2001 Aging Services Environmental Scan

WHAT ARE THE CURRENT CONDITIONS FOR OLDER ADULTS?

PHYSICAL & MENTAL WELL-BEING

Health Status & Care

Prescription Drugs

Mental Health & Substance Abuse

HEALTH STATUS AND CARE

Advances in health care have led to significant increases in the expected life span of adults, making the post-retirement years one of the most important phases in human development. In 1900, the average life expectancy was 49 years of age, today it is 76 (Federal Interagency Forum on Aging Related Statistics, 2000). While this increased life span brings great opportunity, it also brings challenges for older adults. For many, the later years are full and active, while for others this time is marked by the struggle to maintain good health, quality of life, and independence. Mobility and Disability As people live longer, issues of quality of life take on greater importance. Many older Americans suffer chronic health problems that limit their ability to enjoy their later years. These conditions often lead to serious physical limitations that have a major impact on an individual's ability to live independently.

Mobility and Disability

The most common chronic health problem among older adults is arthritis. Nationally, among persons aged 70 or older, 50% of men and 64% of women reported having arthritis (Federal Interagency Forum on Aging Related Statistics, 2000). In Texas, the percentage is virtually the same - 51.3% of persons 65 and older report that they have some form of chronic joint symptoms (Texas Department of Health, 1999). A local survey of older adults in the Travis County region found that 50.8% reported having been told by a health professional that they have arthritis or rheumatism. Among persons age 75 and older, the percentage was 55.9% (Seton Healthcare Network, 1998, Survey). Arthritis can be a crippling and painful disease that makes it difficult for older adults to perform even the most basic ADLs.

rates resulting from falls are especially high for older women and rising (Centers for Disease Control and Prevention, cited 2000; Pfizer, Inc., 2000).

Despite these problems, national studies indicate that the percentage of older persons with a chronic disability decreased slightly (from 24% to 21%) between 1982-1994. The majority of these individuals reported difficulty performing one or two ADLs, such as eating, getting in and out of bed, performing housework and laundry and getting around outside. Areas where elders reported improved functioning included the ability to walk a quarter of a mile, climb stairs, reach over one's head, and stoop, crouch or kneel. Although the percentage of older adults with chronic disabilities decreased, the overall number with this problem increased. This can be explained by the fact that growth in the older adult population as a whole outpaced the decline in disability among them (Federal Interagency Forum on Aging Related Statistics, 2000; Desai, Zhang & Hennessy, 1999).

In Travis County, the number of older adults with limited ability to perform ADLs is expected to increase as well. Projections by the Texas Health and Human Services Department indicate that the number of persons over age 64 with these limitations will increase from 13,032 in 2000 to 17,347 in 2010 (Texas Health and Human Services Commission, 1999, Selected). This increase is likely to result in a significant increase in demand for additional social and medical services among the population.

RETURN TO TOP

Prevention Measures to Protect and Enhance Mobility

by bone loss, muscle weakness and osteoporosis. These problems in turn are risk factors for falls and fractures resulting from falls. (Desai, et.al., 1999).

According to national data, only one third of older Americans take part in leisure-time physical activity during an average two week period (Federal Interagency Forum on Aging Related Statistics, 2000). The remainder lives a sedentary lifestyle. In Texas, 35.1% of persons between the age of 55 and 74 are physically inactive. Among persons age 75 and over, 44.4% are inactive (Desai, et. al, 1999). Women are slightly less likely than men to engage in physical activity (Federal Interagency Forum on Aging Related Statistics, 2000). Travis County rates are better, with 50.6% of elders reporting regular exercise. Exercise rates are even higher - 57.6% - among persons 75 and older (Seton Healthcare Network, 1998, Survey). Elders that do exercise regularly usually engage in moderate activities such as walking, gardening and stretching.

Physical pain, mobility limitations and hospitalizations due to hip fractures and other falls can also be prevented through exercise, proper diet and modifications to the home. Prevention should focus on a combination of behavioral and environmental changes, including exercise, education, medication review, risk factor reduction and home modifications. These strategies have reduced hospitalizations due to falls by 30-50%. Even minor home modifications, such as using non-skid rugs and keeping things within reach, have been shown to reduce health care costs due to falls.

RETURN TO TOP

Health Care Needs of Older Adults

Life expectancy is an indicator of the overall health of a population. Life expectancy measures the average number of years a person at a given age would be expected to live, assuming a consistent death rate (Federal Interagency Forum on Aging Related Statistics, 2000). In Texas, the current life expectancy of men and women is 73.5 and 79.5 respectively. As on the national level, life expectancy rates in Texas are lowest among Blacks as compared to White and Hispanic residents (Texas Department of Health, cited 2000).

