When we talk about senior mental health, the conversation often revolves around cognitive conditions such as dementia or Alzheimer’s. But over the last two years, the pandemic and other global stressors have shined a spotlight on other mental health conditions — anxiety, depression and substance-use disorders —which also impact senior health.
A Kaiser Family Foundation study revealed increased rates of anxiety and depression among older adults during the pandemic, which have yet to taper off significantly. According to a recent brief published by the Centers for Disease Control and Prevention (CDC), 20% of older adults suffer from mental illness. Cases of suicide are higher among senior males, ages 65 and over.
For health plans and their provider partners, these trends are a call to action.
Mental health is not only correlated with poor health outcomes but also member satisfaction, experience, hospital utilization and associated costs. By addressing mental health, we can improve not only seniors’ quality of life — but also their overall experience with the healthcare system.
Multiple factors besides the pandemic have fueled the rise in mental health disorders among elderly adults in the U.S., who reportedly have more cost-related mental healthcare access challenges than seniors in other developed nations.
The pandemic exacerbated many of these issues as community health centers and group support programs shuttered in 2020 amid rising case numbers. Meanwhile, opioid-use disorders, suicide and behavioral health issues flared up in all age cohorts. But even as life regains some sense of “normalcy” in the U.S. and abroad, it’s been difficult for seniors especially to acclimate to life post-Covid.
One reason may be that because seniors account for an estimated 80% of all Covid deaths, many elderly individuals are grieving the loss of a partner, spouse or close friend from the virus. Another reason could be the isolation required of pandemic related social distancing measures.
As the KFF study noted, people of color or those of low socioeconomic status tend to experience multiple barriers to adequate health simultaneously. These can include lack of transportation, lack of access to nutritious foods or even a lack of clean air. For those who are struggling to pay rent or ration food budgets on a fixed income, self-care and mental health treatment-seeking behaviors may fall by the wayside.The study also notes that for many over 65, mental health conditions like depression may be mis-treated as processes related to aging.
There is a positive correlation between improved mental health and other health outcomes. Programs that impact both mental and physical health are essential as we uncover and impact social drivers of health. Organizations like Papa are addressing loneliness in senior populations, while other applications support mental health virtually through treatment & counseling.
Other whole person approaches focus on individuals’ needs including finances or food.
For example: Embedding principles of behavioral economics into a solution by offering incentives that address individual needs, can improve care plan compliance while improving physical and mental health outcomes.
A recent pilot study of members with multiple mental health illnesses and opioid use disorder plus other comorbidities (e.g., diabetes) proved this theory. Study participants, all members of a state Medicaid program, were asked to use an app (powered by Wellth) to check-in their health status every day.
“I always go through my mania phases and it hurts me really bad to where it makes my emotions go up and down...I completely shut out the world, except you guys I would answer you because I was trying to keep up my meds. But when I was encouraged to take them and I was able to take them so long in a row it actually became easier for me to stay with it” -Wellth Member
Members would use the mobile app to log in completion of basic daily and weekly health-related tasks — such as taking daily glucometer readings, checking blood pressure and eating healthy meals. They’d receive ongoing positive reinforcement for accomplishing health-related tasks, such as posting a photo of a healthy meal or logging in a numeric value.
But what truly made the difference and kept participants motivated, at least initially, was the potential to earn something they needed. Depending on the cohort, participants were eligible for $75-125 in rewards they could put toward groceries, transportation costs and other essentials.
By the end of the 90-180 day pilot period, the program saw a 44% reduction in inpatient utilization.
In a similar pilot study, where Medicaid & Dual Eligible (Medicaid & Medicare) participants used Wellth for 12 months, members saw a 59% reduction in inpatient hospital utilization.
Considering that ED settings are traumatic for patients with mental health disorders — and costly for health plans — the rewards of using a simple coaching program to build healthier habits was a win-win for health plans and their members.
Members felt like they had a stakeholder in their corner and that they weren’t isolated in their goal to improve their health. The financial rewards for improving their health increased positive sentiments. Members have also said building toward rewards is a confidence builder.
As health plans seek new resources to help seniors live their best lives, it’s important to approach solutions with empathy. Incentivizing positive health behaviors can help us nudge the needle while empowering individuals to live healthier lives.