MedCity Influencers, Physicians

Seniors’ Mental Health and SDOH – A Family Physician’s View

As a physician I have witnessed the dramatic impact social determinants of health (SDOH) can have on the mental health of older patients. Fortunately, there are steps every practice can take to proactively address them.

When I founded my practice, I chose the name Family Health and Wellness. My mission every day was, and still is, to ensure that patients are treated like family, and that their family members are involved in their care. Now twenty-one years later, I am privileged to have treated many of the same patients as they mark milestones in their life, such as marriage, raising their children, retirement, caring for loved ones, and the births of grandchildren.

With more than a third of my patients now Medicare or Medicare Advantage enrollees, I also encounter the challenges faced by older patients on a daily basis. On a fundamental level, my experience underscores the significance given to social and economic barriers, or social determinants of health (SDOH), and their direct impact not only on seniors’ physical health, but especially their mental and emotional well-being.

Recent research reveals what physicians have long known: the health of patients is determined more by SDOH than by the care we provide – with some estimates indicating clinical care is only responsible for up to 20% of an individual’s health. For that reason, SDOH are crucially important considerations that must be addressed in any treatment plan, both for their impact on physical and mental patient outcomes.

This may seem like common sense – doctors strive every day to address the external hurdles many patients must overcome to live healthy lives – but today there is greater understanding of the immense impact SDOH have on the mental health of older patients. In my personal journey as a physician, I’ve come to believe this shift is not only long overdue, but also that some of the lessons I have learned are applicable to all practices:

  • Understand the mental health stigma is real among seniors
    Older patients are often reticent to share the mental health issues they struggle with. This is particularly true within many Black and Latino communities, where psychiatric concerns are often associated with weakness. Tackling this bias in a sensitive, yet frank manner is important to ensure that patients feel comfortable voicing feelings of depression or anxiety.
  • Consider transportation a challenge
    Each year, more than 3.6 million people miss medical appointments due to transportation issues. The problem is particularly acute for older patients, with one study showing that 61% find it difficult to get to appointments. Despite the availability of ride-share services like Lyft and Uber, transportation should be considered a challenge as a matter of course until proven otherwise.
  • Take advantage of virtual consultations
    Telemedicine is often applauded for the convenience it offers and the ability it gives patients to overcome transportation-related challenges. It also provides physicians with an opportunity to see what kind of home environment their older patients live in. As a result, it is a highly effective way of identifying SDOH. Notably, not all seniors have access to the technology needed for virtual appointments, and even those that do might require training. Both issues must be considered, but I am grateful for the opportunity to better understand what kind of environments my patients live in, even if it is just a brief glimpse. I have uncovered important treatment considerations on many occasions as a result.
  • Be vigilant when looking out for depression and loneliness
    Most older patients experience the loss of friends and loved ones. The associated impact on mental health should be proactively discussed. Early in my career an older patient put this in stark focus. After I could find no cause for the debilitating headaches she suffered from, I asked if something was upsetting her. This wonderfully proud woman began sobbing while she shared how lonely she was. The appointments she made were efforts to address how heartbroken she felt – a realization that empowered us both to look for proactive solutions to ease her mental and emotional pain.
  • Check in with patients about managing their health care
    At least several times each day, I receive requests from older patients seeking help with bills that are unrelated to my practice. Many also need support managing and organizing their medications. Every staff member in my practice accepts this as an important aspect of the care we provide. Asking the patient if this kind of assistance is needed is also a great way to immediately alleviate an issue that causes many older people significant stress.
  • Learn what your patients eat
    We provide our older patients with advice, and often instruction, to ensure that they are able to attain and prepare healthful meals. Never assume they are eating well or have enough food though. It is important to ask them directly on a routine basis what their meals consist of. Notably, many seniors find cooking difficult, particularly if they suffer from arthritis and other conditions that can make it difficult to open containers and prepare ingredients. Again, proactively make a point of asking if this is an issue for them. Proper nutrition is absolutely crucial for both physical and mental health, and fortunately there are many government and community-based programs that can provide assistance.
  • Create partnerships with public and community-based organizations
    You want to have agencies on speed dial like adult protective services who can assist older patients when needed. I have learned to trust my intuition and that of the volunteers and public servants I partner with in my service to older patients. If you suspect an issue, don’t hesitate to reach out to those who may have additional visibility into your patient’s situation.
  • Foster a productive dialogue with family members
    The complexities associated with any number of mental and physical conditions encountered by older patients can be intimidating. Encourage family members to be involved, attend appointments and ask questions. Just having a second set of ears present can contribute to the patient’s mental well-being.
  • Don’t forget your own mental health
    Whenever possible, find ways to attend to your own mental health and that of your staff members. Burnout is a very real and significant concern even for the most altruistic physicians, clinicians and administrators. Try to manage it before it becomes an issue.

The link between SDOH and older patients’ mental health is inextricable. Conversations, treatments and interventions which emphasize overall well-being and help address the socio and economic issues that impact it are a step in the right direction. It is imperative to remember our commitment to patients extends far beyond the services we deliver, and just as importantly, we are not alone in our efforts to help older patients live healthier, happier lives.

Photo: LPETTET, Getty Images

Dr. Stacey Jones-Reed is the physician-owner of the Family Health and Wellness Center, a staple of the Acres Home community in Houston that has served more than 10,000 patients since its establishment 21 years ago. Family Health and Wellness Center is also a member of Renaissance Physicians, which is an independent physician association supported by CareAllies.

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