Philosophers, religious leaders, and anthropologists have long asserted that the true measure of the goodness of a culture is how it treats those hardest to care for — namely children and the elderly. According to a new report by the National Research Council, our society is missing the mark.

The report specifically examined the ability of U.S. healthcare workers to meet the mental health needs of an aging population. In 2010, 40.3 million Americans were 65 years or older. By 2030, that number will grow to 72.1 million. Currently, an estimated 1 in 5 of these older adults have at least one mental health or substance abuse condition. Depressive disorders and dementia-related symptoms are the most common problems.  Additionally, age alters the body’s ability to metabolize medications and cognitive impairments lead to an inability for self-care. These age-related issues lead to multiple healthcare challenges, including high costs, decreased quality of life, and increased morbidity and mortality. To add insult to injury, the report claims that there is a shortage of healthcare workers who are able to care for these elderly patients.

Primary care providers are currently ill-equipped to care for the mental healthcare needs of an aging population. And, as the aging population grows and becomes more diverse, providers will fall further behind in their ability to care for the elderly. Most providers receive little training in geriatric care and virtually no training on mental health in this specific population. The authors of the IOM report cite a lack of financial incentives and mentorship opportunities within this specialty. They released the report as a wake-up call to the nation that will, hopefully, prompt an expansion and preparation of a geriatric healthcare workforce. The authors suggest augmenting Medicare and Medicaid reimbursement for mental health and substance abuse counseling services and intensifying government grants and programs that encourage professional training in geriatrics.

However, all of these recommendations require money and time — two other things facing significant shortages in the American healthcare system. Inadequate training and personnel shortages are not easily overcome. Coordinated efforts by health professional and social services schools, agencies that promote training in geriatric care, and public and private care providers must espouse a new attitude toward caring for an aging population. Educational experiences that encourage a quality-of-life, rather than just a medical, approach to geriatric care has proved successful in some healthcare curriculums. Clinical knowledge and didactic education are obviously important for improving the care of elderly patients, but the attitude and affective knowledge gained through non-clinical interactions with older adults may be the best approach to expand and improve the care of our aging population. Affection and care for the elderly are truly gold mines of a culture. If we are not able to care for those who have spent their lifetimes caring for us, what kind of care can we expect in our own golden years?

References

Henderson J, Xiao L, Siegloff L, Kelton M, & Paterson J (2008). ‘Older people have lived their lives’: first year nursing students’ attitudes towards older people. Contemporary nurse, 30 (1), 32-45 PMID: 19072189

National Research Council. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? Washington, DC: The National Academies Press, 2012.

Rosen J, Stiehl E, Mittal V, Fox D, Hennon J, Jeste D, & Reynolds CF 3rd (2012). Late-Life Mental Health Education for Workforce Development: Brain Versus Heart? The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry PMID: 22935925

Turner A, Hochschild A, Burnett J, Zulfiqar A, & Dyer CB (2012). High prevalence of medication non-adherence in a sample of community-dwelling older adults with adult protective services-validated self-neglect. Drugs & aging, 29 (9), 741-9 PMID: 23018610

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