Older adults in rural Ky. to benefit from more behavioral health services

Older adults are often burdened with a variety of health conditions, sometimes coupled with loneliness, anxiety and depression. A strategy to engage primary care practitioners in meeting behavioral health needs of older adults is at the heart of a new federal grant awarded to the University of Louisville Institute for Sustainable Health & Optimal Aging (ISHOA).

Nearly $2 million in funding from the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, will provide stipends each year over a four-year period to 13 master level social work students, five counseling psychology students, and four doctoral level psychiatric nursing students for a total of 88 students. These students will be part of the Rural Geriatric Integrated Behavioral Health (BH) and Primary Care (PC) Training Network and will complete behavioral health practicums in primary care settings throughout Bullitt, Henry, Oldham, Shelby, Spencer and Trimble counties. They also commit to seek employment in those areas upon graduation.

“Isolation and transportation are big issues for older adults. Often there are limited behavioral health clinicians in rural areas, and it is the perfect marriage to incorporate behavioral health services within the primary care offices where older adults are already seeking care,” said Anna Faul, Ph.D., executive director of ISHOA and associate dean of academic affairs at the UofL Kent School of Social Work.

Christian Furman, M.D., the institute’s medical director and a professor of geriatric and palliative medicine, said the combination of multiple health conditions like diabetes, high blood pressure, heart failure and hearing or vision loss can be overwhelming for older adults.

“The mind-body connection is so important,” Furman said. “Physicians can write prescriptions but unless a person understands why they have a disease and receives the proper training on how to be resilient, people can feel helpless in their situation. We see a lot of alcohol and drug-abuse, and now the opioid epidemic.”

As the result of a $2.55 million HRSA grant awarded to the institute in 2015 for the creation of the Kentucky Rural & Underserved Geriatric Interprofessional Program, older adults in rural areas are already seeing the benefits of coordinated care.

Former Henry County resident Lynn Retzlaff, 66, has been living with a degenerative bone disease most of his life, resulting in a number of health complications leading to such factors as poor nutrition, reliance on opioids, isolation and despair.

Through meeting with one of the institute’s community health organizers, Retzlaff was able to get connected with multiple services for older adults, including a nutritionist, a student counselor and transportation services. He also learned new techniques for managing pain.

“I am no longer on opioids,” Retzlaff said. “I now use meditation tapes and have found they help me more than the pain medication. Before, I would cycle between relief and suffering.”

Retzlaff says he now eats more balanced meals and is in an overall better mental state.

“Many older people feel they can’t cope – they feel helpless. Without the help of the institute and community health organizers I would have deteriorated and life would be very gray.”

The newest HRSA grant also aims to bring enhanced training to both students and primary care providers. Utilizing the institute’s already established Interdisciplinary Curriculum for the Care of Older Adults, along with development of a curriculum for the Professional Certificate in Rural Geriatric Interdisciplinary Integrated BH-PC and continuing education courses for health care professionals, the initiative hopes to build capacity for the mind-body approach to care for seniors.

“We are thrilled to receive this grant award,” Faul said. “With this funding, we will improve the health outcomes of vulnerable older adults in our rural counties. We also will dramatically increase the interdisciplinary approach to health care education and service delivery, infuse behavioral health into rural primary care, and provide students with increased employment possibilities.”

Furman, who practices geriatric medicine with UofL Physicians, says both older adults and their care-givers stand to benefit from the grant.

“When you look at a disease like dementia, patients deal with many behavioral disorders like paranoia or agitation, and there can be a lot of anxiety on how to problem-solve around those factors. This grant is important in not only getting behavioral health specialists into rural areas but also in opening up opportunities for physicians and nurse practitioners to coordinate with behavioral specialists to improve patient outcomes from a social support stand-point.”

Watch a video about the institute's work to benefit older adults in Kentucky.