integration.samhsa.gov

GROWING OLDER

SAMHSA-HRSA CENTER for 

INTEGRATED HEALTH SOLUTIONS

integration.samhsa.gov

Providing Integrated Care For An Aging Population
GROWING OLDER

Providing Integrated Care For An Aging Population

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services
integration.samhsa.gov 3

ACKNOWLEDGMENTS

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) 

and Health Resources and Services Administration (HRSA) by the National Council for Behavioral Health 

under contract number HHSS283201200031I, with SAMHSA, U.S. Department of Health and Human 

Services (HHS). Tenly Pau Biggs served as the Government Project Officer.

DISCLAIMER

The views, opinions, and content of this publication are those of the author and do not necessarily reflect 

the views, opinions, or policies of SAMHSA, HRSA or HHS. Any non-Federal resource listed in this document 

does not constitute endorsement by SAMHSA, HRSA or HHS, and resource lists are not to be considered 

all-inclusive. 

PUBLIC DOMAIN NOTICE

All material appearing in this report is in the public domain and may be reproduced or copied without 

permission from SAMHSA. Citation of the source is appreciated. However, this publication may not 

be reproduced or distributed for a fee without the specific, written authorization of the Office of 

Communications, SAMHSA, HHS.

ELECTRONIC ACCESS AND PRINTED COPIES

This publication may be downloaded or ordered at http://store.samhsa.gov. Or call SAMHSA at 

1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

RECOMMENDED CITATION

Substance Abuse and Mental Health Services Administration and Health Resources and Services 

Administration, Growing Older: Providing Integrated Care for an Aging Population. HHS Publication No. 

(SMA) 16-4982. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016. 

ORIGINATING OFFICE 

Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 5600 

Fishers Lane, Rockville, MD 20857. HHS Publication No. (SMA) 16-4982. 2016.

integration.samhsa.gov
4 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS

THE NUMBER OF AMERICANS AGE 65 AND OLDER INCREASED 

BY 25 PERCENT FROM 2003 TO 2013 AND THE NEXT 25 YEARS 

PROMISE ANOTHER 50 PERCENT INCREASE. FROM 2018 TO 2038, 

THE NUMBER OF AMERICANS AGE 85 AND OLDER IS EXPECTED 

TO MORE THAN DOUBLE FROM 6 MILLION TO 14.6 MILLION.i

Nearly one in five older adults have one or more mental 

health or substance use conditions (referred to in this document under the umbrella term, “behavioral health”).ii About 

16 percent of women and 11 percent of men age 65 and 

older experience symptoms of depression.iii The majority 

of older adults’ behavioral health issues are identified and 

treated in primary care settings instead of specialty behavioral health settings.iv

 

Older adults are distinct from other populations in key 

ways: 

• Complex chronic health conditions. Older adults are 

more likely than any other age group to have complex 

chronic health conditions, including mental health conditions, substance use disorders and cognitive impairments.v

 About two-thirds of older adults have two or 

more chronic conditions.

• Drug use and abuse. Older adults receive a high proportion of prescription drugs in the U.S. 

due to increased likelihood of being prescribed long-term and multiple medications.vi Improper 

use is common, whether because of cognitive decline or attempting to save money by using 

their medications sparingly or taking another person’s remaining medications. Additionally, 

commonly prescribed medications – opioids for pain and benzodiazepines used to treat anxiety and sleep disorders – are addictive and can increase the risk of falls and memory/retention 

issues affecting up to 17 percent of older adults.vii Co-morbid health conditions, age-related 

changes in drug metabolism; potential interactions with prescribed drugs, over-the-counter 

medications, dietary supplements and alcohol; and cognitive decline make drug misuse a special concern.viii

• Health disparities. Life expectancy and overall health have improved for most Americans in 

recent years, but factors related to economic status, race, sexual orientation, gender identity 

and rural status, as well as limited access to adequate housing and transportation services, keep 

many older adults from benefiting from these gains. 

• Safety concerns. Individuals become more frail as they age and their risk of falls and injury 

increases. One in every three adults aged 65 or older falls each year and falls are the leading 

cause of both fatal and nonfatal injuries for older adults.ix

• Loss is common. Some older adults may experience loss. Loss of spouses, friends, physical 

functioning, independence, routine and sense of purpose affects overall health, including 

“WHAT 

DOES THIS 

MEAN

FOR MY 

PRACTICE?”

