Addressing the Rising
Mental Health Needs of
an Aging Population
__________
Alexandra Andrada, Kat M. Anderson,
and Sharyl J. Nass, Rapporteurs
Forum on Mental Health and Substance
Use Disorders
Forum on Aging, Disability, and
Independence
Board on Health Care Services
Health and Medicine Division
Proceedings of a Workshop
NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Purchase Order No. 75FCMC22P0038 with the Centers for Medicare & Medicaid Services and Contract No. HHSN263201800029I, Order No. HHSN26300025 with the National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health), and by the American College of Clinical Pharmacy, American Psychiatric Association, American Psychiatric Nurses Association, American Psychological Association, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Council on Social Work Education, Janssen Research & Development, LLC, Office of the Assistant Secretary for Planning and Evaluation, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust.
International Standard Book Number-13: 978-0-309-71257-6
International Standard Book Number-10: 0-309-71257-2
Digital Object Identifier: https://doi.org/10.17226/27340
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the rising mental health needs of an aging population: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27340.
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WORKSHOP PLANNING COMMITTEE1
JIE CHEN (Co-Chair), Professor, Department of Health Policy and Management, Director, The Hospital and Public health InterdisciPlinarY Research (HAPPY) Lab
CHARLES F. REYNOLDS, III (Co-Chair), Distinguished Professor of Psychiatry and UPMC Endowed Professor in Geriatric Psychiatry, University of Pittsburgh School of Medicine (emeritus)
JENNIFER BEAN, Clinical Pharmacist Practitioner, Geriatric Mental Health, Pharmacy Service, VISN 9 Clinical Resource Hub
KIRSTEN BERONIO, Senior Policy Advisor, Center for Medicaid and CHIP Services
MICHAEL B. FRIEDMAN, Adjunct Associate Professor, Columbia University School of Social Work
NARDA IPAKCHI, Vice President of Policy, The SCAN Foundation
VINCENT MOR, Florence Pirce Grant Professor, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence RI U.S. Department of Veterans Affairs
EMMA NYE, Public Health Analyst, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Staff
ALEXANDRA ANDRADA, Director, Forum on Mental Health and Substance Use Disorders
ISAAC SUH, Research Associate
ANESIA WILKS, Senior Program Assistant
TRACY LUSTIG, Director, Forum on Aging, Disability, and Independence
SHARYL J. NASS, Senior Director, Board on Health Care Services
Consultant
KAT M. ANDERSON, Consulting Writer
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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Reviewers
This Proceedings of Addressing the Rising Mental Health Needs of an Aging Population was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID REUBEN, University of California, Los Angeles. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The National Academies of Sciences, Engineering, and Medicine’s Forum on Mental Health and Substance Use Disorders wishes to express its sincere gratitude to the planning committee co-chairs Jie Chen and Charles Reynolds III for their valuable contributions to the development and organization of this workshop, in addition to the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. The forum wishes to thank all the speakers who shared a perspective on living with a mental illness as an older adult or caring for an older adult with mental illness: Michael B. Friedman (planning committee member), Charita Cole Brown, Sandra Cohen, Nicole Jorwic, and Harvey Rosenthal. Finally, the forum wants to thank all the speakers and moderators, who generously shared their expertise and their time with workshop attendees. Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to its work. The sponsors include the American College of Clinical Pharmacy, American Psychiatric Association, American Psychiatric Nurses Association, American Psychological Association, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Council on Social Work Education, Janssen Research & Development, LLC, the National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health), Office of the Assistant Secretary for Planning and Evaluation, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foun-
dation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust. The sponsors of the Forum on Aging, Disability, and Independence include AARP; Administration for Community Living; American Geriatrics Society; Consumer Technology Association Foundation; The Gerontological Society of America; John A. Hartford Foundation; LeadingAge; National Institute on Aging; National Institute on Disability, Independent Living, and Rehabilitation Research; PHI; and SCAN Foundation.
