Dr. Regina Koepp 0:03

I'm Dr. Regina Koepp. I'm a clinical geropsychologist, which means that I'm a psychologist who specializes with older adults and families. And this is the psychology of aging podcast, your go to resource for Mental Health and Aging.

Dr. Regina Koepp 0:21

With older adults having the highest suicide rates compared to any other age group, it's essential that we have conversations like the one we're gonna have today, about older adults and depression and older adults and suicide. And today's episode I interviewed Dr. Yeates Conwell, and we talk about statistics about older adults in suicide. Why older white men have the highest rates of suicide. We discuss risk factors, with Dr. Cowell's really simple and easy to use a system called the five DS of suicide risk. And we talk about what you can do if you're a family member who's concerned about an older adult who is depressed or suicidal. Dr. Yeates Conwell is a Professor of Psychiatry at the University of Rochester School of Medicine and Dentistry, where he directs the geriatric psychiatry program, and the University of Rochester his medical centers office for aging research and health services. He co directs the University of Rochester Center for the Study and prevention of suicide. Dr. Conwell received his medical training at the University of Cincinnati and completed his psychiatry residency and a fellowship in geriatric Psychiatry at Yale University School of Medicine. In addition to teaching clinical care and service system development, Dr. Conwell directs an interdisciplinary program of research in aging, mental health services and suicide prevention. I cannot imagine a better guest and expert to talk about Mental Health and Aging, and particularly suicide and suicide prevention among older adults. In today's episode, we talk about the importance of listening, listening to older adults when they talk about what's causing their distress, and what might be contributing to some other reluctance to have these really difficult and important conversations. Speaking of conversations, let's jump into this one.

Dr. Regina Koepp 2:29

How did you get interested in suicidality and suicide prevention and older adults?

Dr. Yeates Conwell 2:35

I knew from the get go, that I was interested in mental health and older adults in particular, actually, I think it stemmed mainly from an experience I had as a college student working in a in a rehabilitation hospital, actually, where there were many older adults who were there for extended periods of time, recovering from falls, and broken hips and strokes and the like. And I was just so impressed with how hard they work and how determined they were and all the resources they were able to draw on to overcome those really major challenges to their independence and to their, their being. And so it really came from a kind of a strengths based approach, recognizing that there's a tremendous wealth of resources there. And I wanted to learn more about that. And then going into medical school and residency and being able to contrast that kind of strength on the one hand with the remarkable contrast when it goes off the rails on the other and then recognizing that the two come together, that people who have encountered challenges can either do very well with that, or on occasion, not the suicidal person, older person. Kind of is the worst outcome, then of that. So how do we help those people or prevent that by helping those people find connect with the resources that have made them older adults to begin with survivors? So

Dr. Regina Koepp 4:32

yeah, we're all striving to get there. We're all striving to get into to older adulthood. None of us want to die young.

Dr. Yeates Conwell 4:39

Right? We want to do it well.

Dr. Regina Koepp 4:42

Yes. You mentioned the profound resilience and strengths that help older adults age well, and you also mentioned when, when there's suicidality or untreated depression that worsens and worsens and worsens that there. is a worst case outcome or there's a profound toll that that can take on older adults. And I think you were hitting on or alluding to suicide rates for older adults. Can you talk about that what the suicide rates are for older adults.

Dr. Yeates Conwell 5:19

When you look around the world at all the countries that report such statistics to the World Health Organization, what you see is a is a trend with increasing rates of suicide across the life course for both men and women. Men tending to have higher rates than women. In the United States, it's a little different. We see increasing rates with age for men. And that's accounted for largely by the majority population, older white men. African American, Hispanic men tend to have a more varied kind of pattern over the course of the life with peak and younger adulthood and somewhat of a rise in later adulthood, but not as high. And then for women in the United States. Interestingly, suicide rates tend to keep quite low, but peak and midlife and then drop a little bit into older adulthood. So in later life, what one sees is a really very pronounced difference between suicide rates for men and women where it's about 12 times higher actually 10 or 12 times higher in old old adulthood for for men, for white men in particular.

