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Older people are often invisible in mental health settings. Here are some tips to get care

By The Seattle Times

There’s a dark joke that the best time to start shoplifting is when you move into older age, Anya Johnston said, because no one pays attention to you.

Johnston doesn’t actually shoplift, but they do feel “increasingly invisible anywhere I go” — especially in medical settings.

Johnston, a Tri Cities-area resident who is 65, said they were diagnosed in their 50s with attention-deficit/hyperactivity disorder, after being told for years that they were experiencing depression.

Despite pleading with doctors, Johnston said they found it hard to get attention and care for their mental health concerns, since they exist in multiple margins of society: They’re older and trans. “I certainly didn’t feel heard, not at all believed,” Johnston said.

Johnston’s feelings are not uncommon for their age: While people of all ages may report feeling ignored and dismissed in medical and mental health settings, the sentiment is particularly prevalent among older adults, experts say. Health care providers often carry implicit biases that slip through and affect patients, even when their medical education has trained them otherwise.

For older people, said Douglas Lane, a clinical psychologist in geriatric psychology, ageism plays out often in one of three ways: They may be infantilized by providers. Providers can also be dismissive, assuming that older people can’t be suicidal or have intimate relationships. Other times, issues among older people get normalized as a so-called routine part of aging.

“Well of course they’re frail. Of course they’re depressed. Of course they don’t remember things as well as they used to,” Lane said, referencing negative stereotypes of older people.

Heidi Weispfenning, a 63-year-old who lives in Renton, said as she got older, she felt more and more like “everybody assumes that I’m completely stupid,” even though she grew up in a medical family.

“To be treated like a child because I have gray hair is just infuriating,” she said.

If this sounds familiar, here are some tips that aging adults, their loved ones and health care providers can use to ensure older people get the mental health care they need.

Understand how aging does — and does not — affect you

Ageist stereotypes are all around in culture, but they can also be within ourselves. Aging adults as well as medical providers often normalize physical ailments and mental health challenges as a regular part of the aging process when that doesn’t have to be the case.

People will say, “I guess this is what old age is supposed to be like,” said Whitney Carlson, the medical director of the geriatric psychiatry clinic at Harborview.

It’s not a normal part of aging to be sad. Medical providers should give people hope that it doesn’t have to stay that way, Carlson recommends. Remind them that people have felt better once they got help, and that that person can, too.

These negative views of aging often come from our own fears, Lane said. Medical providers should understand how they can protect their patients from negative emotions that come with a providers’ own feelings about aging and death.

How to talk to doctors

In every medical appointment or counseling session, remember that you are entitled to quality care regardless of your age.

There are cues you can use to determine whether a doctor may be a good fit. Is the doctor looking in your eyes? Do they seem like they’re in a hurry? Do they give you the time you need and let you ask questions?

Tracy Bell, a licensed mental health counselor in Seattle who is also a senior herself, said she recommends asking to record an appointment. For her, “it’s so much easier to listen if I don’t have to worry about remembering what you’re saying.”

A provider may say that they put information in chart notes, but recordings allow you to play the conversation over again and pick up on what you missed and ask others for their opinions.

Mary O’Leary, a senior planner at Seattle’s Aging and Disability Services, suggests bringing an advocate, like a friend or family member, as a “second set of eyes and ears” who can ask questions on your behalf.

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