Mental Health, Substance Use, and Aging: Conditions, Current Figures and Projections

1. Focusing attention, building capacity, supporting action Mental Health, Substance Use, and Aging: Conditions, Current Figures and Projections Debbie A. Webster, MS Mental Health Program Manager Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

3. Focusing attention, building capacity, supporting action Pasquotank Currituck Camden Alleghany Northampton Surry Gates Ashe Stokes Warren Caswell Rockingham Person Vance Hertford Halifax Watauga Perquimans Wilkes Granville Forsyth Yadkin Chowan Franklin Guilford Bertie Mitchell Avery Orange Alamance Nash Durham Caldwell Davie Yancey Alexander Edgecombe Madison Martin Washington Wake Davidson Iredell Dare Tyrrell Burke Chatham Randolph Wilson Catawba Rowan Buncombe McDowell Pitt Beaufort Haywood Johnston Greene Hyde Lee Swain Rutherford Lincoln Cabarrus Harnett Wayne Henderson Graham Moore Stanly Gaston Montgomery Jackson Polk Cleveland Lenoir Craven Mecklenburg Pamlico Macon Transylvania Cherokee Cumberland Clay Hoke Jones Richmond Sampson Union Anson Duplin Scotland Carteret Onslow Robeson Bladen Pender New Columbus Hanover Brunswick Percent of population 65 and over, 2011 10% or less 11% to 20% North Carolina – 13% Range: 7.6%-26.7% 21% to 30% Source: NC State Data Center

4. Focusing attention, building capacity, supporting action Pasquotank Currituck Camden Northampton Gates Stokes Warren Caswell Rockingham Person Vance Hertford Halifax Perquimans Granville Forsyth Chowan Franklin Guilford Bertie Orange Alamance Nash Durham Edgecombe Martin Washington Wake Davidson Dare Tyrrell Chatham Randolph Wilson Pitt Beaufort Johnston Greene Hyde Lee Harnett Wayne Moore Stanly Montgomery Lenoir Craven Pamlico Cumberland Hoke Jones Richmond Sampson Anson Duplin Scotland Carteret Onslow Robeson Bladen Pender Columbus Hanover Brunswick Percent of population 65 and over, 2031 Alleghany Surry Ashe Watauga Wilkes Yadkin Mitchell Avery Caldwell Davie Yancey Alexander Madison Iredell Burke Catawba Rowan Buncombe McDowell Haywood Swain Rutherford Lincoln Cabarrus Henderson Graham Gaston Jackson Polk Cleveland Mecklenburg Macon Transylvania Cherokee Clay Union New 11% to 20% 21% to 30% North Carolina – 19.6% Range: 10.6%-33.7% 31% or more Source: NC State Data Center

5. Focusing attention, building capacity, supporting action Pasquotank Currituck Camden Alleghany Northampton Surry Gates Ashe Stokes Warren Caswell Rockingham Person Vance Hertford Halifax Watauga Perquimans Wilkes Granville Forsyth Yadkin Chowan Franklin Guilford Bertie Mitchell Avery Orange Alamance Nash Durham Caldwell Davie Yancey Alexander Edgecombe Madison Martin Washington Wake Davidson Iredell Dare Tyrrell Burke Chatham Randolph Wilson Catawba Rowan Buncombe McDowell Pitt Beaufort Haywood Johnston Greene Hyde Lee Swain Rutherford Lincoln Cabarrus Harnett Wayne Henderson Graham Moore Stanly Gaston Montgomery Jackson Polk Cleveland Lenoir Craven Mecklenburg Pamlico Macon Transylvania Cherokee Cumberland Clay Hoke Jones Richmond Sampson Union Anson Duplin Scotland Carteret Onslow Robeson Bladen Pender New Columbus Hanover Brunswick Projected Growth of Population 65 and Over from 2011 to 2031 150% and above 100 to 149% increase 50 to 99% increase 8 to 49% increase Range: 8% - 161% Projected growth for the State is 78% Source: NC State Data Center

6. Focusing attention, building capacity, supporting action Mental Health Issues Common mental health issues experienced by older adults: • Anxiety • Depression

7. Anxiety Disorders Anxiety disorders - worry or fear becomes long term and may get worse instead of better as time goes on. * Generalized Anxiety Disorders (GAD) - most common: • Uncontrollable worry about things that are ok. • Easily startled; trouble falling asleep/staying asleep; headaches, difficulty concentrating, twitching. * Social Phobia - uncontrollably anxious around people • Difficulty talking to people; afraid of being judged and embarrassed; worry days/weeks before event; isolate themselves; interferes with everyday life activities.

8. Anxiety Disorders * Panic Disorder – sudden, unexplainable attack of terror; heart pounding like heart attack ; feelings of pending doom; fear of losing control and losing one’s mind; feels he or she is about to die. * Post-Traumatic Stress Disorder (PTSD) – constantly re-live trauma experienced; flashbacks – images, sounds, smells, feelings. • trauma – experiencing a horrific/terrifying ordeal - act of violence, abuse, accident; observing death of a loved one. • emotionally distanced; lost interest in things one used to enjoy doing; irritable; may become aggressive and violent.

