JustCare

Tag: Mental health

  • Get older, cope better

    Get older, cope better

    Benedict Carey reports some good news for older adults in the New York Times. Our emotional well-being improves as we grow older. And, the novel coronavirus pandemic confirms this scientific finding.

    The data show that people who are 50 and older fare better than younger people on a range of emotions. Older people are more positive, regardless of wealth or education. What’s the reason?

    Some might think that older people experience less stress than younger people because they have learned to accept life and all its quirks. Others might think that older people have figured out a way to dodge the negative stuff, at least mentally. Scientists tested the emotions of 1,000 adults in the context of the novel coronavirus.

    Here’s what they found. The threats of getting COVID-19 and dying from COVID-19 were far greater for older adults than for younger adults. But, older adults and younger adults reported the same stress levels in response to COVID-19. Older people, in fact, reported less distress than younger people.

    To be sure, people over 50 tend to have different daily routines than people under 50. They tend to have older children who are better able to fend for themselves. Older people also generally have more resources, making it easier for them to get help and to cope with COVID-19 and other stressors. In addition, older people are generally not as focused on self-improvement as younger people, spending their days doing things they enjoy rather than on taking risks or being challenged.

    In short, older people face fewer disruptions in the face of a pandemic than younger people. One result appears to be that older people experience less stress.

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  • Well Connected provides companionship to older adults by phone

    Well Connected provides companionship to older adults by phone

    Well Connected, a free program launched by Covia, a nonprofit organization that promotes positive aging, offers phone and online companionship to older adults. It aims to address social isolation and improve people’s physical and mental health.

    The data suggest that having people to talk to and engaging in social activities improves your health and extends your life. Buddies can provide mental, physical, emotional, social and psychological support that many older adults, particularly those living alone, are lacking. Indeed, even casual buddies, people you may not know well, but with whom you are in regular contact, can improve your health.

    Through Well Connected, people can participate in group conversations on a wide range of topics seven days a week. Topics include everything from advocacy to religion, just plain conversation, books, health and wellness. There are more than 20 pages of options listed in the Well Connected catalogue.

    Group discussions are usually no larger than 12 people. And, there’s always a facilitator. People from all backgrounds and all parts of the country come together on the call. The goal is to provide a venue for mutual support, where participants can learn from and support one another.

    Calls are free of charge–there’s a toll-free number–and last 30 minutes to an hour. If you enjoy the program and want to participate on multiple calls, you can join as many sessions as you’d like.

    Today, more than 1,500 older adults from 41 states enjoy the benefits of Well Connected. If you’re interested in learning more about the program, you can contact Covia at 877.797.7299, or [email protected]

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  • Judge finds UnitedHealth illegally denied care to thousands

    Judge finds UnitedHealth illegally denied care to thousands

    CNN reports that UnitedHealth was found to have illegally denied care to thousands of its members. Policymakers in Washington should take note of the risk commercial health insurers may pose to Americans and question their viability. Why do the politicians behave as if they are fenced in?

    Judge Spiro of the US District Court for the Northern District of California has yet to set the punishment. What is clear, however, is that UnitedHealth—the largest mental health insurer—established mental health coverage guidelines that wrongfully and systematically denied its enrollees benefits to which they were entitled. It illegally denied its enrollees access to needed care–in this case, mental health care. The judge also found that UnitedHealth’s medical directors were misleading in their sworn testimony.

    Most important, the judge found that UnitedHealth focused on cost-cutting over appropriate treatment.  Cost-cutting through wrongful delays and denials of care appears to be widespread in commercial health plans. See this report from the Government Accountability Office.

    If United Health’s medical directors are wrongly denying mental health care, isn’t it reasonable to assume that its medical directors are wrongly denying other needed care? There’s good reason to believe that the wrongful denials affect not only the 50,000 enrollees needing mental health care but the hundreds of thousands of enrollees needing other care.

    United Health’s medical directors are supposed to adhere to particular effective treatment guidelines for people with mental health issues. They did not. As a result, these patients received a lower level of care than appropriate, putting them at risk of worse health outcomes.

    Now, UnitedHealth and other commercial insurers are trying to keep CMS from getting more patient encounter data from people enrolled in their Medicare Advantage plans. This data could help show whether enrollees are getting needed care or going without it. So, naturally, the insurers want to keep it from government scrutiny.  Taxpayer dollars pay for this care; the public should be able to see what it is paying for.

