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An Overview of Barriers & Solutions
© 2013 Griswold International, LLC
“Held annually during
Mental Illness Awareness Week
in October, National Depression
Screening Day (NDSD) raises
awareness and screens people for
depression and related mood
and anxiety disorders.”
National Alliance on Mental Illness (NAMI)

© 2013 Griswold International, LLC
Our Goal for Today
• Increase awareness of mental health issues in
older adults and the importance of treatment
• Drive early and effective….
- Dialogue related to mental health and depression
- Mental health screening and diagnosis
- Treatment that drives positive outcomes

© 2013 Griswold International, LLC
Presented by:

Chris Kelly, MEd

Director of Learning & Development
Griswold Home Care

© 2013 Griswold International, LLC
Thank you for your courage, energy, and dedication!
Healthcare Providers

Professional Caregivers

Family Caregivers

Clients Living with Mental Illness

© 2013 Griswold International, LLC
Lit Review
Social Media
Advocacy
Solutions Webinar & Toolkit

© 2013 Griswold International, LLC
Orange Arrow Button:
Minimizes or expands the
GoToWebinar control panel.

BRAIN WRITING

Solutions

Brainwriting is…
• a fun, engaging way to brainstorm
• sharing as many ideas as possible within a short timeframe
Brainwriting Process
• Listen for our questions
• When prompted, enter your solutions using the webinar chat function
• Don’t overthink or agonize…There are no right or wrong answers
Brainwriting Outcomes
• Peer-to-peer learning and sharing
• A publication that benefits others who are living with Depression
Important
• Avoid sharing any information that you would not want others to see

© 2013 Griswold International, LLC
Mental Health and Aging in America
• 20% of people age 55 years or older have mental health issues
• The most common mental health conditions for older adults are:
- Mood disorders

- Anxiety

- Severe cognitive impairment

• Depression is the most common mental health condition among
older adults
The State of Mental Health
and Aging in America

Mental Health and Aging

http://1.usa.gov/HfIfqP

http://1.usa.gov/17GDCNq

TOOLS

© 2013 Griswold International, LLC
The Impact
Untreated mental health conditions in older adults have
been connected with chronic conditions such as:
- Heart disease
- Diabetes
- Stroke
- Increased health care costs
- Inability to function
- Disability

© 2013 Griswold International, LLC
The Impact
Older adults with untreated depression have…
- More doctor/ER visits
- Increased use of medicine
- Higher outpatient charges
- Longer hospital stays
- Increased readmission rates
- Highest risk for suicide as
compared to other age groups

© 2013 Griswold International, LLC
Core Barriers –
Older Adults

“Well, I feel as
though most people that
are depressed really feel
unloved - that’s the main thing
or they feel unwanted or they
feel as though that they are
useless…like…I’m no more
use to you any more
so just let me go.”
Quote from older adult
with depression

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782754/pdf/nihms150724.pdf

© 2013 Griswold International, LLC
Core Client Barriers - Awareness,
Beliefs and Stoicism
Older adults are often…
- Unaware of the symptoms
- Stoic about emotional and
physical pain
- Reluctant to “complain”

- Skeptical about the need for
treatment
- Feel they can handle things
on their own

Depression In Older Adults

- Lou Gehrig

Older Americans Behavioral Health

TOOLS

http://bit.ly/1ibEAWU

http://1.usa.gov/19YXM5d
© 2013 Griswold International, LLC
Core Client Barriers Access to Support and Services
Older adults often lack access to care and support due to:
- Medical issues

- Decreased mobility

- Lack of transportation

- “Digital divide” – low access/comfort with e-tools (email, text,
online portal)

- Depression - which triggers isolation

© 2013 Griswold International, LLC
Core Barriers –
Healthcare Providers

“Depression in
elderly people often goes
untreated because many
people think that depression is
a normal part of aging and a
natural reaction to chronic
illness, loss and social
transition.”
National Alliance on Mental Illness
(NAMI)

© 2013 Griswold International, LLC
Core Healthcare Provider Barriers Healthcare Provider Time Constraints, Tools, Access
• Healthcare providers work very hard to recognize and
treat depression
• Recent research highlights that the prevalence of
depression in older adults has lowered
• Common provider barriers remain:
- Inadequate vigilance and screening
- Time constraints
- Misperception/Stigma
- Poor access to older adults
- Using language/terms that clients and family caregivers
cannot identify with
http://www.huffingtonpost.com/2013/07/11/depression-in-older-adults-down_n_3575569.html