If you serve 100 adults 

65 and older, it is likely 

that 20 of them have 

a behavioral health 

condition.
integration.samhsa.gov 5

mental health and substance use. Health care providers and older adults often mistake depression for a 

natural response to aging. This can lead providers to 

not screen for or treat depression and older adults 

to not seek help.

• Elder abuse. Elder abuse is a serious problem, with 

an estimated 8 to 10 percent of older adults experiencing abuse, not including financial exploitation.x

Other estimates found that between one and two 

million older adults are mistreated each year, while 

only 27 percent of hospital emergency departments have elder abuse protocols (compared 

with 75 percent for child abuse).xi

• Negative attitudes and discrimination toward 

people with behavioral health concerns. These 

attitudes can be a barrier for all age groups. Generational and cultural differences may be a barrier 

to identifying concerns, treatment follow-through 

and active engagement in behavioral health 

treatment.xii, xiii 

While providers, family members, peers and community stakeholders must be aware of these concerns, it is also important to be skeptical of antiquated stereotypes and assumptions about older 

adults’ health status. Older adults remain physically 

active for longer than ever before, continue to be 

active learners and frequently use health technologies to manage their health. Most older adults do 

not have a cognitive impairment. Recovery from 

depression, back pain and other injuries or illnesses 

is the norm. The overall category of older adults 

(age 65 and older) is further divided into subgroups 

– “young old” (65-74 years), “middle old” (75-84 

years) and “oldest old” (85+ years) – to help understand variability in patients’ experiences. However, 

it is important to consider an individual’s functional 

age as well as their chronological age. 

Patient-centered care requires that you treat all of 

your patients, regardless of age, as individuals with 

unique strengths, histories and needs.

Successful practices establish outcome measures 

that meet the range of behavioral health and primary care needs of older populations.

BE AWARE OF THE 

SIGNS AND SYMPTOMS 

OF ABUSE AND 

KNOW WHO TO 

CALL TO REPORT 

SUSPECTED ABUSE.

SALLY IS 83 and recently 

fractured a hip. She has severe osteoporosis, high blood pressure, chronic 

pain and a history of depression. She 

is cared for by her daughter who is 

trying to get her to move into an assisted living center, but Sally refuses, 

saying she can live on her own. Using 

a standardized screening tool, Sally’s 

integrated primary and behavioral 

health care program identified increasing depressive symptoms. An assessment for pain management prompted 

a full review of medications for effectiveness and risk of abuse, leading 

to changes in her prescriptions to 

decrease side effects and increase 

function. An in-house social worker 

provided support and intervention for 

Sally and her daughter regarding care 

decisions and ultimately connected 

them with an external caregiver support provider. Together, they identified the resources Sally needed in her 

home to manage her health.
6 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS

CAREGIVER CONCERNS: UNDERSTANDING THE ROLE OF THE FAMILY

As some adults age, they may begin to rely more heavily on spouses, children, grandchildren and 

other loved ones for assistance with daily living activities and navigating the health care system. 

Unlike the pediatric population, where parents legally and functionally act as caregiver and decision-maker for their child, caregiver relationships for older adults are much less straightforward and 

obvious. In conditions like dementia, capacities are slowly lost and there is often not a clear point 

at which patients require surrogate decision-makers. 

Family caregivers, as well as paid home health workers, often advocate for their loved one in addition to providing needed care to compensate for workforce shortages and gaps in service. Primary 

care providers integrating behavioral health must support patient empowerment, encouraging as 

much patient control over treatment and life decisions as possible, while also building caregivers 

into decision-making to improve outcomes. 

