Assessing and Screening Geriatric Mental Health

The following is a literature review of the article “Mental Health Promotion in Older Adults: Addressing Treatment Approaches and Available Screening Tools” by Kristen H. Sorocco, PhD and TJ McCallum, PhD. The article originally appeared in Geriatrics, volume 61 issue 1, in January 2006.

Mental health is an area of geriatric healthcare that will require more attention as the adult population increases. Older adults have a greater propensity to mental health disorders. The following are some supporting statistics:

• 20% of adults over the age of 65 have a mental health disorder.
• By 2030, the number of adults with a mental health disorder will be 15 million.
• 1 out of every 5 adults will develop a mental health disorder.
• 4% of adults with mental health disorders will seek professional help.

There are three primary categories of mental health disorders as regarding the elderly: anxiety, depression, and dementia. Anxiety disorders are the most common, with a prevalence of 11.4%. Clinical depression has a prevalence of 4.4%, and non-clinical, but significant, depression comprises 20%. Dementia ranges between 5-7% but increases with age, finally reaching 30% for adults aged 85 or older.

There are three primary types of screening used to validate that an elderly patient has a mental health disorder. These include the following:

• Anxiety screening – evaluated through a series of three primary questions
• Depression screening – assessed through a questionnaire
• Brief cognitive screenings – used to determine the necessity of additional evaluation

Regarding non-pharmacologic treatment, there are four primary psychological treatments that have proven to be effective in treating mental health disorders.

• Interpersonal therapy – Looks into past and present relationships as they relate to current depression
• Cognitive behavioral therapy – Identifies unhealthy patterns of thought and emotion
• Behavioral intervention – Includes relaxation techniques, exposure therapy, and imaginal exposure
• Brief treatment interventions – Encompasses multiple counseling sessions, education, and motivation

Primary care physicians are encouraged to remain involved in the treatment and support of geriatric patients diagnosed with a mental health disorder. Physicians should refer such patients to a specialist for extensive evaluation and treatment. However, physicians should also collaborate with the specialists to maximize the quality of care given to the patient. In addition, physicians are encouraged to proved educational materials to patients, explaining treatments and providing advice for family members.