Oregon’s older adult population is growing rapidly, with over 1 million residents who are at least 65 expected by 2030. By the same year, the number of older adults experiencing a mental health disorder such as anxiety or depression is expected to double. Aging presents unique mental health challenges, with factors like isolation, dementia and other co-occurring conditions compounding those challenges. And access to treatment is often limited for older adults. According to the Pan American Health Organization, only a third of older adults receive the mental health treatment they need.
Oregon’s Older Adult Behavioral Health Initiative was launched in 2015 to address those challenges. It funds 24 specialists across the state who work to improve access to care and “provide coordinated, quality and culturally responsive behavioral health and wellness services.” Kera Magarill is one of the specialists for Washington County, and Lualhati Anderson is the specialist for Coos and Curry County. They join us with more details on the biggest mental health concerns for Oregon’s older adults and what treatment access looks like.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Oregon’s older adult population is growing rapidly. By 2030, there will be over a million residents, 65 or older, and the number of those residents experiencing a mental health disorder such as anxiety or depression is expected to double. Oregon’s Older Adult Behavioral Health Initiative was created in 2015 to address these challenges. It funds two dozen specialists in all 36 counties to improve access to care and provide coordinated services. Kera Magarill is one of the specialists for Washington County. Lualhati Anderson is in Coos and Curry counties. They both join me now. Welcome to the show.
Kera Magarill: Great to be here.
Lualhati Anderson: Good afternoon.
Miller: Good afternoon. Lualhati, first. So how is this Older Adult Behavioral Health Initiative set up?
Anderson: Well, as you mentioned, Oregon Health Authority funds our position, and we are either contracted out to a community mental health organization or a CCO or like a senior-related service or agency. So for me, I am contracted at Coos Health and Wellness, even though I cover two counties.
Miller: And, Kera Magarill, what are the problems that you’re hoping to solve?
Magarill: Well, when this initiative was initially created, we were looking at depression and anxiety as being treatable but largely either minimized or missed conditions in our older adult population. So that’s where it started. I know a lot of our specialists have branched off into other specialties. We do a lot of education and training around dementia, hoarding…more severe mental illness. But anxiety and depression have always been our priorities in this initiative.
Miller: Lualhati, are there mental or behavioral health concerns that are specific to older adults or more common among older adults than kids or younger adults?
Anderson: So the concern that we see with older adults is they will most likely visit their primary care provider for medical concerns that may have an underlying cause that’s mental health-related, such as that lingering backache or a headache or chronic pain - there may be some physical chronic pain, you know, true chronic pain, but it’s also that depression, that anxiety exacerbates that. So, the stereotypical that we see as an older adult, maybe that goes into a primary care and they’re presenting with some physical ailment, but the assessment of the mental health piece is not looked at. So it’s still somewhat siloed and there’s also some there’s still stigma about mental health challenges.
There’s also how they describe their symptoms. So, yes, they do have some unique ones. And oftentimes we see the word dementia is used for even just a minor, maybe memory lapse. There’s not a baseline screening that’s equivalent to what we would see in a medical setting, such as their vital signs in the medical settings. When you establish a new primary care provider, they check your weight, your vitals, but there’s not an equivalent where they create a baseline of where you are cognitively at that present time, assessed for depression or anxiety or any other symptoms that may be prohibiting the older adults from being active in their daily lives or even connecting with others. So, social isolation and loneliness, it’s there, but they will describe it as something else - I just need something or I just need to connect with other people, but somehow, they also have difficulty navigating the system.
One of the things that I really recognize [that] I see often in a complex case is that the dementia piece… there’s a stereotype but when an older adult says I just feel fatigue, lack of energy, I don’t feel like doing anything. Sometimes it’s clumped up to it’s just generalized weakness, it’s just part of aging, [but] really the underlying cause is depression.
Miller: Well, Kera, it seems like one of the things that you are doing is saying that if primary care providers are going to be, maybe in some cases, the main health care professionals that older adults are seeing - doctors or PAs or Nurse Practitioners, whoever - is that they need more training to help assess their older patients or to get them the specialists that they might need?
Magarill: Yeah, the training and also the motivation to do it. And then there are assessments that are available that can help identify some of these concerns and especially earlier on, that’s what we want to be able to do for our communities to catch things earlier. So we can put them on a better path so that their mental health can be taken care of just like Lualhati said, just like their physical health would be. So that training on what screenings and assessments that there are that can be used in primary care settings, which is where we know a lot of older adults are seeing folks for their mental health.
