeter Medical School, scoured previous studies to better understand how simply being outside benefits us. What did they find? They discovered being immersed in nature lower probabilities of asthma hospitalization, cardiovascular disease, diabetes, mental distress, obesity, and mortality in adults; it has also been shown to reduce obesity and myopia in children.

Two hours weekly appears to be the sweet spot, with peak positive associations capping between 200–300 minutes. One caveat: the research is based on nearly 20,000 people that live in dense urban regions. This makes sense, as it is this population most in need of woods, lakes, and mountains. There's only so much one can take staring at asphalt (or a screen).

That being in nature bestows health benefits shouldn't be surprising; it is where humans spent most of their time until quite recently. Many other prescriptions, from Japanese forest bathing to Swedish plogging (cleaning up trash in natural environments) have been touted as being mentally and physically positive activities. It seems the further disconnected from nature we become, the more we crave it.

It doesn't matter how you break up the weekly 120 minutes. A daily walk or a once-weekly hike both do the trick. The researchers also don't differentiate between environments. A local park appears to be as effective as an oceanside hike or heading deep into the forest.

Prescribing Nature for Health | Nooshin Razani | TEDxNashville

Such information is especially important considering that 68 percent of the world's population is expected to live in urban areas in the next three decades. Social animals by nature, the allure of cities is pulling residents to congregate in tighter proximity. The trade-off is further disconnection from the land that first gave birth to our species.

Of course, escape is always possible. Motivation and time management are key factors. Consider the varied possibilities for those living in New York City. You can always jump on a train in any direction: east to the Rockaways and Long Island, north to New York State's incredible hiking, west to the Delaware Water Gap, south to plenty of green space in Jersey. Making it part of your week is the real challenge for Manhattanites that rarely leave their borough.

On the other side of the nation, nature is everywhere in Los Angeles. Ironically, the metropolis boasts the fewest public parks in the world for a city of this size. Again, time management and motivation: getting to the mountains is possible from most parts of the city within 20 minutes. The benefits are worth it. Being proactive about your health is the challenge.

Interestingly, the study draws the line at 120 minutes. Participants that logged between one and 119 minutes reported no better subjective well-being than those who spent no time in nature. The threshold appears to be 120 minutes, with benefits lasting up to 300 minutes. At that point, no further benefits accrue.

Photo credit: Blake Richard Verdoorn on Unsplash

Medical professionals are also recognizing this trend. In Scotland, doctors are authorized to prescribe nature walks to their patients. As far back as the '70s doctors realized that hospital patients with more natural light in their rooms healed quicker than those facing buildings or other obstructions.

City governments realize that urban regions need to include plenty of green space. The Brooklyn waterfront is being transformed from ports of industry to parks of leisure. In 2008, Portland, Oregon, launched its Grey to Green initiative to reimagine its entire infrastructure. Even as Copenhagen is becoming a tech leader, the nine artificial islands under construction of the city's coast includes plenty of green space.

While cities and doctors are playing a role in bringing us closer to nature, it's still up to us city dwellers to put in the effort. Personal history, biodiversity, and even ethnicity are involved in the study above. As the team writes,

"Research considering the quality of the natural environment in terms of plant and/or animal species richness suggests that experiences may be better in more biodiverse settings. Contact with nature is more than just a complex multi-sensory experience, to varying degrees personal histories and meanings, longstanding cultural practices, and a sense of place play some role in the benefits realized, factors which may account for why we did not find the same pattern for health individuals not identifying as White British."

Even weighing in these factors, the message is clear: get outdoors. We were born of this earth. The less time we spend locked away from it, the more likely we are to experience negative mental and physical health. Fortunately, the opposite is also true. We just have to step outside.

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