'Distorted belonging': How mental health in older adults can be brushed aside
When people think of depression, they may think of sadness, listlessness, and a lack of motivation. Those are common, but not the only symptoms.
“So you can end up with older adults who are being treated for memory loss, when memory loss is not really the problem," said Dr. Emily Bloesch, an associate professor of psychology at Central Michigan University. “The problem is this underlying mental health problem, like depression, but it’s just harder to recognize.”
Senior mental health is some times brushed under the rug, she said.
“We forget that older adults are still full human beings that have their physical bodies, but also just as full and rich mental and psychological lives," she said.
Bloesch said tending to mental health can be challenging with current data. There are not a lot of longitudinal studies. And psychologists studying seniors can run into selection bias— that’s where the simple process of choosing study participants can skew the results. Sometimes it’s impossible to avoid. For example, when choosing older study participants, people who survive to 65 are then more likely to make it to 85.
Also, if you’re studying mental disorders, people from older generations may have died or already overcome their disorder by older adulthood.
“The people that we lose before they meet older adulthood means that we don’t have really good data on: what do the trajectories look like? how are they changing? What do some of these diagnoses really clearly look like in older adulthood?” said Bloesch.
“I think the preventions themselves are similar across the board. I think the risk factors are different," said Chris Baeumler, crisis team supervisor for Central Michigan Health. He said older adults, especially men, have higher lethality when they attempt suicide. They plan it out rather than acting impulsively.
He said older adults are less likely to seek the help they need for crisis care. But if they do, they can end up seeking the wrong kind of treatment. And even admit themselves into a mental hospital when it may not be necessary.
“Which inevitably puts them in a greater risk for completing suicide because, more often than not, people feel defeated when they come out of a mental health hospital," Baeumler said. "They’ve had these chronic suicidal thoughts, or these depressive thoughts, and it’s not being fixed through medication.”
He said older adults can feel like a burden. A tendency that’s increased during the COVID-19 pandemic.
“We very much isolated them and kept them away from everybody for a good reason," he said. "But I think the unintended consequence of that was bringing around those thoughts of distorted belonging.”
Finding the right medication for a mood disorder is often a challenge. Different people respond to different treatments. And Medicare, which insures many older adults, does not offer a lot of flexibility
“The only chance they can change their medication plans is during the open enrollment period," said Bob Callery, supervisor for the Michigan Medicare and Medicaid Assistance Program in Grand Rapids. He said Medicare beneficiaries can run into barriers if they need to change medications.
If a prescribed drug is out of formulary—that’s the official list of medications that are covered in a plan—then the patient would have to pay full cost unless they get an exemption, he said. But even that doesn’t cover the full cost.
“People will flat out tell me, ‘You know what? I can’t afford that, that medication. I’m not gonna take it.’ We see that with all types of medication," Callery said.
There has been some improvement to lowering costly barriers to mental health services. For example, Dr. Emily Bloesch said telehealth has improved conditions for some people. And she said younger generations might not run into the same barriers as older generations because in recent years there has been a greater discussion of mental health within families and in popular culture.
Communication breaks down barriers. The hope is that barriers will fall quickly so older adults who struggle can still find peace of mind.