Transcript Aging in oklahoma

2014 PREVENTION AND RECOVERY CONFERENCE
Karen Orsi, Director
Oklahoma Mental Health and Aging Coalition
www.omhac.org
[email protected]
405.858.2827
White House Conference on
Aging scheduled for 2015 –
possibly July
• Coincides with 80th
anniversary of Social
security (1935)
• 50th anniversary of creation
of Medicare and Medicaid
(1965 Social Security
Amendments)
OLDER OKLAHOMANS
• Oklahoma is an aging state in an aging Country
• Population over 60 growing; under 60 shrinking
(U.S. Census)
• 33% of population over age 50
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20% over age 60
• 10% over age 70
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4% over age 80
HEALTH RANKINGS
Health of Oklahomans age 65 and over
• Overall health ranking of 49th *
• Ranks 46th in diabetes; Ranks 46th in smoking; 33rd in obesity *
• 30th in multiple chronic conditions ; 47th in depression *
• 92% live with at least one chronic health condition **
• 77% live with two or more conditions
*America’s Health Rankings, United Health Foundation
**Administration for Community Living, 2014
BEHAVIORAL HEALTH
Behavioral health is a state of mental and emotional well-being and/or
choices and actions affecting wellness. Behavioral health
problems—such as depression, substance abuse and misuse,
addictions and suicidal thoughts - are not a normal part of aging.
Physical
Health
Chronic
Diseases
Addiction
Mental
Health
Wellness
Environments
Medication
Disability
Support
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BEHAVIORAL HEALTH
Oklahoma
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2013- between 700,000 and 950,000 experienced mental illness or substance
use disorder
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Ranks 2nd nationally in both serious mental illness and any mental illness
among adults
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Ranks 46th in per capita spending on mental illness
Older Adults
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Reported frequent mental distress higher than regional and national rates
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17% of 50-64 reported frequent mental distress; 8% of 65 and older (2011
Behavioral Risk Factor Surveillance System)
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State ranks 47th in depression for 65 and older
(SOME) AGING ISSUES
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Boomers
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Older Adults
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Even Older Adults
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Health and Mental Health
literacy
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Fear of loss of independence
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Long term care; long term
supports; availability of
community supports
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Needing a Caregiver; being a
Caregiver
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Retirement security
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Financial exploitation
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Access
Aging and disability – more
vulnerable
Lethal
Culture, shame, secrets
Ageism
Depression
Anxiety
Substance use
Chronic illnesses
Pain
Self medication
Limited opportunities for
intervention
Medicare; supplements;
enrollment
BEHAVIORAL HEALTH ISSUES
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Mental health disorders – depression, anxiety most prevalent
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Substance use – alcohol, illegal substances
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Medication misuse and abuse – prescription and over the counter
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Abuse and neglect
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Self neglect
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Self medication
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Trauma; safety
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Dementia; cognitive issues; reduced capacity
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Suicide
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One in five (20%) experience mental health disorder; less than 40% get
treatment; majority of treatment done by primary care physicians
OLDER ADULT BEHAVIORAL HEALTH PROBLEMS
Substance Abuse and Mental Health Administration
Issue Brief 2013
Prevalence
% with clinically significant anxiety
27%
% with depressive symptoms
26%
% using psychoactive prescription medication having abuse
potential (pain, sleep, anxiety)
25%
% with co-occurring alcohol and depression
20%
% affected by a combination of alcohol and medication
misuse
19%
% at risk of problem drinking
16%
OLDER ADULT SUICIDE
• White males over 85 highest rate
• Lethal methods
• Access to firearms, medications, substances
• 20% died by suicide on same day as PCP visit
• 40% died by suicide within 1 week of visiting physician
• 70% saw PCP one month prior
• Link between depression and suicide; alcohol abuse
• Poorly controlled pain
• Higher rates of completion: 1per 4 attempts; 1 completion per 100-200 attempts
in younger ages
SUICIDE PREVENTION ACTION NETWORK
SENIOR SUICIDE
Risk Factors
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Depression
Substance abuse
Debilitating physical
health problems
Social dependency or
isolation
Family discord, losses
Access to means
Protective Factors
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Effective clinical care for
mental and physical
health and substance
abuse
Restricted access to
highly lethal means
Strong connections to
family and community
support
Skills in problem solving
and conflict resolution
CONNECTEDNESS AND SUICIDE IN OLDER ADULTS
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Family discord and social isolation (Beautrais, 2002; Rubenowitz et al, 2001;
Duberstein et al, 2004; Harwood et al, 2006)
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Having no confidantes (Miller, 1977; Turvey et al, 2002)
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Living alone (Barraclough, 1971)
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Not participating in community organizations or having hobbies (Rubenowitz