9. Anxiety Disorders *Obsessive-Compulsive Disorder (OCD) – The uncontrollable need to check things over; perform repeated rituals; being overly tidy; having repeated unwanted thoughts such as hurting loved ones, violent or sexual acts. Obsessive – repeated, unsettling thoughts Compulsive – to control obsessions – repeat rituals or behaviors *NIH Senior Heal: Anxiety Disorders Symptoms of Anxiety Disorders, http://nihseniorhealth.gov/anxietydisorders/aboutanxietydisorders/01.html • specific phobias

10. Focusing attention, building capacity, supporting action Depression in Older Adults • Up to 20% of Americans 65+ are currently depressed. Depressed older adults visit the doctor or emergency room more often, have longer stays in the hospital, incur more medical expenses, and take more medications.1 • Depression is not considered a normal part of aging. • Common depressive symptoms should be viewed as possible symptoms of a treatable illness. • Depression treatment is effective with older adults.2 1. Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. (2008). The state of aging and mental health in America. Retrieved from http://www.cdc.gov/aging/pdf/mental_health.pdf 2. Canadian Coalition for Seniors’ Mental Health, 2006. National Guidelines for Seniors’ Mental Health: Assessment and Treatment of Depression

11. Focusing attention, building capacity, supporting action Depression in Older Adults Nationally, • More than 55% of older persons receive mental health care from primary care physicians.  • Less than 3% of those aged 65 and older receive treatment from mental health professionals. • Primary care physicians accurately recognize less than one half of patients with depression. *http://www.nmha.org/index.cfm?objectid=C7DF94FF-1372-4D20-C8E34FC0813A5FF9

12. Depression in Older Adults Causes: • Moving from their home • Chronic illness or pain • Children moving away • Spouse or close friends passing away • Loss of independence

13. Depression in Older Adults Symptoms of Depression: persistent sadness weight changes feeling slowed down pacing and fidgeting excessive worries difficulty sleeping frequent tearfulness difficulty concentrating feeling worthless/helpless physical symptoms

14. Depression in Older Adults Physical illness symptoms similar to depression: • Thyroid disorders • Parkinson's disease • Heart disease • Cancer • Stroke • Dementia (such as Alzheimer's disease)

15. Focusing attention, building capacity, supporting action Depression and Suicide • Depression is a significant predictor of suicide in elderly Americans. • Comprising only 13% of the U.S. population, individuals aged 65 and older account for 20% of all suicide deaths. • Suicide among white males aged 85 and older is nearly six times the suicide rate in the U.S. * http://www.agingstats.gov/Main_Site/Data/2012_Documents/Population.aspx

16. Youth vs. Older Adult Youth (10-24) Older Adult (65+) Completions (North Carolina 2004-2008) 679 deaths, 7.5 rate 875 deaths, 16.2 rate Completion and Attempt Ratio (National Estimates) 1 death for every 100 to 200 attempts 1 death for every 4 attempts

17. Gender-Specific Suicide Rates by Age: NC-VDRS, 2010

18. Prevention/Intervention Opportunity • Most older adults who die by suicide had been seen recently by their primary doctor. • 20 percent had been seen by their doctor within 24 hours of their suicide. • 41 percent had been seen by their doctor within a week of their suicide. • 75 percent had been seen by a physician within a month

19. Elder Suicide Circumstances NC-VDRS, 2008-2010

20. Suicide Warning Signs • Depressed or sad most of the time • Talking or writing about death/writing a will • Withdrawn from loved ones • Feeling hopeless or helpless • Feeling trapped - no way out • Dramatic mood changes/eating habits/personality • Giving away prized possessions • Acting impulsively or reckless • Feel excessive guilt or shame *Suicide Warning Signs, http://www.suicide.org/suicide-warning-signs.html

21. Focusing attention, building capacity, supporting action Substance Use and Older Adults “The‘baby boomer’ cohort - people born from 1946 to 1964 - is the first in U.S. history with a majority having used illicit drugs sometime in their lives.” Joseph C. Gfroerer, Director of the Division of Population Surveys at SAMHSA’s Office of Applied Studies (OAS). *http://www.samhsa.gov/SAMHSAnewsLetter/Volume_17_Number_1/OlderAdults.aspx

22. Focusing attention, building capacity, supporting action Substance Use andOlder Adults Nationally, Of the 2.2 million adults age 50 and older who used illicit drugs in the past month: • 54 percent used marijuana. • 28 percent misused prescription drugs. • 17 percent used another illicit drug. *http://www.samhsa.gov/SAMHSAnewsLetter/Volume_17_Number_1/OlderAdults.aspx

23. Substance Use and Older Adults Substance use in older adults is overlooked. • They are more likely to drink or use drugs at home than in public. • They may not be involved in work or other daily activities. • They may have symptoms similar to health problems, such as depression or dementia. • Caregivers may be aware of problem but may not want to talk about it.

