When Medicare first came into being in the 1960’s, the average lifespan was almost 70 years-old (69.77). By 2010 it had risen to 78.5 years. It is predicted that the lifespan may reach the late 80’s or early 90’s by 2050. What quality of life can be expected with the current systems of care?
I was reading a study in Lancet that said that Australians with mental illness have as much as an 18-year shorter lifespan than the general population. This jumped out at me for several reasons, not just the number 18. The article focuses on things that can be changed within a healthcare system that will result in an improvement in a quality of life, not just in a lowering of statistics. By looking at what is manageable and identifying gaps in services, the article makes a case for achieving something worthwhile: a longer lifespan for people who are challenged by mental illness. The authors make a case for collaboration between providers and a recommend a focus on lifestyle changes.
Remember that Australia has a national health service, so implementation of such a plan is not out of the question for them. It is a bit of a stretch for us, here in the U.S.A. Still, it is something that would benefit so many.
According to the study, the Aussies found that people with mental illness can make changes to their lives that will have an impact on how long they live. Here are some highlights:
There are modifiable risks – what you eat, how much you exercise, and how much you weigh all contribute to diseases, both physical and mental. If you have depression and diabetes, you are probably going to live a shorter life.
People with mental illness tend to have more unhealthy lifestyles when compared with the general public. They sit more, smoke more, and eat food that isn’t good for them. This is particularly true for people diagnosed with schizophrenia.
The medications used to treat mental illness in some cases create problems of their own. This is especially true for anti-psychotics. The challenge here is to provide relief from the suffering caused by the mental illness and not add to weight gain or appetite changes which are the primary metabolic side effects from these medications. Sometimes people are given anti-psychotics even though they don’t have a diagnosis of schizophrenia because this class of medications turns out to have benefits in helping people sleep, improving depression when it is particularly severe, and addressing behavioral problems in those with dementia.
The conclusions drawn by the study suggested several different ways to address all this.
First, healthcare systems need to expand their information collection from looking only at blood pressure, lipid levels, and weight. While these are important measures of health, they do not adequately address lifestyle choices or provide direction for intervening when the reasons for high blood pressure, high cholesterol and weight gain or weight loss are psychological rather than metabolic. Answering questions about your lifestyle has not traditionally been what you talk about at the doctor’s office!
Secondly, getting people to change their lifestyle is notoriously difficult. Having depression or anxiety can sometimes get in the way of making changes you know you should make. Until the underlying issues are resolved or treated, expecting someone to “get better” or “lead a healthier life” is unrealistic.
Thirdly, availability of and collaboration between quality health care, alongside access to nutritionists, physical therapists, socialization and support groups, skills-building groups such as how to quit smoking and how to address alcohol or other substance abuse, all can provide the framework within which change can occur. But our health care systems don’t work that way.
These are lofty goals. They would require a huge shift in how our system works and what is paid for by whom. There is little political will to make these changes at present. Major gains made with the passage of the Affordable Care Act are now being systematically taken apart in Congress. Calls for “Medicare for All”, while admirable, will not structurally change how services are delivered, just who is eligible for services and how providers get paid.
While the study was done in Australia, the results can easily be applied here in the U.S. We are a nation that is obese, sedentary, still uses alcohol and cigarettes, and has poor dietary habits. Our illnesses reflect our lifestyles: heart disease, diabetes, and substance use problems. When we do see health professionals, most of them have little or no training in working specifically with aging adults. Integrated care between medical and psycho-social providers requires much effort on the part of the patient, medical providers, and behavioral providers. The system does not make getting help easy.
Sadly, many older Americans never share their concerns and worries with their medical providers, fearing that they will be labeled crazy or perhaps even more distressing, thinking that depression isn’t an illness, but just a state of weakness. In my area, the majority of depression and anxiety is identified in a primary care setting, even though most primary care providers have little or no training in the diagnostic intricacies of these disorders. Understandably, they offer first line medical interventions, (which in this case is typically a pill). Medications they prescribe have been tested and trialed on individuals between the ages of 18 and 45, and few have information on the impact of that medication on an older adult with complex medical conditions.
In spite of all this, there are things we can each do to live a healthier lifestyle. Connecting with people, eating fresh vegetables, and exercising are just a few that have a huge impact on your quality of life. Depression and anxiety are experiences that can be helped by these same things. Connecting with a therapist or spiritual director, eating healthy foods and staying away from alcohol, and walking for just 30 minutes a day can be life changing. And, you might get a few extra years to share your journey with friends, loved ones, and others.
