Delaware's age 65-plus residents have unique mental health challenges. What's being done

Twenty-two percent of Delawareans are over the age of 65, according to the Delaware Population Consortium. By 2030, the same age group is projected to make up almost a quarter of the state’s population.

And while many people are aware of the unique health challenges that older people more commonly face — such as hearing loss, dementia and osteoporosis — another, less talked-about issue is rising in prevalence: mental illness.

Just as rates of mental health issues have risen in the U.S. in recent years, exacerbated by the pandemic and isolation, so too has the frequency of mental illness among older Americans.

When combined with the physical and neurological health struggles that also tend to increase with age, addressing the mental illness and substance abuse among the elderly can be particularly challenging.

It’s why the Delaware State Epidemiological Outcomes Workgroup dedicated most of its February meeting to discussing the data and potential solutions for handling behavioral health dilemmas among Delaware’s older population.

Mental illness among older adults

“I think we often overlook older individuals when we're talking about behavioral health,” Sharon Merriman-Nai said at the meeting.

Merriman-Nai is an associate scientist at the University of Delaware’s Center for Drug and Health Studies, which also runs the SEOW. Funded by federal grants disseminated by state agencies, the workgroup has been tasked since its inception in 2008 with gathering and analyzing data to find emerging issues, highlighting trends, identifying high-risk groups and evaluating the effectiveness of interventions.

The workgroup also translates the data into more consumer-friendly forms like infographics, builds monitoring systems like school surveys and trains the community on how to understand and use data.

One of SEOW’s newest infographics centers around the rates of mental illness, including substance use disorder, among older Delawareans. It hinges on one key fact: Although older people are less likely than younger ones to experience mental health issues and abuse substances, the consequences can be much more severe.

People 85 and older have the highest suicide rate of any demographic, according to the Centers for Disease Control and Prevention, and Americans between the ages of 75 and 84 have the second-highest rate.

This is partially because suicide attempts are more often fatal among older people, Dr. James Ellison explained at the SEOW meeting on Feb. 13. It’s why providers need to be extra vigilant when older patients express potentially suicidal thoughts.

Ellison, a professor of psychiatry and human behavior at Thomas Jefferson University’s medical college, told the workgroup that, although Delaware has expanded screenings for depression and suicidal ideation in recent years, “access to behavioral health care for late-life depression remains limited.”

There are few geriatric psychiatrists available, both in the First State and nationwide, and only one place in Delaware that provides access to an interdisciplinary team working to address older patients’ unique neurological and psychiatric issues: the Swank Center.

Geriatric psychiatry

The Swank Center for Memory Care and Geriatric Consultation at ChristianaCare, located inside the Wilmington Hospital, focuses on the all-around impact that aging can have on people.

Dr. Steven Huege, the newly named endowed chair at the Swank Center, said he was drawn to the job because of its multidisciplinary, “holistic” approach. Rather than trying to tackle the issues facing older Delawareans on their own, the Swank Center employs a team of neurologists, psychiatrists and social workers to address the interconnected factors of geriatric health.

Huege, a geriatric psychiatrist himself, has experienced firsthand the unique challenges and rewards of working with older patients.

Solutions that may be beneficial for younger and middle-aged people struggling with mental illness can’t always be applied to older patients, or need to be adapted in some way. Recognizing the way that one’s body changes with age is crucial when it comes to recommending medications, as older patients’ bodies often process what may be a “typical” dose of a drug as something much stronger.

And because geriatric patients are more likely to be dealing with other physical or cognitive ailments, there is a greater chance that they are already taking medications that could interact negatively with a psychiatric drug. Some psychiatric medications may even worsen cognitive decline in older patients or increase risks of falling, Huege said.

Geriatric psychiatry is also unique in that doctors are often dealing with larger family systems. Huege compared it to child psychiatry, in that parents and other caregivers are typically involved in the patient’s care. And while these external figures can act as supports, they also have the potential to undermine treatment.

None of this means that older people with mental health issues can’t benefit from psychiatry; but with geriatric psychiatrists in limited supply across the country, this specialized help isn’t always within reach.

“I think that there's a lot of misconceptions that getting older has to equal illness and impairment, and that certainly is not universally the case,” Huege said. “Older adulthood can be an incredibly enriching and rewarding time in one's life.”

Huege said ageism plays a part in both the small number of geriatric psychiatrists and a lack of public knowledge or understanding about the profession. The similarity in symptoms between mental and physical health issues commonly faced by older people also makes distinguishing the need for psychiatric help more difficult.

Huege said that anyone who worries that an older relative may be experiencing cognitive decline or mental health issues—or both—should talk to that relative’s primary care physician.

The Delaware Aging and Disability Resource Center also provides information and assistance to both individuals and caregivers. Call 800-223-9074 for free, 24/7 information and connection to resources, or visit delawareadrc.com.

Send story tips or ideas to Hannah Edelman at hedelman@delawareonline.com. For more reporting, follow them on X at @h_edelman.

This article originally appeared on Delaware News Journal: What Delaware is doing about mental illness in elders