This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) by the National Council for Behavioral Health under contract number HHSS283201200031I, with SAMHSA, U.S. Department of Health and Human Services (HHS). Tenly Pau Biggs served as the Government Project Officer. DISCLAIMER The views, opinions, and content of this publication are those of the author and do not necessarily reflect the views, opinions, or policies of SAMHSA, HRSA or HHS. Any non-Federal resource listed in this document does not constitute endorsement by SAMHSA, HRSA or HHS, and resource lists are not to be considered all-inclusive. PUBLIC DOMAIN NOTICE All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS. ELECTRONIC ACCESS AND PRINTED COPIES This publication may be downloaded or ordered at http://store.samhsa.gov. Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). RECOMMENDED CITATION Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration, Growing Older: Providing Integrated Care for an Aging Population. HHS Publication No. (SMA) 16-4982. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016. ORIGINATING OFFICE Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857. HHS Publication No. (SMA) 16-4982. 2016. integration.samhsa.gov 4 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS THE NUMBER OF AMERICANS AGE 65 AND OLDER INCREASED BY 25 PERCENT FROM 2003 TO 2013 AND THE NEXT 25 YEARS PROMISE ANOTHER 50 PERCENT INCREASE. FROM 2018 TO 2038, THE NUMBER OF AMERICANS AGE 85 AND OLDER IS EXPECTED TO MORE THAN DOUBLE FROM 6 MILLION TO 14.6 MILLION.i Nearly one in five older adults have one or more mental health or substance use conditions (referred to in this document under the umbrella term, “behavioral health”).ii About 16 percent of women and 11 percent of men age 65 and older experience symptoms of depression.iii The majority of older adults’ behavioral health issues are identified and treated in primary care settings instead of specialty behavioral health settings.iv Older adults are distinct from other populations in key ways: • Complex chronic health conditions. Older adults are more likely than any other age group to have complex chronic health conditions, including mental health conditions, substance use disorders and cognitive impairments.v About two-thirds of older adults have two or more chronic conditions. • Drug use and abuse. Older adults receive a high proportion of prescription drugs in the U.S. due to increased likelihood of being prescribed long-term and multiple medications.vi Improper use is common, whether because of cognitive decline or attempting to save money by using their medications sparingly or taking another person’s remaining medications. Additionally, commonly prescribed medications – opioids for pain and benzodiazepines used to treat anxiety and sleep disorders – are addictive and can increase the risk of falls and memory/retention issues affecting up to 17 percent of older adults.vii Co-morbid health conditions, age-related changes in drug metabolism; potential interactions with prescribed drugs, over-the-counter medications, dietary supplements and alcohol; and cognitive decline make drug misuse a special concern.viii • Health disparities. Life expectancy and