The Importance of Behavioral Health Screening in Older Adults

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(Editor’s note: This content is sponsored by Landmark Health.)

Depression affects millions of Americans each year. Symptoms of depression for them occur most of the day, nearly every day for at least two weeks. Depression can affect your thoughts, feelings, physical health and behavior. There are several types of depression, but major depression (also sometimes referred to as clinical depression) is the best-known.

According to the Center for Medicare and Medicaid Services, 14% of those 65 and older seek treatment for depression, and according to the Centers for Disease Control (CDC), 20% of people age 55 and older have some type of mental health concern such as anxiety, severe cognitive impairment and mood disorders.Many older adults with serious illness report facing significant cognitive and mental-health challenges, including forgetfulness, sadness and depression, feeling like a burden on others, and loneliness.

Depression is often underrecognized in older adults, and yet if properly diagnosed, it can be improved through treatment around 80% of the time. To determine your total care needs, routine health checks should include physical, behavioral and social health assessments.

For older adults living with chronic disease, poor mental and behavioral health can complicate effective treatment of those conditions. Dr. Chris Dennis, psychiatrist and chief behavioral health officer at Landmark Health says, “Social behaviors, like smoking, diet and activity levels are often learned behaviors that impact mental and physical health. Addressing a disease without addressing the behaviors that led to the disease is short-sighted. Beyond medical interventions, patients need a more holistic approach to their health and lifestyle, and it helps if they are receptive to change.”

Most people with depression can get relief with talk therapy and/or medications. Medicines used to treat depression can take up to eight weeks before you notice a difference. The sooner you get help for depression, the sooner you may begin to feel better.

Many factors can contribute to depression, including family history, certain medications, drug or alcohol abuse, extreme stress or grief and other behavioral/mental health disorders. To determine if you are depressed, examine how you feel and discuss your concerns with your doctor. Symptoms of depression vary, but may include:

• Persistent feelings of sadness or hopelessness; feelings of worthlessness or guilt
• Restlessness, irritability, excessive crying, anxiety
• Sleeping too much or too little
• Loss of interest or pleasure in activities you used to enjoy
• Weight gain or weight loss
• Fatigue or lack of energy
• Difficulty concentrating while reading or watching TV
• Thoughts of harming yourself

Call your doctor or 911 right away if you experience symptoms of depression that do not resolve or you are having thoughts of self-harm. Call your doctor also if you think there are any problems with your medications, even if they seem minor, such as nausea, dizziness, fatigue, insomnia, weight gain or not feeling a benefit from the medication.

All older adults should be regularly screened for depression. These screenings can bring meaningful insights into struggles of depression, loneliness and other social factors. Your doctor or behavioral health provider might ask you to answer some questions to determine if you might be depressed. Answer the questions honestly, so your doctor can provide you with the appropriate resources and supports to help you feel better.

Dennis says, “Ask your provider if they screen for behavioral health or social determinants of health, which include your physical environment, childhood experiences, education, access to health services and more. These are often simple surveys that can help to identify unmet social or mental health needs, allowing your provider to address your needs early.”

There are many activities you can do to help lift your mood.

• Don’t blame yourself. Be as kind and patient with yourself as you would be to a good friend.
• Focus on the positive. Start a gratitude journal. List five things per day that went well for you or that you are thankful for. Review it often.
• Eat well. Much of the body’s serotonin (a chemical believed to act as a mood stabilizer) comes from the intestines or bowels. A healthy, well balanced diet can increase serotonin and help boost mood.
• Remain physically active. Exercise is known to release endorphins or “feel good” chemicals from your brain.

Take all your medicine as prescribed and directed. Never change medications or skip doses. Keep your follow-up appointments with your behavioral health specialist or primary care provider, even if you’re feeling well. Continued monitoring is very important.

“Your total health depends on an integrated approach to monitoring and treating your medical and behavioral health care needs,” says Dennis. “Your provider, health care specialists, community resources and personal support system should work together to support your needs. The hardest step is often the first one, asking for help. But remember, you are not alone.”

By Landmark Health

Since 2014, Landmark Health and its affiliated medical groups (Landmark) have delivered comprehensive in-home medical care to older adults, 24/7 – 365 days a year. Specialized in complex chronic care, Landmark's physician-led multidisciplinary teams work with patients' existing health care networks to bring medical, behavioral, and palliative care, along with social services, to individuals where they reside. As one of the nation's largest value-based health care companies, more than 100,000 people across 14 states and 46 metropolitan communities can access Landmark's care at no cost. Most critically, Landmark is bending the cost curve in health care by reducing avoidable ER visits and hospital admissions while extending lives of patients. www.landmarkhealth.org