Aging in Texas
9:01 am
Tue January 7, 2014

Experts Turn to Tech as Texas Population Ages and Geriatric Doctors Dwindle

Almost 3 million people in Texas are between the ages of 65 and 85, according to the office of the state demographer. That number is expected to more than double by the year 2040.

Texas – like the rest of the country – lacks enough geriatric mental health professionals to match the population. So experts are looking at alternatives to help seniors overcome depression -- that includes one approach using technology.

Joe Bachicha, 80, gets food delivered to his home in Austin five days a week by a Meals on Wheels volunteer. Bachicha has three daughters, and he sees them often. But on weekdays, he’s usually on his own at home.

"I just don’t feel like going out. There’s no place to go, really. I don’t do very much except house work and yard work, and that’s about it," he says.

His wife Margaret died about eight months ago.

"Luckily we were able to keep her at home, so she died right here in the house," Bachicha says. "My two daughters were with me when she passed away, which was a big, big help."

Since then, he says he has good days. But there are as many rough days.

"When I’m feeling down usually what I do is take the dog for a long walk and that helps me. Helps me get out of my depression," Bachicha says.

Bachicha, unlike most men his age, did see a psychiatrist.

"When I went to see my primary care doctor, when it was time to see him, it was recently that I’d lost my wife. So I was feeling pretty bad. And I broke down there with my primary doctor and that’s when he referred me to the psychiatrist," he says.

The psychiatrist offered medication, but Bachicha refused it. And he hasn’t seen a psychiatrist since.

"I always confer with my daughters about it. I always let them know and they’re very understanding," he says. "I feel more comfortable with my daughters than I do with a doctor."

Experts hope more seniors like Bachicha will find alternatives to medicine.

Professor Namkee Choi teaches at the University of Texas School of Social Work. She’s working on a project about problem-solving therapy for low-income older adults with depression.

"The anti-depressant medications are not that effective with low-income homebound older adults because medications don’t treat psychosocial stressors," Choi says.

Psychosocial stressors include lack of transportation, financial concerns, dealing with many caregivers and also grappling with bereavement.

"Since depression is so disabling as a condition, we have to think about having people do what we have them do with every other chronic condition," says Professor Nancy Wilson, who teaches at Baylor College of Medicine in Houston. "It's no different than diabetes or heart disease. There needs to be a therapeutic approach to their care."

Wilson is Choi's research partner.

"Older adults prefer non-medication approaches when they’re available and it’s particularly sad when low-income older adults for whom medication isn’t effective are given that as the treatment and not given the option to do something that would be their preference," Wilson says.

The seniors in their study got psychotherapy through a screen at home, using video conferencing technology like Skype.

In the beginning, some doubted the success of this method.    

"They said older adults don’t use technology and it’s not gonna work," Choi recalls. "And when we were talking to our participants, most said I hope I’ll get in-person sessions rather than tele-sessions."

At the end of the six-week study, some still disliked it. But 94 percent of the participants praised the experience.

"This was the best experience. And some people actually cried when they were talking about this actually changed my life and they were so proud," Choi says. 

Choi and Wilson say they’re focused on improving access to psychotherapy because it’s hard for homebound seniors to get to a clinic.

"And also because of the shortage of geriatric mental health providers," Choi says. "There are not enough clinicians who can go around and do in-home, in-person sessions. So if we use tele-health delivery methods, we can serve more older adults with fewer clinicians. And it’s cheaper."

Public health experts are paying attention to this as the Texas population continues to grow and age.

"If we think about aging in the state, and kind of look at the population, it’s a phenomena that’s largely being driven by the non-Hispanic White population in the state," State Demographer Lloyd Potter says. "When I say aging, it’s really talking about the age structure of the population becoming older. So there are relatively fewer younger people."

Joe Bachicha says he tried to learn how to use a computer with little success. But he says his walks with his dog do a lot for him. Choi and Wilson hope more seniors will follow in his footsteps – being more active and talking about their depression.

This story is part of the MetLife Foundation’s “Journalists in Aging Fellows Program” – organized by The Gerontological Society of America and New America Media.

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