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Integrating the mental health care needs of seniors into the overall health care strategy

By Dr. Kiran Rabheru - Professor of Psychiatry, University of Ottawa Geriatric Psychiatrist, The Ottawa Hospital.

Canada is in the midst of a major demographic shift. As Canadians are living longer, many are more engaged with their own health. With a longer lifespan comes the burden of chronic disease, including dementia and mental illness. The overlap of chronic physical and mental illness within the aging population is having a significant impact on our health care system. Mental health systems of care have traditionally been under-resourced, stigmatized and marginalized. While the need for mental health services specifically for seniors is rising, the capacity to manage the need seems to be dwindling.

This is particularly true in the acute care hospitals, where many older patients are hospitalized for long stays, often leading to declines in the patients’ physical and mental abilities, which in turn lead to costly institutionalization and poorer quality of life. We should strive to prevent seniors from being hospitalized, and we should keep hospital stays as short as possible when they are unavoidable. Most health care for seniors should be provided in the community, not in hospitals.

The prevalence of mental illness rises with age. By the age of 40 years, nearly 50% of Canadians will have experienced some form of mental illness. By the age of 90 years, two out of three men and seven out of 10 women in Canada will have experienced mental illness. By the year 2041, 2.8 million Canadians will be over the age of 60 and enormous numbers of patients will be suffering from mental illness, if we fail to address their needs. The combination of the physical and mental health needs of Canadians must be addressed in a systematic and pre-emptive way, and this must be done in the community. Support for older adults at home in their own community will play a big role in reducing the burden of disease in Canada.

The most common mental health condition we face is depression. Forty-four per cent of older adults living in a residential facility suffer from depression, compared with 15% of older adults living in the community. Sadly, the rate of completed suicide for older adults is the highest among all age groups, particularly among older men, who are very successful at completing suicide compared with the average population. We don’t hear about this issue very often – people don’t talk about it, and that needs to change.

In general, our society doesn’t value or respect our elderly enough, and this needs to change as well. Promoting a more positive attitude toward the elderly, along with health promotion and reducing the risk of chronic conditions, both physical and mental, should be a major priority. Support programs that help people to live well in the community are a good start and can promote and provide better access to community-based prevention initiatives.

Our failure to address this problem comes at an immense economic cost and it has resulted in considerable psychological stress. Better community programs will also help the over 8 million Canadians working as informal caregivers. The economic value of informal caregiving is estimated at $25 billion. It is concerning that approximately one-third of informal caregivers have at least one health issue themselves. Informal caregivers are feeling worried, tired and stressed, and as a result there is a very high rate of depression in this group. Caring for someone at the end of their life or for someone who suffers from dementia can be very stressful. 

I believe that a coordinated effort at the national level to improve seniors care is required and a multi-sectoral partnership that would include the federal, provincial and territorial governments. It is vital that health care policies, practices and resource allocation integrate mental health care with physical health care for older adults. I cannot stress enough the importance of promotion and prevention in chronic disease management. Reallocation of resources, services to increase individuals’ capacity to live at home, support for primary care and specialty sectors – these would all improve access particularly to mental health care for adults. We need to keep seniors out of hospitals. 

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