WASHINGTON -- Getting older doesn't just mean a risk for physical ailments like heart disease and bum knees: A new report finds that as many as 1 in 5 seniors have a mental health or substance abuse problem.

As the population ages rapidly over the next two decades, millions of baby boomers may have a hard time finding care and services for mental health problems such as depression. The nation is woefully lacking in doctors, nurses and other health workers trained for their special needs, the Institute of Medicine said yesterday.

Instead, the country is focused mostly on preparing for the physical health needs of what's been called the silver tsunami.

"The burden of mental illness and substance abuse disorders in older adults in the United States borders on a crisis," wrote Dr. Dan Blazer of Duke University, who chaired the Institute of Medicine panel that investigated the issue. "Yet this crisis is largely hidden from the public and many of those who develop policy and programs to care for older people."

From 5.6 million to 8 million Americans 65 and older have a mental health condition or substance abuse disorder, the report found, calling that a conservative estimate. Depressive disorders and psychiatric symptoms related to dementia are the most common.

Those numbers are sure to grow as the senior population nearly doubles by 2030, said report co-author Dr. Peter Rabins of Johns Hopkins University. How much substance abuse treatment for seniors will be needed is a particular question, as rates of illegal drug use are higher in boomers currently in their 50s than in previous generations.

"This is a wake-up call for many reasons," said Dr. Ken Duckworth of the National Alliance on Mental Illness. The coming need for geriatric mental health care "is something we need to attend to urgently," he said.

Merely getting older doesn't make mental health problems more likely to occur, Rabins said, noting that middle age is the most common time for the onset of depression. But when issues do occur in older adults, the report found, they are too often overlooked and tend to be more complex. Among the reasons:

People over 65 almost always have physical health problems that can mask or distract from mental health needs. The physical illnesses, and medications used for them, also can complicate treatment. Older adults with untreated depression are also less likely to have their diabetes, high blood pressure and other physical conditions under control, and consequently wind up costing a lot more to treat.

Age alters how the body metabolizes alcohol and drugs, including prescription drugs. That can increase the risk of dangerous overdoses, and worsen or even trigger substance abuse problems.

Grief is common in old age as spouses, other relatives and friends die. It may be difficult to distinguish between grief and major depression.

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