THE INSTITUTE OF Medicine (now the National Academy of Medicine) issued a report in 2012, “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?” that said 14 to 20 percent of U.S. adults over age 65 have one or more mental health or substance use conditions. That’s about 8 million people. Yet a number of studies also indicate that mental illness in older adults is underrecognized and underdiagnosed.
For instance, a telephone survey of nearly 10,000 adult households, published in 2003 in the American Journal of Geriatric Psychiatry, found that half of adults over age 65 with a probable mental illness were significantly less likely to be receiving any mental health treatment than younger adults. Of those, only 7 percent had used specialty mental health care.
“Indeed, compared with younger adults and middle-aged adults, adults over age 65 were much less likely to be asked by their primary care physician if they felt tense or anxious and were much less likely to be referred by their primary care physician for mental health specialty care,” says Dr. Susan W. Lehmann, clinical director of the division of geriatric psychiatry and neuropsychiatry and director of the Geriatric Psychiatry Day Hospital at the Johns Hopkins University School of Medicine. A more recent study of seniors receiving home health services found that 23 percent screened positive for depression, yet less than 40 percent of those people were receiving treatment for depression, she says.
Individual regions of the brain have to team up to get things done. And like in any team, the key to working together is communication.
Duke researchers used brain imaging to identify how patterns of brain connectivity — the ability of different brain regions to talk to each other — can affect a person’s likelihood of developing common forms of mental illness.
Surprisingly, they found that brain regions that help process what we see may play a key role in mental health. The results show that a person’s risk of mental illness broadly increases when the visual cortex has trouble communicating with brain networks responsible for focus and introspection.
A study from members of the research team investigating whether increasing blood levels of the antioxidant urate can slow the progression of Parkinson’s disease has found that the neuroprotective effects of urate extend beyond its own antioxidant properties. In their paper receiving online publication in the journal Neurobiology of Disease, the Massachusetts General Hospital (MGH) investigators report that urate also stimulates brain cells called astrocytes to activate a major antioxidant pathway believed to have a role in several neurodegenerative disorders. A National Institute of Neurological Disorders and Stroke (NINDS)-funded phase 3 trial of a urate-elevating drug, led by the senior author of the current study, will begin enrolling patients next year.
“While the antioxidant properties of urate are well-established, several other direct antioxidant treatments like vitamin E have failed to show disease-modifying benefits in clinical trials for Parkinson’s disease,” says Michael Schwarzschild, MD, PhD, MassGeneral Institute of Neurodegenerative Disease, senior author of the current paper and principal investigator of the urate clinical trials. “This new evidence of a more nuanced molecular mechanism for urate-induced neuroprotection boosts our enthusiasm that this will be a truly novel strategy and not ‘just another direct antioxidant’ that will fail to protect the brain cells that degenerate in Parkinson’s.”
Researchers at Case Western Reserve University School of Nursing, who studied the emotional distress of caring for a family member diagnosed with a mental illness, found anxiety is high for the primary caregiver at the initial diagnosis or early in the course of the illness and decreases over time.
“This finding is significant,” said Jaclene A. Zauszniewski, PhD, RN-BC, FAAN, the Kate Hanna Harvey Professor of Community Health at the Frances Payne Bolton School of Nursing and study’s corresponding author.
She attributes the differences to possibly two factors: the family member becomes more stable with treatment or medication, or the caregiver learns to adapt or cope with the situation over time.
Elderly patients who receive anesthesia are no more likely to develop long-term dementia or Alzheimer’s disease than other seniors, according to new Mayo Clinic research.
The study analyzed thousands of patients using the Rochester Epidemiology Project — which allows researchers access to medical records of nearly all residents of Olmsted County, Minn. — and found that receiving general anesthesia for procedures after age 45 is not a risk factor for developing dementia. The findings were published Wednesday, May 1, online in Mayo Clinic Proceedings.
Researchers know that some elderly patients have problems with cognitive function for weeks, sometimes months, following surgical procedures, says senior author David Warner, M.D., a pediatric anesthesiologist at the Mayo Clinic Children’s Center.