Providers must not only care for the patient, but also the caregiver; one-third of caregivers report 

their health as being fair to poor.xiv Caregivers need resources on mental health and substance use 

disorders, including support on how to handle their stress and obtain treatment for behavioral 

health concerns and other chronic conditions. The best models for promoting the caregiver relationship and supporting caregivers are those that are easy to access and culturally informed.
integration.samhsa.gov 7

CONDITION BEHAVIORAL HEALTH/

COGNITIVE SYMPTOMS PHYSICAL SYMPTOMS

Infection/urinary tract infection Decreased appetite or fluid intake

Sudden onset of confusion

Change in functioning

Pain, burning on urination

Frequent urination

Myocardial infarction Fatigue

Decreased functioning

Chest pain

Nausea

Vomiting

Shortness of breath

For women, pain in upper chest area

Thyroid disease Confusion

Agitation

Fatigue

Diminished energy and apathy 

Impaired memory

Hair loss

Weight gain

Changes in bowel movements

Dry skin

Muscle aches, stiffness, pain in joints

Depression (can be confused with normal 

reactions to loss and aging)

Agitation

Change in appetite

Concentration and memory loss

Sleep disturbance

Gastrointestinal symptoms/constipation

Pain

Headaches

Alcohol misuse Cognitive decline/confusion

Sleep disturbance

Self-care deficits

Injuries/falls

Osteoporosis

Gastrointestinal problems

Infection

Unstable hypertension

Prescription drug misuse Delirium

Dementia

Daytime sedation/sleep disturbance

Problems with attention

Physiological arousal

Injuries/falls

Psychomotor abilities

Malnutrition/weight loss

Blurred vision

Slurred speech

This is not a comprehensive list of common conditions or all symptoms for each condition. It is not intended to serve as a diagnostic tool, but demonstrates the complexity of diagnosing and treating older adults.

BEHAVIORAL HEALTH AND PHYSICAL HEALTH: RELATIONSHIP CHART

In older adults, physical, behavioral and cognitive conditions often present differently than younger 

adults. To assist in understanding these differences, the following chart presents some of the common conditions, impairments and physical symptoms, keeping in mind that:

• Physical health conditions often present as behavioral health concerns or cognitive impairments.

• Behavioral health conditions often present as physical conditions or cognitive impairments.

• Many medications have side effects that may present as symptoms of another illness. The interaction of multiple medications can exacerbate symptoms and even cause health problems. 

Further, sometimes having a condition, such as dementia, prevents older adults from being able 

to take medications for other conditions due to potential interactions.

• Depression often occurs with physical health conditions. Symptoms of dementia and delirium 

frequently emerge in conjunction with many behavioral health and physical health conditions.
8 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS

ENSURING AN INTEGRATED BEHAVIORAL HEALTH AND PRIMARY 

CARE WORKFORCE FOR AN AGING POPULATION

Given the unique and complex needs of older adults, what can be done to ensure that the 

safety-net primary care workforce is prepared to meet the behavioral health needs of this aging 

population? Since it is unlikely that there will ever be enough specialty behavioral health providers, primary care organizations are now focusing on adapting their systems and expanding their 

existing workforce skill sets to include behavioral health. The coordination of primary and behavioral health services is also called integrated care. In January 2014, the SAMHSA-HRSA Center 

for Integrated Health Solutions described the Core Competencies for Integrated Behavioral 

Health and Primary Care. The following lists specific strategies for serving older adults as they relate to each of the 

core competencies:

I. Interpersonal Communication. Provide anticipatory 

guidance for patients and caregivers, especially related to advanced care planning. Actively engage family 

members who may not accompany patients to appointments but are part of the patient’s care. Accommodate 

for the impact of dementia, language and hearing barriers. Avoid confusing medical terminology. Clearly explain medication and treatment options, repeat when 

necessary and provide in writing using friendly, helpful, 

accessible language. Tap into the patient’s strengths to 

promote self-management and communicate positive 

views of aging. Recognize sensory changes that occur 

with age such as diminished peripheral vision and differential auditory strength.

II. Collaboration and Teamwork. Recognize that one 

provider cannot address all medical and behavioral 

health needs in 15-20 minutes. Use an informed team 

approach to provide comprehensive services, with all 

team members aware of their responsibilities. Train 

non-medical staff to conduct environmental, social and 

medical histories and screenings. Establish working 

relationships with other internal and external members 

of the care team. Listen to patient and caregiver and 

recognize that the desired outcome for older adults 

may be a change in function, not a change in symptoms. Refer to specialty behavioral health care or aging 

services as needed or use telebehavioral health, especially in rural settings.