Figure 11.
Five Leading Causes of Death in Travis County for Persons 65+ by Gender - 1998 (Rate per 100,000)

Source: Texas Department of Health, Epigram 1998

Increases in life expectancy are largely the result of improvements in health care and the prevention and treatment of chronic diseases. Despite these improvements, however, chronic diseases remain the leading cause of death among older adults. Both nationally and locally, the leading causes of death for older residents are heart disease, cancer and stroke. The five leading causes of death in Travis County are heart disease, cancer, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and pneumonia and influenza. Of these causes, women have higher rates of stroke (cerebrovascular disease) and chronic obstructive pulmonary disease (COPD) than men. (See Figure 11.)

Figure 12.
Five Leading Causes of Death in Travis County for Persons 65+ by Race/Ethnicity - 1998

Source: Texas Department of Health, Epigram 1998

As with life expectancy, mortality rates vary by race and ethnicity. The following chart shows 1998 death rates by race and ethnicity in Travis County. While heart disease is the most common cause of death for all older residents, death rates from this disease are more than one and a half times higher among Blacks than Whites and Hispanics. Other significant differences are deaths due to diabetes and chronic obstructive pulmonary disease (COPD). While diabetes is not a leading cause of death among White Travis County older adults, it is the fourth leading cause of death among Hispanics. Similarly, COPD is not a leading cause of death among Blacks or Hispanics, but is the third leading cause for White older adults.

Causes of death also vary somewhat by age. In Travis County, cancer and heart disease are the primary causes of death for all persons over age 55; however, death from cerebrovascular disease and pneumonia and influenza are not among the five leading causes of death until age 65. Falls and accidents are the fifth leading cause of death among persons aged 55-64, but are not in the top five causes for persons 65 and older. (See Table 6.)

Table 6.
Five Leading Causes of Death by Age in Travis County (Rate per 100,000) - 1998

Source: Texas Department of Health Bureau of Vital Statistics

RETURN TO TOP

Chronic Health Problems

In a survey of ten counties in the Central Texas region, 58.1% of adults age 65 and older reported that chronic disease was one of their top three health problems (Seton Healthcare Network, 1998, Behavioral). The three most common chronic diseases among older adults are arthritis, hypertension and heart disease. As discussed, arthritis is the number one chronic health problem for this population. The second is hypertension, with 45% of Americans reporting that they suffered from this disease in 1995. In Travis County, 45.7% of those 65 and older reported suffering from hypertension. However, the rate for Blacks was significantly higher at 76.2%. Finally, 21% of Americans report having heart disease. The reported rate in Travis County is much lower at 14.2%.

RETURN TO TOP

Prevention of Health Problems

As with younger adults, the keys to a healthy life for older adults are social activity, exercise and diet. Social activity is important to maintaining both emotional and physical health. In addition to providing a network of support for older persons, social activities help elders stay mentally active and positive about their lives.

According to national data, the majority of persons age 70 and older engage in some form of social activity on a regular basis. Most of this activity is with family, followed by visits with friends and neighbors. As might be expected, the level of social activities among older persons declines with age (Federal Interagency Forum on Aging Related Statistics, 2000). This may be a result of declining health and mobility and the loss of older friends over time.

Regular physical activity also reduces the risk of many chronic diseases, especially heart disease. Moderate physical activity helps to lower high blood pressure, control cholesterol levels and reduces the incidence of diabetes among older adults.

Along with physical activity, diet plays a major role in determining one's risk for heart disease, cancer, hypertension and other chronic diseases. A national study found that older adults over 65 generally had better diets than persons aged 45-64. Older adults were especially good at maintaining low cholesterol diets. However, the percentage of older adults with "good" diets was still relatively small, comprising slightly over one-fifth of the total population of persons over 65. The diets of elderly persons were especially poor with regard to intake of daily servings of fruit and milk products (Federal Interagency Forum on Aging Related Statistics, 2000). In Texas, less than one-third of adults aged 55-65 eat the recommended amount of fruits and vegetables daily. Rates for Central Texans are shown in Figure 13.

