In 2011 the post-World War II “baby boom” generation starts turning 65. With this change it is expected that the census of elderly people diagnosed with a mental illness will also increase. It is projected that by the year 2030, the number of older adults diagnosed with a mental illness will rise significantly from 7 million to 14 million people. With the anticipation of this large growth in our nation’s geriatric cohort it becomes imperative to not only acknowledge the medical needs of this generation, but their psychiatric needs as well.
In a report published in 2006 by the National Association of State Mental Health Directors (NASMHPD) entitled “Morbidity and Mortality in People with Serious Mental Illness” it was found that individuals suffering from a severe and persistent mental illness die on average, 25 years prematurely than when compared to the general population. As the average U.S, citizen lives to age 78, this means that the average mental health consumer has an expected lifespan of 53 years. This statistic indicates that many mental health consumers will not even reach the traditional “geriatric” age of 65, making it an even more imperative task to clinically intervene as early as possible.
A major factor in the early mortality of older clients is the diagnosis of serious mental illness, combined with substance abuse and chronic health conditions. The types of mental disorders most commonly afflicting older adults include anxiety, depression, schizophrenia, and dementia. Individuals suffering from these diagnoses also experience greater rates of medical conditions such as diabetes, cardiovascular, respiratory and infectious diseases. Such conditions, combined with the prevalence of negative health habits such as poor diet and exercise routines, higher rates of smoking and the low utilization of medical services, in conjunction with medication side effects, all result in the tragic early death of mental health consumers. Another factor shortening the life span of consumers is the stress of years of institutional living in large state psychiatric hospitals, as well the psychosocial strain caused by homelessness and poverty.
With a lack of age appropriate psychiatric services available for older adults it is crucial that additional programs continue to develop in order to ensure adequate care for this unique group. Local senior and recreational centers may be an option, however, age requirements prove to be a limiting factor as these programs typically accept individuals 65 and older. Additionally, staff at Senior Centers may not be equipped to meet the needs of older mental health clients.
So, what options exist for older mental health consumers?
One program making strides to tackle this predicament is the PROS program operated by the Mental Health Association of Nassau County. To help offset such discouraging projections, the MHA has initiated an age specific geriatric track open to all members ages 50+, to educate consumers about age related issues relevant to both mental and physical health and wellbeing.
What is the PROS Model?
PROS stands for Personalized Recovery Oriented Services and is defined by the Office of Mental Health as a short-term, comprehensive recovery program for individuals with severe and persistent mental illness. It is a model that intends to integrate treatment, support and rehabilitation in a manner that facilitates a consumer’s recovery. Such goals of the PROS model include: improving functioning, reducing the need for inpatient hospitalization, increasing employment and educational opportunities as well as securing housing. Structurally and conceptually the PROS model has proven to be successful for adult consumers; however there lies a major discrepancy for its use with geriatric clients.
Anecdotal evidence suggests that there is some confusion about the applicability of the PROS model for older adults. PROS and Medicaid require that the consumer demonstrate “progress.” If the consumer does not show progress, then the “medical necessity” of the services rendered can be called into question; a lack of medical necessity will result in the claim being denied, and the provider would undergo a “take back” of the funds. Some in the field would argue that it is much easier to show “progress” with younger consumers who would be better able to demonstrate the attainment of goals in regards to employment or educational pursuits.
Some of the early PROS programs reported that when they converted from a clubhouse or social club model that many older members left, and were replaced by a group of younger consumers. What then does recovery mean for our older clients? Will the mental health system allow them to “retire” from the pursuit of employment and educational goals, and instead pursue other goals that can be deemed “medically necessary?”
To avoid the loss of members, and to help enhance the experience of our program’s older clientele, our geriatric track has maneuvered the PROS concept to include groups that integrate services specific to the health and wellness needs of our older adult population. Our schedule is constructed to include groups that focus specifically on medical and physical concerns, complete with weekly weight and blood pressure management and groups that teach age appropriate exercise, fitness and nutrition for clients to implement in their daily lives. Additional groups provide a review of the mental health concerns associated with aging, including depression, anxiety and long-term conditions such as schizophrenia, in addition to reviewing effective coping strategies.
To help offset the development of such conditions as dementia and Alzheimer’s disease, members are encouraged to participate in our “Thinking Skills for seniors” group, which teaches simple and fun exercises to engage the brain and help prevent future cognitive decline. Our program also looks to enhance socialization and relationship building. Members participate in a socialization group that teaches social and communication skills pertinent to older adulthood and emphasizes the importance of maintaining interpersonal relationships across the lifespan.
Our program also provides the opportunity for members to revisit and process their own personal experiences. The PROS program addresses pertinent issues that are not oftentimes discussed, for example, the struggles with parenting mentally ill children and taking on the caregiver role for grandchildren, while at the same time managing their own aging and mental health needs.
Our geriatric track provides an age appropriate arena for older clients to share in their experiences and to learn from one another in a comfortable setting. Our goal is to allow members to be responsible for their own health and wellbeing, teach warning signs and preventative measures to avoid the development of negative health conditions, and most importantly, increase longevity.
Within the year our program has witnessed the untimely passing of several members, both young and old. Such incidents serve as an eerie reminder of the reality that mental illness creates more challenges than originally thought. However, despite such events, our program continues to service older clients effectively and help assist with important aspects of life including finding appropriate housing, securing benefits and providing socialization outlets to improve interpersonal relationships.
Specific cases exemplifying the benefits of the PROS model for older adults can be measured by the improvement seen in several members of our geriatric track. One consumer, a 62-year-old male suffering from Schizophrenia, has led a life of isolation. With paranoid symptoms such as delusions and hallucinations believed to come from the television and newspaper, he was unable to accumulate a work history and develop interpersonal relationships. In his time at the Gathering Place PROS he has decreased his anxiety and the presence of symptoms. He has utilized the material at PROS to return to his long lost hobbies, and has organized several fishing trips and group outings to continue to improve his socialization and self-esteem; a feat 30 years in the making. Gary has also conquered his fears of social interactions by participating in several public speaking engagements at the NYAPRS and Geriatric Mental Health Alliance of NYC conferences.
Another example of our PROS success is demonstrated by a 61-year-old Vietnam veteran, diagnosed with schizophrenia and PTSD. This member served for 15 months in Vietnam and was honorably discharged. Upon his return home, he developed symptoms of PTSD and schizophrenia. For 40 years, he was institutionalized at various state hospitals and psychiatric programs. During that time, no one assisted him with the task to obtain the veterans benefits he deserved. The PROS program intervened and has since connected him with the VA; helping him file a claim for veteran’s benefits related to his PTSD.
The older adult client encompasses a distinctive history and psychiatric development and requires a specific approach to treatment. It is crucial that treatment be age appropriate and relevant. It is imperative that all health and medical providers strive to improve their geriatric services in order to create a united and cohesive approach to care. The PROS model, despite initial criticism, can be viewed as a useful treatment modality for older consumers. Its structure and mission for rehabilitation can prove beneficial for all age groups. However, it is recommended that a stronger, more direct approach to geriatric mental health be put forth, starting today in order to prevent an epidemic of neglected consumers.