QUALITY IMPROVEMENT
Depression, Culture, and Care: Making Connections
By Sara Wildberger I
t’s a number that sets off alarm bells: 70 percent of people experiencing a health problem don’t get help. But that’s how
many seniors experiencing mental health problems don’t use services, according to research from Jin Hui Joo, M.A., M.D. from Johns Hopkins University. As a clinician and researcher, Joo focuses
on late-life depression in seniors, as well as the diff erences among cultures and communities in mental health and use of interventions. Countering the disheartening number is
some good news: depressive symptoms oc- cur in only about fi ve to 10 percent of older adults, with the majority reporting that they feel they’re aging well. And whether depres- sion is related to other health issues such as dementia, or occurs on its own, prevention and treatment are possible. But this requires not only access to care,
but cultivating awareness, listening skills, and cultural sensitivities. In an interview and in a recent presentation at a Hopkins conference on Aging in America, Joo shared an overview of the problem, some common assumptions, and fi ndings on practical interventions.
The key to mental health in aging Age can carry built-in protective influ- ences against depression. The key factor? Acceptance. “Some studies suggest that with age, you
may have the ability to emotionally regulate in ways you couldn’t when you were younger,” Joo said. “Acceptance of something you can- not change is the key to aging well. If you can’t accept these changes, therein lies the kernel that can blow up into developing depression.” Other factors include genetics, physical health, and social engagement. As for the role of social isolation and loneliness, Joo said what is more important
42 SENIOR LIVING EXECUTIVE JULY/AUGUST 2018
is the person’s perception of these states. Simply piling on the social activities and contact with others may not help and could even exacerbate that perception of isolation.
Why do few get help? Stigma is still a major factor among gener- ations taught not to mention such feelings, or to perceive them as weaknesses. “Talking about mental health results in
vulnerability. People will not share these things with those whom they don’t feel safe around. It’s not like asking about hyper- tension,” Joo said. “Clinically speaking, we often see seniors not used to talking about personal things, either with their cohort or in talking with their children. They may be ashamed to say they need help. It betrays their sense of not doing for themselves.”
Family connections: Two sides Another assumption: Strong family connec- tions among some cultures mean decreased vulnerability to loneliness or depression. But it’s more nuanced than that, Joo said. “Family involvement is a good thing, the
literature seems to suggest,” Joo said. “But there are lots of stresses that come from hav- ing big families, too. To have a large social network does not necessarily mean you have lots of support. Children are good for instru- mental support but not for emotional sup- port,” she said. Adult children, for instance, may not make good confi dants about per- sonal issues or traumas—it’s not their role. So for a senior, having peers, friends, or
sources of support outside the family can be valuable—they off er perspective.
The role of community How can caregivers help? In developing interventions at Hopkins, Joo knows that
Thought Leader Profi le
Jin Hui Joo
M.A., M.D. Assistant Professor of Psychiatry and Behavioral Sciences & Community Physician Johns Hopkins University School of Medicine
geriatric psychiatric treatment often isn’t accessible, or aff ordable. But they’re seeing good results through
integrated care: A primary care setting with a social worker or psychiatrist onsite makes it easy to shift the conversation from treatment for diabetes to a mood check, for instance, and removes obstacles to getting help. Joo also sees potential in the involvement
of peer specialists for mental health issues. Seniors can be intimidated by professionals, as if they’re being judged by an authority. And in the years ahead, generational dif-
ferences and identities may be even more important than cultural ones in mental health treatment. “Culturally, a new generation coming has
a diff erent way of looking at this, with diff er- ent expectations,” Joo said. “With increasing numbers of people who accept or use medi- cations to manage mental health conditions, it would make sense to anticipate changes in care needed and medical involvement.” The most important defense against
depression may be a very simple one: “Ask. It seems so simple, but it can be diffi cult,” Joo said. “It’s much easier to rely on as- sumptions.”
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