© 2013 Griswold International, LLC
Screen, Discuss
and Diagnose
Depression

CDCP - http://www.cdc.gov/aging/pdf/cib_mental_health.pdf

“I didn’t know
anything about depression,
so I didn’t know I was
depressed.”
Older adult with depression

© 2013 Griswold International, LLC
Learn About Depression
It is important to learn about the symptoms of depression and
treatment that can help
About Depression

Caregiving and Depression

TOOLS

http://1.usa.gov/GFAHxt

http://bit.ly/1bTH8rh

© 2013 Griswold International, LLC
Know the Symptoms of Depression
• Memory problems
• Confusion
• Social withdrawal
• Loss of appetite
• Weight loss
TOOLS

• Vague complaints of pain
• Sleeping too much or too little
• Anxious and/or irritated
• Delusions (thinking things that are not
reality-based)
• Hallucinations (seeing, hearing or feeling
things that are not reality-based)

Depression in Older
Persons Fact Sheet

Screening for Depression in Adults
and Older Adults in Primary Care

American Psychiatric
Association

http://bit.ly/1fgHz38

http://1.usa.gov/19sleuG

http://bit.ly/1ibTLzv
© 2013 Griswold International, LLC
Talk About Depression
This is easier said than done. Depression and other mental health conditions
are difficult to discuss due to the long-standing stigma of mental illness.
How to Talk to Your Elderly
Parent About Depression
TOOLS

Discussing Sensitive Topics

http://1.usa.gov/1bfewYm
http://bit.ly/1ioFaRm
© 2013 Griswold International, LLC
Screen for Depression
There are several validated screening tools that help clients,
providers and family caregivers to recognize and discuss depression.

TOOLS

Geriatric Depression Scale

The Hamilton Rating
Scale for Depression

http://stanford.io/1bWD7SL
http://bit.ly/163MP55

© 2013 Griswold International, LLC
Get an Early, Accurate Diagnosis
A diagnosis of depression should include:
- A physical exam
- Speaking with family members or close friends
- A review of medicines
- Blood tests and lab studies
- A clinical interview
- Imaging studies

Diagnosis and Treatment of
Depression in Adults: 2012
Clinical Practice Guideline
http://1.usa.gov/1cdWNFT

© 2013 Griswold International, LLC
Seek Innovative
Treatment
Approaches

“Once diagnosed,
80 percent of clinically
depressed individuals can be
effectively treated by medication,
psychotherapy, electroconvulsive
therapy (ECT) or any
combination of the three.”
National Alliance on Mental Illness

© 2013 Griswold International, LLC
Seek Innovative
Treatment
Approaches
CDC Promotes Public Health Approach to
Address Depression Among Older Adults

“For older adults
(age 60+), the top
recommended treatment
is home or clinic-based
depression care
management (DCM).”
Task Force on Community
Preventive Services

http://1.usa.gov/1atPwMV
© 2013 Griswold International, LLC
Depression Care
Management (DCM)

Family Doctor/Physician’s Assistant/
Nurse Practitioner/ Nurse

Care management and coordination is
critical to successful treatment for
older adults with depression.

Geriatric Psychiatrist
Physical Therapist
Dietician

Your care team
should include:

Advocacy/
Support Group

Wellness Coach

Occupational
Therapist
Speech Therapist

Home Care
Professional
Social worker/Geriatric
Care Manager/Psychologist
© 2013 Griswold International, LLC
Innovative Treatment Approaches
• Cognitive Behavioral Therapy (CBT) – A form of counseling that helps a
person to understand and change the thoughts, feelings and beliefs that
might be related to depression
• Medicine • Client and Family Education • Support Groups • Wellness
• Electroconvulsive Therapy (ECT) and other brain stimulation therapies
A Guide to Mental
Wellness in Older Age

Cognitive–
Behavioral Therapy

WRAP Plus

http://bit.ly/1a9OiX1

http://bit.ly/1gFja93

http://bit.ly/163RaW0

TOOLS

© 2013 Griswold International, LLC
About Geriatric Psychiatrists
• Older adults can be sensitive to medicine, but with proper support,
medicine can play an important role
• Geriatric Psychiatrist can play a key role in:
- Assessing the need for medicine/s - Choosing the right medicine and dose

TOOL

Find a Geriatric
Psychiatrist
http://bit.ly/19vx8ny

© 2013 Griswold International, LLC
About Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy can help older adults to understand
and change the thoughts, feelings and beliefs that might be related
to depression.
Find a Therapist Service

