As the aging population in America continues to grow, the health care system must evolve to meet the increasingly complex needs of older adults. Despite the significant investments older Americans make in health care, many feel that the system falls short in addressing their overall needs, especially when it comes to behavioral health for seniors. The stark reality is that, although older adults engage with health care services more than any other group, their desires for a holistic and patient-centered approach are not being met.
The findings from a recent survey conducted by The John A. Hartford Foundation and Age Wave, a research and consulting firm focused on aging, paint a troubling picture. Terry Fulmer, the president of The John A. Hartford Foundation, put it bluntly when she said, “Older adults are stuck in a health care system that is not responsive to their goals and preferences. Boomers want health care that maximizes their health and ability to function, and they want their providers to listen to them.” This sentiment is echoed throughout the survey, which shows that a significant portion of older adults feels that their health care providers are not addressing their mental health and cognitive needs as part of a comprehensive care plan, including behavioral health for seniors.
A Disconnect Between Health Care Spending and Patient Satisfaction
One of the most significant findings from the survey is the mismatch between the amount of health care older adults use and the care they feel they are receiving. Older adults aged 65 and over engage with the health care system more than any other age group. According to national health care expenditure data, this demographic spends more on personal health care than any other age group, over five times more than children and 2.5 times more than working-aged adults. Additionally, the Centers for Disease Control and Prevention (CDC) reported that in 2018, 33% of all physician office visits were for patients aged 65 and older, the largest single group in the data. Despite this, 82% of older adults say that the health care system is not prepared to meet their needs. This stark contrast highlights a systemic failure—older adults are deeply embedded in the health care system, yet they feel the system is failing them.
A key area where the health care system falls short is in addressing behavioral health for seniors. While the system has focused heavily on extending lifespans, the survey revealed that nearly all older adults (94%) value quality of life over the number of years lived. In fact, many seniors would rather experience fewer years of good health than prolonged years with compromised quality of life. This presents an urgent call for a shift in focus—older adults need a system that prioritizes their well-being and supports their goals for health, functionality, and mental wellness.
Behavioral Health: A Critical Yet Overlooked Need
Behavioral health for seniors issues, including mental health and cognitive decline, are among the most pressing concerns for older adults. However, despite their significance, many older adults report that their health care providers are not asking the right questions. According to the survey, only 45% of seniors say their doctors inquire about their mental health, and even fewer (40%) report that their cognitive and brain functioning are given adequate consideration. This gap in care is alarming, particularly as older adults face unique challenges related to mental health, such as the impact of aging on cognition, the stress of managing multiple chronic conditions, and the social isolation that often comes with aging.
The failure to address behavioral health for seniors adequately could have far-reaching consequences. Behavioral health issues can affect older adults’ ability to manage their physical health, and vice versa. A lack of attention to mental health can exacerbate chronic conditions, decrease quality of life, and increase the risk of hospitalization or institutional care. Thus, there is a critical need for health care providers to take a more holistic approach that integrates physical and mental health care, addressing behavioral health for seniors as an integral part of their overall well-being.
The Role of Socioeconomic and Geographic Factors
The survey also revealed disparities in how older adults view their mental health, based on factors like socioeconomic status and geographic location. Rural respondents reported lower levels of “excellent” or “very good” mental health (57%) compared to urban respondents (65%). This gap can likely be attributed to limited access to health care services in rural areas, including mental health professionals, and greater social isolation.
Financial resources also played a significant role in the mental health of older adults. Those with low financial resources reported lower levels of good or better mental health (50%) compared to those with higher financial resources (76%). The survey findings suggest that individuals with fewer financial resources are more likely to want health care providers who take the time to understand their needs, manage their chronic conditions, and offer support for mental health issues. The financial burden of health care can also exacerbate feelings of stress, anxiety, and depression, making it even more crucial for providers to address these concerns comprehensively, including addressing behavioral health for seniors.
Moreover, as functional health declines, so too does mental health. The survey found that 68% of older adults with no functional health limitations reported very good or higher levels of mental health, compared to only 56% of those with one or two limitations and just 36% of those with three or more limitations. This underscores the interconnection between physical and mental health—when physical health is compromised, it becomes increasingly difficult to maintain mental health. Therefore, the health care system must address both aspects simultaneously, offering a more integrated approach to care, with special focus on behavioral health for seniors.
Responding to the Needs of Older Adults
There is growing recognition in both the public and private sectors that the health care needs of older adults require a comprehensive overhaul. Lawmakers have made some attempts to reform Medicare, the public health program for seniors, but much more needs to be done. In recent years, the Centers for Medicare & Medicaid Services (CMS) have made incremental changes to policies related to behavioral health services for seniors, but these changes have not yet gone far enough to meet the full spectrum of seniors’ needs.
In the private sector, new models of care are emerging. For example, digital mental health providers like Talkspace Inc. are expanding access to therapy services for seniors through Medicare coverage, which is expected to be available nationwide by the end of 2024. This is a positive step forward in providing more accessible and affordable mental health care to older adults, especially those who may face barriers to in-person care due to geographic, financial, or mobility challenges.
A Call for Holistic, Person-Centered Care
The current health care system is not meeting the needs of older adults. A fundamental shift is needed to ensure that health care providers are addressing the totality of their patients’ needs, from physical health to mental health and cognitive function. Older adults want care that maximizes their ability to live fully and independently, and they want to be heard by their providers. It’s not enough to simply extend life; quality of life must be prioritized.
The health care system must take a more integrated, person-centered approach to care, one that listens to the unique needs and preferences of older adults. This includes not only providing physical health care but also offering mental health support and addressing the social determinants of health, such as access to care and financial security. By doing so, we can ensure that older Americans have the opportunity to live longer, healthier, and more fulfilling lives.
The time for change is now. It is up to both the public and private sectors to work together to build a health care system that truly supports the aging population and provides them with the care they deserve. Only then can we ensure that older adults live not only longer lives but better lives, with comprehensive care that fully addresses their behavioral health for seniors.
