1. NC Mental Health, Substance Use, & Aging Coalition Mental Health, Substance Use, and Aging: Conditions, Current Figures and Projections Debbie A. Webster, MS Mental Health Program Manager Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Focusing attention, building capacity, supporting action

2. NC Population Projections Year 2010Year 2020Year 2030 Percentage Population Growth 2010 to 2030 Total NC Population 9,574,47710,629,05111,712,23422.3% Age 55 - 641,149,6811,343,4821,355,72218% 65 - 74703,9651,048,2251,232,73775% 75 -84361,108525,850777,625115% 85 - 94137,982170,811236,31471% 95 -100+11,06918,23423,870116% Total Age 55+ Population 2,393,8053,106,6023,626,26851.5%

3. NC Mental Health, Substance Use, & Aging Coalition Alexander Alleghany Ashe Avery Buncombe Burke Cabarrus Caldwell Catawba Cherokee Cleveland Davie Gaston Graham Haywood Henderson Iredell Jackson McDowell Macon Madison Mecklenburg Mitchell Polk Rowan Rutherford Surry Swain Union Watauga Wilkes Yadkin Yancey Clay Transylvania Lincoln Granville Nash Alamance Anson Bladen Caswell Chatham Columbus Cumberland Davidson Durham Forsyth Franklin Guilford Harnett Hoke Johnston Lee Montgomery Moore Orange Person Randolph Richmond Robeson Rockingham Sampson Scotland Stanly Stokes Vance Wake Warren Beaufort Bertie Carteret Chowan Craven Dare Duplin Edgecombe Gates Greene Halifax Hertford Hyde Jones Lenoir Martin Hanover Northampton Onslow Pamlico Pasquotank Pender Perquimans Pitt Tyrrell Brunswick Washington Wayne Wilson Camden Currituck Percent of population 65 and over, 2011 11% to 20% 21% to 30% Source: NC State Data Center 10% or less North Carolina – 13% Range: 7.6%-26.7% Focusing attention, building capacity, supporting action

4. NC Mental Health, Substance Use, & Aging Coalition New Alexander Alleghany Ashe Avery Buncombe Burke Cabarrus Caldwell Catawba Cherokee Cleveland Davie Gaston Graham Haywood Henderson Iredell Jackson McDowell Macon Madison Mecklenburg Mitchell Polk Rowan Rutherford Surry Swain Union Watauga Wilkes Yadkin Yancey Clay Transylvania Lincoln Granville Nash Alamance Anson Bladen Caswell Chatham Columbus Cumberland Davidson Durham Forsyth Franklin Guilford Harnett Hoke Johnston Lee Montgomery Moore Orange Person Randolph Richmond Robeson Rockingham Sampson Scotland Stanly Stokes Vance Wake Warren Beaufort Bertie Carteret Chowan Craven Dare Duplin Edgecombe Gates Greene Halifax Hertford Hyde Jones Lenoir Martin Hanover Northampton Onslow Pamlico Pasquotank Pender Perquimans Pitt Tyrrell Brunswick Washington Wayne Wilson Camden Currituck Percent of population 65 and over, 2031 21% to 30% 31% or more Source: NC State Data Center 11% to 20% North Carolina – 19.6% Range: 10.6%-33.7% Focusing attention, building capacity, supporting action

5. NC Mental Health, Substance Use, & Aging Coalition Alexander Alleghany Ashe Avery Buncombe Burke Cabarrus Caldwell Catawba Cherokee Cleveland Davie Gaston Graham Haywood Henderson Iredell Jackson McDowell Macon Madison Mecklenburg Mitchell Polk Rowan Rutherford Surry Swain Union Watauga Wilkes Yadkin Yancey Clay Transylvania Lincoln Granville Nash Alamance Anson Bladen Caswell Chatham Columbus Cumberland Davidson Durham Forsyth Franklin Guilford Harnett Hoke Johnston Lee Montgomery Moore Orange Person Randolph Richmond Robeson Rockingham Sampson Scotland Stanly Stokes Vance Wake Warren Beaufort Bertie Carteret Chowan Craven Dare Duplin Edgecombe Gates Greene Halifax Hertford Hyde Jones Lenoir Martin Hanover Northampton Onslow Pamlico Pasquotank Pender Perquimans Pitt Tyrrell Brunswick Washington Wayne Wilson Camden Currituck 150% and above 100 to 149% increase 50 to 99% increase Source: NC State Data Center Range: 8% - 161% 8 to 49% increase Projected growth for the State is 78% Projected Growth of Population 65 and Over from 2011 to 2031 Focusing attention, building capacity, supporting action

6. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Mental Health Issues Common mental health issues experienced by older adults: Anxiety Depression Focusing attention, building capacity, supporting action

7. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Anxiety Disorders Anxiety disorders - worry or fear becomes long term and may get worse instead of better as time goes on. * Generalized Anxiety Disorders (GAD) - most common: Uncontrollable worry about things that are ok. Easily startled; trouble falling asleep/staying asleep; headaches, difficulty concentrating, twitching. * Social Phobia - uncontrollably anxious around people Difficulty talking to people; afraid of being judged and embarrassed; worry days/weeks before event; isolate themselves; interferes with everyday life activities.

8. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Anxiety Disorders * Panic Disorder – sudden, unexplainable attack of terror; heart pounding like heart attack ; feelings of pending doom; fear of losing control and losing one’s mind; feels he or she is about to die. * Post-Traumatic Stress Disorder (PTSD) – constantly re-live trauma experienced; flashbacks – images, sounds, smells, feelings. trauma – experiencing a horrific/terrifying ordeal - act of violence, abuse, accident; observing death of a loved one. emotionally distanced; lost interest in things one used to enjoy doing; irritable; may become aggressive and violent.

9. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Anxiety Disorders * Obsessive-Compulsive Disorder (OCD) – The uncontrollable need to check things over; perform repeated rituals; being overly tidy; having repeated unwanted thoughts such as hurting loved ones, violent or sexual acts. Obsessive – repeated, unsettling thoughts Compulsive – to control obsessions – repeat rituals or behaviors *NIH Senior Heal: Anxiety Disorders Symptoms of Anxiety Disorders, http://nihseniorhealth.gov/anxietydisorders/aboutanxietydisorders/01.html specific phobias

10. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Depression in Older Adults Up to 20% of Americans 65+ are currently depressed. Depressed older adults visit the doctor or emergency room more often, have longer stays in the hospital, incur more medical expenses, and take more medications. 1 Depression is not considered a normal part of aging. Common depressive symptoms should be viewed as possible symptoms of a treatable illness. Depression treatment is effective with older adults. 2 1. Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. (2008). The state of aging and mental health in America. Retrieved from http://www.cdc.gov/aging/pdf/mental_health.pdf http://www.cdc.gov/aging/pdf/mental_health.pdf 2. Canadian Coalition for Seniors’ Mental Health, 2006. National Guidelines for Seniors’ Mental Health: Assessment and Treatment of Depression Focusing attention, building capacity, supporting action

11. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Depression in Older Adults Nationally, More than 55% of older persons receive mental health care from primary care physicians. Less than 3% of those aged 65 and older receive treatment from mental health professionals. Primary care physicians accurately recognize less than one half of patients with depression. *http://www.nmha.org/index.cfm?objectid=C7DF94FF-1372-4D20-C8E34FC0813A5FF9 Focusing attention, building capacity, supporting action

12. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Depression in Older Adults Causes: Moving from their home Chronic illness or pain Children moving away Spouse or close friends passing away Loss of independence

13. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Depression in Older Adults Symptoms of Depression: persistent sadnessweight changes feeling slowed downpacing and fidgeting excessive worries difficulty sleeping frequent tearfulnessdifficulty concentrating feeling worthless/helpless physical symptoms

14. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Depression in Older Adults Physical illness symptoms similar to depression: Thyroid disorders Parkinson's disease Heart disease Cancer Stroke Dementia (such as Alzheimer's disease)

15. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Depression and Suicide Depression is a significant predictor of suicide in elderly Americans. Comprising only 13% of the U.S. population, individuals aged 65 and older account for 20% of all suicide deaths. Suicide among white males aged 85 and older is nearly six times the suicide rate in the U.S. * http://www.agingstats.gov/Main_Site/Data/2012_Documents/Population.aspx Focusing attention, building capacity, supporting action