III. Screening and Assessment. Screen for depression, anxiety, substance use, chronic pain, 

risk of falls — including any recent stressful events that can elevate risk of a fallxv— and 

abuse. Identify general health concerns that affect or manifest as behavioral health symptoms. Be cognizant of gender differences in prevalence of behavioral health conditions 

DESIGNATE A 

CARE MANAGER

who can help connect 

patients with community 

resources and specialty 

care and can check in 

to ensure the patient 

followed the treatment 

recommendation.

CONSIDER 

USING NONCLINICAL 

LANGUAGE

to discuss behavioral 

health systems (e.g., 

“stressed” instead of 

“anxious,” “sad” instead 

of “depressed”).
integration.samhsa.gov 9

— women are more likely to experience depression, 

dementia and trauma, while men are more likely to 

abuse alcohol and prescription drugs. It is especially 

important that providers differentiate between depression, delirium and dementia. Implement a protocol for 

suspected abuse and ensure that all members of the 

care team, including front desk staff, know the warning 

signs of elder abuse. Be aware of the risk of pain medication abuse/opioid dependency. Monitor for suicide 

risk. Have a consultation arrangement in place with 

geriatric mental health and substance use disorder specialists that includes conducting a medication review.

IV. Care Planning and Care Coordination. Engage unpaid and paid caregivers in care planning. Identify 

and use aging system resources like peer support and 

advanced care planning supports (see “Resources” for 

additional ideas). Collaborate with the pharmacist to 

ensure proper prescribing and dosage to avoid medication risks. Older adults may need additional help 

accessing follow-up care. Employ warm hand-offs to 

ensure continuity of care. Recognize the appropriateness of short, time-limited interventions for addressing 

many mental health and substance use concerns (e.g., 

Florida BRITE).

V. Intervention. Understand common ailments of older 

adults that should trigger a primary care evaluation. Physical symptoms are often caused by 

stress, trauma, loss and mental health conditions while physical health conditions may manifest 

as behavioral concerns. Implement evidence-based practices that are known to be effective 

for older adults and refer to specialist behavioral health providers who use best practices in 

your community (see “Resources” for suggestions). Avoid inappropriately prescribing antipsychotics to alter behavior in older adults with cognitive impairments.xvi

VI. Cultural Competence and Adaptation. Check if your physical space is accessible for older 

adults (e.g., wider doorways, exam rooms with space for caregivers, handrails, smooth transitions at doorways). Recognize and respect cultural differences with patient and caregiver 

involvement. Understand the role negative attitudes and discrimination can play for various 

cultural groups and older adults. Accommodate generational differences in use of technology 

and cultural acceptance of questioning or not questioning providers. Use formal and informal 

community resources to overcome geographic and transportation barriers in rural areas.

VII. Systems-Oriented Practice. Understand and explain Medicare benefits, including Part D and 

preventive benefits (e.g., alcohol misuse screening, depression screening)to patients and their 

caregivers. Coordinate benefits for dually eligible Medicaid/Medicare beneficiaries, including 

certain social services that are available with lower cost sharing. As the health care landscape 

changes (for instance, accountable care organizations [ACOs] are established), ensure that a 

staff member is equipped to help patients understand and use their benefits. 

INCORPORATE 

STRATEGIES 

such as medication 

reconciliation and 

prescription monitoring 

into your EHR to alert 

providers of medication 

interactions and overprescribing to avoid 

associated risks (e.g., 

abuse, falls, delirium).

TRAIN YOUR 

STAFF TO HELP

older patients 

understand and use 

their benefits.
10 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS

VIII. Practice-Based Learning and Quality Improvement. Measure patient and family caregiver 

satisfaction. Provide continual staff training related to major competencies and best practices 

for older adults. Learn to recognize behavioral disorders. Monitor avoidable negative health 

outcomes that are more prevalent with older adults and implement quality improvement 

protocols (e.g., injuries, infections, adverse reactions to multiple medications). 

IX. Informatics. Establish electronic health records that include multiple providers, all prescriptions, social service notes and clinical decision support tools. Use large print informational 

materials. Ensure kiosks and other touchpad technologies have large buttons. Address privacy 

concerns related to sharing health information. 