Contents
Demographics and Epidemiology: Mental Health Disorders in Older Adults
Psychotic Disorders: Schizophrenia in Later Life
Exploring Strategies to Address the Needs of Older Adults With Major Depression
Substance Use Disorders in Older Adults
NEUROBIOLOGICAL VIEW OF MENTAL HEALTH AND SUBSTANCE USE DISORDERS
Co-Occurrence of Dementia and Mental Health Conditions
HEALTH DISPARITIES AND SOCIAL DETERMINANTS OF HEALTH
Race and Ethnic Disparities in Aging Populations: Black Older Adults
Medi-Cal Expansion to Older Undocumented Immigrants
INTEGRATION, ACCESS, QUALITY, COST, AND EQUITY
Integrating Behavioral Health Services and Primary Care
Public Health Integration Into Accountable Care Organizations
Overview: Workforce Needs to Support the Well-Being of Older Adults With Mental Health Conditions
Clinical Pharmacist Practitioners
Cultivating Interprofessional Teams
RISK REDUCTION, PREVENTION, AND EFFECTIVE INTERVENTIONS
Wellness Through Meaningful Activities
Universal, Selective, and Indicated Depression Prevention
Promoting Resilience and Positive Mental Health in Older Adults
Building Community-Based Partnerships
Boxes, Figures, and Table
BOXES
1 Key Takeaways from Speakers in Session 1: Clinical Context
2 Key Takeaways from Speakers in Session 2: Health Disparities and Social Determinants of Health
3 Key Takeaways from Speakers in Session 3: Integration, Access, Quality, Cost, and Equity
4 Key Takeaways from Speakers in Session 4: Workforce
5 Key Takeaways from Speakers in Session 5: Risk Reduction, Prevention, and Effective Interventions
6 Key Takeaways from Speakers in Session 6: Supportive Communities
7 Key Takeaways from Speakers in Session 7: Challenges and Priorities
FIGURES
1 National age distribution of the U.S. population, 2020–2060
2 Poverty rate for individuals aged 65 and older by race and ethnicity, 2020
Acronyms and Abbreviations
AA | Alcoholics Anonymous |
ACA | Affordable Care Act |
ACO | accountable care organization |
AI/AN | American Indian/Alaska Native |
AOA | Administration on Aging |
ASPE | Assistant Secretary for Planning and Evaluation |
CCBHC | Certified Community Behavioral Health Clinics |
CDC | Centers for Disease Control and Prevention |
CMM | Comprehensive Medication Management |
CMS | Centers for Medicare & Medicaid Services |
DSM | Diagnostic and Statistical Manual of Mental Disorders |
e-SMILE | System-Level Multidisciplinary Integration of population health and Equity |
FUNSAT | Functional Skills Assessment and Training |
HAPPY | Hospital And Public health interdisciPlinarY |
HHS | U.S. Department of Health and Human Services |
HRSA | Health Resources and Services Administration |
ICD | International Classification of Diseases |
IMPACT | Improving Mood—Promoting Access to Collaborative Treatment |
IOM | Institute of Medicine |
IT | information technology |
LCSW | Licensed Clinical Social Worker |
LGBTQIA+ | Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual people |
MCI | mild cognitive impairment |
MRI | magnetic resonance imaging |
NAMI | National Alliance on Mental Illness |
NASEM | National Academies of Sciences, Engineering, and Medicine |
NCOA | National Council on Aging |
NIDA | National Institute on Drug Abuse |
NIH | National Institutes of Health |
NYAPRS | New York Association Psychiatric Rehabilitation Services |
OAA | Older Americans Act |
PCP | primary care provider/physician |
PET | positron emission tomography |
PGD | prolonged grief disorder |
PRISM | Personal Reminder Information and Social Management |
PTSD | posttraumatic stress disorder |
RAPP | Release Aging People in Prison |
REACH | Realizing Equity, Access, and Community Health |
SAMHSA | Substance Abuse and Mental Health Services Administration |
SASP | Senescence-Associated Secretory Phenotype |
SBIRT | Screening, Brief Intervention, and Referral to Treatment |
SUD | substance use disorder |
UW | University of Washington |
VA | Department of Veterans Affairs |
WHO | World Health Organization |