Dr. Regina Koepp 6:34

An old old starts when?

Dr. Yeates Conwell 6:37

Oh, probably 75. And over.

Dr. Regina Koepp 6:41

Yeah, I read a statistic that something like there are four attempts to one death by suicide among older adults, where younger adults is 25 to one, are you familiar with that? Or am I off?

Dr. Yeates Conwell 6:56

No, you're quite, you're quite right. What I was talking about was suicide, death by suicide. And it's a remarkably different picture for attempted suicides were in those rates tend to be much higher in younger adulthood and very low, actually, in older adulthood. And in older adults, that ratio of suicides to attempted suicides is about two to one or four to one. Whereas in the over overall population, it's more like the 25 to 40 to one attempts to completed suicides that you see, and in younger adults. And later adolescence is actually many more attempted suicides to completed suicides, and they're much more likely to be counted for by women. So the pattern is shifted by age, and it's also shifted by gender.

Dr. Regina Koepp 8:00

And some of the reasons for that, or what what do you suspect are reasons for the shift in that pattern?

Dr. Yeates Conwell 8:07

Yeah, yeah, I think we're left to speculate a lot about that, but have good reason to think that, that at least with regard to the, the fatalities associated with suicidal behavior, they are much greater in older people, ie, the ratio of attempted to completed suicide is much lower than younger people, because older people, first of all, they're more frail, older people tend to have comorbid medical conditions. And so the reserve to survive a suicide attempt, if it's, if it's initiated is much lower. So they're more likely to die, fewer attempts more deaths by suicide. Interestingly, and importantly, older people who become suicidal, tend to then be more planful and determined to actually end their own lives, it's a less, I'm not a big fan of the construct of impulsive acts of suicide, but, but planful much more. So. In older adults, they're less likely to be discovered in the act or in the preparation for or in the aftermath of the suicides and more likely to die on that basis. And also, older people are more likely than younger and middle aged people to use immediately lethal means which in this country is firearms. Overall, about 50 to 55% of suicides are by a firearm. In older people that's more like 70 to 75%. So late life suicide is in large part a story of, of men using violent means to take their own lives

Dr. Regina Koepp 9:59

And why Men in particular?

Dr. Yeates Conwell 10:01

Yeah, right. And that racial difference in the gender differences are much even more speculative, having to do, potentially with issues of, of cultural factors, the nature of the social networks and people in which people circulate the ability to call on others for help, the willingness to do that the resources that can be drawn on in the, potentially in the African American community, and in the faith communities, the religious communities can be much more easily accessed, acceptable means. But it's fascinating and important to understand how these behaviors unfold in the face of the kinds of stressors that different segments of the population face. And there's a lot of concern currently about how these figures are going to be changing over time, where we're seeing now a relatively rapid increase, although still, overall lower levels in suicide rates, for example, among younger adult and an African American men. Yeah.

Dr. Regina Koepp 11:23

Now, we were speculating on what what might drive? Or what might create greater risk for older white men in terms of access to resources? Can you actually talk about your mental health concerns with somebody? Is that culturally acceptable or not? I was also recently giving a presentation on ageism and mental health care. And one of the studies I came across was a 2017 study. So relatively recent, about adults of different ages presenting to the ER, and younger adults or people under 65, when they endorsed suicidal thoughts, or recent behaviors, were more likely to have a suicide risk assessment and be sent home with resources if they were discharged. And, and, and significantly fewer older adults who were endorsing suicide, and were sent home with resources. And if we know the rates are so high, you know, there's also a structural sort of ageism, the the point of that study was to talk about we can do better, you know that this is happening at many from many angles, there's a structural angle, where How well do providers understand, and professionals understand the mental health needs of older adults and resources available? How well do older adults? How much access to older adults have to talking about mental health concerns? Just one of the reasons I started this podcast was to make it more commonplace that we can have mental health conversations among older adults and adults of all ages. So what do you what do you make of that in terms of on one hand, there's the cultural piece, are men socialized to ask for help around mental health needs? No, no, not well, especially older generations? to how well are the systems supporting older adults, when older adults are seeking services for mental health concerns? It's another and three, you know, then there's the internalized sort of belief, like if I do get these services, can I even benefit? And so there's an there's something called the stereotype, embodiment threat, right, that we believe the stereotypes about ourselves as we age, which are inaccurate, but we believe them nonetheless. And that could be harmful in terms of our willingness to take medications like an antidepressant or to attend to psychotherapy, or what do you make of all of that?

