Imagine a 77-year-old man named Don who lives alone in his small apartment after his wife, Marcia, suddenly died a year ago. She had been his constant companion and long-time caregiver, making sure he took his medications for diabetes and bipolar disorder. Now he is socially isolated, lonely, and depressed. When he neglects to eat, his blood sugar levels tend to drop, and he becomes light-headed. He won’t call his doctors then; he doesn’t want to bother them. Besides, it was his wife who used to communicate with his doctors and psychiatric team about any concerns. Without her, he doesn’t have much motivation to do anything.
Don illustrates several U.S. demographic and epidemiologic trends:
He is a “Baby Boomer” driving the ongoing aging of this country. Within the next 20 years, the number of Americans aged 65 and over will exceed the number of those under 18. The population of working age, including those available to care for older adults, will decline by 5 percent. As a result, the emerging care gap between the numbers of Americans who need care and those who can provide it will greatly increase.
Like greater numbers of older Americans, he has at least two chronic illnesses, adversely affecting his overall functioning and quality of life. According to a 2025 Centers for Disease Control research summary, chronic conditions put him at risk for higher healthcare costs[1]. The combination of chronic physical and mental health conditions will likely mean very high health care costs.
Like increasing numbers of older Americans, he has a behavioral health disorder. About 25% of older adults have a diagnosable mental, substance use, and/or cognitive disorder. These conditions are often exacerbated by social isolation and loneliness, which is associated with increased rates of both mental and physical health problems.
Unfortunately, about half of older adults with mental or substance use disorders do not get treatment or are treated by primary health care providers who have limited training in addressing geriatric psychiatric concerns. As a result, only about a third of people who get treatment receive what is “minimally” adequate treatment. Only about half of those who get treatment from mental health professionals receive adequate care.
The low utilization by older Americans of behavioral health services reflects several access challenges including:
- Access to providers who are clinically, culturally, linguistically, and generationally competent are in short supply. The shortages are most acute for rural residents. There is also a shortage of geriatric mental health professionals participating in the Medicare program.
- Service access is also problematic. Many treatment programs are in hard-to-reach locations. There is also a tremendous shortage of services in home and community settings, due to workforce shortages.
- Discrimination including stigma and ageism, plus the lack of awareness about mental illness and the effectiveness of treatment result in reluctance to seek or accept behavioral health services.
Unlike many of his contemporaries suffering from a behavioral health condition, Don does have long-standing behavioral health treatment which has been effective for most of his lifetime for managing his bipolar disorder. But without his wife’s support, his attendance and adherence have faltered. He now needs other sources of support and guidance, as well as more intensive treatment, or he faces several major risks:
- He may wind up being taken by ambulance to hospital emergency rooms for falls. *
- He may be admitted to the hospital for broken bones, diabetic complications, or even a stroke or heart attack.
- He may deteriorate further and become unable to care for himself, eventually transferring from a hospital to a long-term care facility.
- He may suffer premature death.
Older Americans, like Don, need not suffer injury and decline in addition to grievous loss. With the right systems of behavioral health, supported by care coordination and person-centered care plans, they can recover, adapt, and remain in their homes, as most Americans prefer.
HMA has the expertise to create and strengthen those systems of care. To learn more about How HMA Can Help.
[1] Watson KB, Wiltz JL, Nhim K, Kaufmann RB, Thomas CW, Greenlund KJ. Trends in Multiple Chronic Conditions Among US Adults, By Life Stage, Behavioral Risk Factor Surveillance System, 2013–2023. Prev Chronic Dis 2025;22:240539. DOI: http://dx.doi.org/10.5888/pcd22.240539