How to Adapt CognitiveBehavioral Therapy for Older Adults

http://bit.ly/18bZjo1

http://bit.ly/17fMsrf

TOOLS

© 2013 Griswold International, LLC
Supporting Family Caregivers
• Family Caregivers also live with depression
• It is important for family caregivers to take care of themselves

TOOLS

Caregiver Action Network Toolbox

Caregiving and Depression

http://bit.ly/17fMFdO

http://bit.ly/1bTH8rh

© 2013 Griswold International, LLC
Using Technology

For Healthcare Providers:

Geriatric
by Doctot
http://bit.ly/17J03l6

© 2013 Griswold International, LLC
Using Technology

For Clients and Family Caregivers:

Lotsa Helping Hands
Mobile App

The 3 Minute Test for Depression,
Anxiety, Bipolar Disorder and PTSD

Digital Technology for
the Family Caregiver
http://bit.ly/17bUFKI

http://bit.ly/Hfc77G

http://bit.ly/1ce5ccx

© 2013 Griswold International, LLC
Support Groups Can Help
The most practical coping strategies for depression can be
found through support groups.
DBSA Chapters/Support Groups

NAMI Support and Programs

http://bit.ly/GFAIBu

http://bit.ly/17fO0kU

© 2013 Griswold International, LLC
Key Takeaways
Depression and mental health issues ARE NOT a
normal part of aging
Untreated mental health conditions in older adults have
a serious impact
Education, discussion, screening and diagnosis are
challenging but essential
 

Older adults and their family caregivers CAN BENEFIT
from treatment and support
© 2013 Griswold International, LLC
Open Q&A
1. Click to expand
if necessary
2. Type questions here

© 2013 Griswold International, LLC
Brought to you by:

Griswold Home Care offers access to affordable
non-medical care options to assist your loved one.
CareAssure Screening System™

The Griswold Golden Rule: We only approve
caregivers we would trust in our own homes.

Extraordinary Home Care
at Affordable Rates Since 1982

QuickCare Placement™

We give each family access to the most
experienced caregivers available.
ValueCare Commitment™

Simple Rates. Unmatched Value. Our allinclusive rates are among the most affordable.

