As the baby boom generation ages, millions of people will face mental health and substance abuse problems that will go undiagnosed or untreated unless there are significant changes to the current health care system, a new report says.
Currently, there are too few health care workers who have the training needed to recognize the symptoms of mental health conditions and substance abuse problems in older people, and the system of coordinating the care between providers is too fragmented to adequately treat these patients, according to the report from the Institute of Medicine (IOM).
"We have a significant burden, if not a crisis, facing us," said Dr. Dan Blazer, a psychiatry and behavioral sciences professor at Duke University Medical Center, one of the authors of the report.
The number of older adults with mental health conditions or substance abuse problems is expected to increase, not only because the now-aging baby boom generation is larger than the generation that preceded it, but also because the rate of such problems is higher among the boomers, Blazer said.
The report is based on the IOM committee's review of the literature looking at the burden of mental health conditions in older adults, and also its analysis of the number of health care workers trained to treat these patients. The committee considered those who are currently working, as well as the scope of existing training programs.
Survey results showed that 20 percent of people age 65 and older, or about 8 million people in the U.S., have mental health or substance abuse problems that need medical attention.
The committee found that the number of care workers is insufficient to deal with this coming demand, Blazer told MyHealthNewsDaily. More generalists, such as nurses and primary care providers, as well as specialists, such as geriatric social workers, will be needed in the coming years, he said.
The way that care is coordinated between primary care providers and mental health specialists also needs to be improved, the report said.
One issue is that there there's no mechanism in place to reimburse providers for coordinating patients' care with specialists, the report found. For example, for people with alcoholism or depression, studies have shown a strong benefit to patients when a specialist such as a geriatric psychiatrist is involved in their treatment. But currently, primary care providers aren't reimbursed for coordinating with such a specialist.
"We know that involving a specialist leads to more effective care — there are evidence-based models that show this. Yet payment doesn't support this," Blazer said.
Such specialists are needed because treatments for older adults with mental health conditions are different than those for younger patients with the same conditions, he said. For example, older adults often also have complicated physical health problems, or need to take prescription drugs for conditions such as cancer or hypertension. Mental health problems can interfere with taking care of their physical healthor their adherence to their medication regimens, and providers need to take this into account.
One improvement that would help address this issue is better coordination at the top level between the agencies within the Department of Health and Human Services, such as the Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid Services, Blazer said. These agencies, he added, need a more centralized approach to coordinating care.
Additionally, in the coming decades, there will be greater racial and ethnic diversity — both among the people in the aging population, and the care providers who treat them, Blazer said.
"The culture and the context of health care are different across different cultures," he said.
Providers who speak more than one language will be needed, and they will need an understanding of the cultural issues surrounding their patients' conditions, he said.
Pass it on: Baby boomers' mental health may face a crisis as the generation ages, a new report finds.
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