Evidence-based guidelines are a great resource for identifying clinical, organizational and systems 

level changes to improve care for older adults. The National Coalition on Mental Health and Aging 

has compiled a directory of competencies, standards and guidelines for providers working with 

older adults encountering behavioral health concerns. Many other national provider organizations 

have practice guidelines and protocols to consider when working with older adults (See the resource list at the end of this document).

THE ROLE OF THE COMMUNITY

Primary care providers are not alone in caring for the aging population. Caregivers, neighbors, 

friends and community-based organizations also play a vital part in supporting older adults’ primary and behavioral health. Rural communities with workforce shortages are of special concern and 

older adults may have to depend on community partnerships and existing informal networks of 

friends and neighbors to promote healthy behaviors and allow 

them to remain in their own homes and engaged in community life. As part of care coordination, providers must know the 

community resources equipped to address social determinants 

of health, elder abuse and isolation, and appropriately connect 

patients to those services.

Your community may have the following organizations and 

services available to serve as partners in the health promotion 

and disease prevention of older adults:

• Adult protective services 

• Nutrition programs 

• Senior centers 

• Transportation services

The Eldercare Locater can help you find these resources in your 

community.

In addition, Mental Health First Aid for Older Adults provides community members with the required 

tools to identify a behavioral health problem and get their neighbor, friend or loved one help. A more 

informed community can be integral to addressing gaps in services and promoting the health of all its 

ENGAGE PATIENTS 

AND THEIR 

CAREGIVERS EARLY 

IN ADVANCED 

CARE PLANNING 

FOR END-OF-LIFE 

CONSIDERATIONS 

AND CONNECT 

THEM WITH AREA 

LEGAL AND SOCIAL 

RESOURCES AS 

NEEDED.
integration.samhsa.gov 11

citizens, especially older adults with potential mental 

health and substance use concerns.

OLDER ADULTS RESOURCES

BEHAVIORAL HEALTH IDENTIFICATION 

AND TREATMENT

The Treatment of Depression in Older Adults 

Evidence-Based Practices KITs — A SAMHSA publication that provides an array of evidence-based 

programs to treat depression and dysthymia

Substance Abuse by “Mature” Adults: Is Your 

Patient Using or Abusing? — A video with Louis 

A. Trevisan, MD that describes how to identify and 

address substance abuse in older adults

Preventing Suicide in Older Adults — An issue brief 

from SAMHSA and the Administration on Aging to 

help health care and social service organizations develop strategies to prevent suicide in older adults

Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior Living Communities — A 

SAMHSA publication that includes guidelines for integrating suicide prevention into ongoing 

programs, hands-on tools, and training manuals for senior living communities

EVIDENCE-BASED INTEGRATED CARE PRACTICES FOR OLDER ADULTS

Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) — Collaborative care 

approach to treat depression or dysthymia that involves a trained depression care manager, 

patient, primary care provider and psychiatrist.

Wellness Initiative for Senior Education (WISE) — Health promotion program related to health 

behaviors, the aging process, managing care, medication management and signs of alcohol misuse 

and depression.

EnhanceWellness — Helps older adults with chronic health conditions manage their illness and 

avoid psychiatric medications, physical inactivity, depression and social isolation.

Senior Reach — Training for community partners to identify older adults experiencing mental 

health and related concerns and help get them into recovery-oriented behavioral health treatment.

Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors) – A program that integrates depression awareness and management into existing case management services.

SAM’S SON brought him to 

see his primary care provider saying 

that Sam was increasingly confused 

over the past week. His wife died 

last month and now Sam lives alone, 

but his children check in on him daily. 

Sam’s primary care provider evaluated him for physical causes of confusion (e.g., dehydration, urinary tract 

infection, stroke) and for depression. 

His primary care provider also asked 

Sam’s son about his own level of 

stress. As a result, the provider connected Sam with their in-house counselor to provide grief counseling for 

Sam and identified outside resources 

to support Sam’s son as a caregiver.
12 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS

Program to Encourage Active, Rewarding Lives (PEARLS) — Community-based intervention for 

individuals with depression or dysthymia that helps reduce symptoms and suicidal ideation through 

problem-solving, social and physical activation and pleasant activity scheduling.

Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) — Primary care 

intervention to recognize depression and suicidal risk and manage treatment.

Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II) — At home and telephonebased intervention to reduce caregiver burden and depression, improve self-care and offer 

social support.

BRIEF SCREENS FOR PRIMARY CARE PROVIDERS

Depression Screen — Patient Health Questionnaire (PHQ-9)

Anxiety Screen — Generalized Anxiety Disorder 7-item scale (GAD-7)

Cognitive Measure for Dementia — The Mini-Cog

Cognitive Impairment Screen — Montreal Cognitive Assessment (MoCA)

Dementia Functional Assessment — Functional Activities Questionnaire (FAQ)

Delirium Assessment Tool — The Confusion Assessment Methods Diagnostic Algorithm (The CAM) 

Brief Alcohol Screen — Alcohol Use Disorders Identification Test (AUDIT-C)

Opioid Abuse/Chronic Pain Medication Abuse Screen — The Opioid Risk Tool (ORT)

INTEGRATED CARE WORKFORCE RESOURCES

2012 Institute of Medicine Report — The Mental Health and Substance Use Workforce for Older 

Adults: In Whose Hands? 

2013 Institute of Medicine Report — Elder Abuse and its Prevention: Workshop Summary 

American Association for Geriatric Psychiatry — Geriatric Psychiatry Core Competencies

Association for Gerontology in Higher Education — Online Directory of Educational Programs in 

Gerontology and Geriatrics

National Institute on Aging - Talking with Your Older Patient 

SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) — Workforce Resources

FINANCING INTEGRATED CARE RESOURCES — Medicare is the major payer of integrated health care for older adults. The following resources provide information for understanding 

Medicare’s role in the financing of primary care, behavioral health and other specialty medical care.

Medicare Accountable Care Organizations — Overview of the ACO model

Center for Medicare and Medicaid Services Financial Alignment Initiative — Financing for 

Medicare-Medicaid enrollees
integration.samhsa.gov 13

CIHS Medicare Resources — Medicare billing guidance

GENERAL RESOURCES AND ORGANIZATIONS RELATED TO CARE FOR OLDER 

POPULATIONS

AARP — www.aarp.org/health

Administration for Community Living — www.acl.gov

Elder Abuse Resources — www.aoa.acl.gov/AoA_programs/elder_rights/EA_prevention/WhatToDo.

aspx

The American Geriatrics Society — www.americangeriatrics.org

American Association for Geriatric Psychiatry — www.aagponline.org

Caregiver Action Network — www.caregiveraction.org

Center for Medicare and Medicaid Services — www.CMS.gov

Family Caregiver Alliance-National Center on Caregiving — https://caregiver.org/national-centercaregiving

National Alliance for Caregiving — www.caregiving.org

National Clearinghouse on Abuse in Later Life — www.ncall.us

National Council on Aging — www.ncoa.org

National Institute on Aging — www.nia.nih.gov

Veterans Administration — www.va.gov/geriatrics

REFERENCES

i

 Administration on Aging. (2015). Future Growth. Administration for Community Living. Retrieved from www.aoa.acl.

gov/Aging_Statistics/Profile/2014/4.aspx

ii IOM (Institute of Medicine). (2012). The mental health and substance use workforce for older adults: In whose hands?

Washington, DC: The National Academies Press. Retrieved from www.iom.edu/Reports/2012/The-Mental-Health-andSubstance-Use-Workforce-for-Older-Adults.aspx

iii Federal Interagency Forum on Aging-Related Statistics. (2012). Older Americans 2012: Key indicators of well-being. 

Washington, DC: U.S. Government Printing Office. Retrieved from www.agingstats.gov/agingstatsdotnet/Main_Site/

Data/2012_Documents/Docs/EntireChartbook.pdf

iv IOM (Institute of Medicine). (2012). The mental health and substance use workforce for older adults: In whose hands?

Washington, DC: The National Academies Press. Retrieved from www.iom.edu/Reports/2012/The-Mental-Health-andSubstance-Use-Workforce-for-Older-Adults.aspx 

v

 IOM (Institute of Medicine). (2012). The mental health and substance use workforce for older adults: In whose hands? 

