Adults age 65 and older represent an ever-growing portion of the United States population. This page contains a variety of resources to help integrated primary and behavioral health care providers prepare their services to align with the unique needs of older adults.
• Behavioral Health Identification and Treatment
• Screening and Assessment Tools
• Evidence-based Practices
• Resources for Individuals and Families
• Federal and National Entities for Older Adults’ Health
Growing Older: Providing Integrated Care for an Aging Population is a new publication from the SAMHSA-HRSA Center for Integrated Health Solutions that offers tips for safety-net primary care providers to be prepared to meet the behavioral health needs of older adults.
In older adults, behavioral and cognitive conditions often present differently than younger adults. These resources provide information to help understand these differences.
- Patient-Centered Medical Homes and the Care of Older Adults is a resource from the John Hartford Foundation and the Gerontological Society of America that outlines special considerations for providers in treating older adults.
- The National Institute on Aging’s Talking with Your Older Patient webpage contains guidance for talking to older adults, including how to discuss cognitive impairment and work with families and caregivers.
- The American Psychological Association’s Office on Aging has a number of resources related to the integration of primary and behavioral health care for older adults, stemming from their report, Blueprint for Change: Achieving Integrated Health Care for an Aging Population. The fact sheet, Integrated Health Care for an Aging Population, offers recommendations for promoting integrated care for older adults. The APA also produced a series of video testimonials from both patients and providers in Psychiatrists in Integrated Health Care: Geriatrics to describe the many ways physical and mental health of older adults are intertwined.
Depression and Suicide
- SAMHSA’s The Treatment of Depression in Older Adults Evidence-Based Practices KITs provides information on evidence-based programs to treat and improve outcomes for depression and dysthymia.
- Preventing Suicide in Older Adults, an issue brief from SAMHSA and the Administration for Community Living, assists health care and social service organizations in de¬veloping strategies to prevent suicide in older adults.
- The American Medical Association’s Differentiating among Depression, Delirium, and Dementia in Elderly Patients, published in the Journal of Ethics details the distinguishing characteristics of depression, delirium and dementia and practical advice for differentiating among them.
- The National Council on Aging’s Suicide Prevention Among Older Adults webinar described the prevalence of and risk factors for suicide among older adults, discussed how suicide is being addressed at the federal level and shared a list of resources.
- SAMHSA’s Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior Living Communities provides guidelines, hands-on tools and training manuals for senior living staff to integrate suicide prevention into ongoing programs.
- Major Neurocognitive Disorder and Geriatric Depression: What’s New in 2016?, a presentation from Brent Forester, MD, MSc, reviews the general principles of geriatric psychopharmacology, the identification, treatment and prevention of major neurocognitive disorders and geriatric depression, and the risks associated with pharmological interventions.
- Screening and Brief Intervention for Substance Misuse Among Older Adults: The Florida BRITE Project is a review of the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a three year, state-funded pilot program of screening and brief intervention for older adults. The study found those who received the brief intervention had improvement in alcohol, medication misuse and depression measures.
- Substance Abuse by “Mature” Adults: Is Your Patient Using or Abusing? is a video with Louis A. Trevisan, MD that describes how to identify and address substance abuse in older adults.
There are many screening tools for behavioral health conditions, many of which are appropriate for adults of all ages. Learn more about these assessments on our screening tools page.
In addition to screening for behavioral health conditions, such as depression and substance use, you may want to assess the cognitive functioning for older adults. Here are a few tools to help.
- The National Institute on Aging’s Assessing Cognitive Impairment in Older Patients: A Quick Guide for Primary Care Physician provides information and tips for assessing patients with memory loss or other signs of cognitive impairment.
- The Mini-Cog is a three minute instrument to detect cognitive impairment in older adults. It consists of a 3-item recall test for memory and a clock drawing test.
- Montreal Cognitive Assessment (MoCA) is a 10 minute screening tool that assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculation and orientation.
- Functional Activities Questionnaire (FAQ) is a six to 10 minute paper questionnaire that can be administered by a spouse, caregiver, relative or friend.
- The Confusion Assessment Methods Diagnostic Algorithm (The CAM) enables clinicians to recognize delirium and distinguish it from other types of cognitive impairment.
Evidence-based practices are a great resource for identifying clinical, organizational and systems level changes to improve care for older adults. These programs are specifically designed and tested for use with older adults.
- Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) is a collaborative care approach to treat depression or dysthymia that involves a trained depression care manager, patient, primary care provider and psychiatrist.
- Wellness Initiative for Senior Education (WISE) is a curriculum-based health promotion program related to health behaviors, the aging process, managing care, medication management and signs of alcohol misuse and depression.
