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Mental Health and Older Adults Facebook Live Q&A


BRIAN ALTMAN: Good afternoon. My name's Brian Altman. I am with the Substance Abuse and Mental Health Services Administration at the US Department of Health and Human Services. I'm very excited to be hosting today's live Facebook Q&A on older adult mental health because I've been working at the intersection of older adult mental health program and policy for a number of years. I'm also excited to be joined here today with two of my colleagues from the National Institute of Health, Dr. Elizabeth Necka with the National Institute on Aging and Dr. Jovier Evans with the National Institute of Mental Health. Thank you so much for being with us today.

ELIZABETH NECKA: Thanks, Brian. I'm excited to get started.

JOVIER EVANS: Yeah. Thank you. I'm looking forward to diving into today's topic about older adults in mental health.

BRIAN ALTMAN: Me too. All right. Just a couple of things before we get going with some questions and answers among all of us. First of all, if you have questions for our panelists, we'll be answering them at the end, and you can drop them into the chat function of the live Q&A, and we'll answer them at the end, as I said. Secondly, we wanted to make sure you know that we will be providing information based on research and resources that might help individuals who are older adults and may have mental health concerns. However, we will not be providing medical advice, and this is not considered medical advice. If you do have a medical condition, please consult your healthcare professional. All right. It's really quick Q&A, so let's go ahead and dive in. First off, what are some basics? So what are some common mental health concerns that older adults face?

JOVIER EVANS: I'm happy to take this question. Mental health or emotional, psychological, and social well-being is important at every stage of life. Studies show that many older adults feel satisfied with their lives. However, at any age, mental health concerns can come up. For older adults, two common concerns are depression and anxiety. Depression is a serious but common mood disorder that negatively affects one's thoughts and behaviors. Feelings of anxiety, depression, or other mental health issues can be normal life changes that happen as you age. These changes could include the passing of a loved one, taking on a caregiver role, or moving into an assisted living facility. All of these things can put you at an increased risk for feelings of grief, social isolation, and loneliness. When they persist, that can lead to depression. Depression is also more common in people who have had other illnesses, such as heart disease or cancer, or whose function and mobility becomes limited. Depression, along with other risk factors, like disability, can increase a person's risk for late-life suicide.

ELIZABETH NECKA: And so I'll add that depression is also common in people with Alzheimer's and related dementias. Depression can cause similar symptoms as dementia. And depression can be an early warn sign of possible dementia. So if you or someone you know has been recently diagnosed with dementia, it's important to make sure that you have a support system in place. This might include a local support group or an organization, family, friends, a faith group. Dementia caregivers, along with all caregivers, are at increased risk for depression. So the everyday stress of taking care of another person can make someone more likely to feel socially isolated or lonely, which can lead to depression. So I want to be clear. Depression is not a normal part of aging. But if you feel depressed, treatment can help.

BRIAN ALTMAN: Okay. Let's talk a little bit more about depression. So what are some of the signs people might see in somebody who has depression, and does it look different in older adults?

ELIZABETH NECKA: Yeah. I can take this one. Depression can present itself in many ways, and it can look different in younger and older adults. So common signs and symptoms in any age group often include feelings of hopelessness or persistent sadness, decreased energy or fatigue, difficulty sleeping, changes in eating habits, and difficulty concentrating or making decisions. You might also experience thoughts of death or suicide. Now, one symptom of depression that is more unique to older adults is experiencing cognitive problems or challenges with one's ability to clearly think, learn, and remember. This is not a complete list of symptoms. Everyone can experience depression differently. So it's important to keep an eye out for any sudden or gradual changes in your mood. Feeling down every once in a while is a normal part of life. However, if these feelings persist for a few weeks or a few months, then you may have depression. It's important, however, to know that depression is treatable.

JOVIER EVANS: I'd like to add that there are a few things that we often see among older adults experiencing symptoms of depression. First, the reasons for developing depression are usually different among older people versus young adults or children. As I mentioned before, certain medical or lifestyle changes that are more likely to occur later in life, like a serious illness or becoming widowed, may be precursors to depression among older people. Secondly, healthcare providers may mistake an older person's symptoms of depression as just a normal or natural reaction to an illness, disability, or the life changes that may occur as you get older and, therefore, not think that the depression is something that needs to be treated. This, unfortunately, means that older adults are often misdiagnosed and under-treated when it comes to depression. And finally, older people tend to be less likely to share what they're feeling. That could be because of stigma around mental health issues or other reasons. So it's important to check up on the older people in your life and ask how they're doing, especially if you notice a shift in their behavior and/or their mood.