Figure 13.
Percentage of Elderly Eating Daily Recommended Amount of Fruits and Vegetables in Central Texas (10 County Region), 1998

Source: Seton Healthcare Network Behavioral Risk Factor Surveillance Survey, 1998

Regular medical screenings are another preventive measure that protects older adults. In the Central Texas area, 98.7% of seniors report having had their blood cholesterol checked by a health professional in the last year while 96.5% had their blood pressure checked (Seton Healthcare Network, 1998, Behavioral). Rates for cancer screenings, however, are not as high, but are increasing nationally. Among women over fifty, mammography screenings once every two years can significantly reduce the risk of death from cancer (Pfizer, Inc., 2000). National studies show that the percentage of women age 65 or older who have had a recent mammogram is increasing, rising from 23% to 55% between 1987 and 1994 (Federal Interagency Forum on Aging Related Statistics, 2000). In the Central Texas region, 65.2% of elderly women report having had a mammogram in the last year, while nearly half (43.4%) examine their breasts monthly for lumps. Older men are also taking advantage of cancer screenings, with 72.5% reporting to have had a prostate screening test in the last year (Seton Healthcare Network, 1998, Behavioral).

Influenza and pneumococcal infections are primary causes of hospitalization among elderly. Studies show that vaccinations for pneumonia and influenza can reduce complications and hospitalizations by one-half. Yet, in 1997, only 65% of elder adults received an influenza vaccination in the past 12 months, while only 45% had ever received pneumococcal vaccination (Desai, et. al, 1999). Among elderly in the Central Texas region, 60.5% reported receiving a flu shot in 1998. Over half (56.6%) also reported that their spouse had received a flu shot that year (Seton Healthcare Network, 1998, Behavioral).

RETURN TO TOP

Barriers to Health Care

Health Care Costs

Health care costs present a major financial burden for older adults and their families. These costs generally increase as people grow older and experience a decline in health and mobility. For individuals with limited income or chronic health problems, these costs can be a significant factor in their ability to live at home or independently.

In 1996, the average annual health care expenditure among persons aged 65-69 (including expenditures covered by health insurance) was $5,964. Among persons aged 75-79, annual expenditures averaged $9,414, while among persons 85 and older it was $16,465. As might be expected, costs were significantly higher for individuals living in nursing homes ($38,906 on average) than for those living in the community ($6,360). The relative cost burden of health care is also greater for lower and middle income elderly (Federal Interagency Forum on Aging Related Statistics, 2000).

Most older adults are covered by Medicare, which provides a variety of medical services at relatively low cost. Unfortunately, Medicare does not cover all the health care needs of seniors, making out-of-pocket expenses and prescriptions a heavy cost burden for seniors who cannot afford supplemental insurance. Elders in Texas have slightly lower out of pocket health care expenditures than older adults nationwide. On average, Texas elders pay $1,722 in out of pocket health care expenditures per year as compared to the national average of $2,022 (McClosky, 2000).

RETURN TO TOP

Access to Health Care and Use of Health Care Services

In addition to cost, the availability and convenience of medical services often limit seniors' access to health care. Factors that impact convenience include hours of operation, waiting times and accessibility by public transportation.

In the Seton survey of older adults in the Travis County region, elders reported an average score of 9.11 out of ten in response to the question of whether or not they had a primary care physician. This response indicates that most elders do have regular and convenient access to health care. Among elders ages 75 and older, however, the response was slightly lower - 8.85 (Seton Healthcare Network, 1998, Survey). This could reflect the difficulty that older persons have in obtaining transportation to needed services. Nonetheless, in a separate survey of the ten county region surrounding Travis County, 88.5% of elderly reported they had gone for a routine health checkup in the past year, while 67.7% had gone for a dental checkup. These rates are higher than those for non-elderly respondents among whom only 63.3% had received a routine health checkup in the past year (Seton Healthcare Network, 1998, Behavioral).

Other data on the use of low cost health care services among elders in Travis County are indicators of a growing problem. People's Community Clinic (PCC) reports that elderly patients seeking health care have nearly doubled in the past three years (see Figure 14). Because elderly patients have a greater number of health problems than younger people, they usually require more visits, lab tests and medications. According to People's, elderly patients average 4.7 visits per patient per year. With an average cost of $62 per visit, and a growing number of older adults in our community, caring for elders represents a significant cost for the clinic. The rise in the number of older adults seeking care at PCC and other clinics may reflect the fact that older adults are having increasing difficulty accessing care. Low Medicare reimbursement rates are causing physicians and other private providers to limit the number of Medicare clients they treat. Anecdotal information from St. David's Senior Clinic confirms this, where 8 of 10 clients are unable to find a provider willing to accept Medicare.