24. Alcohol Older adults: • Need less to be intoxicated. • Stay intoxicated longer. • Intoxication slows reaction time if person has hearing problems or poor vision. • Mix with prescribed and non-prescribed medication – this may be fatal.

25. Misuse of Medicine Older adults: • Take many medicines causing the misuse of medicines. • Take more than what was prescribed, or when they do not need them. • Use older medicines, or another person's medicine. • Take medicine to feel good or "high" (pain meds). • Don’t take meds as prescribed or skipping dose.

26. Changes in Behavior • Frequent falls • Becoming incontinent • Having more headaches and dizziness than usual • Incomplete hygiene • Appetite changes • Ignoring and losing touch with family and friends • Suicidal ideations • Beginning to have legal or money problems

27. Changes in Mental Abilities • Anxious most of the time • Cognitive changes • Difficulty in focusing • Not interested in usual activities • Mood swings, sadness or depressed

28. Emergency Department and Older Adults • 2004, 115,798 emergency department (ED) visits, involving pharmaceutical misuse or abuse; • 2009, number ED visits = 300,082, increase of 159 percent; • Between 2008 and 2009 – 45% increase, involving misuse or abuse of oxycodone; • 2009 - 33 % ED visits, involving pharmaceutical misuse or abuse among adults aged 50 to 54. *http://www.samhsa.gov/data/2k12/DAWN108/SR108PharmaAbuse2012.htm Focusing attention, building capacity, supporting action

29. Focusing attention, building capacity, supporting action Caregivers – Toll on Health and Well-being Family Caregivers: • Increased level of depression and anxiety • Higher use of psychotropic medications • Poorer physical health • Compromised immune functioning • Increased mortality • Result – inability to provide care * Center of Disease Control and Prevention, Care giving: A public health priority, http://www.cdc.gov/aging/caregiving/index.htm

30. MCOs • Alliance Behavioral Healthcare • Centerpoint Human Services • CostalCare • Eastpointe • East Carolina Behavioral Healthcare • MECKLink • Partners Behavioral Health Management • Cardinal Innovations Healthcare Solutions • Sandhills Center • Smoky Mountain Center and Western Highlands Network

31. Adult MH Treatment Services • Medication Management • Outpatient Treatment • Peer Support Services • Psychosocial Rehabilitation • Community Support Teams – MH and/or SA • Assertive Community Treatment Team

32. Adult SA Treatment Services • SA Intensive Outpatient Services (SAIOP) • SA Comprehensive Outpatient Treatment Program (SACOT) • SA Non-Medical Community Residential Treatment • SA Medically Monitored Community Residential Treatment • Detoxification Services • Outpatient Opioid Treatment

33. Crisis Services • Mobile Crisis Management • Walk-in Crisis and Psychiatric Aftercare Programs • Facility-Based Crisis Programs • Crisis Intervention Teams • NC START (Systematic, Therapeutic, Assessment, Respite and Treatment)

34. Geriatric Adult Mental Health Specialty Teams (GAST) Purpose – To increase the ability of community partner staff providing services and support to older adults which increases community tenure. Activities – To provide training and consultation to community partner staff on topics such as: • Signs & symptoms of depression, anxiety, and dementia • Crisis prevention • Substance use/misuse

35. CCNC & LME-MCO Collaboration • CCNC is NC Health Home • LME-MCO is a vital partner that supports Health Home • Shared Care Management of recipients • Identification, linkage to services • Coordination of MH/DD/SA & physical health needs • Data exchange into informatics • Collaboration on integrated care practices • Regular partnership meetings • Care Coordination + health promotion = cost savings.

36. Mental Health and Substance Abuse Services

37. What You Can DO 1. Know your GAST program staff. 2. Know how to access MH/SU and Aging services. 3. PARTNER, PARTNER, PARTNER with each other. 4. Develop Local Mental Health, Substance Use, and Aging Collaboration. 5. Use data to convey seriousness of issue and need for action to your local, county, state and federal officials.

38. Focusing attention, building capacity, supporting action Contact Information Debbie A. Webster Office: 919-715-2774 E-Mail: debbie.webster@dhhs.nc.gov Department of Health and Human Services - http://www.ncdhhs.gov/ Division of Mental Health, Developmental Disabilities, and Substance Abuse Services - http://www.ncdhhs.gov/mhddsas/ Managed Care Organizations for Mental Health, Developmental Disabilities, and Substance Abuse Services Contacts - http://www.ncdhhs.gov/mhddsas/lmeonbluebyname.htm

39. Caregiver Resources NCcareLINK • http://www.fullcirclecare.org/nc/carelink.html North Carolina Aging Service Plan 2011-2015 http://www.nasuad.org/documentation/tasc/state%20plans/North%20Carolina%20State%20Plan.PDF North Carolina family Caregiver Support Program http://www.ncdhhs.gov/aging/fchome.htm