Addressing the Rising
Mental Health Needs of
an Aging Population

__________

Alexandra Andrada, Kat M. Anderson,
and Sharyl J. Nass, Rapporteurs

Forum on Mental Health and Substance
Use Disorders

Forum on Aging, Disability, and
Independence

Board on Health Care Services

Health and Medicine Division

Proceedings of a Workshop

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Purchase Order No. 75FCMC22P0038 with the Centers for Medicare & Medicaid Services and Contract No. HHSN263201800029I, Order No. HHSN26300025 with the National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health), and by the American College of Clinical Pharmacy, American Psychiatric Association, American Psychiatric Nurses Association, American Psychological Association, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Council on Social Work Education, Janssen Research & Development, LLC, Office of the Assistant Secretary for Planning and Evaluation, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust.

International Standard Book Number-13: 978-0-309-71257-6
International Standard Book Number-10: 0-309-71257-2
Digital Object Identifier: https://doi.org/10.17226/27340

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Addressing the rising mental health needs of an aging population: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27340.

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WORKSHOP PLANNING COMMITTEE¹

JIE CHEN (Co-Chair), Professor, Department of Health Policy and Management, Director, The Hospital and Public health InterdisciPlinarY Research (HAPPY) Lab

CHARLES F. REYNOLDS, III (Co-Chair), Distinguished Professor of Psychiatry and UPMC Endowed Professor in Geriatric Psychiatry, University of Pittsburgh School of Medicine (emeritus)

JENNIFER BEAN, Clinical Pharmacist Practitioner, Geriatric Mental Health, Pharmacy Service, VISN 9 Clinical Resource Hub

KIRSTEN BERONIO, Senior Policy Advisor, Center for Medicaid and CHIP Services

MICHAEL B. FRIEDMAN, Adjunct Associate Professor, Columbia University School of Social Work

NARDA IPAKCHI, Vice President of Policy, The SCAN Foundation

VINCENT MOR, Florence Pirce Grant Professor, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence RI U.S. Department of Veterans Affairs

EMMA NYE, Public Health Analyst, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

Staff

ALEXANDRA ANDRADA, Director, Forum on Mental Health and Substance Use Disorders

ISAAC SUH, Research Associate

ANESIA WILKS, Senior Program Assistant

TRACY LUSTIG, Director, Forum on Aging, Disability, and Independence

SHARYL J. NASS, Senior Director, Board on Health Care Services

Consultant

KAT M. ANDERSON, Consulting Writer

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

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Reviewers

This Proceedings of Addressing the Rising Mental Health Needs of an Aging Population was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID REUBEN, University of California, Los Angeles. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

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Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Forum on Mental Health and Substance Use Disorders wishes to express its sincere gratitude to the planning committee co-chairs Jie Chen and Charles Reynolds III for their valuable contributions to the development and organization of this workshop, in addition to the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. The forum wishes to thank all the speakers who shared a perspective on living with a mental illness as an older adult or caring for an older adult with mental illness: Michael B. Friedman (planning committee member), Charita Cole Brown, Sandra Cohen, Nicole Jorwic, and Harvey Rosenthal. Finally, the forum wants to thank all the speakers and moderators, who generously shared their expertise and their time with workshop attendees. Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to its work. The sponsors include the American College of Clinical Pharmacy, American Psychiatric Association, American Psychiatric Nurses Association, American Psychological Association, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Council on Social Work Education, Janssen Research & Development, LLC, the National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health), Office of the Assistant Secretary for Planning and Evaluation, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foun-

dation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust. The sponsors of the Forum on Aging, Disability, and Independence include AARP; Administration for Community Living; American Geriatrics Society; Consumer Technology Association Foundation; The Gerontological Society of America; John A. Hartford Foundation; LeadingAge; National Institute on Aging; National Institute on Disability, Independent Living, and Rehabilitation Research; PHI; and SCAN Foundation.

Contents

OVERVIEW OF THE WORKSHOP

LIVED EXPERIENCE

CLINICAL CONTEXT

Demographics and Epidemiology: Mental Health Disorders in Older Adults

Psychotic Disorders: Schizophrenia in Later Life

Exploring Strategies to Address the Needs of Older Adults With Major Depression

Substance Use Disorders in Older Adults

NEUROBIOLOGICAL VIEW OF MENTAL HEALTH AND SUBSTANCE USE DISORDERS

Co-Occurrence of Dementia and Mental Health Conditions

HEALTH DISPARITIES AND SOCIAL DETERMINANTS OF HEALTH

At-Risk Communities

Race and Ethnic Disparities in Aging Populations: Black Older Adults

Medi-Cal Expansion to Older Undocumented Immigrants

INTEGRATION, ACCESS, QUALITY, COST, AND EQUITY

Integrating Behavioral Health Services and Primary Care

Public Health Integration Into Accountable Care Organizations

Certified Community Behavioral Health Clinics

Medicare

CLOSING DISCUSSION FOR DAY 1

WORKFORCE

Overview: Workforce Needs to Support the Well-Being of Older Adults With Mental Health Conditions

Clinical Pharmacist Practitioners

Paraprofessionals

Cultivating Interprofessional Teams

Discussion

RISK REDUCTION, PREVENTION, AND EFFECTIVE INTERVENTIONS

Wellness Through Meaningful Activities

Universal, Selective, and Indicated Depression Prevention

Promoting Resilience and Positive Mental Health in Older Adults

Discussion

SUPPORTIVE COMMUNITIES

Social Disconnection

Victims of Trauma

Building Community-Based Partnerships

Discussion

CHALLENGES AND PRIORITIES

Telehealth

Rural Challenges

Technology Development, Implementation, and Dissemination

Discussion

ADVOCACY GROUPS

CLOSING REMARKS

REFERENCES

APPENDIX A STATEMENT OF TASK

APPENDIX B WORKSHOP AGENDA

APPENDIX C Recommendations From the 2012 IOM Report on The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?

APPENDIX D Recommendations From the 2020 NASEM Report on Social Isolation and Loneliness in Older Adults

Boxes, Figures, and Table

BOXES

1 Key Takeaways from Speakers in Session 1: Clinical Context

2 Key Takeaways from Speakers in Session 2: Health Disparities and Social Determinants of Health

3 Key Takeaways from Speakers in Session 3: Integration, Access, Quality, Cost, and Equity

4 Key Takeaways from Speakers in Session 4: Workforce

5 Key Takeaways from Speakers in Session 5: Risk Reduction, Prevention, and Effective Interventions

6 Key Takeaways from Speakers in Session 6: Supportive Communities

7 Key Takeaways from Speakers in Session 7: Challenges and Priorities

FIGURES

1 National age distribution of the U.S. population, 2020–2060

2 Poverty rate for individuals aged 65 and older by race and ethnicity, 2020

3 Cumulative percentage change in the U.S.-born and foreign-born population in California, by age (2003–2019)

4 Health IT-supported SMILE Framework

5 Conceptualization of peer support

6 Framework for Mental Health and Substance Use Disorder Workforce

TABLE

1 Five-Tier Taxonomy of Clinical Recovery in Older Adults with Schizophrenia

Acronyms and Abbreviations