Figure 14.
Number of Patient Visits at the People's Community Clinic by Individuals Age 65+ - 1998 to 2000

Source: People's Community Clinic

Data on the use of the City and County Medical Assistance Program (MAP) show that persons ages 65 and over currently comprise 14% of the City and County's Medical Assistance Program registrants, and the number of registrants ages 65 and over increased nearly 13% from fiscal year 1997 to 1999. The majority of these seniors are receiving supplemental insurance to Medicare for dental and prescription coverage. A smaller percentage of elderly clients, 1.1%, are enrolled in the City and County's sliding scale program for medical care.

Lack of regular medical care can result in increased hospitalization as individuals delay treatment for their health needs until they become urgent. A national study of older Americans found that among Medicare beneficiaries not enrolled in HMOs (82% of beneficiaries in 1998), the rate of hospital admissions during the year increased from 307 per 1,000 in 1990 to 365 per 1,000 in 1998 (Federal Interagency Forum on Aging Related Statistics, 2000). Given that hospitalization is the most expensive level of care available, this also represents a significant portion of current health care costs.

RETURN TO TOP

CURRENT EFFORTS

health care for persons age 65 and older. These programs also offer case management, support groups, nutritional counseling and educational classes on maintaining good health. The Seton Good Health Club offers a variety of services including transportation for hospital stays, low cost classes and discounts on medical equipment. The Area Agency on Aging also provides durable medical equipment to eligible seniors.

Table 7.
Findings and Recommendations

RETURN TO TOP

PRESCRIPTION DRUGS

Currently, the issue of prescription drug coverage for older adults is being hotly debated at all levels of government. This issue is critical for older adults for two reasons. First, prescription drugs are a significant out of pocket health care cost for this group. Second, trends indicate that the situation is worsening and is unlikely to improve without government intervention.

In terms of drug coverage, older adults fall into three categories:

• those who have year round coverage (53%),
• those who are covered part of the year (19%), and
• those who have no coverage (28%).

The most common source of drug coverage is employer-sponsored retiree benefits, which provide for 30% of those with coverage. Nationally, nine out of ten Medicare beneficiaries have some type of supplemental coverage that helps cover prescription drug costs. For individuals who have Medicare coverage, 13% are covered through Medicare managed care plans, 8% are covered through Medigap policies, and 13.8% are covered by Medicaid or other public benefits. Despite the availability of supplemental coverage, at any time during a year, 35% of

Prescription drugs are the fastest growing health care cost for seniors. Nationwide, older adults constitute approximately 13% of the population, but are prescribed 34% of all drugs and pay 42% of all prescription drug costs. That translates into a per person cost of $559 in 1992, projected to rise to $1,205 in 2000. This increase is attributed, in part, to the rise in the cost of individual prescriptions. In 1992, the average cost per prescription for older adults was $28.50, whereas in 2000 it is expected to be $42.30, an increase of 48% (McClosky, 2000).

In a comparison of total prescription drug costs and total out of pocket (OOP) costs, McClosky found that total drug expenditures for Texas seniors are slightly below the national average for US seniors, but about the same on OOP expenditures. Therefore, as a percentage of total drug expenditures, Texas seniors have higher OOP costs.

In a comparison of out of pocket health care expenditures and prescription drug expenditures for Texas and the US, it was found that, Texas seniors spend a higher percentage of their total OOP health care dollars on prescription drug costs than other seniors (McClosky, 2000).

Table 8 shows the trend in total health and prescription drug spending per senior in the United States. For several years, drug costs as a percentage of total health care expenditures have risen at a faster pace than inflation. Based on projections from the Health Care Financing Administration, these costs are expected to continue rising.

Table 8.
Total United States Health Care and Prescription Drug Spending Per Senior - 1992 to 2010

Note: Numbers for 1998 through 2010 are projections. Source: McClosky 2000

For uninsured seniors, the picture is even bleaker. A recent study conducted by the United States Department of Health and Human Services found that drug costs for uninsured seniors are, on average, 15% more than those paid by third party payers. This is attributed to the ability of third party payers to negotiate lower drug costs because they are purchasing for large groups of individuals (McGinley, 2000).