BRIAN ALTMAN: Yeah. That's a really good point. I know it's really important to reach out to loved ones and see how they're doing and see if, by talking to them, you might be able to get them to seek treatment if they need it. So speaking of treatment, when should someone sort of seek out treatment for depression or another mental health issue?

ELIZABETH NECKA: It's important to seek help as soon as you start experiencing symptoms. Depression, even severe depression, can be treated. So if you think you may have depression, start by making an appointment to see your doctor or a mental health care provider, and they can evaluate you to determine a diagnosis and the best treatment plan. Now, as a caregiver, you may notice signs of depression in the person that you're providing care for. If that's the case, encourage them to talk to a healthcare provider as soon as possible. Receiving treatment sooner rather than later is important.

JOVIER EVANS: Exactly. Reaching out to your doctor sooner can make all the difference. Your doctor may refer you to a mental health provider for treatment, such as counseling or psychotherapy. These types of treatment are usually provided by a licensed mental health professional, and they can help you identify and change troubling emotions, thoughts, or behaviors. It is also not uncommon for a person's treatment plan to include a combination of both medication and counseling. Medication can help balance the hormonal changes that might [affect it?], but it's also very important to help with regard to counseling. So for most people, depression does get better with treatment, and if your treatment plan isn't working, you should talk to your doctor.

BRIAN ALTMAN: Thank you both. That's really helpful. So before we take any questions from the live audience, I just had one more. Is there something people can do to help improve their mental health and well-being proactively?

JOVIER EVANS: Sure. Self-care and a healthy lifestyle can play a role in maintaining both your mental and physical help. And it can help support your treatment and recovery if you have a mental illness. Being physically active, eating a healthy diet is one way to improve your mood and your overall health. Staying hydrated can also improve your energy and keep you focused throughout the day. Getting the recommended seven to nine hours of sleep each night can also help. Small things like keeping your bedroom a comfortable temperature and avoiding long naps in the late evening can help you to get a good night's sleep. And a good night's sleep has been related to good overall mood. Try to focus on positive things. Identifying and challenging your negative and unhelpful thoughts may also help you feel better.

ELIZABETH NECKA: Yeah. I'll also add that the pandemic has shed light on how important it is that we stay connected for our mental health. Research has shown that staying in touch with family and friends and not socially isolating yourself really makes a difference and can boost your mood. So participating in activities that you enjoy, like riding your bike through the park or playing board games, for example, with grandchildren, can help ward off feelings of social isolation and loneliness, which can increase a person's risk for depression.

BRIAN ALTMAN: That's definitely true. I know staying connected is really important. I always try to schedule Facebook-- or I mean FaceTime or Zoom meetings with my parents, and that way, I can check in on them, see how they're doing, update them on my life. But of course, really, what they're interested in is their granddaughter's life, and they love hearing what she's been up to at school and hearing her laugh. And that just, I know, helps their mood tremendously. So I think there's lots of things that people can do to stay connected and help their mental health and well-being. All right. I think it's the point in time now where we're going to see if we have any questions for the audience. Let me take a look here. Okay. Let's see. What thoughts do you have regarding the impact of the lack of digital accessibility and the lack of access to digital information that is a cause for stress and depression?

JOVIER EVANS: Well, I'll take a stab at the first part of this, and then Liz can follow up with any other comments and/or issues. I think there has been, with the pandemic, a complete point to the idea, the digital divide and the lack of access to information with regard to things over the internet and the like. And there needs to be more of an effort made to deal with a lot of these things. But at the same time, a lot of people have access to their smartphones, and a lot of older adults, contrary to some particular myths, do have their smartphones and are able to stay in contact with aspects of the internet and their families, as Brian just mentioned. But there's also a nice benefit to phone calls, social connectedness. Could be talking to a neighbor, talking to family members that it may not necessarily have to be all computer-related. But that is a good point.

