Written by Behnaz Sarrami, MS, PharmD, pharmacogenomics coach, medical science liaison at Missouri Pharmacogenomics Consulting, LLC, and Emily Somerville, OTD, OTR/L, instructor of occupational therapy and neurology, Program in Occupational Therapy, at the School of Medicine, Washington University in St. Louis
The Harvey A. Friedman Center for Aging has partnered with the Center for Community and Health Partnership and Research to host Pitch Partners, during which WashU community members, organizations, and faculty “pitch” health-related projects to an audience to receive feedback and potentially discover possible partners. This Pitch Partners event focused on community-academic partnerships aimed at intersectional aging issues. Thanks to seed funding from the Center for Aging, a new partnership has been formed between the Program in Occupational Therapy at Washington University School of Medicine and Missouri Pharmacogenomics Consulting, LLC. The partners will develop a new program that decreases the impact of mental health conditions affecting older people by providing them individualized, in-home services to address physical and mental health changes.
According to the U.S. Census Bureau, in the year 2030, all baby boomers will be older than age 65 and one in every five Americans will reach retirement age. In 2034, it is projected that older people will outnumber children for the first time in U.S. history. The population of adults ages 85 years and older is expected to nearly double by 2035 to 11.8 million.
Older adults are at risk for mental health problems – depression affects approximately 15 out of every 100 adults who are over the age of 65 – but mental health problems are not a normal part of aging. Major life changes including the death of a loved one, retirement, or dealing with a serious illness can adversely affect a person’s mental health. Many older adults are able to cope and adjust to these changes, but some people have a hard time adjusting and can be at risk for mental disorders such as depression and anxiety.
Mental disorders in older people can make it harder to manage other chronic health problems, and can cause physical illness, mental suffering, and poor quality of life. Depression can also impair peoples’ physical and cognitive functions and can lead to medication non-adherence, difficulty completing activities of daily living, increased doctor and hospital visits, the prescribing of potentially unnecessary medications, and if left untreated, can lead to an older person dying by suicide.
Medication is one of the most common forms of treatment for mental health disorders in older adults, however, 60% of older adults have difficulty adhering to a medication routine. Reasons for decreased adherence can include decline in physical and cognitive abilities and difficulty accessing healthcare outside the home.
The COVID-19 pandemic has contributed to an increase in mental health conditions in some older people, although as a group, older adults seem to be more resilient to stress-related mental health disorders than was expected. At the beginning of the pandemic, older people were worried about COVID-19’s severe complications and increased mortality and were concerned about disruptions to their daily routines, accessing care, and being socially isolated. Many older adults lacked resources needed to deal with the stress of COVID-19, such as the knowledge of, or access to, smart technology to connect with people, availability of friends and/or family, and the ability to engage in physical exercise or participate in activities or routines. Older adults were also concerned about their long-term physical and financial well-being. Older people from underrepresented populations or with lower incomes or who are unpaid caregivers are at an even higher risk of experiencing negative health outcomes due to the pandemic.
Additionally, many health care providers switched to telehealth in place of in-office visits to provide safer health care services to older adults during the pandemic. This created accessibility issues for the older adults that did not have the resources necessary to access these services including smart phones, computers, internet access, and the physical and cognitive ability to utilize telehealth platforms.
Developing a program to address these issues
Thanks to the funding from Pitch Partners, a team of interdisciplinary professionals, including a pharmacist, psychiatrist and occupational therapist was established in 2021 to identify physical and mental health changes in older adults and to provide them with individualized, in-home services with the goal of decreasing the negative impact of mental health conditions. Eighteen older adults were referred for participation in this intervention and eight went on to complete the program. The average age of the adults was 75 year old, 50% were both male and female, and all were Caucasian.
An occupational therapist (OT) completed a comprehensive in-home evaluation. The pharmacist reviewed medications and identified any possible drug-drug interactions, potentially unnecessary medications and discussed lifestyle management of any chronic conditions. The pharmacist and OT communicated recommendations for medication changes to the prescribing physicians. The older adults received additional visits from the pharmacist and OT to improve medication adherence. The older adults were also referred to a psychiatrist who provided mental health treatment through short-term therapy, medication recommendations, and referrals to long-term therapy services, if appropriate.
The intervention identified common barriers to accessing mental health services such as the cost of mental health services, availability of mental health service providers, and the stigma and misinformation surrounding mental health medications. Solutions to these barriers included providing immediate access to the program psychiatrist, covering the cost of co-pays or the entire appointment if necessary, offering both remote or in-person services, and providing counseling about medications used to treat mental health conditions. Barriers to successful medication adherence among the older adult participants included inaccurate medication lists, complex medication regimes, and lack of a pill organization system. These barriers were resolved for older adults by simplifying medication routines, reducing pill burden, and by using pill sorters, accurate medication lists, and medication alarm clocks.
Older adults are at risk of experiencing mental health conditions, which can be exacerbated by chronic health conditions, a decreased ability to access mental health service providers, and difficultly managing multiple prescriptions. This program helped participants access important mental health services and simplified medication regimens. Program facilitators will continue to seek partnerships with physicians, mental health organizations, and community-based older adult living facilities to increase older people’s willingness to engage in mental health services by decreasing the stigma surrounding mental health conditions in older adults and improving community education on this important subject.