Cost is not the only escalating factor; so is the number of prescriptions per older adult. The average number of prescriptions in 1992 was 19.6 versus a projected average of 28.5 in 2000 - a 45% increase. In part, this increase is explained by the development and approval of new drugs and the fact that people are living longer with more chronic conditions (McClosky, 2000). However, not all seniors are using more prescriptions. A review of the 1996 MCBS found that Medicare beneficiaries who do not have drug coverage fill one-third fewer prescriptions and spend 60 percent less on prescriptions drugs in comparison to those who have year round drug coverage (Stuart et. al., 2000).

problem given the recent news that some drug companies are paying millions of dollars to keep generic drugs off the market. Currently, Medicare managed care plans offering drug coverage are only available to 69% of Texas Medicare beneficiaries. Retiree health insurance is only offered by 19% of Texas companies, below the national average of 22-28%. Lastly, while some seniors have Medigap policies that cover prescription drugs, these plans are only available to those who have Medicare Part B. These plans are expensive and have high deductibles, keeping them out of reach of many seniors. The average monthly premium for Medigap coverage with prescription drug benefits is $124 in Texas. (McClosky, 2000; Gerth, 2000; "Congressman", 2000; National, 2000).

Currently, 62,618 older adults are enrolled in Medicare in Travis County, but none of the Medicare plans currently offer prescription drug coverage. The City and County and Seton Healthcare Network offer two viable options for Travis County seniors needing help to defray the cost of prescription drugs. Travis County and the City of Austin operate a prescription drug program to help low income individuals defray the cost of medicine. (For more information on this program see Appendix H). Additionally, seniors who enroll in the Good Health Club with Seton Healthcare Network can take advantage of prescription drugs at a discounted price. The average discount is approximately 15 percent. Enrollment in the Good Health Club is free to individuals age 65 and older. (T. D. Froehlich personal communication, Feb. 13, 2001; US HHS, 2000, HMO).

RETURN TO TOP

Implications for Seniors

The rise in cost of prescription drugs poses a dilemma for many seniors. As research indicates, some choose not to fill prescriptions, possibly further impairing their health status. This means that seniors are being forced to make difficult choices about expenditures - choosing between medications and other basic needs such as food and shelter. Inability to purchase medications could result in higher medical costs if individuals develop more advanced conditions as a result of not following treatment protocols. This decline in health could, in turn, further strain the public health system.

Along with not purchasing medications, some seniors seek less expensive prescription alternatives. Recent news stories tell about seniors going to Mexico to purchase drugs where they can achieve considerable savings. A diabetes medication that costs $46.00 in the United States, for example, costs $6.75 in Nuevo Progresso, Mexico (Harmon, 2000).

Unless significant changes occur in the cost of drugs and the availability of help purchasing them, the issues for seniors and the community around prescriptions drugs will only increase.

• First, the size of the population is increasing and living longer. The longer people live the more chronic conditions they are likely to develop that need treatment.
• Second, older people tend to have lower incomes the longer they live.
• Third, the local older population will increasingly be comprised of individuals from traditionally lower socioeconomic groups who historically have poorer health outcomes.

These factors combined with the trends showing increasing numbers of prescriptions and costs of drugs will create a growing economic burden.

RETURN TO TOP

CURRENT EFFORTS

The City of Austin and Travis County both offer help to low income seniors through the Medical Assistance Program (MAP) and the Community Health Clinics (CHC), which are payers of last resort. Currently, 3,370 seniors are provided some type of assistance through this program. (For details on the program and the number helped, please see Appendix H.)

Travis County also has a fund for emergency prescription needs that is available to individuals living at or below 85% of poverty. Help is only available once a year. Despite national trends indicating an increased need, in 1999, $7,330 was allocated for pharmaceutical assistance, but only $5,373 was spent. For FY 2000, $6,230 was allocated and, as of September, only $3,363 had been spent (Personal Communication with Travis County Health and Human Services and Veteran's Services, October 2000).

The most recent national plan to address this issue includes allowing prescription drugs to be imported from countries such as Canada, which set limits on drug costs. If a national plan is passed that only addresses the needs of low-income seniors, this will still leave out a large group of Texans that may need help - the middle class. Some 43% of Texans have incomes between $15,000 and $50,000 and would not be helped by a low income benefit (National, 2000).

Table 9.
Findings and Recommendations

RETURN TO TOP

MENTAL HEALTH & SUBSTANCE ABUSE

The term "mental health" encompasses a wide range of diagnoses among older adults including dementia, Alzheimer's, depression, and severe mental illness such as bipolar disorder and schizophrenia. Many of the mental

Failure to properly address the mental health needs of older adults has negative consequences. This can cause unnecessary nursing home placement, result in more expensive physical health interventions, and lead to impairments in social, mental, and physical functioning. Older adults with depression, for example, go to the doctor and emergency room more often, take more medicine, have higher outpatient costs, and longer hospital stays (Diagnosis, 1991; United States Department of Health and Human Services, 1999).

