Mental cases.

Elderly shorted on mental health care

TWO-THIRDS OF NURSING HOME RESIDENTS suffer from some type of mental disorder, yet most such long term care facilities fail to meet their needs, according to the first-ever Surgeon General's report on mental health.

Long term care experts hope that the 500-page report, which devotes a chapter to older adults, will heighten awareness for providers about the importance of providing early recognition and treatment of mental illness, regardless of the setting.

"I think the most important thing is the recognition that late-life mental disorders are really in the mainstream, both from a mental health or behavioral health perspective, as well as from a general medical perspective," says Ira Katz, MD, a geriatric psychiatrist at the University of Pennsylvania in Philadelphia who helped write the chapter on older adults.

Nearly 20 percent of people aged 55 and older suffer from some mental disorder that is not part of normal aging, according to the report, Mental Health: A Report of the Surgeon General, which was issued by U.S. Surgeon General David Satcher, MD, in December.

Dementia, depression, and schizophrenia rank as the top three conditions that affect older adults, says the report. Though many effective treatments exist for Alzheimer's disease and most other mental disorders, nearly half of all Americans who have a severe mental illness never seek treatment, it notes. Among adults age 65 years and older, as many as 63 percent do not receive adequate care.

Dilip Jeste, MD, coauthor of the chapter on older adults, says that without significant changes in geriatrics training and research, the number of untreated elderly with mental illness will reach a crisis proportion. "What is needed is a mass education at every level, including administrators and clinicians, so that one can detect depression in the early stages," notes Jeste, director of the geriatric psychiatry clinical research center at the University of California, San Diego.

In addition to better training for primary care physicians, the report calls for changes in reimbursement policies. It points a finger at Medicaid for weakening incentive for mental health professionals to participate in nursing home care. That conclusion might help promote a significant change in reimbursement policy, says Katz. "It makes no sense that osteoarthritis care for a nursing home resident is reimbursed by Medicare with a 20 percent copayment, while care for depression or a psychotic disorder requires a 50 percent copayment."