Helping Older Patients Get Comfortable Talking About Mental Health

Alfred Wettermark, MD – Regional Medical Executive, Northeast

One in five people over the age of 55 have at least one mental health concern, with depression and anxiety being the most common. There are many factors that can negatively impact an older person’s mental health. Declining physical health, the onset of multiple chronic conditions, less independence, and more limited social interactions can lead to or escalate mental health conditions.

If left untreated, these feelings and conditions can worsen, and in some cases result in suicide. Older adults have one of the highest suicide rates as compared to other age groups—with white men over the age of 65 having the highest rate.

There are many opportunities to improve how we treat senior mental health, as this population tends to avoid talking about what they are experiencing and/or downplay the seriousness. The senior population may feel that sadness and isolation are a normal part of the aging process. They also may be embarrassed to discuss mental health concerns for fear of appearing weak or dramatic. With a condition like dementia, admitting there may be a cognitive problem can be scary and avoiding it is sometimes easier.

To help older patients get the care they need, primary care physicians must be proactive about spotting mental health issues and taking action. Here are three ways primary care doctors can make a difference.

Screen for risk factors. Screening can identify patients at risk, even when they are not able to recognize or articulate their feelings. Nationally published tools can help screen patients for the presence of common behavioral health issues like depression. Annual physicals present the perfect opportunity to conduct screenings. In addition, watch for red flags that may come up organically during a visit. For instance:

• Does the patient have trouble sleeping?
• Do they seem to be worried about many things?
• Have they recently lost a spouse or close friend?
• Are they suffering from a terminal illness or a condition that has recently gotten worse?
• Are they difficult to engage?
• Do they discuss any unusual ideas or disturbing thoughts they have had recently?
• Do they anger easily?

Should you notice anything that makes you suspect a mental health issue, take further action—whether that’s providing education, referring the patient to a specialist, scheduling a follow-up call, or talking about treatment options.

Engage in conversation. Primary care physicians are in a good position to change people’s minds about the importance of good mental health and how to achieve it. Listening to patient concerns, providing education, and discussing how to access resources can increase the chances that a patient will engage. You should approach mental health discussions with the same care and attention as physical health discussions. Topics to cover may include self-care tips, therapy options, and possible medications. When making therapy referrals, consider connecting patients with providers who offer virtual therapy appointments as these allow patients to receive treatment in the privacy of their home, which may make the patient more comfortable. Sharing information about the new Suicide and Crisis Lifeline (the new three-digit crisis number 998) may also be beneficial, although be careful about the context in which you share the information to avoid causing alarm.

Look beyond the appointment. Although engaging patients during the appointment is important, you should also stay in touch between visits. This may include conducting follow-up calls, scheduling telehealth check-ins, and connecting patients with community resources, such as transportation, companionship, or meal delivery services. Those providers that participate in alternative payment models may have more flexibility to think creatively about how to connect with patients outside the traditional visit.

With Baby Boomers aging, there will soon be more adults over the age of 65 than ever before. Consequently, the prevalence of mental health issues, including mental health issues that can lead to an increased risk of suicide, is expected to increase. As an industry, we need to take the necessary steps to proactively identify patients with potential mental health challenges and intervene early before they escalate.