National 24x7 Care Line:
800-GRISWOLD
www.GriswoldHomeCare.com

© 2013 Griswold International, LLC

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Mental Health and Aging

  • 1. An Overview of Barriers & Solutions © 2013 Griswold International, LLC
  • 2. “Held annually during Mental Illness Awareness Week in October, National Depression Screening Day (NDSD) raises awareness and screens people for depression and related mood and anxiety disorders.” National Alliance on Mental Illness (NAMI) © 2013 Griswold International, LLC
  • 3. Our Goal for Today • Increase awareness of mental health issues in older adults and the importance of treatment • Drive early and effective…. - Dialogue related to mental health and depression - Mental health screening and diagnosis - Treatment that drives positive outcomes © 2013 Griswold International, LLC
  • 4. Presented by: Chris Kelly, MEd Director of Learning & Development Griswold Home Care © 2013 Griswold International, LLC
  • 5. Thank you for your courage, energy, and dedication! Healthcare Providers Professional Caregivers Family Caregivers Clients Living with Mental Illness © 2013 Griswold International, LLC
  • 6. Lit Review Social Media Advocacy Solutions Webinar & Toolkit © 2013 Griswold International, LLC
  • 7. Orange Arrow Button: Minimizes or expands the GoToWebinar control panel. BRAIN WRITING Solutions Brainwriting is… • a fun, engaging way to brainstorm • sharing as many ideas as possible within a short timeframe Brainwriting Process • Listen for our questions • When prompted, enter your solutions using the webinar chat function • Don’t overthink or agonize…There are no right or wrong answers Brainwriting Outcomes • Peer-to-peer learning and sharing • A publication that benefits others who are living with Depression Important • Avoid sharing any information that you would not want others to see © 2013 Griswold International, LLC
  • 8. Mental Health and Aging in America • 20% of people age 55 years or older have mental health issues • The most common mental health conditions for older adults are: - Mood disorders - Anxiety - Severe cognitive impairment • Depression is the most common mental health condition among older adults The State of Mental Health and Aging in America Mental Health and Aging http://1.usa.gov/HfIfqP http://1.usa.gov/17GDCNq TOOLS © 2013 Griswold International, LLC
  • 9. The Impact Untreated mental health conditions in older adults have been connected with chronic conditions such as: - Heart disease - Diabetes - Stroke - Increased health care costs - Inability to function - Disability © 2013 Griswold International, LLC
  • 10. The Impact Older adults with untreated depression have… - More doctor/ER visits - Increased use of medicine - Higher outpatient charges - Longer hospital stays - Increased readmission rates - Highest risk for suicide as compared to other age groups © 2013 Griswold International, LLC
  • 11. Core Barriers – Older Adults “Well, I feel as though most people that are depressed really feel unloved - that’s the main thing or they feel unwanted or they feel as though that they are useless…like…I’m no more use to you any more so just let me go.” Quote from older adult with depression http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782754/pdf/nihms150724.pdf © 2013 Griswold International, LLC
  • 12. Core Client Barriers - Awareness, Beliefs and Stoicism Older adults are often… - Unaware of the symptoms - Stoic about emotional and physical pain - Reluctant to “complain” - Skeptical about the need for treatment - Feel they can handle things on their own Depression In Older Adults - Lou Gehrig Older Americans Behavioral Health TOOLS http://bit.ly/1ibEAWU http://1.usa.gov/19YXM5d © 2013 Griswold International, LLC
  • 13. Core Client Barriers Access to Support and Services Older adults often lack access to care and support due to: - Medical issues - Decreased mobility - Lack of transportation - “Digital divide” – low access/comfort with e-tools (email, text, online portal) - Depression - which triggers isolation © 2013 Griswold International, LLC
  • 14. Core Barriers – Healthcare Providers “Depression in elderly people often goes untreated because many people think that depression is a normal part of aging and a natural reaction to chronic illness, loss and social transition.” National Alliance on Mental Illness (NAMI) © 2013 Griswold International, LLC
  • 15. Core Healthcare Provider Barriers Healthcare Provider Time Constraints, Tools, Access • Healthcare providers work very hard to recognize and treat depression • Recent research highlights that the prevalence of depression in older adults has lowered • Common provider barriers remain: - Inadequate vigilance and screening - Time constraints - Misperception/Stigma - Poor access to older adults - Using language/terms that clients and family caregivers cannot identify with http://www.huffingtonpost.com/2013/07/11/depression-in-older-adults-down_n_3575569.html © 2013 Griswold International, LLC
  • 16. Screen, Discuss and Diagnose Depression CDCP - http://www.cdc.gov/aging/pdf/cib_mental_health.pdf “I didn’t know anything about depression, so I didn’t know I was depressed.” Older adult with depression © 2013 Griswold International, LLC
  • 17. Learn About Depression It is important to learn about the symptoms of depression and treatment that can help About Depression Caregiving and Depression TOOLS http://1.usa.gov/GFAHxt http://bit.ly/1bTH8rh © 2013 Griswold International, LLC
