continued from page 1

Positive Aging Resource Center. "They also grew up thinking that if you're sad, you just need to pull yourself up by your bootstraps." Even those people who know they need help may be reluctant to seek treatment for fear of being stigmatized.

Health care providers may also have misguided notions about older people and mental illness. Many providers assume that depression, anxiety, and other mental health problems are just a normal part of aging, said Dr. Levkoff, an associate professor of psychiatry at Brigham and Women's Hospital, and an associate professor of social medicine at Harvard Medical School. Others don't even realize that such conditions can be treated. Even when health care providers do recognize the importance of identifying

and treating older patients' mental illnesses, many simply don't have time to make mental health a priority.

"Most older people go to primary care providers who aren't really trained in providing care to older people in general and to older people with mental health problems specifically," Dr. Levkoff explained. "When they have a 6- or 7-minute visit to deal with medical issues that demand attention, asking about things like sadness or anxiety doesn't even get on the agenda."

And while there's plenty of evidence demonstrating the effectiveness of various approaches to diagnosing and treating older people's mental health problems, Dr. Levkoff adds, many health care providers don't have time to learn about such practices.

"There's a huge amount of information about evidence-based practices out there, but providers don't have access to it," she explained. "People are busy. And the health care system has become so bureaucratic, there's little time for health care professionals to provide the kind of care they want to provide, much less do all the extra things they need to do to keep up."

Some sites focus on screening. The City of El Paso, for example, has Project FOCUS (For the Optimal Care of Underserved Seniors). The city knew that older adults receiving home-delivered meals through a nutrition program were at high risk for depression and other mental health problems. A TCE grant allowed the city to develop a mental health screening instrument that nutrition staffers now incorporate into their annual assessments. Depending on client scores, they are referred to a preventionoriented case management program, a community mental health center, or a more intensive program that uses lay community workers to address medical and social needs of homebound elders.

"We provide services that aren't perceived as mental health services," said principal investigator Robert A. Salinas, M.S.W., social services administrator for the city. "People are more receptive to them." Other sites focus on treatment. In Madison, WI, for instance, language barriers, transportation difficulties, and stigma kept many older Hmong refugees from seeking help for the depression, anxiety, and post-traumatic stress disorder they've developed in response to war, refugee camps, and resettlement.

"They were very isolated," explained principal investigator Linda Keys, M.S.S.W., program director at Kajsiab House at the Mental Health Center of Dane County, Inc.

July/August 2004

"Family members who were connected with services would bring home psychotropic medications to share with their elders."

A TCE grant allowed Kajsiab House

to increase the number of older adults in its programs, make its services more age appropriate, and create a mobile program. In the latter, a psychiatrist, psychologist, and Hmong staff members assisting as "culture brokers" provide therapy and other services in the homes of elders who can't or won't come to Kajsiab House.

The center incorporates Hmong cultural beliefs with Western concepts. For example, many Hmong view mental illness as an

invasion of bad spirits. Diagnoses are often made by a shaman who interprets the curling of boiled chicken feet.

"Like all immigrant cultures, things are changing quickly for the Hmong," said Ms. Keys. "But for the older folks, those beliefs are still there."

Another site is enhancing treatment of depression and agitation in residents of nursing homes and board-and-care homes. "Facility managers were telling us, 'We're tired of overmedicating our patients in order to control their behavior,'" said principal investigator Patricia A. Arean, Ph.D., associate professor of psychiatry at the University of California San Francisco.

A TCE grant led to the creation of Project Renewal, a collaborative effort in which a social worker, psychologist, and psychiatrist train facility staff, offer assistance to other treatment providers, and provide direct services to clients when needed. Some interventions are remarkably straightforward, Dr. Arean added. A woman who threw food during mealtimes turned out to need more appetizing meals, for example.