    The lack of accountability in the commercial health insurance system is untenable. It’s one of the key reasons that we pay more for our health care and get poorer health outcomes than people in other wealthy countries with government-administered health care,  We need Medicare for All.

    If you want Congress to pass Medicare for All, please sign this petition.

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  • This is your brain on exercise

    This is your brain on exercise

    To support brain health, we know many things that people should not do, such as smoke, drink alcohol heavily, use most recreational drugs, and engage in activities associated with frequent head trauma. But other than getting adequate sleep, there isn’t much that we know people should do to promote brain health, sharp cognition, and good mental health. Of course, we recommend eating a healthy, well-balanced diet, but very few individual foods or nutritional supplements have been proven to be good for the brain. The same goes for “brain teaser” activities and “cognitive skills training” programs. Contrary to logic, they haven’t been shown to produce sustained benefits. However, time and again, one activity has been connected to robust improvements in brain health and prevention of brain diseases and mental health problems: exercise. And the encouraging results keep rolling in.

    Regular aerobic exercise has been linked to reduced risk of developing dementia, such as Alzheimer’s disease. This type of exercise has also been repeatedly shown to prevent depression, and has even been proven to be an effective treatment for depressive and anxiety disorders, with effect sizes roughly equivalent to medications. These benefits have been consistently demonstrated in both human studies and in studies examining animal models of mental illness. More recently, non-aerobic weight training has also been definitively associated with positive effects on brain and mental health outcomes.

    As if this news wasn’t good enough, the amount or “dose” of exercise that people need to promote brain health is not as high as you may think. Minimal amounts of exercise such as 20-30 minutes of walking or gardening a day – not even enough to lose weight – may be enough to boost cognitive functioning and lower the risk of mental health problems. So, it should be possible to fit into all but the very busiest schedules.

    Exactly how exercise helps the brain is unclear, and there are many theories, multiple of which may be simultaneously true. Exercise may increase blood flow and oxygen supply to the brain. It may also increase the production and activity of “neurotrophic” (literally “brain feeding”) factors, such as brain-derived neurotrophic factor (BDNF) []. BDNF in critical brain areas such as a memory center called the hippocampus promotes brain health and mental resilience through stimulating the growth of new neurons and connections between them. Exercise causes chemicals to be released from muscles and bones that may be essential to sustaining proper brain functioning. In addition, physical activity causes the release of several “feel good” substances, such as endorphins and endocannabinoids, which have been implicated in the feeling of general well-being and relaxation after a workout often referred to as a “runner’s high.” Finally, exercise may benefit your brain for the same reasons that it is good for the rest of your body – it lowers blood pressure and inflammation levels and enhances proper blood flow and heart functioning.

    Regardless of the exact reasons why it’s so healthy, we know that exercise is a relatively easy-to-do, inexpensive, and fun way to improve brain health and reduce the risk of mental illness and cognitive decline. So, do your brain a favor and grab those running shoes or that bicycle and head outside!

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  • How does your state rank on health care?

    How does your state rank on health care?

    The Commonwealth Fund recently issued its 2018 report ranking states on their health systems performance. Hawaii remains in first place. Mississippi ranked in last place. Overall, the picture is not pretty. How does your state rank on health care outcomes?

    The researchers found that life expectancy in the US fell for the second year in a row, in large part as a result of opioid and other substance abuse and suicide. They found a 50 percent increase in deaths from suicide, drugs and alcohol use since 2005. Rates rose in all states, doubling or more in Delaware, New Hampshire, New York, Ohio, and West Virginia.

    Deaths from conditions that are treatable also rose in two out of three states between 2014 and 2015. In a handful of states, the rise was more than five percent: 351 in Colorado, 643 in Oklahoma, and 988 in Texas, for example.

    And, the researchers found that most adults do not get mental health treatment. On average, 56 percent of adults with mental illness were not treated for it. In Nevada, two out of three adults were not treated.

    As for the states that did relatively well and those that did poorly: The five highest ranking states were Hawaii, Massachusetts, Minnesota, Vermont and Utah. The five lowest ranking states were Arkansas, Florida, Louisiana, Oklahoma and Mississippi.

