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Better treatment, more research needed for older adults with mental disorders

Older adults have the lowest mental health service use despite having a high prevalence of mental health conditions, according to a viewpoint published in JAMA Psychiatry.

“There remains — as a matter of health justice — a significant need to improve outcomes for older adults with mental disorders,” Warren Taylor, MD, from Vanderbilt University’s Center for Cognitive Medicine, and Charles Reynolds III, MD, from department of psychiatry, University of Pittsburgh, wrote.

“Recent observations that the U.S. life expectancy has been decreasing are unlikely to change these trends,” they continued. “Instead, factors likely contributing to that decline, such as suicide, addiction and medical conditions related to obesity, only highlight the need to better identify and treat mental disorders in older populations.”

Taylor and Reynolds offered some recommendations for future research to focus on that could reduce mental illness burden and improve outcomes among geriatric patients, including:

• suicide prevention;
• prevention strategies for recurrent disorders, particularly mood and anxiety disorders;
• managing addiction-related complications;
• treating mental disorders that negatively affect the outcomes of medical disorders; and
• further examining the link between mental disorders and cognitive decline/dementia risk.

Older adults have the highest risk for suicide completion, therefore Taylor and Reynolds emphasized the need for better evidence-based treatment and early detection approaches, like machine learning, to detect individuals at high risk.

In addition, there’s no enough evidence on how to avoid future episodes of mood and anxiety disorders, the most common disorders in older populations, and there are no markers informing recurrence risk other than medical history, which limits the ability to develop preventions.

The older population has high rates of coexisting medical illness, increasing rates of substance use and high risk of cognitive impairment, indicating the need for collaborative care, according to the researchers.

Mental disorders like depression accelerate cognitive decline and increase dementia risk, Taylor and Reynolds wrote. In the context of cognitive decline, depression results in greater cognitive impairment than would be expected based on neuropathology alone; however, the underlying mechanisms remain unclear, hindering the ability to maintain long-term cognitive function in this at-risk population.

“Research in these areas requires transdisciplinary and translational team-based science, where psychiatrists and psychologists work with geroscientists, implementation scientists and social scientists,” they wrote. “We need better research and clinical services focused on mental disorders in the elderly, along with integrated interventions promoting resilience, wellness and successful aging. This will proactively enhance our ability to care for older adults as, with changing populations, we will all eventually be geriatricians.” – by Savannah Demko

Disclosure: This work was supported by NIMH grants.