Depression

It is estimated that 15% of older adults living in the community experience depression, with 3% experiencing major depression. However, for individuals living in nursing homes the rate is between 15 and 25%. Among widows, it is estimated that 10-20% develop depression in the first year after the death of a spouse. Depression is linked with

A number of interventions are recommended for treating depression among older adults. Self help groups, bereavement groups, and life review exercises have been shown to be effective in addressing symptoms of depression (US HHS, 1999, Mental Health).

RETURN TO TOP

Memory Function and Dementia

new activities or changing routines can strengthen brain function. With proper prevention and intervention, most individuals can maintain sharp and clear thinking for the majority of their senior years (National Institute on Aging, 1996).

There are several types of dementia, the best known being Alzheimer's Disease. It is estimated that 50% of individuals with a family history of Alzheimer's will eventually develop the disease. Diagnosis of the illness must include memory impairment co-occurring with a second cognitive deficit such as language problems or

Level of education is related to the age of onset of Alzheimer's - the higher the level of education attained, the later the onset. Extensive research is ongoing to discover ways to impede the development of Alzheimer's (US HHS, 1999).

Alzheimer's is an incredibly destructive disease in that it may severely alter behavior and level of functioning. Symptoms may include psychosis, wandering, agitation, physical violence, and verbal outbursts. The stress for caregivers of individuals with Alzheimer's is well documented. Caring for a person with Alzheimer's can be financially draining for family members and other caregivers - costing an estimated $38,906 to $43,600 a year (Tennstedt, 1999).

Similar to other mental health issues, the magnitude of the problem of substance abuse among older adults is often overlooked and underestimated. Attitudes and beliefs about older adults, aging and substance abuse often prevent recognition and diagnosis of the problem. As with any mental health issue, family members and others may mistake symptoms of substance abuse as part of the aging process. In addition, a stigma exists around identifying and confronting this problem among older adults. The traditional methods for recognizing a substance abuse issue often

Certain characteristics of older adults make the issue of alcohol use and abuse even more critical. First, older adults do not metabolize alcohol as easily as younger people and are therefore affected more by even small amounts. Second, most older adults take one or more prescription or over the counter drugs. The combination of drugs and alcohol can cause adverse drug reactions. Older adults use more psychoactive drugs such as anti-depressants than any other group. These types of medications are frequently accompanied by warnings not to be used with alcohol. Third, alcohol use among older adults can cause or exacerbate other problems such as depression and other mental health issues, gastrointestinal bleeding, cognitive impairments, sleep disorders and hypertension (National Council on Aging, 2000).

Addiction to drugs unrelated to alcohol is also problematic. Like alcohol, these drugs may have a stronger impact on older adults than they do younger persons. As individuals get older and take more drugs, the likelihood of medication mismanagement increases.

RETURN TO TOP

CURRENT EFFORTS

Several private providers offer mental health care to seniors suffering from depression, dementia, Alzheimer's disease and other disorders associated with aging. The Pavilion at St. David's and Seton Shoal Creek Hospital are the two primary service providers for mental health issues in the Austin/Travis County area. Last year, Seton Shoal Creek served 114 individuals ages 65 and older. Family Eldercare's Eloise's House offers day care for individuals with Alzheimer's. (For more information on Current Efforts, see Appendix A.)

Table 10.
Findings and Recommendations

Best Practices

The Substance Abuse and Mental Health Services Administration (SAMSHA), Center for Substance Abuse Treatment recommends that all individuals over 60 be screened for substance abuse problems. In cases where treatment is necessary, SAMHSA recommends that protocols include certain components:

• Older adults are best treated in age-specific group treatment. Ensure that environment is supportive and non-confrontational and works to build self-esteem.
• Treatment should include ways to cope with depression, loneliness and loss.
• Identify ways to strengthen social support networks.
• The content and pace of the treatment should be geared toward the older adult, whose needs may differ from other groups.
• Treatment staff should have experience and interest in working with older clients.
• Provide holistic care that addresses the range of needs a client may have including case management.

Texas C.A.R.E.

A collaboration between the Texas Department of Human Services and the Alzheimer's Association, this program is designed to improve service connection for individuals with Alzheimer's. The program is based on the Community Resource Coordinating Group model but is designed strictly for those with Alzheimer's. The program is unique in that each site has flexibility to design a program that will be most effective in the given geographic area served by that site. After an immensely successful pilot program in 4 sites across Texas, the program was expanded to include Central Texas in 2000.

Assessment Home Page