"The report is sufficiently alarmist," said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. "I think [the report authors] are right."
Kennedy was not involved with the report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? It was mandated by Congress and issued by The Institute of Medicine in light of a "silver tsunami" of health care needs expected to accompany a senior population that will reach 72.1 million by 2030.
The "silver tsunami" is the result of simple supply-and-demand forces gone awry, the report authors explained.
Up to 8 million older Americans, or 20 percent of the current senior population, suffer from some form of mental health condition, often depression, at-risk drinking or dementia-related behavioral and psychiatric symptoms, according to the IOM report. (A basic diagnosis of Alzheimer's disease was excluded from the study.)
And 2 million seniors have severe mental illnesses, a number that is "greatly under-appreciated," said Dr. Peter Rabins, one of the authors of the report.
Also, as baby boomers age, studies indicate that their use of illicit drugs will continue.
"The reality is the Woodstock Generation has come of age," said Kennedy. "Their background is with psychedelic drugs, marijuana, recreational drugs, non-narcotics . . . It's a real problem."
Against these growing problems, meanwhile, the number of health providers and other service providers is shrinking in proportion. And that means, according to the report, that "a health care workforce that is not prepared to address either [mental health/substance use] problems or the special needs of an aging population is a compelling public health burden."
"The number of individuals with specialty training in both aging and either mental health or substance use issues is extremely small," said Rabins, who is a psychiatry professor at Johns Hopkins School of Medicine in Baltimore.
Nor are candidates rushing to fill the pipeline, Kennedy added, probably because of lower pay in geriatric specialties.
Each of these populations -- the elderly, and those with mental health and/or substance use issues -- require special care. But the two in combination represent a special challenge.
Older people metabolize both alcohol and drugs differently from younger people, putting them at risk for overdoses. According to one estimate, almost two-thirds of emergency room visits for adverse drug reactions in 2008 were by elderly people.
Also, elderly people -- particularly those with depression -- may be less able to adhere to complicated medication regimens for mental and physical ailments.
And medications to treat mental health issues may not react well with other medications needed to treat high blood pressure, diabetes and the host of other physical problems that become common as people age.
"The biggest challenge appears to be the fact that these problems rarely occur in isolation. Most [elderly] people who have mental health or substance use problems also have a physical health problem," said Rabin. "That's not true in younger age groups."
The report provides a number of recommendations for solutions, in what basically amounts to an overhaul of the health care system.
Key to handling the future explosion of seniors with mental health issues and/or substance use issues will be organizing a better health care workforce.
"We really need to be training the existing workforce, which interacts with both older people and mentally ill people, to have the skill set of the other group," said Rabins. "People with general mental health training, such as social workers, psychologists and psychiatrists, have very little training in treating the elderly. Those in the aging network have very little experience treating mental illness."
Better provisions, including funding, need to be made for training professionals to care for this population. This includes primary care providers, nurses and nursing-home assistants.
And Medicare/Medicaid reimbursement schedules need to be overhauled to make sure the services this population requires are covered.
The report also said the federal government should coordinate all the efforts that involve these two vulnerable populations.
In addition, Kennedy suggested that partial forgiveness of medical-school loans would "turn around the onward direction of trainees coming into the geriatric field."
More information
Visit the Institute of Medicine for more on the report.
