Prevalence of Suicide Among Older Adults (Oral Testimony)
Special Committee on Aging, United States Senate
Christopher C. Colenda, MD, MPH
9/14/2006
Written Testimony
Mr. Chairman and Members of the Committee:
I am Christopher Colenda, Dean of Medicine at Texas A&M University, and President of the American Association for Geriatric Psychiatry. My testimony this morning reflects both my work in academia, which involves the education and preparation of the new generations of physicians, and in my own medical specialty, which is geriatric psychiatry.
The toll of suicide among older adults – those who are 65 years of age and older – is stunning. Older men have the highest rates of suicide in the nation. One-third of older adults who die from suicide have seen their primary care physician in the week before their deaths, and seventy percent have seen their doctors within the prior month.
Mr. Chairman, depression is NOT a normal part of aging. Depression is an illness that can be successfully treated at any age that it may strike. The symptoms that a practitioner, either a generalist or a mental health specialist, need to recognize often vary according to age or culture. But depression is as real and as treatable in the very old as in any other age group.
Effectively combating this tragic loss of life requires a three-pronged approach.
1. Improve the content of geriatric curriculum and core competencies throughout the continuum of medical education training: medical school, residency and continuing medical education. This education should include late life psychiatric disorders.
2. We must have sufficient numbers of geriatric mental health specialists to lead the field in research, education, and treatment.
3. And we must ensure that primary care practitioners have the tools and knowledge to identify, treat, and, when necessary, refer vulnerable patients so that their suicides may be prevented.
Academic medicine must increase its commitment to these aspects of professional training. But what makes this issue – caring for frail, older individuals coming to the end of their lives – so hard to address is that the vulnerable folk in our society are the least able to fight for their needs in the hyper-competitive arena of academic medicine.
Competition for time and resources in training is a huge factor in both mental health and primary care specialties. Mental health is complicated and stigmatized. And so, too, is old age. The two together lead to a collective set of negative attitudes that have led to massive disincentives both in terms of reimbursement and in the intangibles derived from long-held, deeply ingrained dual stigma of “mental illness” and “fragile old age.”
In my written testimony, I have suggested a number of steps that the Federal government should take to begin to address the problem.
· First, we need a solid study by the Institute of Medicine to determine the geriatric medicine and geriatric mental health workforce needed to serve older adults.
· We need a review of best practices for programs delivering mental health services in primary care and community settings;
· Best educational and training practices to enhance geriatric core competencies and promote interprofessional collaboration.
· Funding for geriatrics health professions education programs
· More research on mental health for older adults;
· Loan forgiveness programs to encourage practitioners to specialize in geriatrics, and requirements for inclusion of older adults in clinical trials.
· Finally, the financing of health care services for the elderly, especially those with late-life mental disorders, requires a fresh look. Today’s system of reimbursement for primary care and preventive and mental health services does not integrated and compassionate care. Our current financing system does not attract young physicians into the rewarding careers of primary care, psychiatry, geriatric medicine and geriatric psychiatry. Without fundamental financial reform, we will not recruit the best and brightest into this field.
Academic medicine has a steep hill to climb in developing and implementing adequate training for practitioners who must be prepared to help prevent suicide among older adults. The scope and size of the task are going to increase sharply in the next few years. Mr. Chairman, academic medicine and the field of geriatric psychiatry welcome this Committee’s active concern about the devastating illnesses that result in tragic death for far too many of our seniors. We look forward to working with you in focusing public and private resources on finding a remedy.
|
