pediatric population, where parents legally and functionally act as caregiver and decision-maker for their child, caregiver relationships for older adults are much less straightforward and obvious. In conditions like dementia, capacities are slowly lost and there is often not a clear point at which patients require surrogate decision-makers. Family caregivers, as well as paid home health workers, often advocate for their loved one in addition to providing needed care to compensate for workforce shortages and gaps in service. Primary care providers integrating behavioral health must support patient empowerment, encouraging as much patient control over treatment and life decisions as possible, while also building caregivers into decision-making to improve outcomes. Providers must not only care for the patient, but also the caregiver; one-third of caregivers report their health as being fair to poor.xiv Caregivers need resources on mental health and substance use disorders, including support on how to handle their stress and obtain treatment for behavioral health concerns and other chronic conditions. The best models for promoting the caregiver relationship and supporting caregivers are those that are easy to access and culturally informed. integration.samhsa.gov 7 CONDITION BEHAVIORAL HEALTH/ COGNITIVE SYMPTOMS PHYSICAL SYMPTOMS Infection/urinary tract infection Decreased appetite or fluid intake Sudden onset of confusion Change in functioning Pain, burning on urination Frequent urination Myocardial infarction Fatigue Decreased functioning Chest pain Nausea Vomiting Shortness of breath For women, pain in upper chest area Thyroid disease Confusion Agitation Fatigue Diminished energy and apathy Impaired memory Hair loss Weight gain Changes in bowel movements Dry skin Muscle aches, stiffness, pain in joints Depression (can be confused with normal reactions to loss and aging) Agitation Change in appetite Concentration and memory loss Sleep disturbance Gastrointestinal symptoms/constipation Pain Headaches Alcohol misuse Cognitive decline/confusion Sleep disturbance Self-care deficits Injuries/falls Osteoporosis Gastrointestinal problems Infection Unstable hypertension Prescription drug misuse Delirium Dementia Daytime sedation/sleep disturbance Problems with attention Physiological arousal Injuries/falls Psychomotor abilities Malnutrition/weight loss Blurred vision Slurred speech This is not a comprehensive list of common conditions or all symptoms for each condition. It is not intended to serve as a diagnostic tool, but demonstrates the complexity of diagnosing and treating older adults. BEHAVIORAL HEALTH AND PHYSICAL HEALTH: RELATIONSHIP CHART In older adults, physical, behavioral and cognitive conditions often present differently than younger adults. To assist in understanding these differences, the following chart presents some of the common conditions, impairments and physical symptoms, keeping in mind that: • Physical health conditions often present as behavioral health concerns or cognitive impairments. • Behavioral health conditions often present as physical conditions or cognitive impairments. • Many medications have side effects that may present as symptoms of another illness. The interaction of multiple medications can exacerbate symptoms and even cause health problems. Further, sometimes having a condition, such as dementia, prevents older adults from being able to take medications for other conditions due to potential interactions. • Depression often occurs with physical health conditions. Symptoms of dementia and delirium frequently emerge in conjunction with many behavioral health and physical health conditions. 8 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS ENSURING AN INTEGRATED BEHAVIORAL HEALTH AND PRIMARY CARE WORKFORCE FOR AN AGING POPULATION Given the unique and complex needs of older adults, what can be done to ensure that the safety-net primary care workforce is prepared to meet the behavioral health needs of this aging population? Since it is unlikely that there will ever be enough specialty behavioral health providers, primary care organizations are now focusing on adapting their systems and