During the past two decades, health care professions have vastly improved medical services to the elder population. Previously, medical professionals were inexperienced in diagnosing and managing the mental health disorders associated with aging. Consequently, geriatric care received little attention from the medical establishment. The elderly were a disadvantaged minority with inadequate access to mental health care whose treatable symptoms were often attributed to the inevitable deterioration of aging.

But times have changed and the elderly segment of the population has grown. Today, the average physician who treats adult patients, regardless of specialty, spends about 45 percent of the time treating elderly people.

The increasing contact between health care professionals and elderly patients has fostered a better understanding of the distinctions between the normal aging process and concerns and symptoms that can be treated and resolved. Many debilitating conditions previously thought to be the inevitable results of old age can be treated and resolved. Such is the case with many of the mental, emotional and behavioral problems of this population.

Day Treatment Program:

InnerWisdom's unique mental health day treatment program has been designed for the retired and elder person, focusing on the emotional, mental, social, economic and spiritual well being of the client. Mental health and substance abuse issues can be addressed in this day program.

InnerWisdom's Day Treatment Program is not Adult Day Care. The Distinguished Elder's Day Treatment Program requires active participation in group activities and is limited to a specific time-frame. Clients must qualify for the program by meeting specific symptom criteria.

Services include:

• Life Skills Development
  
• Behavior Modification
  
• Self-Esteem Building
  
• Grief Management
  
• Creative Arts Therapy
  
• Activities of Daily Living
  
• Medication Management
  
• Managing a Medical Condition
  
• Social Skills Development
  
• Independent Living Skills
  
  

Supportive Services Include:

• Supervision and admission by a qualified physician specializing in Geriatric Medicine
  
• Transportation to and from the center as needed
  
• Lunch and snacks provided
  
• Identification of other needs and referrals to community based providers
  
• Continuum of care plan developed during their treatment stay
  
• 30, 60 and 90-day follow-up after discharge
  
  

Providing Services For:

• Chronic Physical illness
  
• Depression
  
• Anxiety
  
• Grief and Loss
  
• Substance Abuse
  
• Misuse of Prescription Medication
  
• Diminished Ability to perform Daily Routines
  
• Chronic Disabling Pain
  
• Cancer and Other Potentially Life Threatening Illness
  
• Cardiovascular/Stroke
  
  

Recognizing Signs and Symptoms

Even in the absence of troubling symptoms, the elderly should generally visit physicians more often than younger people. Beyond age 65, they should receive an annual physical exam. Although there are many normal physical changes that accompany advancing age, new symptoms or physical changes should not be automatically dismissed as the effects of old age. Any change in a person's usual physical or mental state should be evaluated, particularly if the change is relatively rapid, has not been previously experienced, or affects ability to carry out daily activities.

Symptoms requiring evaluation include:

• Fatigue, sleeplessness, poor appetite, rapid change in weight, constipation or diarrhea
  
• Headaches and/or dizziness
  
• Vague aches and pains, swellings around the joints; foot problems such as ingrown toenails, ulcers, fungus infections, sepsis, undue coldness, unusual color, pain, or inability to walk, failing vision or hearing or pain in the eyes
  
• Persistent rash, growths on the skin or changes in the color of moles, unhealed ulcers, blood in the stool or black stools
  
• A tendency to fall, shaking of the hands or head, limb weakness
  
• Sexual problems
  
• Breathlessness, chest pain (especially on exertion)
  
• Depression, anxiety, apathy and loss of interest, isolation, withdrawn behavior, slowness of movement or thoughts, forgetfulness, confusion, taking pain or other mood altering medications more often than prescribed.
  
  

Check all that apply:

• Finds it difficult to complete a sentence due to forgetting what words to use or what the discussion is about
  
• Misplaces important items such as food, money or bank records
  
• Seems confused, especially early in morning and before bedtime
  
• Forgets how to use common items or perform simple tasks
  
• Unable to identify day, month, year or season
  
• Becomes disoriented when in familiar surroundings
  
• Sleeps at unusual times and is restless throughout the day
  
• Appetite dramatically decreases/increases
  
• Suffers dizzy spells or severe headaches
  
• Visually displays depressed mood or sadness
  
• Lacks pleasure or interest in usual activities
  
• Feels hopeless, worthless, indecisive, irritable, or preoccupied with thoughts of death or suicide
  
• Problems in concentrating, feels exhausted, complains about aches and pains
  
• Becomes restless, trembles, or shows signs of increased muscle tension
  
• Experiences difficulty breathing, heart palpitations, or accelerated heart rate
  
• Has trouble swallowing, has nausea or diarrhea
  
• Has exaggerated reactions to sudden sounds, feels edgy or keyed up
  
• Experienced recent losses (spouse, home, employment, friends, activities, etc.)
  
• Diagnosed with illness (cancer, heart disease, stroke, diabetes, etc.)
  
  

The Elder Population - Interesting Information

The older population, persons 65 years or older, numbered 34.5 million in 1999. They represented 12.7% of the U.S. population, or about one in every eight Americans. The number of older Americans increased by 3.3 million or 10.6% since 1990.

In 1999, there were 20.2 million older women and 14.3 million older men, or a sex ratio of 141 women for every 100 men. The sex ratio increased with age.