    The authors recommend a move to integrative care, bringing together behavioral health and physical health, with a focus on the social determinants of health. Some states are working to connect residents in need to community social services programs, including good housing and nutrition, health screenings and substance abuse counseling services. In fact, the Centers for Medicare and Medicaid Services is contracting with agencies in many states to create Accountable Health Communities, which are supposed to bridge the gap between clinical care and community services.

    Some good news: Medicare covers alcohol screenings and counseling  as well as nutrition counseling.

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  • Caregiving for someone with serious mental Illness: Secure your own oxygen mask first

    Caregiving for someone with serious mental Illness: Secure your own oxygen mask first

    As a psychiatrist, I know how challenging it can be to ensure that individuals with serious mental illness get the right mental health and medical care, not to mention have access to basics like housing, food, and income. And as a family member of someone with mental illness, I know firsthand the toll it can take on loved ones and caregivers.

    The healthcare system can be bewildering. Navigating health insurance, coordinating between multiple specialists, understanding complex and sometimes conflicting medical advice, and getting timely answers to questions can be dizzying for anyone. Add symptoms of mental illness to this and it is often downright impossible.

    Financially affording mental health care adds another layer of stress. Federal law notwithstanding, many private insurance plans have some ways to go before they can say they provide true parity in mental health coverage. Many people with mental illness are unable to work, which puts employment-based private insurance out of their reach. They therefore must depend on public insurance such as Medicaid and/or Medicare.

    Some types of intensive mental health services (e.g., Assertive Community Treatment teams) are only paid for by Medicaid. However, paradoxically, the people who need public insurance (and other public benefits, like Social Security Disability Insurance) are often the least capable of successfully completing the onerous application process. So, many individuals with serious mental illness who are lucky enough to have supportive family members and close friends often must turn to them for help.

    But helping a loved one with serious mental illness is invariably stressful. First, navigating the healthcare and public benefits systems is complicated, frustrating, and often demoralizing. It can sometimes feel like the entire system is designed to avoid helping the people who need it most. Even as a physician and mental health professional with multiple nurses in my family, I struggled with this when trying to support my own loved one with mental illness.

    Second, the symptoms of the mental illness itself can make caregivers anxious, fearful, angry, or depressed. Family members may spend a lot of the time worrying that their loved one may self-harm or be unable to care for themselves. Caregivers may occasionally worry for their own safety during times of crisis. Loved ones may need to take people with serious mental illness into their homes and feel deprived of privacy or quiet space. They may be juggling many other responsibilities alongside caring for an individual with serious mental illness and have no time for self-care or relaxation.

    Repeatedly witnessing the suffering that mental illness can cause may drag their mood down over time, leading to emotional distress and hopelessness. The list goes on, and for these reasons, family caregivers tend to have worse mental and physical health, and may be at increased risk for suicide. Especially for those with a high level of strain or stress, caregivers are even more likely to die early.

    So, what are caregivers to do? How do we provide the help that our loved ones may so urgently need while maintaining our own mental and physical health? There are no simple answers or easy fixes to this dilemma, but several “best practices” might help. First, do not go it alone. Frequently ask other family members or friends for help or even to take over the primary caregiving responsibility for a while. Consider joining a support group for family members of people with mental illness. The National Alliance on Mental Illness (NAMI) is a wonderful organization; find your local chapter.

    Second, hold treatment providers accountable. Their jobs are stressful, and they are operating under serious resource constraints. You can empathize with this, but remember that it is still their job to do whatever they can to help people with mental illness achieve full recovery, and sometimes family members must remind them of this and focus their attention on important problems.

    Third, look for expert advice outside of the healthcare system. For instance, consulting an attorney to help sort out issues related to benefits, housing, or guardianship could save enormous time, energy, and frustration. Do not assume you cannot afford it; many communities have non-profit agencies that provide this type of assistance on a sliding scale fee or pro bono basis and it is likely worth a little research.

    Fourth, set limits. Realize that recovery from serious mental illness is more like a marathon than a sprint, that setbacks are part of the process, and that you need to reserve your energy if you are to make it to the finish line of the caregiving race. You cannot do it all, you can’t recover for your loved one, and you can’t live their life for them. If you try to do everything for someone and/or be instantly available for them one hundred percent of the time, you will burn out and be less able to help them when truly necessary. Possibly worse, you risk sapping their ability and confidence to care for themselves and (re-)attain independence.