- EnhanceWellness is an outpatient intervention that helps older adults with chronic health conditions manage their illness and avoid psychiatric medications, physical inactivity, depression and social isolation.
- Senior Reach is a training designed for community partners to identify older adults experiencing mental health and related concerns and help get them into recovery-oriented behavioral health treatment.
- Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) is a depression self-management program that includes screening and assessment, education, referral to appropriate health professionals and behavioral activation.
- Program to Encourage Active, Rewarding Lives (PEARLS) is a community-based intervention for individuals with depression or dysthymia that helps reduce symptoms and suicidal ideation through problem-solving, social and physical activation and pleasant activity scheduling.
- Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) is designed for primary care physicians to recognize depression and suicidal risk and manage treatment.
These resources detail the key competencies and guidelines the integrated care workforce needs to understand how to provide quality care and services to older adults.
- Association for Gerontology in Higher Education’s Online Directory of Educational Programs in Gerontology and Geriatrics is a searchable database with educational programs by location, type of degree program, certificate or fellowship offered.
- The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? is a 2012 report from the Institute of Medicine that recommends ways to boost the workforce by funding services and training for health care providers working with older adults.
National Coalition on Mental Health and Aging organized a Directory of Competencies, Standards, and Guidelines for Practice with Older Adults with Mental and Behavioral Health and Substance Abuse Issues that provides an overview of key concepts and issues for practitioners working with older adults with mental health, behavioral health, and substance abuse needs.
For additional resources, visit our workforce section.
Medicare is the major payer of integrated health care for older adults. The following resources provide information for understanding Medicare’s role in the financing of primary care, behavioral health and other specialty medical care.
- The Financial Alignment Initiative from the Centers for Medicare & Medicaid Services (CMS) helps states to better align Medicare and Medicaid programs to ease provision of integrated primary, acute, behavioral health and long-term services and supports for Medicare-Medicaid enrollees.
- Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Medicare's Accountable Care Organizations (ACO) webpage reviews the ACO model and current ACO programs.
- Medicare’s Drug Coverage Part D webpages answer frequently asked questions and provide information on what Medicare drug plans cover.
Your Guide to Medicare’s Preventive Services provides information on the preventive services Medicare covers, how often, who can get services and the cost.
Find more financing resources in our financing section.
Caregivers, neighbors, friends and families also play a part in supporting older adults’ primary and behavioral health. These resources provide information for individuals and families on how to help.
- The Eldercare locator allows users to search by zip code for local resources supporting health and health promotion of older adults.
- The Caregiver Action Network Family Caregiver Toolbox provides resources, videos, checklists and tips for conversations on a variety of topics for caregivers of older adults.
- Mental Health First Aid for Older Adults is an in-person training for anyone who wants to learn about mental illnesses and addictions, including risk factors and warning signs. This 8-hour training teaches participants a 5-step action plan to help a person in crisis connect with professional, peer, social and self-help care.
- The Veterans Administration provides shared-decision making worksheets for veterans and their caregivers to discuss long-term care needs and caregiver roles and responsibilities.
- The Administration on Aging’s Elder Abuse Resources provide information on elder abuse, prevention, reporting and who to call for help.
- Elder Abuse and its Prevention: Workshop Summary summarizes the 2013 Institute on Medicine Forum on Global Violence Prevention workshop on elder abuse and its prevention. The workshop discussion focused on the prevalence and characteristics of elder abuse around the world, risk factors for abuse and adverse health outcomes, and intervention models and opportunities for prevention across sectors.
- The Family Caregiver Alliance’s Family Care Navigator tool helps caregivers find state-specific resources on legal help, government health and disability benefits, living arrangements and services and education for caregivers.
- The National Alliance for Caregiving creates resources for caregivers to address challenges of caring for a loved one and also develops guides for professionals on working effectively with caregivers.
- The Administration on Community Living is the Federal agency responsible for increasing access to community supports for older Americans.
- The National Institute on Aging, part of the National Institutes of Health, leads research on the nature of aging and is the primary Federal agency conducting Alzheimer’s research.
- AARP Health provides information on Medicare, brain health, health conditions and treatment and prescription drugs for adults age 50 and older.
- The American Association for Geriatric Psychiatry provides a search tool for finding a geriatric psychiatrist as well as resources for educators, clinicians and researchers specializing in geriatric psychiatry.
- The National Council on Aging provides resources for health care professionals, caregivers and advocates on benefits, healthy aging and public policies impacting older adults.
- The Veterans Affairs Geriatrics and Extended Care Services has information for older veterans on health care and benefits, home and community based services and shared decision making.
- The American Geriatrics Society provides clinical guidelines and recommendations for health care professionals to build clinical competence in serving a variety of needs of older adults.