ELIZABETH NECKA: Yeah. And I'll just add to what Jovier said. There's been some research during the pandemic that's looked at how people are communicating with their loved ones and the format, so phone or email or in-person. And the main takeaway is that mediums that people are familiar and comfortable with are the best way to communicate. So hopefully, there's increasing access to information online, but if you have a way to reach someone that isn't online, take advantage of that. The phone can be a really great tool for connecting with people.

BRIAN ALTMAN: So we do have a question sort of moving beyond connecting with people, sort of a one-on-one interaction, about actual treatment using sort of digital formats. So the question is has there been research about the effectiveness of telehealth for assessment of cognitive and emotional health?

JOVIER EVANS: Yes. The pandemic especially has brought to the fore the need to use telehealth interventions to help people. And the good news is that a lot of these digital technologies and tele interventions are just as effective as in-person behavioral interventions. And what we've noticed over the last two years is that it improves adherence. It improves, I would say, connectedness with the therapist, that people show up for their appointments, and they're more likely to keep their appointments using telehealth, and that it's been seen as such a good boost that there are now efforts to make sure it's actually covered through Medicare and CMS. So that's a great thing.

ELIZABETH NECKA: Yeah. I will say we're still actively doing research, and both NIA and NIMH are supporting research on the effects of telehealth on emotional, cognitive health, mental health and well-being. But I think there's a lot of promise with telehealth, especially for reaching some people who might not necessarily be close to a specialist in the city center, for instance.

BRIAN ALTMAN: All right. Thanks. I think this one, maybe, Dr. Necka, you could start with because you talked a little bit about both older adult mental health issues and sort of cognitive issues at the same time. So the specific question is can you expand on the area of treatment for depression even in the presence of cognitive disorders? So you're saying sometimes even for mental health providers who are trained in these type of things that it can be challenging to treat both simultaneously. Do you have any sort of thoughts there?

ELIZABETH NECKA: Yeah. I mean, the two tend to go hand in hand in late life. And so it can be tricky to address one or the other. I would say that trust your mental health provider and lean on the people with whom you have in your support network to try to disentangle what parts can be addressed with different types of medication versus therapy to try to disentangle the two.

BRIAN ALTMAN: Dr. Evans, do you have anything to add?

JOVIER EVANS: Well, I would also say that there have been studies looking at the effectiveness of various behavioral treatments for older adults who might also have these cognitive impairments and found that there are issues in approaches, such as motivational interviewing or behavioral activation or things that you can do with a family member to kind of encourage the person or the identified patient in moving forward with engaging in a lot of activities or providing structure to do so.

BRIAN ALTMAN: Thanks. That's actually a good segue to our next question too. Somebody is sort of saying what if you notice some of these signs and symptoms, and you think they may need treatment, but they seem resistant to seeking help? What can you do to help encourage them to get the help that they might need?

ELIZABETH NECKA: Well, we mentioned earlier that sometimes there's a lot of stigma around mental health in late life. And one of the people that you tend to see in late life on a regular basis is your primary care physician. And primary care physicians can be a great place to start. Just mention things and encourage-- you've got someone in your life who you think might be depressed. Encourage them to just mention it to their primary care provider. It makes it seem a little bit more like a-- it seems less stigmatized for some people, and so they might be more willing to open up, and then their primary care physician can help link them up with the right resources.

BRIAN ALTMAN: All right. Our next question is about maybe folks who aren't necessarily living in their community but living in nursing homes or assisted living centers. What do you suggest for those folks who might be living with depression or feel particularly isolated at the moment?

JOVIER EVANS: Well, this may be one of those opportunities to talk to the staff at the assisted living facility and the nursing home. I mean, they have to rate residents overall emotional and mental and physical health regularly. And it may be that they can provide access to services and/or treatment [opportunities?] for the people in the nursing home.

ELIZABETH NECKA: I'll also say that even little things like having plants to take care of or appointments to keep on your calendar can give people a sense of purpose that is sometimes difficult to get in the regulated environment of a nursing home, and that could be a good way to start moving in the right direction.