    So, take time away from caregiving to rest, meet your own emotional and physical needs, socialize with friends who are not connected to your caregiving role, and enjoy your own life. Your loved one will likely be just fine, and even if they aren’t, it’s not your fault for taking a little time away.

    Finally, if you are suffering from symptoms of anxiety or depression, be sure to let your healthcare provider know and seek out your own mental health treatment if necessary. Remember that asking for help is a sign of strength and resilience; a good model for your loved one with mental illness and a lifeline for yourself.

    Here’s more from Just Care:

  • Eating green leafy vegetables could help your memory

    Eating green leafy vegetables could help your memory

    A new cognitive study in Neurology suggests that people who eat green leafy vegetables on a daily basis are more likely to hold onto their memory than people who do not. The observational study, which does not show cause and effect, supports the value of the Mediterranean diet on memory and overall mental ability.

    The study followed almost 1,000 people between the ages of 58 and 99 over an average of just under five years. Participants completed two or more cognitive assessments during this timeframe.

    Researchers observed that the people who ate one or two portions of leafy vegetables, such as kale, spinach, collard greens and lettuce, each day had significantly better memory, spacial ability and perceptual speed than those who ate little or none of these leafy vegetables. Specifically, those eating about 1.3 portions of leafy greens on a daily basis had a mental ability 11 years younger in age than those who  did not.

    It appears that leafy greens’ nutrients, including vitamin K, nitrate, folate, beta carotene, phylloquinone, lutein, α-tocopherol, and kaempferol may be responsible in some significant way for preserving people’s mental health. But, beware. It’s not simply about the nutrients in the leafy greens. It’s about their formulation in the leafy greens.

    Nicholas Bakalar reports for The New York Times that there is no evidence that these nutrients in supplements offer the same benefits as they do in leafy greens or any benefits at all. The study’s lead author says that you cannot convert the nutrients’ formulation in a leafy green into a pill.

    What to make of this study? It’s hard to say since it is purely observational on a relatively small sample. But, why not eat more leafy greens? Unlike supplements which carry substantial risks of harm, eating more lettuce and kale appears to be smart nutrition.

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  • Mental health telemedicine growing in rural areas

    Mental health telemedicine growing in rural areas

    At both the federal and state levels, there is a growing interest in telemedicine. But how is it working? Ateev Mehrotra and his team studied the use of mental health telemedicine in rural areas for people with Medicare with either mental illness or serious mental illness over the ten-year period between 2004 and 2014. They found that telemedicine is serving a small cohort of vulnerable people with mental illness, largely people with disabilities living in poor communities.

    There has always been an unmet need for mental health care. At the beginning of the 21st century, fewer than one in three people with a mental illness received care. And, fewer than one in two people with a serious mental illness received care.

    People with mental illnesses in rural communities are most likely to go without care because of the lack of mental health providers. Telemental health can meet their need because mental health providers do not need to be based nearby. It provides for care through live video teleconference. And, it has been shown to work particularly well for people with depression and schizophrenia.

    To help address the unmet need for mental health care, Medicare covers telehealth via live videoconference for people living in rural communities, so long as it takes place at a health clinic or hospital and the health care provider is licensed in the state in which the patient lives. But, Congress has been reluctant to expand the benefit for fear that it will drive up Medicare costs significantly.

    The researchers found that, in 2014, Medicare covered telehealth services for 1.5 percent of people with mental illness and 3.7 percent with serious mental illness in rural communities. More than 85 percent of them also received in-person mental health care. Many suffered from depression or bipolar disorder. Most of them were under 65 with a disability and lived in poorer communities.

    The researchers also found a huge rise in the use of telehealth services between 2004 and 2014, growing from one in 500 people using the services in 2004 to more than 25 in 500 in 2014. But, the state people lived in affected the rate of usage. Different states have different laws regarding telehealth services.

    For example, no one with mental illness in rural Connecticut, Delaware and Rhode Island received Medicare-covered telehealth services. Whereas, one in ten people with mental illness in rural Iowa and South Dakota received services.

    In rural Nevada and Wyoming, there were 45 visits for every 100 people with serious mental illness. In seven other states, there were more than 25 visits for every 100 people with serious mental illness.

