The recent death of actor and comedian Robin Williams prompted much-needed public discussion about depression, which affects millions of older Americans — including many who face a number of common risk factors such as financial stress, decline in physical and cognitive health, and social isolation. Research has linked depression to poorer functioning, health status and quality of life among older adults. Unfortunately, it can be difficult to identify and treat depression in this population, a challenge that comes with a substantial cost.
Depression Can Be Hard To Diagnose
Research indicates that older adults do not have dramatically higher rates of depression. However, it is common for depression to go unrecognized among older adults. Many are reluctant to discuss
mental health issues with their health care providers. Depression among older adults is also difficult to diagnose. It often occurs alongside other illnesses and can exhibit symptoms similar to cognitive disorders like dementia. In addition, older adults’ symptoms may present differently, and primary care physicians, who are typically responsible for diagnosis, often do not have sufficient training in geriatric mental health. There are also lingering misperceptions that depression is a normal part of aging or simply a side effect of prescription drug use.
Treatment Remains Challenging
Even with proper diagnosis, older adults may face challenges in obtaining appropriate treatment. Some may have difficulty traveling to see their provider or adhering to their treatment regimen. The health care system itself can also present problems. The Affordable Care Act made some headway by requiring health plans to cover mental health services and prohibiting insurers from denying coverage due to mental illness, but problems remain. For example, many mental health providers cannot be reimbursed under Medicare, which can make it difficult for older adults living in rural areas to obtain care. In addition, providers often do not integrate mental health services with other health care services, making it hard for older patients to obtain the most effective care.
Ignoring Depression Is Expensive
The personal, health care and economic costs of depression are huge. Each year, depression costs employers $17 billion to $44 billion in lost workdays. Depression is also associated with many chronic diseases, and research has found that patients diagnosed with both have much higher health care costs. Fortunately, treating depression can reduce or eliminate much of this expense. One study found that older adults who received depression treatment had lower health care costs. Similarly, the economic savings in terms of increased productivity and less absenteeism can offset the cost of depression treatment entirely.
What Can Be Done?
Breaking down barriers to proper diagnosis and treatment is critical. Primary care providers should be better trained to recognize mental illness in older adults, and primary and behavioral health care should be integrated to effectively care for those with complex needs. Public programs like Medicare and Medicaid should ensure that mental health providers are adequately compensated for their services, and Medicare should consider expanding the list of covered mental health professionals. It makes economic sense to address this issue, and it’s the right thing to do.
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