overall health have improved for most Americans in recent years, but factors related to economic status, race, sexual orientation, gender identity and rural status, as well as limited access to adequate housing and transportation services, keep many older adults from benefiting from these gains. • Safety concerns. Individuals become more frail as they age and their risk of falls and injury increases. One in every three adults aged 65 or older falls each year and falls are the leading cause of both fatal and nonfatal injuries for older adults.ix • Loss is common. Some older adults may experience loss. Loss of spouses, friends, physical functioning, independence, routine and sense of purpose affects overall health, including “WHAT DOES THIS MEAN FOR MY PRACTICE?” If you serve 100 adults 65 and older, it is likely that 20 of them have a behavioral health condition. integration.samhsa.gov 5 mental health and substance use. Health care providers and older adults often mistake depression for a natural response to aging. This can lead providers to not screen for or treat depression and older adults to not seek help. • Elder abuse. Elder abuse is a serious problem, with an estimated 8 to 10 percent of older adults experiencing abuse, not including financial exploitation.x Other estimates found that between one and two million older adults are mistreated each year, while only 27 percent of hospital emergency departments have elder abuse protocols (compared with 75 percent for child abuse).xi • Negative attitudes and discrimination toward people with behavioral health concerns. These attitudes can be a barrier for all age groups. Generational and cultural differences may be a barrier to identifying concerns, treatment follow-through and active engagement in behavioral health treatment.xii, xiii While providers, family members, peers and community stakeholders must be aware of these concerns, it is also important to be skeptical of antiquated stereotypes and assumptions about older adults’ health status. Older adults remain physically active for longer than ever before, continue to be active learners and frequently use health technologies to manage their health. Most older adults do not have a cognitive impairment. Recovery from depression, back pain and other injuries or illnesses is the norm. The overall category of older adults (age 65 and older) is further divided into subgroups – “young old” (65-74 years), “middle old” (75-84 years) and “oldest old” (85+ years) – to help understand variability in patients’ experiences. However, it is important to consider an individual’s functional age as well as their chronological age. Patient-centered care requires that you treat all of your patients, regardless of age, as individuals with unique strengths, histories and needs. Successful practices establish outcome measures that meet the range of behavioral health and primary care needs of older populations. BE AWARE OF THE SIGNS AND SYMPTOMS OF ABUSE AND KNOW WHO TO CALL TO REPORT SUSPECTED ABUSE. SALLY IS 83 and recently fractured a hip. She has severe osteoporosis, high blood pressure, chronic pain and a history of depression. She is cared for by her daughter who is trying to get her to move into an assisted living center, but Sally refuses, saying she can live on her own. Using a standardized screening tool, Sally’s integrated primary and behavioral health care program identified increasing depressive symptoms. An assessment for pain management prompted a full review of medications for effectiveness and risk of abuse, leading to changes in her prescriptions to decrease side effects and increase function. An in-house social worker provided support and intervention for Sally and her daughter regarding care decisions and ultimately connected them with an external caregiver support provider. Together, they identified the resources Sally needed in her home to manage her health. 6 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS CAREGIVER CONCERNS: UNDERSTANDING THE ROLE OF THE FAMILY As some adults age, they may begin to rely more heavily on spouses, children, grandchildren and other loved ones for assistance with daily living activities and navigating the health care system. Unlike the