Dr. Yeates Conwell 13:54

Yeah, no, it's it's a complicated issue, isn't it? There are many different pieces to it. I guess the good news, there is that that might suggest different avenues for change, that might have an impact on older adult health and reduce suicide rates. And they're not mutually exclusive. One needs to address these in all sorts of different levels. The Institute of Medicine uses these terms of three different levels of preventive interventions. There's the indicated preventive intervention which targets that individual who is at risk in our discussion that risk for suicide. The next level is selective preventive interventions, which are targeting individuals and groups who share certain characteristics that place them at increased risk, and we can talk about those and then the third is universal preventive interventions which target the entire population. A lot of what what we were just talking about is attitudinal. At any one of those levels, and ageism, the stigma associated with aging, associated with mental illness associated with suicide as a particular kind of behavior or failure or weakness or something. So all of those things can be must be really addressed, I think, by attitudinal change, which is cultural, and it's a universal preventive intervention approach, eventually, hard to do. But, you know, Mothers Against Drunk Driving is, is, is a thing that's often cited as examples of how really powerful social movements can be built. And there's an awful lot of advantages I think we as a society could derive from, from somehow making aging and aging Well, a much more accepted expectation for all of us. I think one of the things that we can come back and talk about the selective and the indicated kind of Prevention's, as well, but I, I want not to leave the stigma and ageism issue yet, because I think it's so important that people don't appreciate the fact that older people tend to be satisfied with with their lives. More so actually, than middle aged and younger people.

Dr. Yeates Conwell 16:43

You're speaking of theory, we've also got socio emotional selectivity theory and Laura Carson's work and others, which shows that, but we don't recognize that in older people, I think, because of the ages on which you were referring, we project our own fears, concerns, culturally embedded ones onto the aging process. And then as we age, we become older people, and we carry those attitudes along with us. But nonetheless, older people still important not forget, are, by and large, on average, very happy and satisfied with their lives, it's not normal to be depressed, it's not normal to be suicidal, it's not normal to think that your life isn't worth living. So those are really important attitudinal issues to address and find ways around them. You know, it's not moving back to the selective preventive intervention idea, if an older person carries those attitudes, and they need help. And they're less likely to get it, because they're, they have innovations against talking about their emotions, and so on. Then we need to design systems in a way that make it okay to do that. So older people aren't going to go to mental health clinics, or psychologists and psychiatrists in their private offices, they're going to go to their primary care doctors. Yeah, that's where the action is in large part for older people, because they're going there. Because they've got all these comorbid medical conditions, on average, you know, once a month, or there abouts. And if that isn't a setting in which it is more comfortable and acceptable for that older person, to talk about their feelings and issues related to depression, or even suicidal thoughts, they will build at that capacity. They've thought about this stuff, off and on, probably all their lives. So this isn't this isn't new to them, and given the opportunity to talk and find ways that are acceptable to them. They'll they'll draw on that.

Dr. Regina Koepp 19:09

Yeah, you're making me think of the importance of primary care mental health integration. So for years, I worked in a geriatric primary care clinic, where I was the mental health provider as part of the primary care team. And, and that's how I think that's how most even outpatient mental health providers get their older adult clients or patients is that they come from other medical providers. Yeah, neurologist or an internist or primary care provider.

