Services Presentation in Older Adults Approximately 75 million baby boomers were born in the United States between1946 and 1964. This generation will stress the healthcare system as has no other generation in history. There are many services available for older adults in relation to their psychosocial, cognitive, and emotional issues. This work will identify available services for older adults in a specific facility and address the issues relating to older adults and mental health programs or the psychosocial health of older adults in this facility. The facility at focus in this work is Tripler Army Medical Center in Hawaii.

Program Description

The adult psychiatric treatment program for older adults at Tripler Army Medical Center in Hawaii is such that focuses on depression experienced in older adults. The U.S. Department of State examines the issues of dealing with elderly parents by those in the service so that the health care of the elderly parent is acceptable as well as the living situation of the elderly parent. The medical programs at U.S. Military Bases and Hospitals are such that assist service members in procuring the right medical, health care, and other necessary provisions for elderly service members.

Funding of Program

According to one report, the FY 2012 budget request "includes $52.5 billion for the DoD health care system that employs 85,000 military personnel and 53,000 civilian DoD employees." (The American Legislative Point Paper, 2011) The system is reported to serve "9.5 million eligible beneficiaries through 56 hospitals, 363 outpatient medical facilities and 275 dental clinics." (The American Legislative Point Paper, 2011) The system's cost, stated at $19 billion in FY2001 is reported to have more than doubled in the last decade. (The American Legislative Point Paper, 2011) The costs of the medical program has been predicted by the Department of Defense to experience an annual increase at the rate of 5-7% though fiscal year 2015 at which time it is predicted to account for in excess of 10% of the new planned Department of Defense budget. (The American Legislative Point Paper, 2011) Until only recently military retirees at least 65 years of age received their sole health care benefits through Medicare however, a new law in 2001 granted retirees who were enrolled in Medicare Part B lifetime rights to health care benefits under TRICARE. Military retirees with 20 years of honorable service are eligible for Medicare Part A and are enrolled in Part B of Medicare. Former military members retired due to medical disability are also eligible for TRICARE for Life. (Brown, Bauman & Smith, 2011)

Provisions of Program

The Tripler Army Medical Center in Hawaii provides the following physician specialties:

(1) Neurologists: including the (a) Clinical Neurophysiology -- reported as a neurologist who "…specializes in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using a combination of clinical evaluation and electrophysiological testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS), among others.

(2) Psychiatrists -- reported to specialize in the prevention, diagnosis, and treatment of mental, addictive, and emotional disorders such as "schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders, and adjustment disorders. The psychiatrist is able to understand the biologic, psychologic, and social components of illness, and therefore is uniquely prepared to treat the whole person. A psychiatrist is qualified to order diagnostic laboratory tests and to prescribe medications, evaluate, and treat psychologic and interpersonal problems, and to intervene with families who are coping with stress, crises, and other problems in living." (Tripler Army Medical Center, nd)

(3) Addiction Psychiatry -- reported as a psychiatrist who "focuses on the evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders and of individuals with the dual diagnosis of substance-related and other psychiatric disorders." (Tripler Army Medical Center, nd)

(4) Clinical Neurophysiology - reported as a psychiatrist "with expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using a combination of clinical evaluation and electrophysiological testing...

The geriatric psychiatrist seeks to improve the psychiatric care of the elderly both in health and in disease." (Tripler Army Medical Center, nd)
(6) Pain Medicine -- reported as a psychiatrist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists." (Tripler Army Medical Center, nd)

Older adults experience great deal of depression and this is addressed by the army as report5ed in the work of Harben (2009) which relates that the army promotes awareness of depression. Depression is reported as a serious medical condition "that may be persistent and can interfere with a person's ability to function. It affects some 18.8 million Americans, according to the Uniformed Services University of the Health Sciences (USUHS)." (Harben, 2009) Harben reports that the signs and symptoms of depression include those of:

Sadness;

Irritability;

Anxiety;

Fatigue;

Lack of energy;

Changes in appetite or weight;

Inability to sleep or changes in sleep pattern;

Inability to concentrate or make decisions;

Feeling worthless or inappropriate guilt; and Thoughts of death or suicide. (Harben, 2009)

Toward addressing this problem, it is reported that the Department of Defense and Department of Veterans Affairs provides "anonymous behavioral-health assessments online at www.militarymentalhealth.org and www.mentalhealth.va.gov/depression.asp." (Harben, 2009) Harben additionally reports that the Department of Defense, Office of Personnel Management (OPM) and the Office of Management and Budget (OMB) "…approved revisions to question 21 on the Questionnaire for National Security Positions, Standard Form (SF) 86, regarding mental and emotional health counseling. The change allows people who have been treated by a behavioral-health professional due to marital or family reasons not related to their violence, or related to adjustments from service in a military combat environment, to answer "no" to the question about receiving behavioral-health care." (Harben, 2009)

According to Dr. Jack Smith, acting chief medical officer of the TRICARE Management Activity "Major depression is a remarkably treatable disorder and the majority of people who receive treatment overcome the illness and return to normal lives." (Harben, 2009) According to Harben (2009) the army is "…committed to decreasing the stigma associated with seeking behavioral-health care and encourages its Soldiers, Family members, and civilians to get help if they need it."

It is reported in the document entitled Senate Report 111-226 - MILITARY CONSTRUCTION AND VETERANS AFFAIRS, AND RELATED AGENCIES APPROPRIATION BILL, 2011 that a recommendation was made by the committee for $85,000,000 for grants in the construction of State extended care facilities. Long-term care is addressed in the bill due to the committee's concern about the ability of the VA to plan for and meet the long-term care needs of veterans. Community Living Center capacity has been decreased by the VA meaning that there is a need for construction of more long-term care VA facilities. The VA has been encouraged by the committee to explore alternative financing mechanisms to ensure that a sufficient number of State veterans homes are available to meet the needs of future patients." (Senate Report, 2011)

Summary and Conclusion

There is a large group of individuals who are entering the older adult age group due to the large population of Baby Boomers who are now retirement age. This is true as well for the military retirees. This expanding retirement age group is placing demands on the medical and healthcare system. Large amounts have been earmarked for expenditures in making provisions for this generation of retirees and even so there are gaps that exist in the provision of health care to these individuals. Depression will be a primary issue for concern with this group as they enter retirement age. Towards this end,…