Happier times: Mental health for the later years

Life’s later chapters are generally happy ones. But challenges remain in mental health care for older adults, says Taft Parsons, Chief Psychiatric Officer of CVS Health.

Declining mental health and aging don’t go hand in hand. In fact, studies find that older Americans tend to be happier and more content than their younger peers.¹ But aging can bring special challenges, and according to the 2021 Health Care Insights Study by CVS Health®, 39% of providers have a high level of concern about the mental health of their patients over 65.²

In fact, other research shows that about 20% of retirement-age Americans have been diagnosed with a mental health condition.³ Many more resist talking to their health care teams about such issues, missing the chance of spotting mental health conditions that might be treated.

Taft Parsons III, MD, Chief Psychiatric Officer for CVS Health, discusses strategies for detecting mental health problems in older adults and how to connect them to care in a timely way.

Are there differences in the mental health issues that older adults face?

Grief and loss can be a prominent part of their psychological experiences — they retire from the workplace and spouses and friends pass away. Dealing with chronic health conditions can also be psychologically challenging. Certain medications associated with aging — such as beta-blockers⁴ to treat hypertension or proton pump inhibitors⁵ for gastroesophageal reflux disease — may also lead to symptoms of depression.

There’s also the isolation and loneliness that can come with age, which can have significant adverse effects on mental and physical health. That factor alone can increase the risk of dementia, heart disease, stroke, depression and anxiety.⁶

So people can carry lifelong mental illness into their later years, and new problems can also arise during this stage of life. We need to be on the lookout for both.

A recent CVS Health National Health Project poll showed that a surprising 94% of people 65 and older rated their own mental health as “well” or “very well.” This is far higher than younger generations report, and it’s at odds with much of the research about the prevalence of mental illness in this group. What’s going on there?

Part of it may be that the current generation of older adults didn’t grow up talking about mental stress. They either toughed it out or maybe talked to their religious leader about their problems. Certainly, they didn’t discuss it with their health care providers. That same poll finds that only 14% of adults from this group are willing to talk to a primary care provider about mental health concerns.⁷  

Luckily, primary care providers are doing a much better job today of getting the real story and detecting anxiety, depression and stress. The latest draft recommendations from the U.S. Preventive Services Task Force advises screening in these settings for depression in older adults.⁸ At every touchpoint, including retail clinics, we’re making a special push to track and treat mental illness in this group. Our recent age-friendly screening guidelines include a mental health component and in 48 states, MinuteClinic® locations now offer depression screenings.

To help bridge the discomfort gap, we tell older patients — and all of our patients — that screening for depression is no different than screening for high blood pressure or high blood sugar. We do this to help them understand they’re being assessed for a medical problem, not a personal weakness.

You mentioned social isolation. Research from the National Academies suggests that one-fourth of older Americans are socially isolated.⁹ What tools does a provider have to address that?

We can encourage older adults to make connections and provide opportunities for them to do that. For instance, in some Medicare Advantage plans, our Aetna® teams are offering services from Papa Inc. This benefit in seven states provides companionship to people at risk for isolation and loneliness. Non-clinicians will visit the member and engage in a number of ways, including playing board games, sharing a meal, helping with technology or taking a walk.

You can also address social isolation in a broader way by looking at the social needs that drive isolation or make it worse. Aetna Resources For Living® program, for instance, connects members with a broad range of community resources, which can include transportation, food programs and caregiver support.

Just 43% of people who are 65 or older have tried to access mental health care, as opposed to 75% of people under 65.¹⁰ A big growth in virtual mental health care has helped with accessibility issues in the wider population. Will that solution work for this group?

One of the big questions has been whether older adults would engage in technology-based care. It’s important that we work toward this because our research shows that, with virtual care, many people speak more freely and personally about mental health issues.

Some older adults still prefer face-to-face, but it turns out that older Americans have been more than adept at getting their care virtually. Today, 40% of our Medicare enrollees who are receiving mental health outpatient care do so online. And all Medicare Advantage plans from Aetna now cover telehealth visits for mental health services.

For people who aren’t comfortable with digital visits, we’re trying to fill the gap in other ways. MinuteClinic locations in 14 states, for instance, currently offer in-person and virtual mental health counseling services, an important distinction that vastly improves access and reduces potential stigma people may feel coming into an actual counseling site.

One further challenge: there aren’t enough mental health practitioners to go around. Can that problem be solved?

We continue to advocate for policies that strengthen the behavioral health workplace to meet the needs of the Medicare population. We were pleased to see that, starting this year, Medicare will open its doors to a wider range of behavioral health practitioners — including trained marriage and family therapists, addiction counselors and licensed professional counselors. They will be able to provide counseling and cognitive behavioral therapy to patients without a doctor or nurse practitioner physically on-site.¹¹ That means more clinicians who can provide mental health care to older adults.

The health care industry is also focused on digital mental health services delivered via mobile phone apps or online as ways to get older people the care they need in a timely way. Studies show, for example, that cognitive behavioral therapy delivered over the internet is as effective as in-person therapy for depression and anxiety.¹²

We need to work diligently for the mental wellness of older Americans. The tools and strategies for doing that are growing, and we need to roll them out across the health care landscape.