Dr. Yeates Conwell 19:40

Right. So you were in an office down the hall and the primaries, right. Walk his or her patient in and introduce Yeah,

Dr. Regina Koepp 19:50

Yeah. And so some of the typical scenarios would be around grief and loss. A new medical diagnosis, like Answer another terminal condition or a neurological illness like ALS or something another would be stopping driving. So I worked with older, typically older men at a VA. So older veterans who, you know, if you want to talk about barriers to talking about emotions, try talking to older veterans. And, but, of course, we all have the capacity to do it. And so as soon as we would just kind of build rapport and scratch the surface, older veterans would tell me older male veterans would tell me, I never knew this would be available. I never knew it would be like this, I always had these ideas about mental health, that, you know, I would be laying on a couch, I didn't know it would be this, you know, it was the Friday and view. And so, but yeah, so if, you know, a primary care provider would would instruct the older adult, you know, unfortunately, you can't drive safely. Now you'll and and the response would be, well, I'm just going to kill myself, if I can drive, you know, I live in a rural area, what am I going to do? How can I go to the bank? And, and so then the primary care provider would walk the older family to my office, or, you know, as a veteran, so we would often work with post traumatic stress disorder, if that was coming up, what do you see are some of the risk factors for older adults in suicidality or suicidal thinking?

Dr. Yeates Conwell 21:23

We need to understand what's driving that person's distress, I find it useful to have a framework and the framework that I think is about as simple as it can get. And something that's complicated isn't, is what I call the five D's in addition to demography, right? So older male, white is Depression, that mental illness is a powerful driver of suicide risk, and we need to understand the underlying condition that somebody has. And for older adults, it's far more often depression, clinical depression, than is the case. For other diagnoses. If they're there, they constitute increased risk, definitely. But depression is that much more common in its association with suicide in older people than is the case in middle age and younger. So depression.

Dr. Yeates Conwell 22:25

Second is a disease or physical illness that, that older people face a lot of that, of course, the, the predictive value of a depression diagnosis is quite high. With regard to suicide outcomes, the predictive value of an older person, an older person of physical illness is, of course, very low, because it's so the base rate of physical illness is so high. But nonetheless, there are studies that show that certain physical illnesses are additional risk factors above and beyond depression. And those things tend to be neurological conditions, central nervous system kinds of things. So it might be strokes, or Parkinson's disease or dementia, epilepsy.

Dr. Yeates Conwell 23:18

And then the third D associated with that is disability or functioning and older people, that's just a big deal. Of course, being able to maintain independent functioning is critical for older people to be able to optimize that. And to help the older person kind of redefine what they regard is acceptable independence. And that's a transition that we all need to go through as our functioning is impaired. But some people can become an increasingly suicidal or at greater risk facing that functional impairment. So that's the third D. Good.

Dr. Yeates Conwell 24:04

Fourth, disconnectedness. We know that social connections, both the objective measurement of the depth primarily of one's social network, the ability to call on individuals to feel close to people to feel as if you belong, is critically important to health. So it's both objective and subjective in that, and there are lots of important studies now that show that the lack of that social connectedness is associated with suicide risk, as well as with mortality from hypertension and diabetes, the likelihood of developing cognitive impairment and on from there, so that is a big Big modifiable risk factor, I would add an important concept.

Dr. Yeates Conwell 25:07

And then the the fifth is deadly means back to that notion that older adults who die by suicide do so with a firearm. Something like 96% of firearm deaths among older people in the US each year are suicides. So that link between firearms and suicide is especially tight for older people. And it's another of those five DS, I think we need to fold into our diagnostic process just simply by understanding as is the recommendation for primary care practitioners and others that you need to know if an older person has a firearm in the home and develop strategies for managing that risk if they become depressed or suicidal. So I hope that's a useful framework. One of the really important concepts here, though, when one thinks about those five, right, is they're not just a list, right? Think of it as a Venn diagram. So each of these domains is overlapping. They're all there.

