The recently appointed chairman of the psychiatry department at the UConn Health Center is working to galvanize research and clinical resources to address what is being called a “silver tsunami” – the burgeoning need for mental health services for older adults.
As baby boomers age, more people will face problems associated with dementia, depression, substance abuse and other mental health issues, says Dr. David Steffens, professor and chairman of the Department of Psychiatry. He believes it is vitally important to support research studies to understand successful aging and lead to better treatment of mental disorders in the elderly.
An expert in geriatric psychiatry with a special interest in late-life depression, Steffens joined UConn in 2012 in large part because of the commitment of the university and the state to genomics and personalized medicine, including the partnership with Maine-based The Jackson Laboratory, which is building a $1.1 billion research facility on the Health Center’s campus.
“Some of what attracted me to UConn was the strength of the faculty in all areas of this department, as well as its vibrant Center on Aging,” he says. “Genetics research also played a large part in why I came here. With the growth of the elderly population, especially those over age 75, the need for mental health and substance abuse research and services will continue to expand.”
Steffens begins a one-year term on March 14 as president of the American Association for Geriatric Psychiatry, a membership association of health care professionals in the United States, Canada and abroad. AAGP promotes the mental health and well-being of older people through professional education, public advocacy, and support of career development for clinicians, educators and researchers in geriatric psychiatry and mental health.
Different Mental Health Needs of the Elderly
The mental health needs of the elderly differ from the rest of the population, Steffens explains. “In general, older adults have more medical illnesses and may have some degree of cognitive problems that can worsen in the face of depression and other mental health issues. They also may have trouble advocating for themselves and articulating their needs from both a physical and a mental standpoint.”
The elderly also are more at risk for losses that can lead to depression, such as the loss of a spouse, friends and, in retirement, the important structure that a job provides. But for this population, mental health issues are highly stigmatized and often are compounded with concerns about memory and Alzheimer’s disease. “Any memory complaint becomes a cause for worry,” Steffens points out. “An additional loss is that their bodies may not function the way they used to, which can add to depression and anxiety.”
Substance abuse is another problem for the elderly that often remains hidden. Seniors may be at higher risk for prescription drug abuse, either intentionally or accidentally, and some turn to alcohol as a way to cope with loss or depression.
People who were used to after-dinner drinks in their 40s and 50s may find that their bodies aren’t processing alcohol the same way in their 60s and 70s, Steffens points out. “Having a few drinks can affect the aging brain,” he says. “It can lead to higher blood-alcohol levels, which in turn can contribute to cognitive impairment and increase the risk of falls and hip fractures.”
Studying Resiliency in Older Age
One area of interest to researchers is the concept of resiliency in older age – how some people can navigate change and loss well as they age, while others struggle with depression and anxiety. “One theory is that people who weathered losses when they were younger and learned from that experience may be better equipped to handle the inevitable losses in old age,” he says.
Answers to some of these questions may come from a newly funded study for which Steffens’ department is now recruiting volunteers. The study will evaluate older adults with and without depression, studying the role of stress in their lives and how they cope with it, as well as their response to treatment. It will consist of clinical interviews, complete cognitive assessments and neuroimaging scans. “This study follows the type of research I’ve done in my career,” he explains. “If people don’t cope with stress well, they’re at risk for continued depression as well as cognitive decline.”
Steffens joined UConn after more than 20 years at Duke University School of Medicine, where he served as professor of psychiatry, vice chair for education, and head of the Division of Geriatric Psychiatry and Behavioral Sciences. He has authored more than 250 peer-reviewed papers and is co-editor of the leading textbook on geriatric psychiatry. His major research project, known as Neurocognitive Outcomes of Depression in the Elderly (NCODE), has been continuously supported by the National Institute of Mental Health (NIMH) for over 15 years.
Goals for the Future
For the UConn psychiatry department, Steffens hopes to capitalize on existing strengths. For example, the Health Center’s Alcohol Research Center is the oldest continuously funded alcohol research center in the country. The child psychiatry division continues to receive substantial research funding, particularly in the areas of trauma and substance abuse, and is active in outreach to schools on topics such as bullying and mental health awareness. Areas of research that will be developed in the department include mood disorders, adult ADHD, obesity and mental health in the prison population.
Steffens also hopes to recruit more faculty to the department’s geriatric psychiatry program as well as partner with other geriatric medicine specialists and neurologists in the Health Center. A goal is to develop an Alzheimer’s disease center of excellence at UConn to improve quality of life and encourage advances in treating the underlying causes of dementia. He is also interested in focusing on the connection between late life depression and later risk of Alzheimer’s disease. “Most of my research over the past 15 to 20 years has been trying to understand that link,” he says.
On a national level, Steffens hopes as AAGP president to lead the group in drawing attention to the impending problem of a clinician shortage. There is growing concern that there will not be enough providers, such as general practitioners, physician assistants, APRNs and social workers, to serve the mental health needs of the elderly. “There is a clear role for geriatric mental health specialists, but we need primary care clinicians on the front lines who are well trained in geriatrics.”
To meet this need, he will lead the AAGP in reaching out to medical and graduate schools to help educate the next generation of clinicians who will be caring for older adults. He also hopes to expand the association’s membership to include members who are not psychiatrists but are interested in mental health, such as psychologists, nurses and social workers. “AAGP believes mental health takes a multidisciplinary approach, so we’ve decided that our organization should also be multidisciplinary,” he says.
Geriatric psychiatry is important to Steffens on a personal as well as a professional level. “I’ve been fortunate in that early in my career, I was exposed to terrific clinicians and researchers who were studying late-life depression. I also was fortunate to have known my grandparents and some of my great-grandparents, and I have a natural affinity for that age group. I like to talk to them and feel I can relate to them. As I went through my own training, I realized that this is a population with challenges that I felt I could meet. Being able to see older adults dealing with a difficult issue and to help them regain their confidence and reduce their mental illness burden is personally very satisfying.”