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Tempest on Golden Pond: The Silver Tsunami of Older Adults with Mental Illness

By Joel Miller posted 11-16-2015 16:27


The Storm Has Arrived

The aging of America, and particularly the aging of the baby boomers, has often been referred to as the approaching “Silver Tsunami.” Well, the storm has arrived and is gathering strength and many older adults will have a serious mental illness and other severe behavioral health conditions if we don’t do something about it right now.

First, let’s look at the problem and the overall numbers:

  • Data from the U.S. Census Bureau estimates that the age 65 and over population increased from 13 percent to 14.1 percent of the total population between 2010 and 2013.
  • The 2010 Census found that there were 40.3 million individuals 65 and over in the country and estimated that this population had grown to over 44.5 million by 2013.
  • By 2030 it is projected that the 65 and over population will increase to 72.1 million. Part of this increase is also a result of people living longer with individuals over 85 being the fastest growing segment of the population.

The Institute of Medicine (IOM) estimated that from 2010 to 2030, although the number of the older Caucasians will increase by 60 percent, their proportion of the total older adult population will decrease from about 80 percent to about 71 percent. During the same time period the number of African-Americans will increase by about 115 percent and the Hispanic-Latino population will increase by over 200 percent.

What does all of this mean for older adults and mental health care?
The IOM report estimated that nearly one in five (20 percent) of individuals age 65 and over in the United States has one or more mental health and/or substance use conditions. This translates to about 8 million older Americans currently having one or more such conditions with approximately 2 million having a serious mental illness. These changing demographics will also have a significant impact on older adult mental health and substance use care and treatment.

The IOM study also identified anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, depressive disorders, schizophrenia, and substance use disorders as the most prevalent conditions among older adults. Other conditions include behavioral and psychiatric symptoms of dementia, complicated grief, fear of falling, severe self-neglect, and suicidal ideation. Depressive disorders and behavioral problems secondary to dementia were identified as the most prevalent diagnoses among older adults. The use of illicit drugs, especially marijuana, is likely to increase as well as non-medical use of prescription drugs. Prescription drug abuse will continue as a major problem. Data also indicates that older veterans are at greater risk of developing mental health and/or substance use conditions than the general population. Suicide is a major concern with older adults as evidenced in 2010 data from the CDC that the suicide rate for persons 65 and over is 14.9 per 100,000 compared to 12.4 per 100,000 for the general population. This rate actually gets worse as people age especially for men.

Special Population; Unique Needs
Many agencies and organizations see older adults as a distinct population requiring special attention.

The following factors are cited as reasons why older adults should be considered as a special or separate population:

  • The possible presence of other medical conditions, cognitive impairment, functional limitations, and/or multiple mental health or substance use conditions
  • Frequent use of multiple medications for concurrent physical health or other behavioral health conditions
  • Different goals of care and treatment and overall health care decisions
  • Loss and grief are common among older adults

The workforce needed to address the behavioral health needs of older adults is not adequate today and is projected to be even worse as time goes by.

The IOM report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?, (2012) put it bluntly that, “The workforce is not prepared—in numbers, knowledge, and skills—to care for the mental health and substance use needs of a rapidly aging and increasingly diverse population.” According to the Administration on Aging (which is now part of the Administration for Community Living (ACL), “It is estimated that only half of older adults who acknowledge mental health problems receive treatment from any health care provider, and only a fraction of those receive specialty mental health services.”

A study in San Diego that included interviews and focus groups with 66 consumers age 55 and over along with 99 mental health service providers, family caregivers, and other older adults identified the following factors why older adults don’t seek mental health care:

  • Stigma (63 percent)
  • Lack of information about available services (50 percent)
  • Lack of age-appropriate and culturally and linguistically appropriate services, including translators in mental health settings (44 percent)
  • Lack of transportation to services (38 percent)
  • Lack of money or insurance to pay for services (23 percent)


One of the biggest challenges is determining who makes up the older adult behavioral health workforce. The American Geriatrics Society estimates that there are less than 1,800 geriatric psychiatrists in the country today and that number will reduce to about 1,650 by 2030. Geriatric psychiatrists are aging out of the field and the next generation is not coming along to take their place. The American Psychological Association (APA) estimates that only 4.2 percent of psychologists have a primary focus on geriatrics in their clinical practice. Moreover, there is also little evidence that the change in Medicare to cover 80 percent of outpatient mental health services or the passage of the Mental Health Parity and Addiction Equity Act of 2008 has had any significant impact on the workforce shortage.

You Have the Power
Unless action is taken quickly the nation will not be prepared to address the future behavioral health needs of a rapidly growing older adult population and will not have the necessary workforce in place.

That is where you come in as a CMHC and AMHCA member.

Medicare does not reimburse clinical mental health counselors for their services. Provider recognition for CMHCs is critical if we are going to address the needs of older persons. Given the number of older persons who are currently suffering from an untreated mental health condition and the “silver mental illness tsunami” headed our way, it is absurd at this time that Medicare continues to not address a brewing major public health issue. Congress cannot ignore this issue any longer.

The good news is that you can do something about it.

Just go to AMHCA's action alert to learn how you can reach the elected officials in your state. Please follow the protocol that Jim Finley, our associate executive director and director of public policy, has developed for contacting your senators and those policymakers who represent your congressional district.

Remember: Politicians pay attention to their constituents.

AMHCA stands ready to work with all public sector – and private sector – stakeholders to move the public mental health system forward in improving the quantity and quality of older adult behavioral health services and developing the workforce necessary to provide services that are available, accessible, cost-effective, and age, gender, and culturally appropriate.

#Aging #Medicare #BabyBoomers #Workforce