Mental health is crucial for the quality of life of the geriatric population. It is imperative to find avenues that lead to greater detection and treatment of mental health problems, keeping the focus on unwinding socioecological interactions of the population group. According to the CDC (2006), according to the behavioral risk factor surveillance system, adults aged 65 or older were more likely to report that they “rarely” or “never” received the social and emotional support they needed than adults aged 50–64 years were. This lack of social and emotional support contributes to perceptions of debased societal values that are intensified by aging (Farriol-Baroni et al., 2021), which gradually leads to diminished help-seeking behavior and a lack of accessibility to mental health care. Effective systematic interventions should involve identifying elements that offer the social and emotional support necessary for older adults, thereby enhancing our access to mental health services as we age.
Social determinants of health and accessibility
The issue of accessibility for older adults can be interpreted in various ways. Aging, healthcare, and mental well-being are complex constructs. The challenges linked to the impact of social, economic, and environmental conditions that dissuade older adults from maintaining their health and well-being have highlighted the subjective nature of these conditions.
These factors include factors such as relationships within the neighborhood and environment, stable employment and income, safe housing, reliable and affordable healthcare services, and perceptions of one’s role in society (Perez et al., 2022). Individuals who struggle with SDoH-related factors are at risk of experiencing poor health, morbidity, and mortality (Lund et al., 2021). For older adults, SDoH factors significantly impact their health and experiences associated with aging, especially their ability to live independently and seek good healthcare services (Pooler & Srinivasan, 2018). These social determinants are beyond the reach of the typical clinical environment but have a wide range of health, functioning, and quality of life outcomes (Fulmer & Chernof, 2018). In the face of these challenges encountered by older adults, they tend to develop a hindsight bias, anticipating that their cognitive limitations and economic constraints will lead to abandonment and insufficient care (Kumar, 2013). On the other hand, the high expenses of healthcare, lack of proper health insurance mechanisms, and decreased spending capacity can lead to further problems accessing mental health support for a better quality of life. Social stratification has been found to divulge the effects of inequality on health as life opportunities become more affected (Hsu et al., 2019). This social stratification emerges from the various social determinants of health that affect an individual’s mental wellbeing and quality of life. On the other hand, there is evidence that some policies of developing nations have complemented the idea that family structure and traditional values provide social security coverage in old age (Kumar, 2013); this in turn has created barriers to accessibility where proper assessment of the effects of social determinants has not been taken into account in designing geriatric care. The concept of “burden” can also be introduced here, which contributes to a major share of insecurity among the older population. The pivotal question that emerges is whether the challenges linked to social determinants for older adults—such as stable employment and income, a secure environment, accessible and affordable healthcare services, and active societal participation—can be addressed through interpersonal and intrapersonal interactions experienced by individuals over the course of their life.
Socioecological Factors in Context to Geriatric Care and Mental Health
Any ecological model assumes that social factors and individual mannerisms, which are influenced by the system with which the individual aligns, affect the patterns of health and well-being (Saarloos et al., 2009). This provides a useful basis for thinking about social-ecological interventions that can channel the components of social-ecological theory to create a mechanism in society to optimize well-structured aging care. Fulmer and Chernof (2018) identify some evidence-based interventions for geriatric care. These interventions can be summarized as enabling seniors to age in place; preventing functional disability; preserving patient quality of life; respecting patients’ values, preferences, and goals for clinical assessment; and addressing the needs of older adults who are psycho-neurological in nature. Most of these geriatric care handbooks are based on which policies are designed and can be used to generalize guidelines on subjective well-being without considering the facets of social and ecological attributes that are subjective to individuals (Das et al., 2020). It can also be noted here that the interventions do not try to decode the concept of accessibility from the perspective of economic security, interpersonal relationships, or the role of the community. According to a study by Bowling and Gabriel (2007) that tried to understand the concept of accessibility to a better quality of life among older adults, an astounding 81% of the sample mentioned that mental well-being is directly associated with better social relationships within the family and with intrapersonal interactions. Neighborliness made them feel secure, and they could develop better judgments about mental protection from these interactions (Loo et al., 2017). A larger social network among older adults within the community is associated with a greater probability of receiving better treatment (Kemperman et al., 2019). Hayashi (2013) explained the benefits of community-enabled residential care for older people where better healthcare facilities are accessible to older people who are part of a community camaraderie or protected by organizational health plans. The ScEcM can provide a framework from which we can evaluate the complexity of factors affecting older adults’ ability to interact with social determinants (Fitzgerald, 2009 as cited in Korlagunta, 2011), which can help integrate these factors into the system and develop better help-seeking behavior. These social and ecological interactions address the insecurities associated with aging by involving the community and multiple sectors to create a secure environment for the geriatric population where they can seek a well-rounded quality of life.
