Older Adults and Mental Health: Issues and Opportunities
The AOA report Older Adults and Mental Health: Issues and Opportunities20 was written as a companion document to the Surgeon General's report on Mental Health.21 The report highlights the major issues in the field of mental health and aging and focuses on community services available to older persons, particularly those funded through the aging network by the Older Americans Act and/or by state, local, or private sources or programs such as Title XX, Medicare, or Medicaid.
The report highlights several strategies for addressing the mental health issues of older adults, while emphasizing the need for expanded partnerships to ensure that appropriate and effective services are widely available. Among the strategies advocated by the report are increased emphasis on health promotion, disease prevention and early intervention services, increasing collaboration among providers and with consumer groups, increasing public awareness and education about mental health issues, and addressing the needs of special populations.
NIA Behavioral and Social Research Program
This program supports research on changes in cognitive functioning over the life course through its Individual Behavioral Process Branch. This program encourages a number of studies that: (1) examine the influence of contexts on the cognitive functioning of aging persons; (2) investigate the effects of age-related changes in cognition on activities of daily living, social relationships, and health status; and (3) develop strategies for improving everyday functioning through cognitive interventions. Topics such as problem solving and decision making, social cognition, memory strategies, and reading and speech comprehension are of primary interest.18 We summarize a few of the studies in these areas below.
Alzheimer's Disease Anti-Inflammatory Prevention Trial (ADAPT)
ADAPT is a clinical trial, introduced in 2001, designed to test the use of anti-inflammatory medications for the prevention of Alzheimer's disease. Previous epidemiological studies have suggested an association between the use of anti-inflammatory drugs and decreased risk for Alzheimer's disease. In this study, two specific drugs--Naproxen and Celecoxib--will be tested for their ability to prevent Alzheimer's disease. Study participants are 70 years old or older and have a parent or sibling who has or had serious age-related memory loss, dementia, senility, or Alzheimer's disease.22
Moderate Exercise Program for Older Women Caregivers
This study was designed to assess the physical and mental health effects of exercising four times a week among 100 women aged 49 to 82. It was the first investigation of the effectiveness of a physical activity intervention tailored specifically to the mental and physical needs of caregivers. In comparison to women receiving only nutrition counseling, moderate exercisers slept better and lowered their blood pressure reactivity to stress tests.
Given that many women eventually will provide care to an ill or disabled relative, the findings of this study are very important. Dr. Sidney M. Stahl, Chief of Behavioral Medicine within the NIA's Behavioral and Social Research Program noted that "studies show that family caregiving accompanied by emotional strain is an independent risk factor for mortality among older adults. The study gives us some evidence that a self-directed exercise program can reduce stress reactions and perhaps improve the health of caregivers. This pilot intervention trial provides encouraging results and hope for a low-cost, effective means to combat caregiver stress."23
SAMHSA Mental Health and Aging Activities
Although SAMHSA's programs are often targeted to children and younger adults, the agency has sponsored several activities focused on health promotion and disease prevention for older adults. These activities are highlighted below.
SAMHSA and NCOA Joint Project
In FY 1999, SAMHSA and the NCOA began a project to identify ways to engage the aging services network (e.g., senior centers, adult day care programs, and nutrition programs) in addressing the mental health needs of older adults. Through meetings with consumers and substance abuse, mental health, and aging services providers, two key priorities were identified: (1) increased awareness at all levels (including older adults, aging services staff, substance abuse and mental health services staff, federal/state/local public officials) of the substance abuse and mental health issues facing older adults, and (2) greater knowledge among services providers about how to address substance abuse and mental health problems among their clients.
SAMHSA and NCOA have responded to these identified needs by implementing two projects. The first is the development of a manual for community-based programs on promising practices/successful strategies for partnership between aging services organizations and substance abuse and mental health providers to address the needs of older adults.
The second is the design of a tool kit to educate staff and clients at aging services organizations about how to identify and address substance abuse and mental health problems among older adults.
Both projects are being advised by a group of approximately 20 partners--national organizations that represent leading constituencies in the substance abuse, mental health, and aging communities.
Substance Abuse Prevention and Treatment Block Grant (SAPTBG) Program
The Substance Abuse Prevention and Treatment Block Grant (SAPTBG), administered by the Center for Substance Abuse Treatment (CSAT) and Center for Substance Abuse Prevention (CSAP), provided $1.6 billion in 2001 to states and territories (including one tribal government) to support substance abuse treatment and prevention services for persons at risk of abusing alcohol and drugs. The SAPTBG supports state activities to maintain viable treatment capabilities and to respond to the citizens who are at greatest risk of or who are abusing alcohol and illegal drugs.
The SAPTBG accounts for approximately 49 percent of all public funds spent by the states for substance abuse prevention and treatment. Using the SAPTBG application as a data source, CSAT collects data from the states on treatment needs for alcohol and drug abuse by race/ethnicity, sex, and age cohort (including persons 45 to 64 years of age and persons 65 years and older.) These data are analyzed annually by state and sub-state planning areas.24
Treatment Improvement Protocol (TIP) on Substance Abuse
SAMHSA's CSAT is developing a series of consumer and provider-oriented materials related to the 1998 Treatment Improvement Protocol (TIP) on Substance Abuse Among Older Adults. These materials will include consumer brochures on substance abuse and the importance of good mental health in preventing substance abuse among seniors, a poster, a provider reference guide, and a pocket screener.24
Community-Initiated Prevention Intervention Program
A grant award was made in FY 1999 to ASA under the CSAP Community-Initiated Prevention Intervention Program. Through this grant, ASA will refine, adapt, and test an alcohol abuse prevention intervention in a community setting with at-risk older adults to determine its effectiveness and potential use in other situations.
Over the past year, CSAP has worked with NCOA and others to disseminate the Community-Initiated Prevention Intervention Program grant announcement and pre-application workshop mailers to the aging services constituency. It is hoped that additional grants targeting seniors will be forthcoming.24