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Abstract
The United States must act now to strengthen the geriatric healthcare workforce to meet the mental health and substance use (MH/SU) needs of a growing older adult population. Older adults have complex MH/SU needs. The geriatric specialist shortage means we need innovative and multileveled solutions. This article describes national efforts that have been implemented to address this shortage and offers recommendations key to preparing the geriatric MH/SU workforce. These strategies include increasing geriatric specialists through unique pathways, building knowledge of older adult MH/SU in generalists, promoting diversity in providers, engaging non-licensed providers, and reforming Medicare/Medicaid billing structures.
Keywords mental health, substance use, geriatric, older adult, workforce
Demographic shifts in the United States toward a growing older adult population create challenges in our healthcare system and workforce. We are underprepared to meet the healthcare needs of older adults and the imbalance in this supply and demand for older adult services is projected to swell. This is especially true for mental health and substance use (MH/SU) services. This shortage creates important opportunities for us to prepare and strengthen the MH/SU workforce in an effort to adequately address the complex needs of older adults.
Older adults and mental health/substance use (MH/SU)
Although rates of mental health disorders and substance use decrease with age, older adults who experience these issues generally endure a greater functional impact. For example, depression is linked to increased morbidity reduced physical,cognitive, and social functioning; and increased mortality in older adults (Wei et al., 2019; Maier et al., 2021). In older adults, even subclinical levels of depression can impact functional impairment (Wei et al., 2019). Older adults also experience complex interactions between mental health, medical conditions, and functional impairment. Older adults with mental illness are more likely to develop medical comorbidities and die 5 to 20 years sooner than those without mental illness (Olfson et al., 2015).
Creative, multipronged national efforts are underway to address the shortage of geriatric mental health providers who also have knowledge of substance use.
Substance use is increasing with the Baby Boomer generation (Masonet al., 2022; Substance Abuse and Mental Health Services Administration, 2021),particularly alcohol use in the context of the COVID-19 pandemic (Leventhal et al., 2022; Eastman et al., 2021). In 2019,approximately 10,292 opioid overdose deaths were...