Resource Center

Guiding all the grantee sites is the Positive Aging Resource Center, which provides training, teleconferences, and a listserv. The center also matched each site with an "implementation coach."

continued on page 4

From the Administrator

Mental Health for
Older Americans

Americans age 65 and older are living longer and, in many cases, finding greater opportunities for a satisfying life in their later years. But for many older adultsparticularly those experiencing mental disorders or substance abuse-a sense of well-being remains elusive.

Some older adults experience late onset of mental and addictive illnesses; others have experienced them throughout their lives. Older adults may experience depression and anxiety as they face physical decline, death of family members and other loved ones, and increased limitations on independence. In lieu of seeking treatment, some older adults as with other populations-may "self-medicate" with alcohol. Further, older adults may misuse prescription medications, often inadvertently.

As the Baby Boom generation ages, the number of older adults is increasing, underscoring the imperative for SAMHSA to respond to unmet needs.

The principle underlying all our programs at SAMHSA is that people of all ages with or at risk for mental or addictive disorders should have the opportunity to lead fulfilling lives in their communities. SAMHSA has already developed a number of programs and initiatives for older adults -some of them highlighted in this issue of SAMHSA News-while simultaneously formulating a SAMHSA-wide Older Adults Action Plan that will coordinate and enhance all our efforts.

For example, SAMHSA awarded $5 million through a Targeted Capacity Expansion program in 2002 that emphasizes both early intervention and the development and use of successful practices for older adults with mental

illnesses. (See cover story.) This program also includes a Positive Aging Resource Center, which not only provides assistance to the program's grantees, but also offers information to older adults, their caregivers, and health and social service professionals. (See SAMHSA News, p. 4.)

In August, SAMHSA is joining with the Administration on Aging and the Centers for Disease Control and Prevention to hold a Policy Academy on Aging. Eight competitively selected states will develop or enhance their service systems for older adults through a more comprehensive and coordinated approach.

Our goal at SAMHSA is not merely to manage symptoms but to build resilience and facilitate recovery. We need to remember that mental health promotion and substance abuse reduction are issues throughout the continuum of life. We must offer everyone-including older adults-treatment, support, and services that reflect a full range of interventions, so that every American, across all age groups, has the chance to pursue a fulfilling life in the community.

Farles Man

Charles G. Curie, M.A., A.C.S.W.
Administrator, SAMHSA

continued from page 3

In addition to assisting grantees, the
center offers Web-based training on specific
conditions and service settings through a
collaboration with the American Society
on Aging.

The center's new Web site offers information to older people, caregivers, and health and social service providers. While professionals can use the site to learn more about evidence-based practices, older people can find helpful information too. Designed with input from older consumers, the highly

Older Adu

"A double whammy" is how Paolo del Vecchio, M.S.W., describes the plight of older people who have mental illnesses. "These older adults not only experience discrimination related to getting old, but they face the stigma associated with mental illness on top of that," said Mr. del Vecchio, Associate Director for Consumer Affairs at SAMHSA's Center for Mental Health Services (CMHS).

The stigma is compounded for members of racial/ethnic minority groups and residents of rural communities.

CMHS convened two roundtables early in the year with help from the Geriatric Mental Health Foundation and the National

Mental Health Awareness Campaign to find ways to counter stigma. The events convened researchers, advocates, practitioners, media representatives, grant writers, and consumers of mental health services.

Roundtable participants began by identifying types of stigma. For example, older people are often afraid to acknowledge their own mental illness.

Participants also identified barriers, such as a lack of understanding, resources, and competent providers. In response, participants formulated a strategy that centers on a two-part awareness campaign.

One effort would focus on empowering older people with mental illness by educating

them. "One of the ways to effect positive change is to engage more older adults," said Mr. del Vecchio.

A broader effort would use the media to send a positive message about mental health and aging to older people, their adult children, and the public. Recommendations include producing articles for use in senior center newsletters, briefing journalists on mental health and aging issues, and developing public service announcements.

SAMHSA will use the recommendations as the Agency starts planning a national anti-stigma campaign this fall. For more information, contact Paolo del Vecchio at pdelvecc@samhsa.gov.▸

SAMHSA and the U.S. Food and Drug Administration (FDA) recently released public education materials to alert older Americans about the dangers of mixing certain prescription drugs or prescription medications with alcohol, and to highlight the need for vigilance and monitoring of prescription intake by older adults.

