Demographics: Aging Trends in the Geriatric

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Demographics Aging Trends in the Geriatric
Mental Health Population

• Janice I. Wassel, PhD
• June 2008

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The Mental Health Challenges of the Boom

• Mental health is key to aging well
• Problem of ageism
• Mental illness is not normal in old age
• Usually treatable

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The Mental Health ChallengesSome Facts!

• Mental health is a low priority
• Number with mental illnesses will double by 2030
• Estimates are only 50 of older adults receive
  treatment (Lebowitz, et al, 1997)
• Treatment for oldest adults is the lowest of age
  groups

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Mental Health IllnessesIncidence in U.S. Older
Adults

• Major depression
• Alzheimers Disease
• Anxiety
• Late Life Schizophrenia
• Alcohol and Substance Abuse Disorders

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Percent of Total State Population 65 Years and
Over 1995 to 2025
NC IOA Slide
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Population Pyramids of North Carolina
Percent of Total Population
U.S. Census 2000
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Population Pyramids of North Carolina
Percent of Total Population
Male
Female
Male
Female
U.S. Census 2000
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NC comparison to U.S.

• United Health Foundation rankings on overall
  health 2006 (all ages)
• North Carolina ranks 36

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NC comparison to U.S.

• NC was
• 13th in the U.S. nursing home residents
• 12th in the U.S. in annual nursing home stays
• 20th in Medicaid payments per day for nursing
  home facility services
• 27th in LTC spending as of Medicaid
• 10th in total LTC spending
• 9th in total Medicaid spending
• 10th in residents w/Alz

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NC comparison to U.S. 1999-2005
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65 Population in 1990 Counties with over 15 of
total population 65
Statewide 12
Source of data North Carolina State Demographics
Unit, Census 1990.
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65 Population in 2000Counties with over 15 of
total population 65
Statewide 12
Source of data North Carolina State Demographics
Unit, Census 2000.
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65 Population in 2020Counties with over 15 of
total population 65
Statewide 15
Source of data North Carolina State Demographics
Unit, Projected County Totals Standard Age
Groups, July 1, 2020.
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Health ? Good Mental Health
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Co-occurring mental Physical Disorders

• Chronic illness clinically significant
  depression
• People with depression and physical illness are
  at high risk for disability, premature death and
  increased medical costs

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U.S. Health StatusCDC 2007
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NC Health StatusCDC 2007
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US Physical ActivitiesCDC 2007
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NC Physical ActivitiesCDC 2007
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U.S. Obesity in Older Adults CDC 2007
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NC Obesity in Older Adults, 2001
NC DHHS 2002
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NC BMICDC 2007
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U.S. SmokingCDC 2007
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NC SmokingCDC 2007
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U.S. AlcoholCDC 2007
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NC AlcoholCDC 2007
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U.S. High Blood PressureCDC 2007
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NC High Blood PressureCDC 2007
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U.S. Limited physical or mentalCDC 2007
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NC Limited physical or mentalCDC 2007
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Had a serious psychological distress past 30 days
2004
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NC TrendMean mentally unhealthy days

• Born 1996 2006
• 1931-1940 1.6 2.3
• 1941-1950 2.4 3.8
• 1951-1960 2.3 3.7

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NC TrendPercent w/ 14 or more mentally unhealthy
days

• Born 1996 2006
• 1931-1940 8.4 7.3
• 1941-1950 5.2 12.4
• 1951-1960 7.4 11.8

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NC TrendPercent w/ 14 or more activity
limitation days

• Born 1996 2006
• 1931-1940 9.4 9.4
• 1941-1950 5.3 11.1
• 1951-1960 4.7 8.4

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Highest NC CountiesTotal Population Mental
Illness

• County MI
• Columbus County 8.4
• Northampton County 8.4
• Hyde County 8.3
• Halifax County 8.1
• Martin County 8.0
• Bertie County 8.0
• State average 4.6

U.S. Census 2000
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Lowest NC CountiesTotal Percentage Mental Illness

• County MI
• Wake County 3.4
• Mecklenburg County 3.6
• Dare County 4.0
• Chatham County 4.2
• Forsyth County 4.1
• Union County 4.1
• Catawba County 4.1
• State average 4.6

U.S. Census 2000
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Highest NC CountiesOlder Adults (65) Mental
Illness

• County MI older
• Sampson County 20.8 14.0
• Martin County 20.5 16.4
• Swain County 20.3 15.4
• Greene County 19.4 16.2
• Hertford County 19.1 15.0
• Duplin County 19.1 13.6
• State average 14.1 14.9