Access versus Help-Seeking Behavior
The transition to retirement age stimulates both social and psychological changes surrounding identity and personal control, which are implicated in changes in physiological well-being (Kim & Moen, 2002, as cited in Clark & Boyd, 2017). Changes in the physiology of older adults contribute to changes in behavior, which need an external impetus to seek healthcare when needed (Teo et al., 2022). The unmet care needs of older adults may be attributed to either limited emotional support from healthcare providers or lack of acceptance of such support from older adults (Woods et al., 2005). Another potential contributor to decreased access to mental health services is that most studies have focused on samples of older adults who are already existing service users, thereby limiting the information available on older adults who do not seek help in the first place (Canvin et al., 2018). This brings to the forefront the concept of help-seeking behavior that can be attributed to individuals not being able to access holistic health care even though the schemes have been designed for them. Andersen’s behavioral model delves into the utilization of health services, which is impacted by how the environment, individual practices, and patient satisfaction from previous encounters with healthcare systems can influence subsequent help-seeking behavior (Aday & Andersen, 2005, as cited in Teo et al., 2021). The environment plays an important role in bridging the gap between available services and the awareness of the need for mental health protection associated with aging. Additionally, the concept of social prescribing (West et al., 2020), which involves the referral of older people with social, emotional, or practical needs to nonclinical services and community-based resources, has been found to be beneficial for developing better awareness within the community. There is an interplay of social deterrents that influence the help-seeking behavior of older adults even though schemes have been designed to make health care accessible.
Parity of Public Policy in Geriatric Mental Care
Healthcare policies and senior citizen protection schemes can be regarded as areas of focus for all governments. However, the contention on public policies for old age care needs to be understood not only by considering the existence of such policies but also by considering the coverage and enrollment process of such policies. Health Services Research has identified the role of public policy in achieving optimal mental health outcomes for older populations (Clark & Boyd, 2017). Public policies that govern Medicare and Medicaid are vital to ensuring long-term health outcomes for older adults and the availability of healthcare resources (Fulmer et al., 2021). However, coverage of these health plans remains tied to retirement. As older adults retire and have a low capacity for spending, policies need to make healthcare affordable and accessible (Chávez et al., 2016). Chávez and colleagues (2016) also highlight how insurance is strongly tied to access to healthcare services. This argument can be used to connect strong insurance that covers mental health care for the geriatric population. The Older Americans Act (1965) has focused on providing older adults with the best possible physical and mental health irrespective of economic status. However, most older adults enrolled in Medicare purchase some form of supplemental insurance (Koma, Cubanski & Neuman, 2021). The ability to purchase insurance and the quality of supplemental insurance are often dependent on income, as it can be costly for low-income older adults who are not eligible for Medicaid (Fulmer & Chernof, 2018). In addition, older adults with less than a high school education have higher rates of limitations in accessing or acquiring information about health schemes and policies than their more highly educated counterparts (Korlagunta, 2011) due to weak social systems constricting focus on making healthcare inaccessible to all groups. Parity is also affected by the stigma associated with mental illness, which is substantial and persistent (Frank et al., 2014). When the HIPAA Mental Health Parity Act (1996) was introduced, people in the U.S. sought to distance themselves from those with mental disorders as much as they had in the 1950s. Community-level participation will make society responsible for the well-being of their geriatric population and contribute to eradicating the stigma associated with seeking mental health support (Corrigan et al., 2014). Although stigma continues to contribute to the differential treatment of mental health care in insurance and public policy, powerful economic forces also work against parity in insurance coverage (Frank et al., 2001). Private health insurance is expensive and has a reduced ability to pay in old age; these factors subscribe to reduced accessibility of mental health care among the older population, thus increasing their vulnerability. These private health insurance plans for senior citizens create a disproportionate coverage of healthcare, which can be countered by structured policies that aim at providing parity. Public policies can be effective media for propagating access when they are designed to be inclusive of all economic backgrounds.