Behavioral Health of Older Adults: Addressing Cultural Issues and Implementing Integrated Care

According to Erik Erikson’s Theory of Psychosocial Development, successful achievement of the developmental task for older age results in ego integrity when one is contemplating one’s accomplishments and perceives oneself as leading a successful life. However, some people are dissatisfied with their life seeing it as unproductive and feeling that their life goals were not accomplished. These people develop despair often accompanied with hopelessness, helplessness and depression.

To help older adults master their developmental task, promote sense of ego integrity and develop successful coping, a practitioner should take into consideration unique stressors and losses associated with an older age.

I would like to highlight some of the major stressors for older adults based on my experience of working with elderly immigrants from the former Soviet Union as a Clinician and the Director of the FEGS Kings Highway Clinic. The primary major stressors of aging are, loss of previous social status, isolation and an increase of medical problems.

Most of the Russian-speaking clients at our clinic had significant education and successful employment experiences prior to their immigration. After immigrating to the United States, they had very few employment opportunities. Most of their employment has been in low-paying, menial positions that were lacking health insurance and job stability. Such poor employment prospects effected our clients’ social self-perception and resulted in lowered self-esteem, hopelessness and anxiety. Many immigrants over age of 65 demonstrate a tendency to social withdrawal and isolation caused by their difficulty to adjust to changes in their social status.

In addition to loss of status, there are other factors causing isolation in elderly immigrants such as language barrier, loss of spouse, separation from loved ones who were left behind, lack of communication with grandchildren who refuse to speak a native language, as well as medical problems limiting their social contacts.

There is a high rate of somatization among older immigrants from the former Soviet Union. This may be explained cultural stigma and shame associated with mental illness in the former Soviet Union. Russian-speaking elderly immigrants often mask their depression and anxiety behind multiple somatic complaints since the latter were more culturally acceptable and not associated with shame.

Trying to express their emotional pain through somatic complaints, the Russian-speaking elderly clients often go to their primary care doctors for mental health issues. That is why it’s essential that physicians working with this population recognize the symptoms of depression and anxiety that require an appropriate referral to a mental health specialist. If a primary care physician does not deal with his patient’s emotional problems and the mood disorders remain untreated, the risk of suicide increases dramatically. Timely recognition and treatment of mood disorders in the Russian-speaking elderly population is important to prevent an exacerbation of the symptoms and escalation of suicidal behaviors.

An education about depression and other mental health disorders for Russian-speaking immigrants will help reduce the cultural stigma about getting help for mental health problems. In working with the Russian-speaking immigrants, the practitioner should convey the fact that even the most severe cases of depression and anxiety can be effectively treated. The earlier that treatment can begin, the more effective it is. Research has shown that psychotherapy or medication alone as well as combination treatment are both effective in managing mood disorders in older adults.

In Russian-speaking elderly immigrants mood disorders often co-occur with other serious medical illnesses such as heart disease, stroke, cancer, diabetes, and Parkinson’s disease. Patients who have mood disorders along with another medical illness tend to have more severe symptoms of both mood disorder and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co-existing depression. Treating mood disorders can also help improve the outcome of treating the co-occurring illness. Elderly clients would greatly benefit from an integrated care model that would address their mental health and medical needs.

This year FEGS, along with its partner Maimonides Medical Center (MMC) has launched a project funded through an NYS OMH grant to integrate behavioral health treatment for adults aged 55+ into a primary care setting.

FEGS embedded a bi-lingual Russian speaking social worker and Spanish speaking care coordinator into two Maimonides Medical Center sites to ensure that the older adults being treated at MMC would receive completely integrated, culturally competent, medical and behavioral health care.

Our project goals are to identify and treat behavioral health disorders in older adults, to reduce the severity of chronic medical conditions exacerbated by behavioral health disorders and improve clients’ physical and mental wellness.

In this project FEGS social work staff is collaborating with MMC primary care physicians to provide comprehensive screening for physical and mental health-related risk factors. If a client screens positive for depression, anxiety and substance use, the social work team works together with the client’s primary care physician to establish a common care plan, to track referrals to medical specialists and provide support to patients with chronic medical illnesses and their caregivers. We are currently working together with our colleagues at Maimonides to make mental health services more accessible for older adults with diverse cultural backgrounds, to develop an effective communication between primary care and behavioral health teams, as well as to promote better treatment engagement and outcomes for elderly clients.

During present changing times, we are excited to be pioneers developing a new model of care for older adults. It’s our hope that our Integrated Care Model would become a path for our elderly clients to their physical well-being and their sense of ego integrity, making their lives healthier and happier.

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