U.S. Census 2000
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Lowest NC CountiesOlder Adults (65) Mental
Illness

• County MI Older
• Dare County 8.0 14.2
• Transylvania County 8.2 21.9
• Tyrrell County 8.3 19.7
• Polk County 8.4 23.9
• Henderson County 8.8 22.1
• Craven County 9.4 15.4
• State average 14.1 14.9

U.S. Census 2000
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Highest NC Counties Adults (21-64) Mental Illness

• County MI
• Columbus County 7.2
• Halifax County 7.0
• Bertie County 6.8
• Richmond County 6.2
• Warren County 6.0
• Northampton County 6.0
• State average 4.3

U.S. Census 2000
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Lowest NC Counties Adults (21-64) Mental Illness

• County MI
• Wake County 2.3
• Chatham County 2.4
• Mecklenburg County 2.4
• Union County 2.7
• Forsyth County 2.8
• Catawba County 2.8
• Orange County 2.9
• State average 4.3

U.S. Census 2000
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Older Adults Migrate to North Carolina
Number of adults age 60 who lived in a different
state 5 years earlier
Source of data 1970-1990 data from Dr. Charles
Longino 2000 data from Internal Migration of the
Older Population 1995 to 2000 (CENSR-10).
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Net Migration
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Counties NC Impact Table, 1995-2000

• County Age 60
• Hendersen, Transylvania 16
• Brunswick, New Hanover 13
• Cherokee, Clay, Graham, Haywood, Jackson, Macon
• Chatham, Orange 11
• Camden, Chowan, Curritack, Dare, Gates, Hyde,
  Pasqoutank 10
• Hoke, Moore, Richmond, Scotland, Carteret,
  Craven, Jones 9
• Buncombe, Madison, Mecklenburg 8
• Durham, Wake, Onslow 7

Charles F. Longino, Jr 2005
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Highest NC CountiesTotal Percent Age 65 2007

• County all county population
• 2000 2007
• Clay County 22.6 23.9
• Transylvania County 21.9 23.7
• Polk County 23.9 22.9
• Macon County 22.9 22.5
• Moore County 22.9 21.6
• State average 12.0

U.S. Census 2000, 2007
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Highest NC CountiesTotal Percent Boomer 2007

• County all county population
• 2007
• Clay County 33.3
• Carteret County 32.8
• Pamlico County 31.4
• Dare County 31.4
• Brunswick County 30.7
• Cherokee County 30.7
• Beaufort County 30.0
• State average 25.1

U.S. Census 2007
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Health Professionals In Short Supply
Source North Carolina Rural Health Research
Program, Cecil G. Sheps Center for Health
Services Research, University of North Carolina
at Chapel Hill
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Mental Health IllnessesIncidence in U.S. Older
Adults

• Major depression (8-20 community up to 37
  primary care settings)
• Alzheimers Disease (10 age 65-84, 50 age 85)
• Anxiety (11.4 adults age 55)
• Late Life Schizophrenia (about .6 or half of
  populations ages 18-54)
• Alcohol and Substance Abuse Disorders (12-21
  drinks 3-9).

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Trends and Policy forNC Mental Health

• Majority older adults do not get adequate mental
  health services
• More older adults
• Boomers in NC not as healthy as U.S.
• Retirees

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Trends and Policy forNC Mental Health

• Increase Geriatric Mental Health psychiatrist,
  Geropsychologist, Geriatric Social Workers and
  Gerontology Case Managers
• Increase home and community-based services
  including crisis services
• Increase caregiver support
• Increase health and mental health maintenance
  activities and preventive interventions
• Increase awareness of and decrease ignorance
  about mental health

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Trends and Policy forNC Mental Health

• Address workforce issues
• Educate primary care physicians
• Ageism
• Integrate and respect all service systems serving
  this population
• Examine and address financial disincentives to
  work with older adults mental disorders
• Use older adults to help older adults

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If NC is to meet the needs of the Aging Boomers,
it needs to.

• Provide training and technical assistance to
  implement state-of-the-art practices in the real
  work
• Promote improved professional and
  paraprofessional education
• Provide training and technical assistance to
  promote integrated service delivery
• Promote use of non-traditional mental health
  service
• Establish training program on mental health,
  substance abuse, behavior management (include
  physical illness in people with mental illnesses)
• Provide information and referral services and
  make available in non-traditional places

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Remember

• Boomers are not expected to have the same aging
  experience as did their parents
• Lets hope those with mental illness also do not
  have the same aging experience as did their
  parents generation

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The UNCG Gerontology Program Visit our
websitewww.uncg.edu/gro