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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Unhealthy diets cause the part of your brain responsible for appetite to become inflamed, encouraging further eating and obesity.

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  • Anyone who has tried to change their diet can tell you it's not as simple as simply waking up and deciding to eat differently.
  • New research sheds light on a possible explanation for this; high-fat diets can cause inflammation in the hypothalamus, which regulates hunger.
  • Mice fed high-fat diets tended to eat more and become obese due to this inflammation.

Your wardrobe won't be the only thing a bad diet will change in your life — new research published in Cell Metabolism shows that high-fat and high-carbohydrate diets physically change your brain and, correspondingly, your behavior. Anyone who has tried to change their diet can tell you that it's far more challenging than simply deciding to change. It could be because of the impact high-fat diets have on the hypothalamus.

Yale researcher Sabrina Diano and colleagues fed mice a high-fat, high-carb diet and found that the animals' hypothalamuses quickly became inflamed. This small portion of the brain release hormones that regulate many autonomic processes, including hunger. It appears that high-fat, high-carb diets create a vicious cycle, as this inflammation caused the mice to eat more and gain more weight.

"There are specific brain mechanisms that get activated when we expose ourselves to specific type of foods," said Diano in a Yale press release. "This is a mechanism that may be important from an evolutionary point of view. However, when food rich in fat and carbs is constantly available it is detrimental."

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The main driver of this inflammation appeared to be how high-fat diets changed the mice's microglial cells. Along with other glial cells, microglia are a kind of cell found in the central nervous system (CNS), although they aren't neurons. Instead, they play a supporting role in the brain, providing structure, supplying nutrients, insulating neurons, and destroying pathogens. Microglia work as part of the CNS's immune system, seeking out and destroying foreign bodies as well as plaques and damaged neurons or synapses.

In just three days after being fed a high-fat diet, the mice's microglia activated, causing inflammation in the hypothalamus. As a result, the mice started to eat more and became obese. "We were intrigued by the fact that these are very fast changes that occur even before the body weight changes, and we wanted to understand the underlying cellular mechanism," said Diano.

In mice fed with a high-fat diet, the researchers found that the mitochondria of the microglia had shrunk. They suspected that a specific protein called Uncoupling Protein 2 (UCP2) was the likely culprit for this change, since it helps to regulate the amount of energy microglia use and tends to be highly expressed on activated microglia.

To test whether UCP2 was behind the hypothalamus inflammation, the researchers deleted the gene responsible for producing that protein in a group of mice. Then, they fed those mice the same high-fat diet. This time, however, the mice's microglia did not activate. As a result, they ate significantly less food and did not become obese.

An out-of-date adaptation

When human beings did not have reliable access to food, this kind of behavioral change would have been beneficial. If an ancient human stumbled across a high-fat, calorically dense meal, it would make sense for that individual to eat as much as they could, not knowing where it's next meal would come from.

But there were no Burger Kings during the Pleistocene. Humanity has been extraordinarily successful in changing its environment, but our genome has yet to catch up. The wide availability of food, and especially high-fat foods, means that this adaptation is no longer a benefit for us.

If anything, research such as this underscores how difficult it is to really change bad habits. A poor diet isn't a moral failing — it's a behavioral demand. Fortunately, the same big brains that gave us this abundance of food can also exert control over our behavior, even if those brains seem to be working against us.

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