BRIAN ALTMAN: Great. Okay. The next question is about nutrition and the impact nutrition has on mental health and aging. It says, "I'd appreciate knowing if NIMH, NIH, or SAMHSA include nutrition as a kind of treatment for depression or other disorders." So I'll start here not necessarily from the SAMHSA perspective, but I have recently worked at the Administration for Community Living's Administration on Aging. And the Administration on Aging, which is also part of the US Department of Health and Human Services, does fully embrace the Nutrition Programs that they have for older adults as a way to combat social isolation. And so in everything that they do in terms of their Nutrition Programs at the Administration on Aging, they ensure that those programs integrate social connectedness and making sure that people are not depressed and potentially referring them to treatment if they see something that occurs when they come either to a congregate meal, like a meal at a senior center, or if there are folks, volunteers who are participating in a Meals on Wheels, and they're taking the meals to the person's home, and they see something that they think might be [inaudible] they also can help connect them to care. So I know that's something the Administration on Aging in their Nutrition Program definitely thinks about as that connection between depression, social isolation, social connectedness, and nutrition. I don't know if Dr. Necka or Dr. Evans have anything else to talk about there.

JOVIER EVANS: I would just say we've supported research looking at the effectiveness of moving out and dealing with aspects of behavioral activation in mental health treatment and things like Meals on Wheels and totally endorse what you just said. It's all connected. So your physical health impacts your mental health and vice versa. So you have to be able to take care of yourself and feel good and healthy to make sure all those other things move forward.

BRIAN ALTMAN: Okay. So here is one that sort of I think may be COVID-ish-related in the sense that we're finally seeing drops in cases, and people are feeling more comfortable, though maybe not entirely comfortable, coming out of their homes, engaging with other people. Do you have anything specifically you would recommend for folks who might be experiencing anxiety in specifically sort of like re-entry into sort of more social settings for older adults? Do you have any suggestions for treatment if people sort of need to get out more and aren't able to get out more, but they're feeling a lot of anxiety about that?

ELIZABETH NECKA: I think that you can start small. Try doing things like scheduling a weekly walk with your neighbor or your grandchild or pick up a new hobby like taking some sort of class so that there's a little bit more structure and regiment. Of course people have to do what matches their level of comfort. And that's going to be very specific to your specific background and where you live. And so there's lots of things to consider there. But essentially, baby steps to resuming a pre-pandemic-type life.

JOVIER EVANS: Exactly. I would also--

ELIZABETH NECKA: I can speak a little bit more-- oh, sorry, Jovier.

JOVIER EVANS: No, no, no. I was just going to basically endorse what you just said and say that you do things that you can to keep yourself safe, but the benefits of contacting relatives, seeing family and friends that you haven't seen probably help outweigh or alleviate a lot of that anxiety and/or stress because you haven't seen these people in such a [inaudible]. Think of the positive benefits of that, I think, moving forward.

BRIAN ALTMAN: Yeah. I know I still feel-- we went to the movie once, and I got really, really anxious like, "There are so many people so close to me." So starting out with like just dinner at a friend's house is definitely, I think, probably a better way if people are experiencing anxiety. So I think we're going to close out and just sort of see if people have thoughts, especially that we can drop into the chat of resources that people who are watching might benefit from.

ELIZABETH NECKA: Yeah. We have a lot of resources available on our website, which I think there'll be a link to after we're done speaking here, about depression and social isolation and loneliness in later life. And I know that NIMH and SAMHSA also have similar resources.

JOVIER EVANS: Oh, sure. And then if anyone you know is suffering in a mental health crisis or needs immediate help, you should call 911. SAMHSA has a National Suicide Prevention Lifeline , 1-800-273-TALK. I should also note that on July 16th, you'll be able to call the hotline by simply dialing 988. And then SAMHSA also has a general information mental health helpline that you can use to find local treatment services. And I think the number will be posted online if it's not already. But it's 1-800-662-4357. And then you can also find a lot of resources about mental health disorders and where to seek out help on the NIMH website. And we'll add these links in the comments. I just saw that, so.

BRIAN ALTMAN: Great. Thank you so much for both participating in this live Q&A. And thanks to our audience. If we didn't get to your question, we will try to respond via other methodology. And like they said, if you would like more information, each of our websites will be up shortly after this for you to find what you need. So thank you so much for everyone who joined us. Thank you to Dr. Evans and Dr. Necka. And we look forward to discussing this topic and others in future Facebook live Q&As. Thanks so much, everybody.

ELIZABETH NECKA: Thanks so much, Brian.

JOVIER EVANS: Thank you.