Dr. Yeates Conwell 26:23

And, and people move in and out of each of these domains, you become ill get treatment, you get better, you can't become ill. But it causes functional impairment loss. You're an older person, and you lose your hearing, very common, but it affects the so then there's a functional impairment, but that functional impairment and that physical underlying condition affects your ability to connect with others socially. I tell the end and on from there that that then those are predisposing factors to depression. And if you happen to have a firearm in your bedside table, a handgun, then that combination as one moves through those different overlapping domains to the center in which all five of those are present. That's that's the scary situation. It's complicated there, all these different moving parts. The good news about that is that it is a dynamic process. And that because there are all these different contributors, it actually isn't that hard, because you can change any one of those five, and you're changing the risk, right? You've got a highly suicidal older person, don't want to overstate it, that person, you might, you know, get right to the emergency room and have treatment initiated. But if there's a depressed, functionally impaired, hopeless, older person, and they've got a firearm in the home, and you can develop some kind of agreement to have that firearm removed by a family member to a safe place for the time being, then that immediately changes that level of risk, right? Yes, he's gonna say the same thing about any one of those five of somebody is feeling disconnected, then we begin to think about how to help that individual feel more connected, even as all of these other domains are still pertinent, or disease, of course, the diagnosis and the treatment of the illness, the optimization of functioning by instituting some kind of supportive intervention, environmental intervention, or depression, diagnosis and treatment for which as you know, we have a lot of really effective treatments for depression and older people. So that the good news is that you don't need to take it all on you need to understand that it's all there and then begin picking things off that are of priority to that older person, generate that relationship, begin instituting the interventions increase the level of of hope that they can experience.

Dr. Regina Koepp 29:21

Yes. Now say families are concerned about a loved one in that situation. What would you recommend that families do?

Dr. Yeates Conwell 29:30

If you're worried about an older person in your family, then do two things First of all, step back and ask yourself what am I worried about? I need to check my own biases and attitudes at the door. Because it's so often is the case that we project our anxiety He's about aging onto that older person. And it may be our own discomfort that we're picking up on. But recognize that, but then go into the room and just tell him that you're worried. Ask him what's up. So often, in our society, I think in particular, again, it's that complicated, ageist thing. As younger people and middle aged folks were reluctant to talk to our seniors about how they're feeling. It's not the way we were raised. It's not the way they were raised to be asked those questions. There's the caregiver care receiver kind of relationship where the parent takes care of the child. And then at some point, in normal aging, that relationship reverses. And that's a tough developmental milestone for families often. So people need to work on that and get comfortable with the idea of having these conversations and taking the responsibility of just asking Mom or Dad, what's up How you feeling? I'm worried about you. And I think people will be not always but more often than not surprised that the older person's capable of talking, beginning to to share something of what they're going through. And that in and of itself is enormously helpful. And then beyond that going, and if you remain concerned helping that older person recognize that there may be help available and looking for it, probably in the primary care doctor's office to begin with.

Dr. Regina Koepp 31:54

You know, that simple act of a conversation and expressing concern to adults talking together? It attends to that d of disconnectedness, which is the simple act of having a conversation requires connection.

Dr. Yeates Conwell 32:11

Yeah, yeah. I don't know, if you, you were of the AFSP is, what do they call it? Share the awkward or something like that. So they have a really very interesting, very effective campaign. public service announcements for adolescence. One asks, the other the, you know, they're sitting there looking awkward, the way you agers would kind of think about these things together, and then one finally turns the other and says something like, what's up?