Two percent of adults age 55 or older who are admitted for treatment abuse prescription narcotic medications, according to SAMHSA data. The As You Age education materials aim to draw attention to the need to manage prescription medication intake,

as well as the dangers of mixing some medications with alcohol.

The materials include a series of print ads, radio and television public service announcements, a brochure, and a Web site featuring all these resources available for download.

In addition, SAMHSA and the FDA have published a brochure, also titled As You Age, which provides a medication checklist to help older adults keep track of medication types, dose amount, and the proper intervals to take their medication. This brochure also points to the dangers of consuming alcohol with a medication that might have adverse effects due to negative interactions. (For sample safety tips, see SAMHSA News, p. 6.)

The materials were released at a joint press conference together with the Administration on Aging during the May observance of Older Americans Month.

SAMHSA has also established a hotline for drug abuse treatment referral. For help, call the SAMHSA substance abuse treatment 24-hour helpline at 1 (800) 662-HELP or 1 (800) 662-4357. For the names of treatment providers, visit SAMHSA's Web site at www.findtreatment.samhsa.gov.

To obtain materials, contact SAMHSA'S National Clearinghouse for Alcohol and Drug Information at P.O. Box 2345, Rockville, MD 20847-2345. Telephone: 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD). On the Web, visit www.asyouage. samhsa.gov.▸

The number of substance abuse treatment admissions among adults age 55 or older has increased.

In 2001, there were 58,000 treatment admissions age 55 or older-about 3 percent of the 1.7 million treatment

admissions in the Treatment Episode Data Set (TEDS), according to a new report from SAMHSA's Drug and Alcohol Services Information System (DASIS).

TEDS is an annual compilation of data on admissions for substance abuse treatment. Among admissions age 55 or older, alcohol was reported as the primary substance of abuse more frequently than among younger admissions (74 percent vs. 44 percent). Cocaine and marijuana were reported less frequently among older admissions than among younger admissions (5 percent vs. 13 percent and 1 percent vs. 15 percent, respectively).

Nearly two-thirds (64 percent) of older admissions reported abuse of alcohol alone, with no secondary drug abuse, while less

Safety Tips on Medicines & Alcohol for Older Adults

Combining prescriptions or using alcohol with a particular medication may inadvertently cause depression, anxiety, or physical health problems. As You Age... A Guide to Aging, Medicines, and Alcohol, is an informational brochure designed to help reduce this danger. (See SAMHSA News, p. 5.)

Following are some tips from the brochure:

Know that some medicines do not mix well with other medications, including over-the-counter medications and herbal remedies.

Note changes in body weight. These changes can influence the amount of medicine needed.

Read labels on medications carefully and follow the directions. • Look for pictures or statements that prohibit drinking alcohol while taking a certain medicine.

• Talk to a health care professional about all medications, including prescription ones, over-the-counter medicines, and vitamins.

Go through the medicine chest and get rid of expired medicines regularly.

For an electronic copy of the As You Age brochure or other materials, visit SAMHSA's Web site at www.asyouage. samhsa.gov.

than one-quarter (23 percent) of admissions younger than age 55 reported abuse of alcohol alone.

In addition, admissions for age 55 and older were more likely than younger admissions to enter treatment through selfreferral (41 percent vs. 36 percent) and more likely to receive detoxification services than younger admissions (36 percent vs. 25 percent).

Older admissions were less likely than younger admissions to be referred through the criminal justice system (25 percent vs. 35 percent).

For a copy of the DASIS Report, Older Adults in Substance Abuse Treatment: 2001, contact SAMHSA's National Clearinghouse for Alcohol and Drug Information at P.O. Box 2345, Rockville, MD 20847-2345. Telephone: 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD). Online, the report

is available on the SAMHSA Web site at www.oas.samhsa.gov.▸