And then also just being aware of what resources are out there. So if we identify an issue that comes up like earlier depression or thoughts of suicide or anxiety about falls, what are the resources available in the community that we can connect that older adult to? And if those resources aren’t there, how do we work with our community partners, like our senior centers or other community centers to be able to develop some of those resources? So it’s kind of this full circle of just creating our own system that’s going to care for everyone as we age.
Miller: Lualhati, speaking of those resources, what does access to care look like in Curry and Coos counties?
Anderson: So even though we’re in the South Coast, we are considered rural. And so attracting quality providers to come stay, especially those with families sometimes, is a great barrier for us to even get anyone to move all the way down the coast. So access to care, especially older adults who have Medicare as their primary, the lack of transportation. Even right now as it stands, only licensed clinical social workers (LCSW) are able to bill for Medicare. So we have that gap. We don’t have a lot of LCSWs. Next year, Medicare has opened up that billing system for even licensed professional counselors and licensed marriage, family therapists. So that should also help.
Access to care…sometimes in the small community, once they’ve visited a primary care provider and they feel that they didn’t make that connection, they don’t want to go back, the older adult does not want to go back. Older adults also may not want to seek care for what they perceive as mental health challenges. Sometimes what they see, that individual walking on the street flapping their hands and talking to themselves, they don’t equate themselves as needing that level of support for mental health just to address treatable conditions such as depression. So access to care in our rural settings can be limiting and also the number of providers that’s available. Sometimes you will see in a metro setting, maybe two months scheduling time. For us, it’s sometimes longer than that.
Miller: Kera, how do you deal with stigma? It’s something Lualhati has mentioned a couple of times now.
Magarill: Yeah, that’s one of our major hurdles. So we really want to normalize accessing mental health and having it be a part of your overall health plan. So, just talking about it. Here in Washington County, we have our ‘Age Cafes,’ our ‘Death Cafes.’ Those are community conversations where we can just talk about some of our concerns and issues and maybe things that are hard to talk about with friends and family. You can come in this community space that is facilitated, that’s normalized, that’s even sometimes a bit fun, to meet with other people and have these discussions. We also embed, kind of, that normalization into our trainings. So we have one training called ‘Aging Attitudes,’ where we talk about how your attitude about aging actually has an impact on how well you age.
So it’s really, really great to be able to get out into the community and share that message and have a lot of heads nodding in the audience because I think it’s just conversations that we haven’t been asked to participate in before. But a lot of people are ready to have those conversations, which helps normalize some of the things they’re going through and then hopefully breaks down that stigma, so people will feel comfortable talking to their doctors and their families when they’re ready to do that.
Miller: Lualhati, I mean, part of what we’re talking about in addition to diagnosable mental illness, is loneliness, is people who don’t have regular meaningful interactions with others. How do you change it? How do you foster community or some sense of togetherness?
Anderson: So the way I approach it is also engaging older adults that they could be more than 80% part of the solution to what they’re experiencing. One example that I like to share all the time is a client of mine stated that, ‘Nobody ever calls anymore,’ and I posed to her the question, ‘Have you tried initiating the phone call?’ And she just had this look, like, ‘What, that’s possible?’
Right now, most of the specialists are delivering PEARLS, which is [the] Program to Encourage Active, Rewarding Lives. And it’s an evidence-based program that has been developed by the University of Washington. And part of that is utilizing behavioral health activation that is actually going out, attending a social activity, doing a physical activity and just putting themselves out there just to either be an observer and then eventually hopefully connect to others. We also have a great pool of retired professionals that they’re wanting to engage in creating a program for themselves, something that they can be part of. So I’m working on that piece and I’m sure some of our specialists are also if not already working on that so that we can engage the older adults themselves to be part of the solution, making that connection one step at a time.
Miller: Kera Magarill, we just have 30 seconds left, but anything you want to add in terms of this loneliness piece?
Magarill: I totally agree with what Lualhati said. It’s about just giving people permission to get out there and make friends even though it’s awkward, giving them some skills and resources to do that. We also embed loneliness into our training. We know that loneliness is more dangerous to your health than smoking 15 cigarettes a day. So it’s something that, yes, impacts our older adults, but it also impacts our communities at large. And if we work together to create more intergenerational connections that create spaces for everyone, that will greatly reduce this epidemic of loneliness that a lot of us are experiencing.
Miller: Kera Magarill and Lualhati Anderson, thanks very much.
Magarill / Anderson: Thank you.
Miller: Kera Magarill is the older adult behavioral health specialist, one of them for Washington County. Lualhati Anderson serves the same role for Coos and Curry counties.
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