Large majorities of older Americans with depression, anxiety, or other mental health disorders are receiving treatment that does not meet evidence-based standards, and many do not know that depression can put their health at increased risk, according to a national survey, "Silver and Blue: The Unfinished Business of Mental Health Care for Older Adults," released today by the John A. Hartford Foundation.
The survey focused on 1,318 Americans age 65 and older. Key findings include:
46% of people currently receiving treatment say their provider did not follow up with them within a few weeks of starting treatment to see how they were doing - a critical component of effective care.
Among all respondents, very few understood the health risks of depression: only one out of five (21%) had heard that depression is believed to double an individual's risk of developing dementia and only one in three (34%) knew it can double the risk of heart disease.
Depression is a common and serious medical condition second only to heart disease in causing disability as well as harm to people's health and quality of life. Mental health problems affect nearly one in five older adults, according to the Institute of Medicine. Depression is not a natural part of the aging process, but almost one in three people surveyed (27%) believed it was.
"It is a needless tragedy that so many older people are still receiving mental health care that does not measure up," said Christopher Langston, PhD, program director for the John A. Hartford Foundation, which funded and directed the survey.
For a complete list of findings, including care preferences, shortcomings in care, reasons for stopping treatment, stigma, and misconceptions, please visit:>
"Like being in a dark hole that you can't get out of"
The survey also asked how it felt to be depressed or anxious, eliciting open-ended answers that reveal serious pain and disability. Respondents described feeling, "that no one cares or loves you;" "like being in a glass cage;" "like a weight in my chest;" and "like you would prefer to be dead."
Serious shortfalls in the quality of mental health care
People 65 and over and currently in treatment for depression, anxiety or other mental health issues were asked whether their provider took any of six specific actions, all of which have been shown to improve outcomes dramatically and are key elements of evidence-based collaborative care models.
Respondents said that their providers:
Had not discussed possible side effects (38%);
Had not discussed different treatment options (33%);
Had not worked with them to decide which treatment would be best (22%);
Had not explained how long treatment would take (40%);
Had not discussed what to do if they felt worse (34%); or
Had not followed up within a few weeks to see how they were doing with treatment (46%).
15% said their provider had not done any of these things, and 49% said their provider had done half or fewer.
"Treating depression and other mental health conditions can be very successful but it is not easy. The first drug, the first treatment, or a single treatment often doesn't work," said Christopher Langston of the John A. Hartford Foundation. "We know that a structured team approach, which includes educating and engaging patients in their own care; following up carefully on response to treatment; and modifying treatment plans if they aren't working, is very effective. This type of care needs to be available to all older adults."
Large majorities of respondents currently receiving treatment with medication for mental health problems also did not receive important and recommended forms of follow-up care. Most said the last time they saw their provider, he or she:
Had not used a survey or set of questions to measure their progress (73%);
Had not changed the dose or type of medication (78%);
Had not added another treatment (88%); or
Had not discussed other things they could do to feel better, like exercise or social activities (51%).
Patients said they were ready to talk about their problems: only 13% of all respondents said they would not tell anyone if they were feeling depressed or anxious and a large majority (77%) would bring the subject up on their own even if their provider did not ask. A quarter of older adults (23%) who had received mental health treatment since turning 65 said they wish their doctor would "do more" to make sure that their treatment was working.
Team-based depression care, known to increase effectiveness, appeals to patients
Many primary care practices do not have a trained person on staff (such as a nurse or social worker) who can help patients with mental health problems; however, the survey indicates that a majority of older adults (62%) thinks they should.
This includes 78% of African-Americans and 82% of those who are currently being treated for a mental health issue but are still struggling with feelings of depression or anxiety.
61% of respondents said they would rather receive help from a trained person working in their doctor's office, rather than somewhere else.
"We've known what works for a decade, but our system is not serving most people well at all," said Christopher Callahan, MD, the Cornelius & Yvonne Pettinga Professor of Medicine at the Indiana University School of Medicine and Director of the Indiana University Center for Aging Research. "Care models that use a team-based approach to care, such as IMPACT and others, have consistently been able to double the effectiveness of usual depression care."
Low awareness of associated health risks
Despite the serious health risks that depression poses to individuals' overall health, public awareness was very low.
Only 34% of respondents knew that depression is associated with doubling their risk of heart disease;
Only 35% knew that depression is associated with increasing their chance of dying from another disease.
the John A. Hartford Foundation