Since 1900, the percentage of Americans 65+ has more than tripled (4.1% in 1900 to 12.7% in 1999), and the number has increased eleven times (from 3.1 million to 34.5 million).

The older population itself is living longer. In 1999, the 65-74 age group (18.2 million), was eight times larger than in 1900, but the 75-84 age group (12.1 million), was 16 times larger, and the 85+ group (4.2 million), was 34 times larger.

Almost 2.0 million persons celebrated their 65th birthday in 1999 (5,422 per day). In the same year, about 1.8 million persons 65 or older died, resulting in a net increase of approximately 200,000 (558 per day).

Data for this section was compiled primarily from Internet releases of the U.S. Bureau of the Census and the National Center for Health Statistics.

Health and Health Care

In 1996, 27.0% of older persons assessed their heath as fair or poor (compared to 9.2% for all persons). There was little difference between the sexes on this measure, but older African-Americans (41.6%) and older Hispanics (35.1%) were much more likely to rate their health as fair or poor than were older Whites (26%).

Because of chronic conditions, limitations in activities increases with age. In 1997, among those 65-74 years old, 30.0 percent reported a limitation caused by a chronic condition. In contrast, over half (50.2%) of those 75 years and over reported they were limited by chronic conditions.

Shifting the focus to disability, in 1994-95 more than half of the older population (52.5%) reported having at least one disability. One-third had at least one severe disability. Over 4.4 million (14%) had difficulty in carrying out activities of daily living (ADLs) and 6.5 million (21%) reported difficulties with instrumental activities of daily living (IADLs).

Most older persons have at least one chronic condition and many have multiple conditions. The most frequently occurring conditions per 100 elderly in 1996 were: arthritis (49), hypertension (36), hearing impairments (30), heart disease (27), cataracts (17), orthopedic impairments (18), sinusitis (12), and diabetes (10).

Older people accounted for 36% of all hospital stays and 49% of all days of care in hospitals in 1997. Older persons averaged more contacts with doctors in 1997 than did persons under 65 (11.7 contacts vs. 4.9 contacts).

In 1998, older consumers averaged $2,936 in out-of-pocket health care expenditures, a 33% increase since 1990. In contrast, those under age 65 spent considerably less, averaging $1,638 in out-of-pocket costs, up 27% since 1990. Older Americans spent 12% of their total expenditures on health, three times the proportion spent by younger consumers. On an average, health costs incurred by older consumers in 1998 consisted of $1,528 or 52% for insurance, $670 or 22% for drugs, $596 or 20% for medical services, and $142 or 5% for medical supplies

Source: Current Population Reports, "Americans with Disabilities, 1994-95," P70-61, August, 1997

Later Life Stress

Common stresses of late life can lead to problem behavior. Physical illness, especially chronic illness, often raises issues of dependence vs. independence, control vs. lack of control, and self care vs. disability. Dependent behavior creates increased stress on caregivers, and resentment when the patient does not seem to help as much with self-care as he or she seems physically capable of doing.

Demanding behavior is sometimes a sign that the patient wants more control over his or her life. Helping the patient, even the institutionalized patient, to find ways to gain more control can often decrease dependent or demanding behavior.

Role reversal occurs when the child becomes caretaker to the parent. This situation is often uncomfortable for both the older parent and his or her child, and can be a source of conflict and tension. Again, allowing the older parent to retain as much control as possible often lessens some of the tension created by this uncomfortable situation.

Poor or non-compliance with treatment is another problem for the physically ill elderly. Sometimes non-compliance is due to the patient's not understanding the reason for the treatment. Other times it represents the elder person's understandable but misguided attempt to maintain a degree of control. Allowing elders to have some control in other areas of their lives can be one way to improve compliance with treatment.

Social isolation with feelings of loneliness and aloneness is a problem among the elderly, especially the homebound and the widowed. Efforts to reduce the amount of social isolation can result in a major improvement in a patient's emotional outlook.

Special Health Problems of the Elderly

The diverse and complicated health problems of the elderly cut across the disciplines of medicine, psychiatry, social work, and nursing. As a result, they may overwhelm a health professional who does not have the time nor capacity to investigate all the nuances of the situation. Moreover, the main complaint may overshadow other less urgent, but still important, secondary problems.

The multiple and interdisciplinary health demands of the elderly require a coordinated effort from many health care professionals for optimal treatment. Uncoordinated efforts may produce conflicting management plans that hinder each other.

In many cases, facilities offering one type of service may lack other services needed by their clients. Elderly with both physical maladies and mental problems may attend a community mental health center where medical services are not available. Similarly, people with a mixture of complaints may only receive services at social service agencies, nutrition sites, or ambulatory medical care clinics.

Added to the difficulty of organizing health services for this age group is their frequent lack of mobility. The elderly may be homebound, lack access to transportation, reside in a long-term care facility, or simply be unwilling to attempt an excursion outside their usual places.

Frequently the cost of needed health and related services to the elderly is not reimbursed by medical insurance. Health coverage usually covers acute rather than chronic conditions, medical rather than psychiatric problems, and institutional rather than community-based services. Payments for social care and home care are severely restricted.

But for the elderly, chronic conditions are usually of chief concern, requiring a different approach than treatment of acute illness. When the elderly suffer acute illness, it is more likely to occur in the presence of a chronic, complicating malady that may follow or be aggravated by the acute condition and often becomes a serious health problem.