Dr. Regina Koepp 32:47

I know when I for 10 years, I was teaching psychology interns and postdoctoral fellows and medical residents in geriatric mental health. Sometimes, you know, the way mental health providers are in some, in some graduate programs are being trained now is to sort of apply a model to an illness, right? And sometimes, that wouldn't work. So well, working with older adults, in my opinion, doesn't work. So well working with anybody, but in the student would come back to me and say, you know, I'm trying to do the kind of behavioral therapy with this structure with this older adults. And I would say, Well, what what about if you just have a conversation, just make it a conversation, don't make it an application. And the student would try it, and it would be night and day, you know, and just the importance of connection and the, the bridging that awkward, that, you know, I think we all want to be seen and understood and valued and heard, especially when we're going through transitions that are, we've never experienced before with illness, and changes in our ability and our functioning and requiring assistance from others. And just all of these, you know, what our life is like, doesn't match how we see ourselves. And that can be, you know, there's a difference between our real need versus our self concept like how we perceive ourselves, and that and that conflict is so complicated internally for people. But just being seen and heard and valued. Is, is a remarkable intervention in and of itself, not that it would be the only intervention for for this, but just how valuable these family conversations are, how valuable bridging that awkward space with curiosity and understanding and connection. I thank you for sharing that that's so important.

Dr. Yeates Conwell 34:50

Actually, just just to get it right. The program that AFSP has as funded is called seize the awkward. I recommend it to you but it The point being, that, don't we need that for our conversations with older people too, we need something that kind of demystifies it and says older people sit down and talk with us and be connected. And that gets us a long way. And maybe it is oftentimes not sufficient, because of the underlying problems that need to be addressed, but necessary in order to get the older person engaged in the process of diagnosis and treatment. Yeah.

Dr. Regina Koepp 35:35

That was very helpful. These five D's, the importance of a conversation, just the need for with, with relentless concern, the need for professional care, and then professionals to have, you know, understanding of these five DS as well, especially in primary care, you know, I worry in primary care, we hear of just shorter, shorter and shorter times with patients, you know, I hear so many families, especially around dementia disorders, who say, you know, we don't get any information from primary care. And I worry, you know, I don't want to vilify primary care, because I think they are kind of left to do a lot of work with a tiny amount of time, which is insufficient to treat all these needs, what are what's your take on that?

Dr. Yeates Conwell 36:27

Well, you know, I did did a bunch of studies with so called psychological autopsy methods where a somebody died by suicide, and you go back, and you try to reconstruct, really what what may have happened by talking with family members, and, and also providers and looking at all sorts of records and that kind of thing. And I had the opportunity to talk with a lot of primary care doctors who had lost a patient to suicide, and it was profoundly difficult for them. They're in the business of primary care to help people and it feels like a failure, sometimes. But I think it's really important. My theory actually, is that primary care, doctors come back to that concept in a minute, are preventing suicide all the time. back up a little bit. And you know, it is this selective preventive interventions, it's the treating pain effectively, it's helping people through rehab and optimizing their independent functioning and recognizing and treating their depression and facilitating referrals to folks like you. And when it gets more complex, these are all things that happen in routine primary care practice. I think that's happening all the time, and I think they do a great job. But times are changing. And, you know, I, there's reason to be concerned, I think about how time available by a primary care doctor to sit with and diagnose and effectively treat this complex mix of contributing factors may not may not be enough.

Dr. Yeates Conwell 38:28

On the other hand, primary care is changing and health systems are changing both in terms of the delivery of care as well as the financing of care. I think we've got to move as thoughtfully and systematically aggressively as possible to that notion of integrated care, where it's not about actually the primary care doctor, seeing the patient for eight minutes. It's the whole episode of care, it starts with the patient's ability to get in to see the doctor quickly by calling up and, and having access they feel comfortable with, it's the smile of the receptionist when they get there. It's the time with the doctor, it's the ability then to trust that within that treatment context, they're going to get the different services that they need that are important to them. So it's it's their own priorities that then drive the nature of the care. And then with regard to financing, you know, we're struggling as, as a nation to figure out how to pay for health care. And there are terms that people may not be familiar with, but things like value based purchasing and so on where the reimbursement for the services that are provided, actually can hinge on the quality of those services and the ability actually to get the end result which might be by having somebody see Or having a social work console or being written a prescription for the air conditioner that they need to make their lives comfortable at home? All of these things are ways to approach the promise and the limitations of primary care practice.