et al, 2001, Duberstein et al, 2004)
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Functional impairment/disability (Conwell et al, 2000, 2010; Duberstein et al,
2004, Waern et al, 2008)
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Bereavement (Erlangsen et al, 2004; Conwell et al, 1990)
Center for the Study and Prevention of Suicide (CSPS)
University of Rochester School o f Medicine, Rochester, NY
RESILIENCY FACTORS - WELLNESS
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Sense of meaning and
purpose in life
Sense of hope or optimism
Spirituality – Religious
practice
Active social networks
Support from family and
friends
Good health care practices
Positive help-seeking
behaviors
Engagement in activities of
personal interest
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CONNECTIONS
Perceptions of friendships
Church
Neighborhoods
Organizations
Clubs
Sports
CIRCLING THE DRAIN
OKLAHOMA INITIATIVES
• Oklahoma Mental Health and Aging Coalition
• Older Adult Behavioral Health State Plan
• Older Adult Peer Support Specialty
• MAPS Senior Wellness Centers
• Oklahoma Aging Initiative
• Integrating Aging, Health, Mental Health, Substance Use and
Disability networks
• Oklahoma Aging and Disability Resource Consortium
OKLAHOMA’S OLDER ADULT ACTION PLAN
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Lance Robertson, Executive Director, DHS Aging Services
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Contract with OMHAC – 8/1/13 thru 9/30/14
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Development of 2 year Older Adult Behavioral Health Plan
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Age 60 +
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Excludes dementia diagnosis or treatment
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No additional funding
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Year one – general population
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Year two – target specific subgroups
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Development of Older Adult Behavioral Health State Plan Advisory Board diverse representation of networks
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Mental Health, Addictions, Prevention, Recommendations/ Strategies
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PREVENTION
• Set of steps along a continuum to promote health,
prevent mental health and addiction disorders,
support resilience and recovery, and prevent relapse
• Reduce the likelihood of developing a disorder
• Delay the onset of a disorder
• Reduce the severity of a disorder
• Treat behavioral health as a public health issue like
disease prevention or assuring quality drinking water
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PREVENTION AND RECOVERY
• QPR
• Depression screenings
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PEARLS, Healthy IDEAS, IMPACT – evidence based programs
2 question screen
15 or 30 question self-administered Geriatric Depression Screening tool
PHQ 9 (Patient Health Questionnaire) – clinician administered
Suicide screenings
Recognition of signs and symptoms
Engagement, connectedness, resilience
Ask critical questions
 About feelings
 About possible plan
 About reasons to live
BARRIERS
STRATEGIES
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Network integration
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Cross-training
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Asking the right questions
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Evidence based programs
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Wraparound services for
seniors (Systems of Care
for Older Adults)
SAMHSA – older adults not
a special population
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Medicare trainings for
professionals
SAMHSA – 2015-2018
Strategic Plan – older adults
mentioned 2x in 40 pages
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Education
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Screenings
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Diminish stigma / ageism
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Unprepared system
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Fragmented services
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Funding
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Workforce
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Cultural Competence
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Ageism
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OLDER AMERICANS BEHAVIORAL HEALTH
TECHNICAL ASSISTANCE CENTER
Older Americans Behavioral Health Issue Briefs
Brief 1 – Older Americans Behavioral Health Series Overview
Brief 2 – Aging and Behavioral Health Partnerships in a Changing Healthcare
Environment
Brief 3 – Screening and Preventative Brief Interventions for Alcohol and
Psychoactive Medication Misuse / Abuse
Brief 4 – Preventing Suicide in Older Adults
Brief 5 – Prescription Medication Misuse and Abuse
Brief 6 – Depression and Anxiety: Screenings and Interventions
www.aoa.gov
www.samhsa.gov
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OLDER AMERICANS BEHAVIORAL HEALTH
ISSUE BRIEFS
Brief 7 - RE-AIM Implementation and Framework
Brief 8 - Integration of Behavioral Health and Physical Health Care
Brief 9 - Sustainability and Financing
Brief 10 – Expanding Home and Community Based Services
Brief 11 – Reaching and Engaging Older Adults
Brief 12 - Behavioral Health for Caregivers
Brief 13 - Rural Issues and Cultural Competence
www.aoa.gov
www.samhsa.gov
Behavioral Health
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CONTACT INFORMATION
Karen Orsi | OMHAC Director | 405-858-2827
NorthCare | 4436 NW 50th, OKC 73112
[email protected]
www.omhac.org
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Immediate Past Chair, State Planning and Advisory Council to the Oklahoma
Department of Mental Health and Substance Abuse Services
National Coalition on Mental Health and Aging – National Advocacy Committee
Behavioral Health Advisory Council – Health Care Authority / ODMHSAS
Older Adult Behavioral Health State Plan Advisory Committee
ADRC Transformation Cabinet
Olmstead Committee, ODMHDAS
Healthy IDEAS trainer and coach
QPR (Question, Persuade, Refer) Suicide prevention program trainer