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State of the Science: Supporting Elders to Live as Vibrant Elders in Recovery (S.I.L.V.E.R.)
March 4, 2024
Steve Bartels MD, MS
It is my distinct privilege to provide this inaugural commentary as the Senior Scientist for the recently funded Rehabilitation Research and Training Center “Supporting Individuals to Live as Vibrant Elders in Recovery” (S.I.L.V.E.R. RTCC) at the Boston University Center for Psychiatric Rehabilitation. The 5-year S.I.L.V.E.R. RRTC is funded by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR), Administration for Community Living, HHS and under the direction of Drs. Marianne Farkas and Zlatka Russinova of the Center for Psychiatric Rehabilitation at Boston University.
Over the past three decades I have been involved in research with a research team including researchers on the S.I.L.V.E.R. RRTC ( i.e., Sarah Pratt and Kim Mueser) focused on the growing numbers of older adults with serious mental health challenges. What have we learned?
First, with the aging of the baby boomer population, the numbers of individuals who are over the age of 60 with serious mental health challenges has been dramatically increasing. However, this increase is qualified by a dramatic health disparity for middle-aged and older adults with mental health diagnoses such as schizophrenia and bipolar disorder. This health disparity is manifested in a 20 to 30-year reduced life expectancy, largely due to high rates of health-related conditions such as obesity, tobacco use, cardiovascular disease, diabetes, and cancer. In addition, people with serious mental health challenges between the ages of 50 and 65 are three and one-half times more likely to be admitted to a nursing home, despite most individuals preferring to live independently in the community.
The United States Supreme Court “Olmstead Decision” interpreted the Americans for Disability Act (ADA) as a directive that individuals who prefer to live in the community with a disability should have that choice. Tragically we have not delivered on that mandate. There are many reasons for this shortfall, including a lack of affordable housing, a lack of appropriate community-based mental health and physical health care services, and a lack of rehabilitative and support services tailored to meet the special needs of older adults with mental health challenges living in the community.
Of note, this shortfall in services is not due to a lack of research on evidence-based practices. We know what works, but evidence-based practices have not been adopted by state mental health authorities or broadly implemented. There is a small, but significant body of research on effective psychosocial interventions and treatments for older adults with serious mental health challenges. To provide guidance, I was pleased to lead the development of an evidence based resource guide for the Substance Abuse and Mental Health Administration (SAMHSA) titled “Psychosocial Interventions for Older Adults with Serious Mental Illness” that is now featured in SAMHSA’s Evidence Based Resource Guide Series
(https://store.samhsa.gov/sites/default/files/pep21-06-05-001.pdf).
This review provided detailed descriptions of five evidence-based psychosocial interventions with proven effectiveness, including two developed by our research team: Integrated Illness Management and Recovery, and Helping Older People Experience Success or “HOPES.” With the newly funded center, S.I.L.V.E.R. researchers are engaged in building on what we have learned in prior research to develop and test exciting new interventions and programs over the coming years.
Among the most pressing impediments to advancing mental health access is a substantial shortfall in the trained workforce. I also had the recent privilege of participating in a National Academy of Medicine workshop on this topic titled “Addressing the Rising Mental Health Needs of an Aging Population.” This 2024 report provides a valuable overview of data on the incidence and prevalence of mental health conditions in older adults – it describes mental health disparities and the role of social determinants, as well as approaches to improving access and quality of services. This report also provides critical recommendations for addressing the workforce shortfall, and key approaches to advancing supportive communities and future priorities.
As we dedicate efforts to gaining knowledge on optimal approaches to improving services for older adults with serious mental health challenges, there are many high impact opportunities. For example, a team of S.I.L.V.E.R. researchers is currently engaged in a multi-state project to determine the status of dedicated state plans and policies for older adults with serious mental health needs. Other opportunities include modifying and adapting the proven evidence-based practices to improve broad uptake, implementation, spread, and sustainability. These efforts will benefit from considering health equity as a major goal and understanding factors contributing to physical and mental health disparities. The Knowledge Translation team at the S.I.L.V.E.R. RRTC will be contributing to determining the most promising approaches to developing a trained workforce prepared to address the needs and preferences of older adults with serious mental health challenges and the policy initiatives necessary to achieve effective service delivery for this important and rapidly growing population.
I am excited by the amazing opportunity provided through funding from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) supporting the newly funded S.I.L.V.E.R. RRTC. I look forward to working with our extraordinary team to make a difference in the lives of older people with mental health challenges. Details on many of these efforts will be featured in future blogs. Stay tuned!
Dr. Bartels is Senior Scientist for “Supporting Individuals to Live as Vibrant Elders in Recovery (SILVER RRTC) and the James J. and Jean H. Mongan Chair in Health Policy and Community Health, Director of Mongan Institute, Massachusetts General Hospital, Professor of Medicine, Harvard Medical School.
Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTHF0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.