Washington, DC: The National Academies Press. Retrieved from www.iom.edu/Reports/2012/The-Mental-Health-andSubstance-Use-Workforce-for-Older-Adults.aspx 

vi Centers for Disease Control and Prevention. (2010) Prescription Drug Use Continues to Increase: U.S. Prescription 

Drug Data for 2007-2008. NCHS Data Brief No. 42, September 2010. Hyattsville, MD. Retrieved from: http://www.cdc.

gov/nchs/products/databriefs/db42.htm
vii Center for Substance Abuse Treatment. (1998). Substance abuse among older adults. Treatment Improvement Protocol (TIP) Series, No. 26. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from 

www.ncbi.nlm.nih.gov/books/NBK64422/

viii National Institute on Drug Abuse. (2015). Prescription drug abuse: Older adults. Retrieved from www.drugabuse.

gov/publications/research-reports/prescription-drugs/trends-in-prescription-drug-abuse/older-adults

ix Centers for Disease Control and Prevention. (2015). Falls among older adults: An overview. Retrieved from www.cdc.

gov/homeandrecreationalsafety/Falls/adultfalls.html

x

 National Center on Elder Abuse. (2015). Statistics/Data. Administration on Aging, Department of Health and Human 

Services. Retrieved from www.ncea.aoa.gov/Library/Data/#problem

xi Ahmad, M. & Lachs, M. S. (2002). Elder abuse and neglect: What physicians can and should do. Cleveland Clinic 

Journal of Medicine, 69(10), 801-808. Retrieved from http://ccerap.org/images/stories/pdf/newsletters/links/

Cleveland-Clinic-Journal-of-Medicine-2002-Ahmad-801-8.pdf

xii Jimenez, D. E., Bartels, S. J., Cardenas, V., Dhaliwal, S. S., & Alegría. (2012). Cultural beliefs and mental health 

treatment preferences of ethnically diverse older adult consumers in primary care. American Journal of Geriatric 

Psychiatry, 20(6), 533-542. doi: 10.1097/JGP.0b013e318227f876

xiii Wetherell, J. L., Kaplan, R. M., Kallenberg, G., Dresselhaus, T. R., Sieber, W. J., & Lang, A. J. (2004). Mental health 

treatment preferences of older and younger primary care patients. International Journal of Psychiatry in Medicine, 

34(3), 219-233.

xiv Administration on Aging. (2015). National Family Caregiver Support Program. Retrieved from www.aoa.acl.gov/

AoA_Programs/HCLTC/Caregiver

xv Fink, H. A., Kuskowski, M. A., & Marshall, L. M. (2014). Association of stressful life events with incident falls and 

fractures in older men: The Osteoporotic Fractures in Men (MrOS) Study. Age and Ageing, 43, 103-108. doi: 10.1093/

ageing/aft 1 17

xvi Lindsey, P. L. (2009). Psychotropic medication use among older adults: What all nurses need to know. Journal of 

Gerontological Nursing, 35(9), 28-38. doi: 10.3928/00989134-20090731-01

SPECIAL THANKS

SAMHSA and HRSA would like to thank the following people for their assistance in the preparation of this document: 

• Steven Bartels, MD, MS – Director, Dartmouth Centers for Health and Aging

• Pamela Z. Cacchione, PhD, APRN – Clinical Educator, University of Pennsylvania School of Nursing and Ralston 

House Endowed Term Chair in Gerontological Nursing

• Marty Lynch, PhD – Executive Director/Chief Executive Officer, Lifelong Medical Care

• Nina Marshall, MSW – Senior Director, Policy and Practice Improvement, National Council for Behavioral Health

• Vicki K. Rodgers, MS, LPC – Vice President, Clinical Systems Administration, Jefferson Center for Mental Health

• Sarah Steverman, MSW, PhD – Consultant

• Stephen Thielke, MD, MSPH – Assistant Professor, University of Washington School of Psychiatry and Behavioral 

Sciences; Puget Sound VA Medical Center

• Kimberly A. Williams, LMSW – Director and Co-Founder of the Geriatric Mental Health Alliance, Vice President for 

Integrated Policy and Program Solutions Health Association of New York City; and Chair of the National Coalition 

on Mental Health and Aging

14 SAMHSA-HRSA CENTER for INTEGRATED HEALTH SOLUTIONS
HHS Publication No. (SMA) 16-4982