    The researchers did not study whether Medicare-covered telehealth services were improving access to care and health outcomes.

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  • 5 Ways Late-Life Divorce Can Affect Your Health — and What to Do About It

    5 Ways Late-Life Divorce Can Affect Your Health — and What to Do About It

    Years of research indicate that a lifestyle of companionship yields more positive health benefits, but those divorcing late in life are not bound by the risks of solitude — if they put forth the energy, that is. Active efforts to maintain health in the face of a divorce can curb the negative impacts of abrupt lifestyle transitions. If you’re currently in the process of ending a marriage or are divorced, check out the potential ways that divorce can affect your health — be sure to talk to your doctor or nurse practitioner about any concerns.

    ● Chronic Health: The risk of conditions like heart disease, diabetes and cancer increase for divorced and widowed people by 20 percent, according to a study published in the U.S. National Library of Medicine. Attending annual physicals and check-ups for existing chronic conditions can help mitigate this risk. Make sure you talk to your medical provider about your health concerns, and stay away from lifestyle choices that can contribute to chronic conditions, like smoking, excessive drinking and eating sugary foods.

    ● Mental health: Starting a new chapter of life on your own can yield uncertainty, which undoubtedly leads to anxiety for many older adults. Navigating major transitions that occur after a divorce — finding a new living space, establishing new financial patterns — can create a lot of stress when adjusting quickly between two very different lifestyles. Seeing a counselor regularly can help you manage changes in your mental health, practice mindfulness and establish a routine of self-care.

    ● Weight management: Though weight fluctuation often occurs after any major transition in life, changes in weight often come after a divorce for several reasons. For one, shifts in appetite are closely linked to mental health changes, and can result in significant weight fluctuation. Furthermore, married adults are more likely to eat meals together, which keep diets regular and well-rounded. Sharing meals with a companion after divorce is an easy way to exercise self-care and consistency — both of which affect metabolism. Keep in mind that Medicare covers weight-loss counseling.

    ● Fitness routine: Many older adults also rely on their spouse as an exercise buddy, so a parting of ways can leave one at a loss for a fitness partner. Looking into community circles for single adults is a quick way to find a friend with similar exercise interests, or even a group class at a local gym.

    ● Social engagement: Beyond just having a fitness buddy, it’s important to make sure you still find companionship for your day-to- day activities. Seek out people who enjoy the same hobbies as you, like gardening, traveling, or playing sports. Whether it’s a caregiver, family member or friend, spending quality time with others is a pivotal aspect of self-care, and should be treated as a primary aspect of maintaining health.

    While these aren’t all the ways that mid or late-life divorce can affect your health, they encompass a starting point for older adults who want to ease their transition out of a marriage. Everyone’s experience is unique, so it’s important to discuss any health or lifestyle-related choices made with a medical provider or caregiver.

    Here’s more from Just Care:

  • Be positive about aging and be healthier in old age

    Be positive about aging and be healthier in old age

    Some say you are what you do. Others say you are what you think. In fact, Becca Levy, PhD, Yale University, who has studied people’s views about growing older, finds that people who think more negatively about aging are significantly more likely to experience mental and physical decline as they age than people who are more positive about aging. In short, be positive about aging and be healthier in old age.

    In their article, Memory Shaped by Age Stereotypes over Time, Levy’s team reports finding that people who are more negative about old age experienced a 30 percent larger loss of memory over 38 years than people who are less negative about old age.

    A separate study found that older people who blame old age rather than a particular disability for their difficulties performing activities like walking or getting dressed are also more likely to have serious chronic conditions, such as heart disease, hearing loss and arthritis, than people who see the value of aging. To underscore the importance of seeing being old in a positive light, one study found that people who see old age as sickness–their chronic conditions stemming from being old–are more than doubly likely to die earlier than people who do not.

    Interestingly, societal views about aging have also been found to play a role in the mental health of older adults. One study found that older adults in China have far better memories than older adults in the U.S.  Researchers Becca Levy and Ellen Langer see a link between these findings and the fact that the Chinese have a more positive view of aging than Americans.

    What can you do to increase your likelihood of enjoying old age? Look to older adults who are doing great things for inspiration. Watch the video below of this 86-year old gymnast performing on the parallel bars. Talk about a source of inspiration!

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    https://www.youtube.com/watch?v=aZjljqReu1I