Dr. Regina Koepp 40:19

Now Dr. Conwell, what would you say for families who are hearing from their loved ones, some either flippant statements about suicide or clear statements about suicide? What would you recommend to families in that instance?

Dr. Yeates Conwell 40:37

Yeah, yeah, really important. We've talked about a little of this, that the first thing is to hear them to take seriously what they're saying and not let one's own anxiety, get in the way of actually being available to and asking that question of How are you doing, and I'm concerned about you, and let's find some help. And then to help that older person find that help. And very likely that might be with suggesting that they see their primary care doctor going along with them, helping provide the information that that doctor can then use to make that diagnosis and draw the resources in that are necessary. But there may be others as well. It may be that if one is very concerned that one thinks about asking if they could take the firearms for a while to keep them safe, to be more present, perhaps, to find to help with the connectedness issue, while they get the care that they need. So ask the question, and then help that older person realize that there are probably really easily accessible answers. And let's get together and try to find them.

Dr. Regina Koepp 41:55

Yes, and I'll just put a plug that treatment for depression, like psychotherapy is equally effective for older adults as it is for adults at younger ages. And so I know there's a lot of misconception about that. And primary care is a great place to start. Like you're saying, I'll also link to the National Suicide Prevention hotline for families who are very concerned and need immediate attention. And I want to thank you Dr. Conwell for being here and sharing so much the five DS are great rubric for helping families just to conceptualize what's happening and you know, sometimes we get in tunnel vision, it's hard to see the the sort of full nature of what can be causing distress for for folks and especially older adults. That's very helpful conceptualization tool, the five DS and and the importance of connection and conversation. So thank you so much for being here.

Dr. Yeates Conwell 42:56

I've enjoyed our conversation. Thanks for having me.

Dr. Regina Koepp 42:59

So I have been working tirelessly over the last several months to build the Center for Mental Health and Aging, so that you have a place that you can go to online for the mental health care of older adults. Our mission is to improve mental health care for older adults by providing education and then to get you access to mental health providers. Because one of the most significant reasons that older adults do not get the mental health care that they need is because lack of access to mental health providers. And so we want to change that we want to be sure that any older adult who needs mental health care can get it. Are you a licensed therapist, psychiatrist or neuro psychologist who specializes with older adults. I would love for you to have a profile in the Mental Health and Aging provider directory.

Dr. Regina Koepp 43:53

I would love for you to join me in the movement to make mental health care for older adults and caregivers easier to find. Together we'll build the largest geriatric and the only geriatric mental health provider directory in the nation. Let's make it easier for older families to get the mental health care that they need by helping them get access to you to be the first to know when this provider directories available. Go To www.drreginakoepp.com/facts and that will take you to download a guide which is the five must know facts when you're working with older adults. If you go if you go there and download that guide, you will be the first to know when the provider directory is available. And I cannot wait until the Center for Mental Health and Aging is launched. I'm counting down the days. Let's make it easier for older families to get the mental health care they need by helping them get access To you.

Dr. Regina Koepp 45:02

That's all for today. If you like this episode, I would really appreciate a subscription wherever you listen to this podcast and a review. And here's why you can join the movement to because the more people who subscribe and leave a review for this podcast, the more the podcast algorithm sends this podcast to other people who might be looking for similar things. And this begins to spread the message around Mental Health and Aging or mental health care for older adults. I can't do this by myself, I really need your help. Together, we can do this. Together, we can address the mental health crisis for older adults and their families. I'll see you next week. Same time, same place. Lots of love to you and your families. Bye for now.