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Finding solutions to a gray future

February 1, 2008
by Ronald W. Manderscheid, PhD
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Provider organizations can take concrete steps to prepare and care for aging baby boomers

Afew months back, the first baby boomer signed up for Social Security retirement payments. This watershed event was heralded with news stories about the growth of the elderly population, Generations X and Y's unwillingness to support higher taxes to pay for their elders’ care, and the likely demise of the Social Security system.

The country's elderly population is expected to more than double between 2000 and 2030, growing from about 35 million to more than 71 million. At the same time, the total U.S. population will grow from about 282 million to 364 million. A little arithmetic shows that almost half of the anticipated growth in the U.S. population between 2000 and 2030 will be due to the growth of the elderly population. Americans are living longer; those age 85+ are the fastest growing group.

Viewed conservatively using our best epidemiologic data, the growth of the elderly population during this 30-year interval will lead to almost 6 million

new cases of mental illness cumulatively over this period, including more than 2 million

new cases of serious mental illness. These new cases will be in addition to the approximately 5 million current annual cases in today's elderly population, including 2 million current SMI cases.





To put these numbers into perspective, the U.S. mental healthcare system currently serves slightly more than 12 million consumers per year. The growth of the elderly population has the potential to create a greater demand for services that could increase this figure considerably. For example, the number served could grow to 15 million if just half of the new gero-consumers are served by mental healthcare providers.

An immediate issue is the degree to which our current mental healthcare services are prepared to handle the increased volume of gero-consumers over the next quarter century. In my January 2007 column, I discussed the current mental healthcare workforce and the need for new training programs. Like American society itself, the mental healthcare workforce is aging. Many program managers are baby boomers, as are many clinical staff members; for example, the average age of a practicing psychiatrist is about 57. The retirement of these managers and clinicians over the next decade will lead to increased system strains as more gero-consumers seek care.

Our mental healthcare service programs generally are not oriented to gero-consumers. Most of our clinical research is conducted using younger adults. This raises the question of whether the clinical protocols derived from current research are applicable to gero-consumers. Furthermore, most gero-consumers likely will have a primary care provider, and many are likely to be taking medications for chronic diseases, such as high blood pressure and heart disease. Hence, the potential risks of medication interactions can be expected to be more significant in this population than in other age groups.

Organizational planning, strategic approaches, service linkages, and new types of services will be required to prepare and care for the increase in gero-consumers. Below I present ten propositions to foster both thinking and action in behavioral healthcare organizations.

Set up a council of gero-consumers. This council can provide practical advice on how best to make mental healthcare and related support services available to the elderly population.

Invite retired mental healthcare providers to serve as emissaries to the elderly population. These emissaries can explain services and be trusted points of referral into specialty mental healthcare services.

Work directly with AARP chapters on service strategy development. As the largest national organization representing the elderly population, AARP can have considerable influence on how mental healthcare is viewed and how willing gero-consumers will be to seek specialty care.

Link with state and local agencies and coalitions on aging. These entities already work with large numbers of elderly persons. As such, they represent an important entry point for mental healthcare providers.

Link with local faith-based organizations such as churches, synagogues, and mosques. These organizations frequently are the “first responders” when elderly persons develop mental health problems.

Conduct screening events at local community centers and malls where elderly persons gather. Simple screens can be an effective way to help elderly persons identify emerging mental health problems.

Make “house calls” by providing services on-site in retirement communities, group residences, and nursing homes. Because elderly persons are less mobile than other age groups, services may need to be brought to them.

Provide services over the telephone. Such services do not require elderly persons to be geographically mobile, and they can be accessed easily.

Foster elder support groups using the Internet. A major issue for elderly persons is the progressive erosion of natural support groups. Internet-based virtual support groups can stem that erosion.

Set up specialty services in primary care offices where elderly persons are served. This arrangement would permit a “one-stop” visit with easy dual access to primary and specialty services.

Hopefully I have stimulated your interest sufficiently that you will discuss these strategies in your organization. The graying of America is proceeding at a fast pace. We will need to be fully prepared for the changes in services that the new gero-consumers will require.

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