16. NC Mental Health, Substance Use, & Aging Coalition Youth vs. Older Adult Completions (North Carolina 2004-2008) 679 deaths, 7.5 rate 875 deaths, 16.2 rate Completion and Attempt Ratio (National Estimates) 1 death for every 100 to 200 attempts 1 death for every 4 attempts Youth (10-24)Older Adult (65+)

17. NC Mental Health, Substance Use, & Aging Coalition Gender-Specific Suicide Rates by Age: NC-VDRS, 2010

18. Prevention/Intervention Opportunity Most older adults who die by suicide had been seen recently by their primary doctor. 20 percent had been seen by their doctor within 24 hours of their suicide. 41 percent had been seen by their doctor within a week of their suicide. 75 percent had been seen by a physician within a month

19. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Elder Suicide Circumstances NC-VDRS, 2008-2010

20. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Suicide Warning Signs Depressed or sad most of the time Talking or writing about death/writing a will Withdrawn from loved ones Feeling hopeless or helpless Feeling trapped - no way out Dramatic mood changes/eating habits/personality Giving away prized possessions Acting impulsively or reckless Feel excessive guilt or shame *Suicide Warning Signs, http://www.suicide.org/suicide-warning-signs.html

21. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Substance Use and Older Adults “The‘baby boomer’ cohort - people born from 1946 to 1964 - is the first in U.S. history with a majority having used illicit drugs sometime in their lives.” Joseph C. Gfroerer, Director of the Division of Population Surveys at SAMHSA’s Office of Applied Studies (OAS). *http://www.samhsa.gov/SAMHSAnewsLetter/Volume_17_Number_1/OlderAdults.aspx Focusing attention, building capacity, supporting action

22. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Substance Use and Older Adults Nationally, Of the 2.2 million adults age 50 and older who used illicit drugs in the past month: – 54 percent used marijuana. – 28 percent misused prescription drugs. – 17 percent used another illicit drug. *http://www.samhsa.gov/SAMHSAnewsLetter/Volume_17_Number_1/OlderAdults.aspx Focusing attention, building capacity, supporting action

23. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Substance Use and Older Adults Substance use in older adults is overlooked. They are more likely to drink or use drugs at home than in public. They may not be involved in work or other daily activities. They may have symptoms similar to health problems, such as depression or dementia. Caregivers may be aware of problem but may not want to talk about it.

24. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Alcohol Older adults: Need less to be intoxicated. Stay intoxicated longer. Intoxication slows reaction time if person has hearing problems or poor vision. Mix with prescribed and non-prescribed medication – this may be fatal.

25. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Misuse of Medicine Older adults: Take many medicines causing the misuse of medicines. Take more than what was prescribed, or when they do not need them. Use older medicines, or another person's medicine. Take medicine to feel good or "high" (pain meds). Don’t take meds as prescribed or skipping dose.

26. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Changes in Behavior Frequent falls Becoming incontinent Having more headaches and dizziness than usual Incomplete hygiene Appetite changes Ignoring and losing touch with family and friends Suicidal ideations Beginning to have legal or money problems

27. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Changes in Mental Abilities Anxious most of the time Cognitive changes Difficulty in focusing Not interested in usual activities Mood swings, sadness or depressed

28. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Emergency Department and Older Adults 2004, 115,798 emergency department (ED) visits, involving pharmaceutical misuse or abuse; 2009, number ED visits = 300,082, increase of 159 percent; Between 2008 and 2009 – 45% increase, involving misuse or abuse of oxycodone; 2009 - 33 % ED visits, involving pharmaceutical misuse or abuse among adults aged 50 to 54. *http://www.samhsa.gov/data/2k12/DAWN108/SR108PharmaAbuse2012.htm Focusing attention, building capacity, supporting action

29. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Caregivers – Toll on Health and Well-being Family Caregivers: Increased level of depression and anxiety Higher use of psychotropic medications Poorer physical health Compromised immune functioning Increased mortality Result – inability to provide care * Center of Disease Control and Prevention, Care giving: A public health priority, http://www.cdc.gov/aging/caregiving/index.htm Focusing attention, building capacity, supporting action

30. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition MCOs Alliance Behavioral Healthcare Centerpoint Human Services CostalCare Eastpointe East Carolina Behavioral Healthcare MECKLink Partners Behavioral Health Management Cardinal Innovations Healthcare Solutions Sandhills Center Smoky Mountain Center and Western Highlands Network

31. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Adult MH Treatment Services Medication Management Outpatient Treatment Peer Support Services Psychosocial Rehabilitation Community Support Teams – MH and/or SA Assertive Community Treatment Team

32. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Adult SA Treatment Services SA Intensive Outpatient Services (SAIOP) SA Comprehensive Outpatient Treatment Program (SACOT) SA Non-Medical Community Residential Treatment SA Medically Monitored Community Residential Treatment Detoxification Services Outpatient Opioid Treatment

33. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Crisis Services Mobile Crisis Management Walk-in Crisis and Psychiatric Aftercare Programs Facility-Based Crisis Programs Crisis Intervention Teams NC START (Systematic, Therapeutic, Assessment, Respite and Treatment)

34. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Geriatric Adult Mental Health Specialty Teams (GAST) Purpose – To increase the ability of community partner staff providing services and support to older adults which increases community tenure. Activities – To provide training and consultation to community partner staff on topics such as: Signs & symptoms of depression, anxiety, and dementia Crisis prevention Substance use/misuse

35. NC Mental Health, Substance Use, & Aging Coalition CCNC & LME-MCO Collaboration  CCNC is NC Health Home  LME-MCO is a vital partner that supports Health Home  Shared Care Management of recipients  Identification, linkage to services  Coordination of MH/DD/SA & physical health needs  Data exchange into informatics  Collaboration on integrated care practices  Regular partnership meetings  Care Coordination + health promotion = cost savings.

36. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Mental Health and Substance Abuse Services Quadrant I: CCNC - Primary Responsibility  Low MH/DD/SA service need  Low physical health need- complexity/risk Quadrant II: MCO – Primary Care Coordination Responsibility  High MH/DD/SA service need  Low physical health need- complexity/risk Quadrant III: CCNC – Primary Responsibility  Low MH/DD/SA service need  High physical health need- complexity/risk Quadrant IV: MCO and CCNC share in Care Coordination/Management and Consultation Responsibilities  High MH/DD/SA service need  High physical health need- complexity/risk

37. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition What You Can DO 1. Know your GAST program staff. 2. Know how to access MH/SU and Aging services. 3. PARTNER, PARTNER, PARTNER with each other. 4. Develop Local Mental Health, Substance Use, and Aging Collaboration. 5. Use data to convey seriousness of issue and need for action to your local, county, state and federal officials.

38. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Contact Information Debbie A. Webster Office: 919-715-2774 E-Mail: debbie.webster@dhhs.nc.govdebbie.webster@dhhs.nc.gov Department of Health and Human Services - http://www.ncdhhs.gov/http://www.ncdhhs.gov/ Division of Mental Health, Developmental Disabilities, and Substance Abuse Services - http://www.ncdhhs.gov/mhddsas/http://www.ncdhhs.gov/mhddsas/ Managed Care Organizations for Mental Health, Developmental Disabilities, and Substance Abuse Services Contacts - http://www.ncdhhs.gov/mhddsas/lmeonbluebyname.htm http://www.ncdhhs.gov/mhddsas/lmeonbluebyname.htm Focusing attention, building capacity, supporting action

39. Focusing attention, building capacity, supporting action… NC Mental Health, Substance Use, & Aging Coalition Caregiver Resources NCcareLINK – http://www.fullcirclecare.org/nc/carelink.html http://www.fullcirclecare.org/nc/carelink.html North Carolina Aging Service Plan 2011-2015 http://www.nasuad.org/documentation/tasc/state%20plans /North%20Carolina%20State%20Plan.PDF North Carolina family Caregiver Support Program http://www.ncdhhs.gov/aging/fchome.htm