  • 18. Know the Symptoms of Depression • Memory problems • Confusion • Social withdrawal • Loss of appetite • Weight loss TOOLS • Vague complaints of pain • Sleeping too much or too little • Anxious and/or irritated • Delusions (thinking things that are not reality-based) • Hallucinations (seeing, hearing or feeling things that are not reality-based) Depression in Older Persons Fact Sheet Screening for Depression in Adults and Older Adults in Primary Care American Psychiatric Association http://bit.ly/1fgHz38 http://1.usa.gov/19sleuG http://bit.ly/1ibTLzv © 2013 Griswold International, LLC
  • 19. Talk About Depression This is easier said than done. Depression and other mental health conditions are difficult to discuss due to the long-standing stigma of mental illness. How to Talk to Your Elderly Parent About Depression TOOLS Discussing Sensitive Topics http://1.usa.gov/1bfewYm http://bit.ly/1ioFaRm © 2013 Griswold International, LLC
  • 20. Screen for Depression There are several validated screening tools that help clients, providers and family caregivers to recognize and discuss depression. TOOLS Geriatric Depression Scale The Hamilton Rating Scale for Depression http://stanford.io/1bWD7SL http://bit.ly/163MP55 © 2013 Griswold International, LLC
  • 21. Get an Early, Accurate Diagnosis A diagnosis of depression should include: - A physical exam - Speaking with family members or close friends - A review of medicines - Blood tests and lab studies - A clinical interview - Imaging studies Diagnosis and Treatment of Depression in Adults: 2012 Clinical Practice Guideline http://1.usa.gov/1cdWNFT © 2013 Griswold International, LLC
  • 22. Seek Innovative Treatment Approaches “Once diagnosed, 80 percent of clinically depressed individuals can be effectively treated by medication, psychotherapy, electroconvulsive therapy (ECT) or any combination of the three.” National Alliance on Mental Illness © 2013 Griswold International, LLC
  • 23. Seek Innovative Treatment Approaches CDC Promotes Public Health Approach to Address Depression Among Older Adults “For older adults (age 60+), the top recommended treatment is home or clinic-based depression care management (DCM).” Task Force on Community Preventive Services http://1.usa.gov/1atPwMV © 2013 Griswold International, LLC
  • 24. Depression Care Management (DCM) Family Doctor/Physician’s Assistant/ Nurse Practitioner/ Nurse Care management and coordination is critical to successful treatment for older adults with depression. Geriatric Psychiatrist Physical Therapist Dietician Your care team should include: Advocacy/ Support Group Wellness Coach Occupational Therapist Speech Therapist Home Care Professional Social worker/Geriatric Care Manager/Psychologist © 2013 Griswold International, LLC
  • 25. Innovative Treatment Approaches • Cognitive Behavioral Therapy (CBT) – A form of counseling that helps a person to understand and change the thoughts, feelings and beliefs that might be related to depression • Medicine • Client and Family Education • Support Groups • Wellness • Electroconvulsive Therapy (ECT) and other brain stimulation therapies A Guide to Mental Wellness in Older Age Cognitive– Behavioral Therapy WRAP Plus http://bit.ly/1a9OiX1 http://bit.ly/1gFja93 http://bit.ly/163RaW0 TOOLS © 2013 Griswold International, LLC
  • 26. About Geriatric Psychiatrists • Older adults can be sensitive to medicine, but with proper support, medicine can play an important role • Geriatric Psychiatrist can play a key role in: - Assessing the need for medicine/s - Choosing the right medicine and dose TOOL Find a Geriatric Psychiatrist http://bit.ly/19vx8ny © 2013 Griswold International, LLC
  • 27. About Cognitive Behavioral Therapy (CBT) Cognitive Behavioral Therapy can help older adults to understand and change the thoughts, feelings and beliefs that might be related to depression. Find a Therapist Service How to Adapt CognitiveBehavioral Therapy for Older Adults http://bit.ly/18bZjo1 http://bit.ly/17fMsrf TOOLS © 2013 Griswold International, LLC
  • 28. Supporting Family Caregivers • Family Caregivers also live with depression • It is important for family caregivers to take care of themselves TOOLS Caregiver Action Network Toolbox Caregiving and Depression http://bit.ly/17fMFdO http://bit.ly/1bTH8rh © 2013 Griswold International, LLC
  • 29. Using Technology For Healthcare Providers: Geriatric by Doctot http://bit.ly/17J03l6 © 2013 Griswold International, LLC
  • 30. Using Technology For Clients and Family Caregivers: Lotsa Helping Hands Mobile App The 3 Minute Test for Depression, Anxiety, Bipolar Disorder and PTSD Digital Technology for the Family Caregiver http://bit.ly/17bUFKI http://bit.ly/Hfc77G http://bit.ly/1ce5ccx © 2013 Griswold International, LLC
  • 31. Support Groups Can Help The most practical coping strategies for depression can be found through support groups. DBSA Chapters/Support Groups NAMI Support and Programs http://bit.ly/GFAIBu http://bit.ly/17fO0kU © 2013 Griswold International, LLC
  • 32. Key Takeaways Depression and mental health issues ARE NOT a normal part of aging Untreated mental health conditions in older adults have a serious impact Education, discussion, screening and diagnosis are challenging but essential   Older adults and their family caregivers CAN BENEFIT from treatment and support © 2013 Griswold International, LLC
  • 33. Open Q&A 1. Click to expand if necessary 2. Type questions here © 2013 Griswold International, LLC
  • 34. Brought to you by: Griswold Home Care offers access to affordable non-medical care options to assist your loved one. CareAssure Screening System™ The Griswold Golden Rule: We only approve caregivers we would trust in our own homes. Extraordinary Home Care at Affordable Rates Since 1982 QuickCare Placement™ We give each family access to the most experienced caregivers available. ValueCare Commitment™ Simple Rates. Unmatched Value. Our allinclusive rates are among the most affordable. National 24x7 Care Line: 800-GRISWOLD www.GriswoldHomeCare.com © 2013 Griswold International, LLC