In older adults, mental illness may have developed earlier in life, or the person may have experienced a late onset, may be at risk of suicide, experience dementia with depressed mood, behavioral disturbances or delusions (more about dementia and Alzheimer's below), or have co-occurring problems with substance use or dependency.  Accurate assessment and appropriate treatment are essential for the best possible outcomes.  In many older adults sorting out psychiatric and physical problems is challenging due to multiple medical conditions that may mask as psychiatric conditions, multiple medication interactions, age related changes to physical and mental functioning, and increasing isolation.

Serious mental illness for consumers with dementia includes dementia with delusions, dementia with depressed mood, and dementia with behavioral disturbance but does not include any other dementia unless the dementia occurs in conjunction with another diagnoisable serious mental illness. Accurate assessment is critical, as memory loss is NOT a normal part of aging-taking longer to recall IS a normal part of aging.  There are many reasons for forgetfulness and/or memory loss and early identification is important for treatment and future planning.  Memory loss also occurs for reasons other than Alzheimer's or dementia, some possible causes include: medication interactions, work problems, depression, anxiety, infections, sleep loss, being overwhelmed or having other diseases- so it is important to be assessed.  People frequently go to their primary care doctor with these concerns, and often it is someone other than the older adult with mentall illness who requests services on their behalf.  Adult children, spouses, neighbors and friends might notice troubling changes over time and help the older adult obtain needed assistance. 

Family caregivers of isolated older adults with mental illness or progressive disabling medical conditions are also the focus of interventions designed to improve coping skills, mental health needs, reduction of stress, burden, depression and family conflicts.  Family caregivers are at greatly increased risk of depression and other physical problems.  (See information on dementia resources below.)  Michigan provides grants to some communities for Alzheimer's Education Programs and Alzheimer's Respite Programs.

Older Adults use fewer public mental health services than younger adults; the reasons include stigma, denial, inadequate outreach services, lack of transportation, lack of education about the services and mental illness, and lack of staff trained in geriatrics.   The MDCH is enhancing efforts to improve services to persons with dementia and serious mental illness and to improve integration of service between primary, long term and behavioral health care.  Specialty Services used by older adults are tracked quarterly. 

It remains a priority to improve identification of older adults in all settings who exhibit significant changes and disturbances in mood, cognition or behavior that may pose a danger to themselves or others.   Outreach strategies include traditional and innovative techniques to establish trust, rapport, acceptance and increased use of mental health services by older adults at-risk.  Access to services can be confusing, people may have private insurance, Medicare or Medicaid, but generally primary care physicians, the local Community Mental Health Service Program or Area Agency on Aging can assist. 

Michigan is at the forefront in dementia care.  While no cure exists for non-reversible dementias, there are programs and services (such as Adult Day Programs and in-home respite) and medications that can extend the quality of life and the time the person with dementia lives at home or in the community.

The Alzheimer's Disease Demonstration Grant to States (ADDGS) is a three year project working with the primary care physicians network to enhance doctors knowledge of local Alzheimer's/dementia resources, train 3,500 in home respite workers in dementia competencies, and provide two community Wrap Around pilot models of individualized supports and services for the person with dementia and the caregiver.  All of the ADDGS initiatives are aimed living at home in the community with the highest quality of life possible, for the longest time possible.

For more information

Alyson Rush, Program Specialist rusha@michigan.gov (517) 335-0250

Marcia Cameron, Program Consultant cameronm@michigan.gov (517) 335-0226

Links to resources

www.alzgmc.org      

www.alzmigreatlakes.org